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Pero JE, Mueller EA, Adams AM, Adolph RS, Bagchi P, Balce D, Bantscheff M, Barauskas O, Bartha I, Bohan D, Cai H, Carabajal E, Cassidy J, Cato M, Chaudhary KW, Chen D, Chen YP, Colas C, Darwech I, Eberl HC, Fernandez B, Gordon E, Grosse J, Hansen J, Hetzler B, Hwang S, Jeyasingh S, Kowalski B, Lehmann S, Lo G, McAllaster M, McHugh C, Momont C, Newby Z, Nigro M, Oladunni F, Pannirselvam M, Park A, Pearson N, Peat AJ, Plastridge B, Ranjan R, Safabakhsh P, Shapiro ND, Soriaga L, Stokes N, Sweeney D, Talecki L, Telenti A, Terrell A, Tse W, Wang L, Wang S, Wedel L, Werner T, Dalmas Wilk D, Yim S, Zhou J. Discovery of Potent STT3A/B Inhibitors and Assessment of Their Multipathogen Antiviral Potential and Safety. J Med Chem 2024; 67:14586-14608. [PMID: 39136957 DOI: 10.1021/acs.jmedchem.4c01402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024]
Abstract
In the aftermath of the COVID-19 pandemic, opportunities to modulate biological pathways common to the lifecycles of viruses need to be carefully considered. N-linked glycosylation in humans is mediated exclusively by the oligosaccharyltransferase complex and is frequently hijacked by viruses to facilitate infection. As such, STT3A/B, the catalytic domain of the OST complex, became an intriguing drug target with broad-spectrum antiviral potential. However, due to the critical role N-linked glycosylation plays in a number of fundamental human processes, the toxicological ramifications of STT3A/B inhibition required attention commensurate to that given to antiviral efficacy. Herein, we describe how known STT3A/B inhibitor NGI-1 inspired the discovery of superior tool compounds which were evaluated in in vitro efficacy and translational safety (e.g., CNS, cardiovascular, liver) studies. The described learnings will appeal to those interested in the therapeutic utility of modulating N-linked glycosylation as well as the broader scientific community.
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Affiliation(s)
- Joseph E Pero
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Elizabeth A Mueller
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Ashley M Adams
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Ramona S Adolph
- Cellzome GmbH, a GSK company, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Parikshit Bagchi
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Dale Balce
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Marcus Bantscheff
- Cellzome GmbH, a GSK company, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Ona Barauskas
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Istvan Bartha
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Dana Bohan
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Haiying Cai
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Esteban Carabajal
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - James Cassidy
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Matthew Cato
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Khuram W Chaudhary
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Dingjun Chen
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Yi-Pei Chen
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Christophe Colas
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Isra Darwech
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - H Christian Eberl
- Cellzome GmbH, a GSK company, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Beth Fernandez
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Earl Gordon
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Johannes Grosse
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Justin Hansen
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Belinda Hetzler
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Seungmin Hwang
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Sam Jeyasingh
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Beatriz Kowalski
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Stephanie Lehmann
- Cellzome GmbH, a GSK company, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Gary Lo
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Michael McAllaster
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Charles McHugh
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Corey Momont
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Zachary Newby
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Maria Nigro
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Fatai Oladunni
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Malar Pannirselvam
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Arnold Park
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Neil Pearson
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Andrew J Peat
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Bob Plastridge
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Rohit Ranjan
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Pegah Safabakhsh
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Nathan D Shapiro
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Leah Soriaga
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Neil Stokes
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - David Sweeney
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Lindsey Talecki
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Amalio Telenti
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Ashley Terrell
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Winston Tse
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Lisha Wang
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Shuya Wang
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Laura Wedel
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Thilo Werner
- Cellzome GmbH, a GSK company, Meyerhofstrasse 1, 69117 Heidelberg, Germany
| | - Deidre Dalmas Wilk
- GSK, 1250 South Collegeville Road, Collegeville, Pennsylvania 19426, United States
| | - Samantha Yim
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
| | - Jiayi Zhou
- Vir Biotechnology, Inc., 1800 Owens St., San Francisco, California 94158, United States
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2
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Enhoş A, Doğuş Kus H, Yozgat CY, Cakır E, Yazan H, Erol AB, Erenberk U, Yozgat Y. Short-term azithromycin use is associated with QTc interval prolongation in children with cystic fibrosis. Arch Pediatr 2024; 31:315-319. [PMID: 38637249 DOI: 10.1016/j.arcped.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/07/2024] [Accepted: 02/17/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Azithromycin is used for children with cystic fibrosis (CF) for its immunomodulatory and anti-inflammatory action. This study investigated the short-term alterations in QTc interval associated with azithromycin prophylaxis in pediatric patients with CF. METHODS This study included 121 patients with mild CF, of whom 76 received azithromycin (patient group) and 45 did not receive azithromycin (control group). The patient and control groups were categorized according to age as under 12 years of age and over 12 years of age. The first presentation measured all the patient and control groups at basic QTc time intervals. The QTc intervals of all patients were then remeasured systemically at 1, 3, and 6 months. Age categories and QTc intervals that were calculated at each month in the patient and control groups were compared statistically. RESULTS A statistically significant difference was detected in the patient group between the initial QTc interval time and the electrocardiogram (ECG) findings in the first and third months after prophylaxis treatment (p < 0.001; p = 0.01). However, no statistically significant difference was detected in the sixth month (p > 0.05) in all groups. Almost all of the children's QTc intervals were within normal range and within the safety zone (under 0.44 s). No statistically significant difference was detected in the control group between the initial ECG and the QTc intervals measured at 1, 3, and 6 months. CONCLUSION Short-term use of azithromycin prophylaxis in pediatric patients with mild CF slightly increased the QTc interval in the first and third months of follow-up. Nevertheless, all QTc interval changes fell within the safety zone. Notably, 1 month of follow-up treatment should be performed to check for any alteration in the QTc interval. If increased QTc interval duration is not detected in the first month, azithromycin prophylaxis can be safely prescribed.
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Affiliation(s)
- Asım Enhoş
- Department of Cardiology, Istanbul Medipol University, Istanbul, Turkey.
| | - Hazar Doğuş Kus
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Erkan Cakır
- Department of Pediatric Pulmonology, Istinye University Hospital, Liv Vadi Hospital, Istanbul, Turkey
| | - Hakan Yazan
- Department of Pediatric Pulmonology, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Berk Erol
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Ufuk Erenberk
- Department of Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Department of Pediatric Cardiology, Istanbul Medipol University, Istanbul, Turkey
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Wang X, Liu H, Cui C, Niu X, Li H, Niu S, Yan P, Wu N, Li F, Wu Q, Chen K, Hu B, Liu D. Concentration-QTc Modeling of the DPP-4 Inhibitor HSK7653 in a First-in-Human Study of Chinese Healthy Volunteers. Clin Pharmacol Drug Dev 2024; 13:716-728. [PMID: 38757550 DOI: 10.1002/cpdd.1418] [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: 04/20/2021] [Accepted: 04/22/2024] [Indexed: 05/18/2024]
Abstract
Cofrogliptin (HSK7653) is a long-acting dipeptidyl peptidase-4 inhibitor for the treatment of type 2 diabetes mellitus with a twice-monthly dosing regimen. This study included 62 participants (48 without food effect, 14 with food effect) receiving single doses of HSK7653 (5, 10, 25, 50, 100, and 150 mg) or placebo. Pharmacokinetic samples were collected over 24 hours postdosing and sampling times are aligned with 12-lead electrocardiograms (ECGs) which were derived from continuous ECG recordings. For the concentration-QT interval corrected for heart rate (C-QTc) analysis, we used linear mixed-effects modeling to characterize the correlation between plasma concentrations of HSK7653 and the change from baseline in the QT interval which was corrected by Fridericia's formula (ΔQTcF). The result showed that a placebo-corrected Fridericia corrected QT interval (ΔΔQTcF) prolongation higher than 10 milliseconds is unlikely at the mean maximum observed concentration (Cmax) (411 ng/mL) associated with the recommended therapeutic doses (25 mg twice-monthly), even at the highest supratherapeutic concentration (2425 ng/mL). Thus, HSK7653 does not significantly affect QT prolongation at either recommended doses or the highest supratherapeutic concentration.
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Affiliation(s)
- Xiaoxu Wang
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Science, Tianjin, China
| | - Hongzhong Liu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng Cui
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Xiaoye Niu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Shu Niu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, FL, USA
| | - Pangke Yan
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Nan Wu
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Fangqiong Li
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Qinghe Wu
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Kai Chen
- Haisco Pharmaceutical Group Co. Ltd., Chengdu, China
| | - Bei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
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Valente D, Segreti A, Celeski M, Polito D, Vicchio L, Di Gioia G, Ussia GP, Antonelli-Incalzi R, Grigioni F. Electrocardiographic alterations in chronic obstructive pulmonary disease. J Electrocardiol 2024; 85:58-65. [PMID: 38865856 DOI: 10.1016/j.jelectrocard.2024.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/26/2024] [Accepted: 05/16/2024] [Indexed: 06/14/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality, and its incidence has grown within several years, quickly becoming the third leading cause of mortality. The disease is characterized by alveolar destruction, air-trapping, and chronic inflammation due to persistent exposure to a large spectrum of harmful particles. The diagnosis of COPD is made by demonstration of persistent and not fully reversible airflow limitation, and different phenotypes may be recognized based on pathophysiological, clinical, and radiological features. However, COPD is a systemic disease with effects involving several organs. For example, mechanical and functional alterations secondary to COPD involve heart function. Indeed, cardiovascular diseases are highly prevalent in patients affected by COPD and represent the primary cause of mortality in such patients. An electrocardiogram is a simple and cheap test that gives much information about the heart status of COPD patients. Consequently, variations from "normality" can be appreciated in these patients, with the most frequent abnormalities being P-wave, QRS axis, and ventricular repolarization abnormalities, in addition to conduction alterations and a vast number of arrhythmias. As a result, ECG should be routinely performed as a valuable tool to recognize alterations due to COPD (i.e., mechanical and functional) and possible associated heart diseases. This review aims to describe the typical ECG features in most COPD patients and to provide a systematic summary that can be used in clinical practice.
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Affiliation(s)
- Daniele Valente
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Dajana Polito
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Luisa Vicchio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Institute of Sports Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Raffaele Antonelli-Incalzi
- Research Unit of Geriatrics, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Operative Research Unit of Internal Medicine, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
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Sadeghi A, Taherifard E, Movahed H, Ahmadkhani A, Dehdari Ebrahimi N, Taherifard E. Electrocardiographic findings in patients with sickle cell disease: A protocol for systematic review and meta-analysis. Health Sci Rep 2024; 7:e2212. [PMID: 38915361 PMCID: PMC11194293 DOI: 10.1002/hsr2.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/06/2024] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
Background Despite advancements in the management of patients with sickle cell disease (SCD), the involvement of the cardiovascular system in these patients remains a significant concern. Cardiovascular manifestations of SCD are well-documented, with electrocardiography (ECG) serving as a valuable diagnostic tool. Studies have reported a high rate of critical ECG findings in patients with SCD that warrants consideration when managing these patients, indicating the need for proactive cardiac screening and management strategies in this patient population. This study aims to systematically review the literature to identify sociodemographic, clinical, and paraclinical factors associated with ECG abnormalities in patients with SCD. Methods A comprehensive search strategy will be employed across multiple online databases, including PubMed, Embase, Scopus, Web of Science, and Google Scholar, for published and gray literature. Eligible studies will include original articles reporting associations between sociodemographic, clinical, and paraclinical variables and a spectrum of ECG findings in patients with SCD. Independent reviewers will conduct the screening, quality assessment, and data extraction. Quantitative analyses will be performed under a random-effect model using Comprehensive Meta-Analysis software, with subgroup analyses based on SCD status, sickle hemoglobinopathy form, and age group.
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Affiliation(s)
- Alireza Sadeghi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ehsan Taherifard
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
| | - Hamed Movahed
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
| | - Alireza Ahmadkhani
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Department of PathologyShiraz University of Medical SciencesShirazIran
| | - Niloofar Dehdari Ebrahimi
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
- Transplant Research CenterShiraz University of Medical SciencesShirazIran
| | - Erfan Taherifard
- Hematology Research CenterShiraz University of Medical SciencesShirazIran
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Kohlbrenner D, Bisang M, Aeschbacher SS, Heusser E, Ulrich S, Bloch KE, Furian M. Automated Quantification of QT-Intervals by an Algorithm: A Validation Study in Patients with Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2024; 19:721-730. [PMID: 38495216 PMCID: PMC10944305 DOI: 10.2147/copd.s445412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 02/15/2024] [Indexed: 03/19/2024] Open
Abstract
Study Objectives To assess the diagnostic accuracy of a purpose-designed QTc-scoring algorithm versus the established hand-scoring in patients with chronic obstructive pulmonary disease (COPD) undergoing sleep studies. Methods We collected 62 overnight electrocardiogram (ECG) recordings in 28 COPD patients. QT-intervals corrected for heart rate (QTc, Bazett) were averaged over 1-min periods and quantified, both by the algorithm and by cursor-assisted hand-scoring. Hand-scoring was done blinded to the algorithm-derived results. Bland-Altman statistics and confusion matrixes for three thresholds (460, 480, and 500ms) were calculated. Results A total of 32944 1-min periods and corresponding mean QTc-intervals were analysed manually and by computer. Mean difference between manual and algorithm-based QTc-intervals was -1ms, with limits of agreement of -18 to 16ms. Overall, 2587 (8%), 357 (1%), and 0 QTc-intervals exceeding the threshold 460, 480, and 500ms, respectively, were identified by hand-scoring. Of these, 2516, 357, and 0 were consistently identified by the algorithm. This resulted in a diagnostic classification accuracy of 0.98 (95% CI 0.98/0.98), 1.00 (1.00/1.00), and 1.00 (1.00/1.00) for 460, 480, and 500ms, respectively. Sensitivity was 0.97, 1.00, and NA for 460, 480, and 500ms, respectively. Specificity was 0.98, 1.00, and 1.00 for 460, 480, and 500ms, respectively. Conclusion Overall, 8% of nocturnal 1-min periods showed clinically relevant QTc prolongations in patients with stable COPD. The automated QTc-algorithm accurately identified clinically relevant QTc-prolongations with a very high sensitivity and specificity. Using this tool, hospital sleep laboratories may identify asymptomatic patients with QTc-prolongations at risk for malignant arrhythmia, allowing them to consult a cardiologist before an eventual cardiac event.
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Affiliation(s)
- Dario Kohlbrenner
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Maya Bisang
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | | | - Emanuel Heusser
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Silvia Ulrich
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Konrad E Bloch
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Furian
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Swiss University of Traditional Chinese Medicine, Bad Zurzach, Switzerland
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7
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Bogaerts C, Schoenmaekers N, Haems M, Storme M, De Loof H. A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting. Int J Clin Pharm 2024; 46:141-149. [PMID: 37962780 DOI: 10.1007/s11096-023-01648-z] [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: 01/18/2023] [Accepted: 09/06/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND A six year collaboration between academics, community pharmacists and informaticians, led to the development of nine guidelines for a clinical decision support system, enhancing community pharmacists' ability to address drug-related problems and improve care. AIM The objective of this study was to assess the effectiveness of clinical decision support system rules in enhancing medication management within the community pharmacy setting. This was achieved through retrospective monitoring of real-world usage and measuring the pharmacotherapeutic impact of the rules. METHOD In 2019, a retrospective observational evaluation appraised the acceptance rate of the clinical decision support system components in 490 Belgian pharmacies. Among these, 51 pharmacies underwent a longitudinal analysis involving (i) co-prescription of methotrexate and folic acid, (ii) gastroprotection with non-steroidal anti-inflammatory drugs, and (iii) drug combinations causing QT prolongation. The study period spanned one year pre-launch, one year post-launch, and two years post-launch. RESULTS Of the targeted pharmacies, 80% used 7 of the 9 rules. After four years, methotrexate-folic acid co-prescription increased 4%, reaching 79.8%. Gastroprotection improved by 3% among older patients and 7.47% in younger individuals (< 70 year) with multiple risk factors. The QT prolongation rules faced implementation difficulties. CONCLUSION Pharmacists' acceptance of the developed rules was high and coincided with a decline in drug-related problems, holding potential public health impact. This real-world data can inform the future implementation of such systems, as it demonstrated the need for more detailed data-gathering and more intensive training of pharmacists in the handling of more complex problems such as QT prolongation.
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Affiliation(s)
- Carolien Bogaerts
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Nele Schoenmaekers
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium.
| | - Marleen Haems
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Michael Storme
- Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
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8
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Wiley AM, Yang J, Madhani R, Nath A, Totah RA. Investigating the association between CYP2J2 inhibitors and QT prolongation: a literature review. Drug Metab Rev 2024; 56:145-163. [PMID: 38478383 DOI: 10.1080/03602532.2024.2329928] [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: 12/22/2023] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
Drug withdrawal post-marketing due to cardiotoxicity is a major concern for drug developers, regulatory agencies, and patients. One common mechanism of cardiotoxicity is through inhibition of cardiac ion channels, leading to prolongation of the QT interval and sometimes fatal arrythmias. Recently, oxylipin signaling compounds have been shown to bind to and alter ion channel function, and disruption in their cardiac levels may contribute to QT prolongation. Cytochrome P450 2J2 (CYP2J2) is the predominant CYP isoform expressed in cardiomyocytes, where it oxidizes arachidonic acid to cardioprotective epoxyeicosatrienoic acids (EETs). In addition to roles in vasodilation and angiogenesis, EETs bind to and activate various ion channels. CYP2J2 inhibition can lower EET levels and decrease their ability to preserve cardiac rhythm. In this review, we investigated the ability of known CYP inhibitors to cause QT prolongation using Certara's Drug Interaction Database. We discovered that among the multiple CYP isozymes, CYP2J2 inhibitors were more likely to also be QT-prolonging drugs (by approximately 2-fold). We explored potential binding interactions between these inhibitors and CYP2J2 using molecular docking and identified four amino acid residues (Phe61, Ala223, Asn231, and Leu402) predicted to interact with QT-prolonging drugs. The four residues are located near the opening of egress channel 2, highlighting the potential importance of this channel in CYP2J2 binding and inhibition. These findings suggest that if a drug inhibits CYP2J2 and interacts with one of these four residues, then it may have a higher risk of QT prolongation and more preclinical studies are warranted to assess cardiovascular safety.
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Affiliation(s)
- Alexandra M Wiley
- Department of Medicinal Chemistry, University of WA School of Pharmacy, Seattle, WA, USA
| | - Jade Yang
- Department of Medicinal Chemistry, University of WA School of Pharmacy, Seattle, WA, USA
| | - Rivcka Madhani
- Department of Medicinal Chemistry, University of WA School of Pharmacy, Seattle, WA, USA
| | - Abhinav Nath
- Department of Medicinal Chemistry, University of WA School of Pharmacy, Seattle, WA, USA
| | - Rheem A Totah
- Department of Medicinal Chemistry, University of WA School of Pharmacy, Seattle, WA, USA
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9
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Demir TG, Gungoren F, Ethemoglu OU, Agircan D. Epilepsy's effect on cardiac rhythm and the autonomic nervous system. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20230742. [PMID: 38265350 PMCID: PMC10807047 DOI: 10.1590/1806-9282.20230742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/01/2023] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy is the most common cause of death in young patients with epilepsy. The aim of this study was to evaluate changes in interictal electrocardiogram parameters and sympathetic skin responses as markers of autonomic dysfunction in patients with epilepsy and to determine their effects on the type and duration of epilepsy, frequency of seizures, and responses to treatment. METHODS A total of 97 patients with epilepsy and 94 healthy controls were recruited. We recorded their clinical and demographic characteristics and analyzed sympathetic skin response latency and amplitude, electrocardiogram recordings, and seven cardiac rhythm parameters: P-wave duration, PR segment, QRS duration, QT interval, QT interval distribution, Tpe duration, and Tpe/QT interval ratio. RESULTS P-wave durations, T-wave durations, QT and QT interval durations, and Tpe and sympathetic skin response latency were significantly longer among patients with epilepsy than the controls, and their heart rate was significantly lower. However, sympathetic skin response latency and heart rate were negatively correlated, and T-wave duration, QT duration, QT interval duration, and Tpe were positively correlated. CONCLUSION Our results from interictal electrocardiograms indicate clinically significant arrhythmias among patients with epilepsy and the correlation of such arrhythmias with sympathetic skin responses. Thus, noninvasive tests that evaluate the autonomic system should be used to predict the risk of sudden unexpected death in epilepsy among patients with epilepsy.
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Affiliation(s)
- Tulin Gesoglu Demir
- Harran University, Faculty of Medicine, Department of Neurology – Şanlıurfa, Turkey
| | - Fatih Gungoren
- Medical Park Florya Hospital, Department of Cardiology – İstanbul, Turkey
| | | | - Dilek Agircan
- Harran University, Faculty of Medicine, Department of Neurology – Şanlıurfa, Turkey
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10
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Donegan DM, Pivonello R, Stigliano A, Lardo P, Kearney T, Mezősi E, Ghigo E, Giordano R, Mariash CN, Feelders RA, Donaldson K, Darpo B, Xue H, Custodio JM, Hand AL, Moraitis AG. Relacorilant, a Selective Glucocorticoid Receptor Modulator in Development for the Treatment of Patients With Cushing Syndrome, Does Not Cause Prolongation of the Cardiac QT Interval. Endocr Pract 2024; 30:11-18. [PMID: 37805100 DOI: 10.1016/j.eprac.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To assess the effect of relacorilant, a selective glucocorticoid receptor modulator under investigation for the treatment of patients with endogenous hypercortisolism (Cushing syndrome [CS]), on the heart rate-corrected QT interval (QTc). METHODS Three clinical studies of relacorilant were included: (1) a first-in-human, randomized, placebo-controlled, ascending-dose (up to 500 mg of relacorilant) study in healthy volunteers; (2) a phase 1 placebo- and positive-controlled thorough QTc (TQT) study of 400 and 800 mg of relacorilant in healthy volunteers; and (3) a phase 2, open-label study of up to 400 mg of relacorilant administered daily for up to 16 weeks in patients with CS. Electrocardiogram recordings were taken, and QTc change from baseline (ΔQTc) was calculated. The association of plasma relacorilant concentration with the effect on QTc in healthy volunteers was assessed using linear mixed-effects modeling. RESULTS Across all studies, no notable changes in the electrocardiogram parameters were observed. At all time points and with all doses of relacorilant, including supratherapeutic doses, ΔQTc was small, generally negative, and, in the placebo-controlled studies, similar to placebo. In the TQT study, placebo-corrected ΔQTc with relacorilant was small and negative, whereas placebo-corrected ΔQTc with moxifloxacin positive control showed rapid QTc prolongation. These results constituted a negative TQT study. The model-estimated slopes of the concentration-QTc relationship were slightly negative, excluding an association of relacorilant with prolonged QTc. CONCLUSION At all doses studied, relacorilant consistently demonstrated a lack of QTc prolongation in healthy volunteers and patients with CS, including in the TQT study. Ongoing phase 3 studies will help further establish the overall benefit-risk profile of relacorilant.
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Affiliation(s)
- Diane M Donegan
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rosario Pivonello
- Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Università "Federico II" di Napoli, Naples, Italy
| | - Antonio Stigliano
- Endocrinology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Pina Lardo
- Endocrinology, Sant'Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Tara Kearney
- Department of Endocrinology, Salford Royal Foundation Trust, Salford, Manchester, United Kingdom
| | - Emese Mezősi
- 1st Department of Internal Medicine, Clinical Center, University of Pecs, Pecs, Hungary
| | - Ezio Ghigo
- Division of Endocrinology, Diabetology and Metabolism, University of Turin, Turin, Italy
| | - Roberta Giordano
- Department of Biological and Clinical Sciences, University of Turin, Turin, Italy
| | - Cary N Mariash
- Division of Endocrinology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Richard A Feelders
- Division of Endocrinology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Austin L Hand
- Corcept Therapeutics Incorporated, Menlo Park, California
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11
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Akturk G, Micili SC, Gursoy Doruk O, Hocaoglu N, Akan P, Ergur BU, Ahmed S, Kalkan S. Effects of nicorandil on QT prolongation and myocardial damage caused by citalopram in rats. Biotech Histochem 2023; 98:479-491. [PMID: 37466068 DOI: 10.1080/10520295.2023.2233417] [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] [Indexed: 07/20/2023] Open
Abstract
Citalopram is a selective serotonin re-uptake inhibitor (SSRI) antidepressant; it exhibits the greatest cardiotoxic effect among SSRIs. Citalopram can cause drug-induced long QT syndrome (LQTS) and ventricular arrhythmias. We investigated the protective effect of nicorandil, a selective mitochondrial KATP (mito-KATP) channel opener, on LQTS and myocardial damage caused by citalopram in male rats. In a preliminary study, we determined that the minimum citalopram dose that prolonged the QT interval was 102 mg/kg injected intraperitoneally. For the main study, rats were divided randomly into five experimental groups: untreated control, normal saline + citalopram, nicorandil + citalopram, 5-hydroxydecanoate (5-HD) + citalopram, 5-HD + nicorandil + citalopram. Biochemical and histologic data from blood and heart tissue samples from six untreated control rats were evaluated. Electrocardiographic parameters including QRS duration, QT interval, corrected QT interval (QTc) and heart rate (HR) were assessed, and biochemical parameters including malondialdehyde, reduced glutathione, glutathione peroxidase, superoxide dismutase were measured. We also performed histomorphologic and immunohistochemical examination of heart tissue. Citalopram prolonged QT-QTc intervals significantly and increased significantly the histomorphologic score and proportion of apoptotic cells, but produced no differences in the oxidant and antioxidant parameters. Nicorandil did not prevent citalopram induced QT-QTc interval prolongation and produced no significant changes in oxidant and antioxidant parameters; however, it did reduce histologic damage and apoptosis caused by citalopram.
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Affiliation(s)
- Gozde Akturk
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
- Department of Medical Pharmacology, Mustafa Kemal University School of Medicine, Hatay, Turkey
| | - Serap Cilaker Micili
- Department of Histology and Embryology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Ozlem Gursoy Doruk
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Nil Hocaoglu
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Pinar Akan
- Department of Medical Biochemistry, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bekir Ugur Ergur
- Department of Histology and Embryology, Dokuz Eylul University School of Medicine, Izmir, Turkey
- Department of Histology and Embryology, Kyrenia University School of Medicine, Kyrenia, Cyprus
| | - Samar Ahmed
- Department of Biochemistry, Dokuz Eylul University Graduate School of Health Sciences, Izmir, Turkey
| | - Sule Kalkan
- Department of Medical Pharmacology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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12
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Samuel Y, Babu A, Karagkouni F, Ismail A, Choi S, Boussios S. Cardiac Toxicities in Oncology: Elucidating the Dark Box in the Era of Precision Medicine. Curr Issues Mol Biol 2023; 45:8337-8358. [PMID: 37886969 PMCID: PMC10605822 DOI: 10.3390/cimb45100526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/12/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
Despite current advancements in chemotherapy, immunotherapy and targeted treatments, the potential for major adverse cardiovascular events, regardless of previous cardiac history, persists. Scoring systems, such as the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) risk assessment tool, can be utilized to evaluate several factors including prior cardiac history, risk factors and cardiac biomarkers to categorize patients into low, moderate, high, and very high-risk groups. Common cardiotoxicity complications include new or worsening left ventricular ejection fraction (LVEF), QT interval prolongation, myocardial ischaemia, hypertension, thromboembolic disease, cardiac device malfunction and valve disease. Baseline electrocardiogram (ECG) and transthoracic echocardiogram (TTE) are routinely performed for all patients commenced on cardiotoxic treatment, while other imaging modalities and biochemical markers have proven useful for monitoring. Management mainly includes early risk stratification and prompt identification of cardiovascular complications, with patient-specific surveillance throughout treatment. A multidisciplinary approach is crucial in determining the relationship between potential treatment benefits and cardiotoxicity, and whether the continuation of treatment is appropriate on a case-by-case basis. Early risk stratification, optimizing the patient's cardiovascular status prior to treatment, and prompt identification of suspected cardiotoxicity are key in significantly reducing risk. This article provides a comprehensive review of the various types of treatment-related cardiotoxicity, offering guidance on identifying high-risk patients, recognizing early signs of cardiotoxicity, and outlining appropriate treatment approaches and follow-up care for such cases.
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Affiliation(s)
- Younan Samuel
- Department of Cardiology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK; (Y.S.); (A.B.); (F.K.)
| | - Aswin Babu
- Department of Cardiology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK; (Y.S.); (A.B.); (F.K.)
| | - Foteini Karagkouni
- Department of Cardiology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK; (Y.S.); (A.B.); (F.K.)
| | - Ayden Ismail
- GKT School of Medicine, King’s College London, London SE1 9RT, UK;
| | - Sunyoung Choi
- Department of Cardiology, Hampshire Hospitals NHS Foundation Trust, Aldermaston Road, Basingstoke RG24 9NA, Hampshire, UK;
| | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Windmill Road, Gillingham ME7 5NY, Kent, UK
- Faculty of Life Sciences & Medicine, School of Cancer & Pharmaceutical Sciences, King’s College London, London SE1 9RT, UK
- Kent Medway Medical School, University of Kent, Canterbury CT2 7LX, Kent, UK
- AELIA Organization, 9th Km Thessaloniki—Thermi, 57001 Thessaloniki, Greece
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13
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Santin L, Verlato G, Tfaily A, Manera R, Zinfollino G, Fusina F, Lugoboni F. Methadone Maintenance and QT-Interval: Prevalence and Risk Factors-Is It Effective to Switch Therapy to Levomethadone? Biomedicines 2023; 11:2109. [PMID: 37626606 PMCID: PMC10452549 DOI: 10.3390/biomedicines11082109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
Methadone is a chiral synthetic opioid primarily used to treat heroin and prescription-opioid addiction: the (R)-enantiomer (Levomethadone) activates the µ-opioid receptor more potently than the (S)-enantiomer, which is a more potent blocker of the hERG potassium channels, resulting in QTc prolongation. The purpose of this retrospective study was to assess the effect of methadone on the QTc interval and to investigate the benefits of Levomethadone. The electrocardiograms of 165 patients taking methadone at various dosages and for different periods of time were examined: the QTc value was manually measured and then adjusted using Bazett's formula. Data analysis revealed a linear association between the dosage of methadone and QTc length; no correlation was found between the QTc value and gender, age, or duration of therapy. In total, 14% of the sample (23 patients) showed a prolongation of the QTc interval (>470 ms in males and >480 ms in females); 10 of the 23 patients with QTc elongation underwent a change of therapy from Methadone to Levomethadone-in 90% of these patients, a normalization in the QTc length was established. This study confirmed the role of methadone, specifically its dosage, in QTc prolongation and the efficiency of Levomethadone as an adequate therapeutic substitute in these circumstances. This study validates the importance of careful electrocardiographic monitoring in methadone-treated patients.
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Affiliation(s)
- Laura Santin
- Addiction Unit, Department of Medicine, Verona University Hospital, 37134 Verona, Italy;
| | - Giuseppe Verlato
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (G.V.); (A.T.)
| | - Ahmad Tfaily
- Section of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, 37134 Verona, Italy; (G.V.); (A.T.)
| | - Roberto Manera
- Addiction Department, ULSS 2, 31100 Treviso, Italy; (R.M.); (G.Z.)
| | | | - Francesca Fusina
- Padova Neuroscience Center, University of Padua, 35122 Padua, Italy;
| | - Fabio Lugoboni
- Addiction Unit, Department of Medicine, Verona University Hospital, 37134 Verona, Italy;
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14
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Das NR, Sharma T, Toropov AA, Toropova AP, Tripathi MK, Achary PGR. Machine-learning technique, QSAR and molecular dynamics for hERG-drug interactions. J Biomol Struct Dyn 2023; 41:13766-13791. [PMID: 37021352 DOI: 10.1080/07391102.2023.2193641] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 02/06/2023] [Indexed: 04/07/2023]
Abstract
One of the most well-known anti-targets defining medication cardiotoxicity is the voltage-dependent hERG K + channel, which is well-known for its crucial involvement in cardiac action potential repolarization. Torsades de Pointes, QT prolongation, and sudden death are all caused by hERG (the human Ether-à-go-go-Related Gene) inhibition. There is great interest in creating predictive computational (in silico) tools to identify and weed out potential hERG blockers early in the drug discovery process because testing for hERG liability and the traditional experimental screening are complicated, expensive and time-consuming. This study used 2D descriptors of a large curated dataset of 6766 compounds and machine learning approaches to build robust descriptor-based QSAR and predictive classification models for KCNH2 liability. Decision Tree, Random Forest, Logistic Regression, Ada Boosting, kNN, SVM, Naïve Bayes, neural network and stochastic gradient classification classifier algorithms were used to build classification models. If a compound's IC50 value was between 10 μM and less, it was classified as a blocker (hERG-positive), and if it was more, it was classified as a non-blocker (hERG-negative). Matthew's correlation coefficient formula and F1score were applied to compare and track the developed models' performance. Molecular docking and dynamics studies were performed to understand the cardiotoxicity relating to the hERG-gene. The hERG residues interacting after 100 ns are LEU:697, THR:708, PHE:656, HIS:674, HIS:703, TRP:705 and ASN:709 and the hERG-ligand-16 complex trajectory showed stable behaviour with lesser fluctuations in the entire simulation of 200 ns.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Nilima Rani Das
- Department of CA, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Tripti Sharma
- School of Pharmaceutical Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Andrey A Toropov
- Department of Environmental Health Science, Laboratory of Environmental Chemistry and Toxicology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alla P Toropova
- Department of Environmental Health Science, Laboratory of Environmental Chemistry and Toxicology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - P Ganga Raju Achary
- Department of Chemistry, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
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15
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Ullah A, Ahmad S, Ali N, Hussain H, Allahyani M, Almehmadi M, Alsaiari AA, Abdulaziz O, Almarshad F, Bukhari SH. The Effects of Moxifloxacin and Gemifloxacin on the ECG Morphology in Healthy Volunteers: A Phase 1 Randomized Clinical Trial. Diagnostics (Basel) 2023; 13:diagnostics13071234. [PMID: 37046452 PMCID: PMC10092949 DOI: 10.3390/diagnostics13071234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
Moxifloxacin and gemifloxacin are the two newer broad-spectrum 8-methoxy-quinolone derivatives that are used to treat various bacterial infections in cardiac patients. In this research study, we assessed the impact of moxifloxacin and gemifloxacin on the QT intervals of electrocardiograms in normal adult doses and draw a comparison, in a controlled environment, on healthy volunteers. Additionally, the effect of both test drugs on the QRS complex was checked. Sixty healthy volunteers were randomly assigned to two groups via R-software, and each respectively received moxifloxacin and gemifloxacin for five days. The research ethics committee approved the research, and it was registered for clinical trial under NCT04692623. The participants' electrocardiograms were obtained before the start of the dose (baseline) and on the fifth day. Significant prolongation of QT interval was noted in moxifloxacin (p < 0.0001) as compared to gemifloxacin treated groups. There were no cases of QTc prolongation over the usual limits (450-470 ms) in the gemifloxacin-treated group, however, QTc prolongations at the rate of 30 and 60 ms from the baseline were noted, interpreted as per the EMEA guidelines. These findings indicate that moxifloxacin caused significant (p < 0.0001) QT interval prolongation (QTIP) as compared to gemifloxacin. In contrast to the previously reported literature, the prominent effect of moxifloxacin on the widening of the QRS-complex was noted with no such effect on QRS-widening in the gemifloxacin-treated group. It is concluded that both drugs have the potential for considerable QT interval prolongation (QTIP) effects, which is one of the risk factors for developing torsade de pointes (TdPs) in cardiac patients. Thus, clinicians should exercise caution when prescribing moxifloxacin and gemifloxacin to cardiac patients and should consider alternate treatment options.
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Affiliation(s)
- Abid Ullah
- Department of Pharmacy, Shaheed Benazir Bhutto University Sheringal, Dir Upper 18000, Khyber Pakhtunkhwa, Pakistan
| | - Shujaat Ahmad
- Department of Pharmacy, Shaheed Benazir Bhutto University Sheringal, Dir Upper 18000, Khyber Pakhtunkhwa, Pakistan
| | - Niaz Ali
- Department of Pharmacology, College of Medicine, Shaqra University, Shaqra 11961, Saudi Arabia
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan
| | - Haya Hussain
- Department of Pharmacy, Shaheed Benazir Bhutto University Sheringal, Dir Upper 18000, Khyber Pakhtunkhwa, Pakistan
| | - Mamdouh Allahyani
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Mazen Almehmadi
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Ahad Amer Alsaiari
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Osama Abdulaziz
- Department of Clinical Laboratory, Sciences Saudi Arabia Department, College of Applied Medical Sciences, Taif University, Taif 21944, Saudi Arabia
| | - Feras Almarshad
- Department of Medicine, College of Medicine, Shaqra University, Shaqra 11961, Saudi Arabia
| | - Syeda Hajira Bukhari
- Department of Pharmacology, Institute of Basic Medical Sciences, Khyber Medical University, Peshawar 25100, Khyber Pakhtunkhwa, Pakistan
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Sahin O, Akturk G, Cilaker Micili S, Gursoy Doruk O, Karapinar F, Hocaoglu N, Ergur BU, Akan P, Tuncok Y, Kalkan S. Effect of the selective mitochondrial KATP channel opener nicorandil on the QT prolongation and myocardial damage induced by amitriptyline in rats. J Pharm Pharmacol 2023; 75:415-426. [PMID: 36527252 DOI: 10.1093/jpp/rgac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/10/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate the protective effect of nicorandil, a selective mitochondrial KATP channel opener, on QT prolongation and myocardial damage induced by amitriptyline. METHODS The dose of amitriptyline (intraperitoneal, i.p.) that prolong the QT interval was found 75 mg/kg. Rats were randomized into five groups the control group, amitriptyline group, nicorandil (selective mitochondrial KATP channel opener, 3 mg/kg i.p.) + amitriptyline group, 5-hdyroxydecanoate (5-HD, selective mitochondrial KATP channel blocker, 10 mg/kg i.p.) + amitriptyline group and 5-HD + nicorandil + amitriptyline group. Cardiac parameters, biochemical and histomorphological/immunohistochemical examinations were evaluated. p < 0.05 was accepted as statistically significant. KEY FINDINGS Amitriptyline caused statistically significant prolongation of QRS duration, QT interval and QTc interval (p < 0.05). It also caused changes in tissue oxidant (increase in malondialdehyde)/anti-oxidant (decrease in glutathione peroxidase) parameters (p < 0.05), myocardial damage and apoptosis (p < 0.01 and p < 0.001). While nicorandil administration prevented amitriptyline-induced QRS, QT, QTc prolongation (p < 0.05), myocardial damage and apoptosis (p < 0.05), it did not affect the changes in oxidative parameters (p > 0.05). CONCLUSIONS Our results suggest that nicorandil, a selective mitochondrial KATP channel opener, plays a protective role in amitriptyline-induced QT prolongation and myocardial damage. Mitochondrial KATP channel opening and anti-apoptotic effects may play a role in the cardioprotective effect of nicorandil.
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Affiliation(s)
- Orhan Sahin
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey
| | - Gozde Akturk
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey.,Mustafa Kemal University, School of Medicine, Department of Medical Pharmacology, Hatay, Turkey
| | - Serap Cilaker Micili
- Dokuz Eylul University, School of Medicine, Department of Histology and Embryology, Izmir, Turkey
| | - Ozlem Gursoy Doruk
- Dokuz Eylul University, School of Medicine, Department of Medical Biochemistry, Izmir, Turkey
| | - Fazilet Karapinar
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey
| | - Nil Hocaoglu
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey
| | - Bekir Ugur Ergur
- Dokuz Eylul University, School of Medicine, Department of Histology and Embryology, Izmir, Turkey.,Kyrenia University, School of Medicine, Department of Histology and Embryology, Kyrenia, Cyprus
| | - Pinar Akan
- Dokuz Eylul University, School of Medicine, Department of Medical Biochemistry, Izmir, Turkey
| | - Yesim Tuncok
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey
| | - Sule Kalkan
- Dokuz Eylul University, School of Medicine, Department of Medical Pharmacology, Izmir, Turkey
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Johannsdottir HX, Gudmundsdottir IJ, Karason S, Sigurdsson MI. Association between pre-operative prolonged corrected QT interval and all-cause mortality after non-cardiac surgery. Acta Anaesthesiol Scand 2023; 67:284-292. [PMID: 36508160 DOI: 10.1111/aas.14178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/16/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Prolonged corrected QT interval (QTc) has been linked to risk of arrhythmias and mortality in the general population. Pre-operative electrocardiography is often obtained for patient-and procedural cardiovascular risk assessment. The aim of this study was to investigate the association of pre-operative QTc and all-cause mortality in a non-cardiac surgical cohort. METHODS A retrospective study of all patients over 18 years undergoing non-cardiac surgery at Landspitali-the National University Hospital in Iceland between 2 January 2005 to 31 December 2015, with follow-up through 20 May 2016. Patients were separated into five categories according to their pre-operative QTc interval ≤ 379, 380-439 (reference group), 440-479, 480-519 and ≥520 ms. Primary outcome was long-term mortality and secondary outcome was 30-day mortality. RESULTS A total of 10,209 surgeries for 10,209 individuals were included. The median follow-up for mortality was 2691 days (interquartile range [IQR] 1620-3705 days). Patients with longer QTc interval had a higher comorbidity burden, were more likely to undergo emergency surgery and were often prescribed cardiac medications. After adjustment for confounding variables, the hazard ratio (HR) for long-term mortality compared with reference (QTc 380-439 ms) was 0.85 [CI: 0.66-1.09] for QTc ≤379, 1.08 [CI: 0.99-1.17] for QTc 440-479 ms, 1.26 [CI: 1.10-1.43] for QTc between 480 and 519 ms and 0.97 [CI: 0.78-1.21] for QTc ≥520 ms. When compared with reference, only patients with QTc interval between 480 and 519 ms had higher odds ratio for 30-day mortality as odds ratio for other groups were following; 1.12 [CI: 0.18-3.8] for ≤379 ms, 1.03 [CI: 0.70-1.51] for QTc 440-479 ms, 1.64 [CI: 1.02-2.60] for QTc 480-519 ms and 0.98 [0.44-2.06] for QTc ≥520 ms. CONCLUSION Pre-operative QTc between 480 and 519 ms is associated with both higher long-term and 30-day mortality after non-cardiac surgery. The results suggest that this could reflect an underlying cardiovascular risk.
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Affiliation(s)
| | - Ingibjorg Jona Gudmundsdottir
- Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.,Division of Cardiology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Sigurbergur Karason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Anesthesia and Intensive Care Medicine, Operational Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
| | - Martin Ingi Sigurdsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Anesthesia and Intensive Care Medicine, Operational Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland
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18
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Theofilis P, Oikonomou E, Lazaros G, Vogiatzi G, Niarchou P, Goliopoulou A, Anastasiou M, Mistakidi VC, Tsalamandris S, Fountoulakis P, Papamikroulis GA, Tousoulis D. The Association of Depression With QT Duration: A Comparison Between Individuals Younger or Older Than 65 Years. Psychosom Med 2023; 85:18-25. [PMID: 36516316 DOI: 10.1097/psy.0000000000001152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The electrocardiogram-derived corrected QT (QTc) interval is an indicator of cardiac autonomic activity that has been proposed as a biological measure to investigate the interplay between depression and cardiovascular diseases. This study assesses whether depression is associated with a longer QTc interval across age groups. METHODS Assessment of depressive symptoms was performed in 1637 participants of the cross-sectional Corinthia study with the Zung Self-Rating Depression Scale in those younger than 65 years (group 1) and with the Geriatric Depression Scale in elderly individuals (≥65 years, group 2). The QT interval was obtained from electrocardiogram recordings and corrected for heart rate (QTc). RESULTS Individuals in group 1 with depression were predominantly women and had a higher prevalence of coronary artery disease and diabetes mellitus. Group 1 individuals with depression had longer QTc duration (no depression versus depression, 389.3 [27.0] versus 401.1 [32.9] milliseconds; p < .001) and percentage of abnormal QTc (no depression versus depression, 2.0% versus 10.8%; p = .001) compared with those without depression. Elderly individuals (group 2) had similar values of QTc and percentage of abnormal QTc irrespective of depression status. Even after adjustment for known QT-prolonging factors, the presence of depression in younger individuals was associated with an increased QTc by 11.1 milliseconds and with an approximately 10.6-fold higher prevalence of abnormal QTc duration. CONCLUSIONS Depression was associated with a longer QTc interval especially in individuals younger than 65 years. These findings may indicate an interrelationship between depression and autonomic dysregulation as potential risk factors for cardiovascular disease and sudden cardiac death.
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Affiliation(s)
- Panagiotis Theofilis
- From the 1st Cardiology Clinic, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
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19
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Higher prevalence of QTc interval prolongation among virologically suppressed older people with HIV. AIDS 2022; 36:2153-2159. [PMID: 35969211 DOI: 10.1097/qad.0000000000003358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess the prevalence, and factors associated with QTc interval prolongation, among 383 virologically suppressed people with HIV (PWH), without evidence of cardiovascular disease and active opportunistic infections in Thailand. DESIGN Cross-sectional study. METHODS Resting 12-lead digital ECGs were performed in 2019. QT interval corrected for heart rate (QTc) >450 ms in males and >460 ms in females was defined as QTc interval prolongation. We used multivariable logistic regression to investigate factors associated with QTc interval prolongation. RESULTS Mean (standard deviation) age was 56 (5.5) years and 42% were female. The median current CD4+ was 619 (interquartile range [IQR] 487, 769) cells/mm 3 . The median duration of antiretroviral therapy (ART) was 11.9 (IQR 7.1-16.1) years. Commonly used ART were rilpivirine (37.9%), efavirenz (20.1%), atazanavir/ritonavir (15.7%), lopinavir/ritonavir (12.3%) and dolutegravir (5%). The prevalence of QTc interval prolongation was 22.7%. In multivariable analysis, older age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.02-1.12, P = 0.005), female sex (OR 1.69, 95% CI 1.01-2.82, P = 0.046) and increasing BMI (OR 1.08, 95% CI 1.01-1.15, P = 0.03) were associated with QTc interval prolongation. With every 1-year increase in age, the odds of QTc interval prolongation increased by 7%. CONCLUSIONS In this well-suppressed aging Asian HIV cohort, the prevalence of QTc interval prolongation was relatively high, and associated with increasing age, female sex, and higher BMI. For PLWH with these characteristics, QTc interval should be monitored before and after initiating any medications known to prolong QTc intervals, to prevent fatal cardiac arrhythmias.
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20
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Toba-Oluboka T, Tibbo PG, Dempster K, Alda M. Genetic factors contribute to medication-induced QT prolongation: A review. Psychiatry Res 2022; 317:114891. [PMID: 36257205 DOI: 10.1016/j.psychres.2022.114891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 09/21/2022] [Accepted: 10/07/2022] [Indexed: 01/05/2023]
Abstract
QT prolongation is a heart rhythm condition that impacts the lives of many people and when severe can be life-threatening. QT prolongation has been linked to variations in several genes, but it can also arise in the course of treatments with medications such as certain antipsychotics and antidepressants. However, it is unclear whether the risk of medication-induced QT prolongation (MIQTP) depends on specific genetic vulnerability. Here, we review the available literature on the interplay between genetic risk and medication exposure in the context of psychiatric treatment. A review was conducted on the genetic contribution to MIQTP in psychiatric patients. A literature search was conducted on the PubMed platform with 8 papers meeting criteria for review. A total of 3,838 patients from 8 studies meeting criteria for a psychotic or mood disorder were included in this review. All studies found evidence for the genetic contribution to MIQTP. The specific genes identified in these studies included the NOS1AP, ABCB1, KCNH2, SLC22A23, EPB41L4A, LEP, CACNA1C, CERKL, SLCO3A1, BRUNOL4, NRG3, NUBPL, PALLD, NDRG4 and PLN genes. The findings highlight both the importance of monitoring heart parameters in psychiatry and the possible role for genetic profiling to increase the treatment safety.
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Affiliation(s)
- Temi Toba-Oluboka
- Department of Psychiatry, Early Psychosis Research, Dalhousie University, Unit Room 4083A AJLB, 5909 Veterans' Memorial Lane, Halifax, NS, Canada.
| | - Philip G Tibbo
- Department of Psychiatry, Early Psychosis Research, Dalhousie University, Unit Room 4083A AJLB, 5909 Veterans' Memorial Lane, Halifax, NS, Canada
| | - Kara Dempster
- Department of Psychiatry, Early Psychosis Research, Dalhousie University, Unit Room 4083A AJLB, 5909 Veterans' Memorial Lane, Halifax, NS, Canada
| | - Martin Alda
- Department of Psychiatry, Early Psychosis Research, Dalhousie University, Unit Room 4083A AJLB, 5909 Veterans' Memorial Lane, Halifax, NS, Canada
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21
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Kallend D, Mason J, Smith PF, Koren MJ, Stoekenbroek R, He Y, Wijngaard P. An evaluation of a supratherapeutic dose of inclisiran on cardiac repolarization in healthy volunteers: A phase I, randomized study. Clin Transl Sci 2022; 15:2663-2672. [PMID: 36196601 PMCID: PMC9652432 DOI: 10.1111/cts.13391] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/02/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023] Open
Abstract
Inclisiran is a small interfering RNA molecule that has been shown to provide an effective and sustained reduction in low-density lipoprotein cholesterol levels. This study aimed to determine whether a supratherapeutic dose of inclisiran affects cardiac repolarization and conduction in healthy volunteers. A phase I, randomized, double-blind, double-dummy, placebo- and positive-controlled, three-way crossover study was performed in 48 healthy volunteers. Volunteers were assigned to three treatments in a randomized sequence: a supratherapeutic dose of inclisiran sodium (900 mg), placebo, or moxifloxacin 400 mg as a positive control, with a minimum 7-day washout period between treatments. Continuous electrocardiogram monitoring was performed from >60 min before dosing until 48 h after dosing. Pharmacokinetics, pharmacodynamics, and safety were also assessed. Inclisiran, at a supratherapeutic dose, did not show a clinically significant effect on the QT interval (Fridericia correction formula [QTcF]; maximal placebo- and baseline-corrected change: 2.5 ms [90% confidence interval: 0.6, 4.5]) near the maximal plasma concentrations at 4 h. In addition, inclisiran did not show any effects on other electrocardiogram intervals or ST- and T-wave morphology. The positive control, moxifloxacin, demonstrated the expected changes in QTcF interval, validating the adequate sensitivity of the study. A supratherapeutic dose of inclisiran sodium (900 mg) had no effect on the QTcF interval or other electrocardiogram parameters, providing additional insight and reassurance regarding the safety profile of inclisiran.
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Affiliation(s)
- David Kallend
- Former Employee of The Medicines Company (Schweiz) GmbHZurichSwitzerland
| | - Jay Mason
- Department of Internal Medicine, University of Utah School of MedicineSalt Lake CityUtahUSA
| | | | - Michael J. Koren
- First Coast Heart & Vascular CenterJacksonvilleFloridaUSA,Jacksonville Center for Clinical ResearchJacksonvilleFloridaUSA
| | | | - YanLing He
- Novartis Institutes for BioMedical Research, Inc.CambridgeMassachusettsUSA
| | - Peter Wijngaard
- Former Employee of Novartis Pharmaceuticals CorporationEast HanoverNew JerseyUSA
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22
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Cuomo A, Libri C, Barillà G, Cattolico M, Carmellini P, Fagiolini A. QTc interval diurnal variations in patients treated with psychotropic medications: implications for the evaluation of drug induced QTc changes. Int Rev Psychiatry 2022; 34:689-692. [PMID: 36786118 DOI: 10.1080/09540261.2022.2135985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychotropic drugs such as antipsychotics may prolong the QTc interval, increasing the risk of torsades de pointes (TdP) and sudden cardiac death. To assess QTc prolongation by psychotropic drugs, an electrocardiogram (EKG) is usually recorded before and after starting treatment. Circadian variations in the QTc interval have been described but have not been adequately studied in patients taking psychotropic drugs. In psychiatric clinical practice, EKGs before and after treatment initiation are often compared, without considering the time of day at which the two EKGs are recorded. To determine whether there is a circadian change in the QTc interval in patients treated with psychotropic drugs, we evaluated the EKGs of a group of patients treated with psychotropic drugs (85% on antipsychotics) and the EKGs of a group of patients that were not treated with medications. In each group, we compared the EKGs recorded before 11:00 am with those recorded after 5:00 pm. The QTc value was significantly longer in the group treated with psychotropic drugs than in the group without drugs at both morning and evening evaluations (p ≤ 0.001). In each group, a statistically significant difference was found between the EKGs recorded before 11:00 a.m. and the EKGs recorded after 5:00 p.m. In patients treated with medications, the mean QTc in the morning was 453.3 ± 25.4 while the mean QTc in the afternoon was 428.4 ± 24.7 (p < 0.0001). In patients who were not receiving any medication, the morning mean QTc was 422.4 ± 22.6 while the mean afternoon QTc was 409.4 ± 19.6 (p = 0.002). These results suggest that a circadian variation in QTc is observed both in patients taking psychotropic drugs and in patients not taking medication. We conclude that any comparison of EKGs to test the effect on QTc of a medication, should be referred to EKGs recorded at the same time of day.
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Affiliation(s)
- A Cuomo
- School of Medicine, University of Siena, Siena, Italy
| | - C Libri
- School of Medicine, University of Siena, Siena, Italy
| | - G Barillà
- School of Medicine, University of Siena, Siena, Italy
| | - M Cattolico
- School of Medicine, University of Siena, Siena, Italy
| | - P Carmellini
- School of Medicine, University of Siena, Siena, Italy
| | - A Fagiolini
- School of Medicine, University of Siena, Siena, Italy
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23
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Billur D, Olgar Y, Turan B. Intracellular Redistribution of Left Ventricular Connexin 43 Contributes to the Remodeling of Electrical Properties of the Heart in Insulin-resistant Elderly Rats. J Histochem Cytochem 2022; 70:447-462. [PMID: 35608408 DOI: 10.1369/00221554221101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The correlation between long-QT and connexin 43 (Cx43) status and localization in elderly rats was determined to demonstrate a correlation between insulin resistance (I-R), ischemia-reperfusion, aging, and heart dysfunction. Male Wistar rats are grouped as 24-month-old rats (Aged-group), those with metabolic syndrome (8 months old; MetS-group), or controls (8 months old; Con-group). Both experimental groups have long-QT and low heart rate. Immunohistochemical imaging and quantification showed marked decreases in Cx43 staining of intercalated disc with less localizations in the Aged-group and MetS-group. The lateralization of Cx43 on longitudinal cell membrane was significantly high in the MetS-group than in the Con-group with no significant change in the Aged-group. Its significant cytoplasmic internalization was higher in the Aged-group than in the MetS-group. There were marked decreases in phospho-Cx43 (pCx43) staining of intercalated disc with less localizations in both groups than in the Con-group. Furthermore, lateralization of pCx43 was significantly low in the Aged-group and MetS-group, whereas there were no significant changes in the cytoplasmic internalization of both groups compared with the Con-group. Furthermore, the ratio of pCx43 to Cx43 was significantly small in both groups. We determined increases in RhoA and endothelin-1 in both groups, further supporting decreases in pCx43. Our data indicate the important role of I-R on long-QT in aging heart through alterations in both Cx43 protein level and localizations, leading to an abnormal spreading of ventricular repolarization in I-R heart.
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Affiliation(s)
| | | | - Belma Turan
- Department of Biophysics.,Faculty of Medicine, Ankara University, Ankara, Turkey, and Department of Biophysics, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
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24
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Comparison of frontal QRS-T angle in patients with schizophrenia and healthy volunteers. J Psychiatr Res 2022; 149:76-82. [PMID: 35255386 DOI: 10.1016/j.jpsychires.2022.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/08/2022] [Accepted: 02/28/2022] [Indexed: 11/23/2022]
Abstract
Cardiovascular diseases are the most prominent cause of death in patients with schizophrenia. Frontal QRS-T (fQRS-T) angle is a novel marker of myocardial depolarization and repolarization heterogeneity. Recent studies have indicated that the fQRS-T angle is associated with some cardiovascular abnormalities. This study aimed to investigate the fQRS-T angle and its relationship with symptoms severity in patients with schizophrenia. One hundred-six patients with schizophrenia and sixty-four healthy controls were included in this study. fQRS-T angle and QT interval measurements were calculated for each participant from the automatic report of the 12-lead electrocardiography (ECG) device. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and The Positive and Negative Syndrome Scale (PANSS) were performed on the patients with schizophrenia. Corrected QT (QTc) interval and fQRS-T angle were significantly higher in the patients with schizophrenia than healthy controls (p < 0.001 and p < 0.001, respectively). fQRS-T angle was positively correlated with age (r = 0.43), duration of disease (r = 0.37), and negative symptoms scores (r = 0.39). In linear regression analysis, the disease duration and negative symptom severity were the independent predictors of fQRS-T angle in patients with schizophrenia (t = 3.730, p = 0.003 and t = 2.257, p = 0.023, respectively). The fQRS-T angle may be an important ECG parameter to interpret cardiovascular disease risk in patients with schizophrenia.
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25
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Svorc P, Svorc P. General anesthesia and electrocardiographic parameters in in vivo experiments involving rats. Physiol Res 2022; 71:177-192. [PMID: 35275702 PMCID: PMC9150551 DOI: 10.33549/physiolres.934848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
In in vivo cardiovascular or toxicological studies involving rat models, changes in selected electrocardiographic (ECG) parameters are monitored after various interventions to assess the origin and development of heart rhythm disorders. Each ECG parameter has diagnostic significance; as such, commonly evaluated ECG parameters, including heart rate, PR interval, P wave duration, P wave amplitude, QRS complex, QT and QTc interval duration, R wave and T wave amplitude, of rats under various types of general anesthesia were the focus of this study. Studies that performed in vivo cardiovascular or toxicological experiments in rats were retrieved from a search of the Web of Science database for articles published mainly between 2000 and 2021. In total, the search retrieved 123 articles. ECG parameters that were reported as baseline or control values were summarized and averages with ranges were calculated. It is important to be cautious when interpreting results and, in discussions addressing the mechanisms underlying a given type of arrhythmia, acknowledge that initial ECG parameters may already be affected to some extent by the general anesthesia as well as by sex and the time of day the experiments were performed.
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Affiliation(s)
- Pavol Svorc
- Department of Physiology, Medical Faculty, Safarik University, Kosice, Slovak Republic
- Department of Physiology and Patophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Pavol Svorc
- Department of Physiology and Patophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
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26
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Charalambous C, Moon JC, Holly JMP, Chaturvedi N, Hughes AD, Captur G. Declining Levels and Bioavailability of IGF-I in Cardiovascular Aging Associate With QT Prolongation-Results From the 1946 British Birth Cohort. Front Cardiovasc Med 2022; 9:863988. [PMID: 35528832 PMCID: PMC9072634 DOI: 10.3389/fcvm.2022.863988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Background As people age, circulating levels of insulin-like growth factors (IGFs) and IGF binding protein 3 (IGFBP-3) decline. In rat cardiomyocytes, IGF-I has been shown to regulate sarcolemmal potassium channel activity and late sodium current thus impacting cardiac repolarization and the heart rate-corrected QT (QTc). However, the relationship between IGFs and IGFBP-3 with the QTc interval in humans, is unknown. Objectives To examine the association of IGFs and IGFBP-3 with QTc interval in an older age population-based cohort. Methods Participants were from the 1946 Medical Research Council (MRC) National Survey of Health and Development (NSHD) British birth cohort. Biomarkers from blood samples at age 53 and 60-64 years (y, exposures) included IGF-I/II, IGFBP-3, IGF-I/IGFBP-3 ratio and the change (Δ) in marker levels between the 60-64 and 53y sampled timepoints. QTc (outcome) was recorded from electrocardiograms at the 60-64y timepoint. Generalized linear multivariable models with adjustments for relevant demographic and clinical factors, were used for complete-cases and repeated after multiple imputation. Results One thousand four hundred forty-eight participants were included (48.3% men; QTc mean 414 ms interquartile range 26 ms). Univariate analysis revealed an association between low IGF-I and IGF-I/IGFBP-3 ratio at 60-64y with QTc prolongation [respectively: β -0.30 ms/nmol/L, (95% confidence intervals -0.44, -0.17), p < 0.001; β-28.9 ms/unit (-41.93, -15.50), p < 0.001], but not with IGF-II or IGFBP-3. No association with QTc was found for IGF biomarkers sampled at 53y, however both ΔIGF-I and ΔIGF-I/IGFBP-3 ratio were negatively associated with QTc [β -0.04 ms/nmol/L (-0.08, -0.008), p = 0.019; β -2.44 ms/unit (-4.17, -0.67), p = 0.007] while ΔIGF-II and ΔIGFBP-3 showed no association. In fully adjusted complete case and imputed models (reporting latter) low IGF-I and IGF-I/IGFBP-3 ratio at 60-64y [β -0.21 ms/nmol/L (-0.39, -0.04), p = 0.017; β -20.14 ms/unit (-36.28, -3.99), p = 0.015], steeper decline in ΔIGF-I [β -0.05 ms/nmol/L/10 years (-0.10, -0.002), p = 0.042] and shallower rise in ΔIGF-I/IGFBP-3 ratio over a decade [β -2.16 ms/unit/10 years (-4.23, -0.09), p = 0.041], were all independently associated with QTc prolongation. Independent associations with QTc were also confirmed for other previously known covariates: female sex [β 9.65 ms (6.65, 12.65), p < 0.001], increased left ventricular mass [β 0.04 ms/g (0.02, 0.06), p < 0.001] and blood potassium levels [β -5.70 ms/mmol/L (-10.23, -1.18) p = 0.014]. Conclusion Over a decade, in an older age population-based cohort, declining levels and bioavailability of IGF-I associate with prolongation of the QTc interval. As QTc prolongation associates with increased risk for sudden death even in apparently healthy people, further research into the antiarrhythmic effects of IGF-I on cardiomyocytes is warranted.
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Affiliation(s)
- Christos Charalambous
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - James C. Moon
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardiac MRI Unit, Barts Heart Centre, London, United Kingdom
| | - Jeff M. P. Holly
- National Institute for Health Research (NIHR) Bristol Nutrition Biomedical Research Unit, Level 3, University Hospitals Bristol Education and Research Centre, Bristol, United Kingdom
- Faculty of Health Sciences, School of Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, United Kingdom
| | - Nishi Chaturvedi
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Alun D. Hughes
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
- UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardiology Department, Centre for Inherited Heart Muscle Conditions, The Royal Free Hospital, London, United Kingdom
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27
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Das B, Rawat VS, Ramasubbu SK, Agnihotri A, Kumar B. Potential drug-drug interaction prevalence and risk factors associated with QT interval prolonging psychotropic use in children and adolescents. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2021.101456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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28
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El Kadri M, Al Falasi O, Ahmed R, Al Awadhi A, Altaha Z, Hillis A, Panikkaveetil B, Abdalla S, Ansel Benette H, Almubarak A, Saifuddin M, Alattar Y, Oulhaj A, AlKaabi S. Changes in QTc interval after hydroxychloroquine therapy in patients with COVID-19 infection: a large, retrospective, multicentre cohort study. BMJ Open 2022; 12:e051579. [PMID: 35140148 PMCID: PMC8829836 DOI: 10.1136/bmjopen-2021-051579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the extent of hydroxychloroquine-induced corrected QT (QTc) prolongation and its relation to COVID-19 infection severity and incidence of polymorphic ventricular arrhythmias and sudden arrhythmic deaths. DESIGN A large-scale cohort study with retrospective analysis of baseline and on-therapy QT interval corrected using Bazett and Fridericia formulas. SETTING A multicentre study involving eight secondary and tertiary care hospitals of the Abu Dhabi Health Services Company (SEHA), United Arab Emirates. PARTICIPANTS 2014 patients consecutively admitted with PCR-confirmed SARS-CoV-2 infection between 1 March 2020 and 1 June 2020. INTERVENTIONS Treatment with hydroxychloroquine alone or in combination with azithromycin for at least 24 hours and with a baseline ECG and at least one ECG after 24 hours of therapy. MAIN OUTCOME MEASURES Maximal QTc interval prolongation and its relationship to clinical severity, polymorphic ventricular tachycardia and sudden arrhythmic death while on treatment. RESULTS The baseline QTc(Bazett) was 427.6±25.4 ms and the maximum QTc(Bazett) during treatment was 439.2±30.4 ms (p<0.001). Severe QTc prolongation (QTc ≥500 ms) was observed in 1.7%-3.3% of patients (Fridericia and Bazett, respectively). There were no cases of polymorphic ventricular arrhythmia or hydroxychloroquine-related arrhythmic death. QTc prolongation was more pronounced in combination therapy compared with hydroxychloroquine alone (22.2 ms vs 11.0 ms, p<0.001) and in patients with higher COVID-19 clinical severity (asymptomatic: 428.4±25.4 ms, severe COVID-19 infection: 452.7±35.7 ms, p<0.001). The overall in-hospital mortality was 3.97% and deceased patients had longer on-therapy QTc(Bazett) than survivors (459.8±21.4 ms vs 438.4±29.9 ms, p<0.001). CONCLUSIONS The incidence of severe QTc prolongation with hydroxychloroquine was low and not associated with ventricular arrhythmia. The safety concerns surrounding the use of hydroxychloroquine may have been overestimated; however, caution should be exercised when using hydroxychloroquine in patients with risk factors for QT prolongation.
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Affiliation(s)
- Moutaz El Kadri
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - Omar Al Falasi
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Rizwan Ahmed
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
| | - Ahlam Al Awadhi
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Zainab Altaha
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Amany Hillis
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Basheer Panikkaveetil
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Sara Abdalla
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Honey Ansel Benette
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Adhba Almubarak
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | | | - Yousef Alattar
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Abderrahim Oulhaj
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi, UAE
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Salem AlKaabi
- Cardiology Department, Sheikh Khalifa Medical City, Abu Dhabi, UAE
- Cardiology Department, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
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Harvey A, Curnier D, Dodin P, Abadir S, Jacquemet V, Caru M. OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1633-1677. [PMID: 35537006 DOI: 10.1093/eurjpc/zwac081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022]
Abstract
Current exercise recommendations make it difficult for long QT syndrome (LQTS) patients to adopt a physically active and/or athletic lifestyle. The purpose of this review is to summarize the current evidence, identify knowledge gaps, and discuss research perspectives in the field of exercise and LQTS. The first aim is to document the influence of exercise training, exercise stress, and postural change interventions on ventricular repolarization in LQTS patients, while the second aim is to describe electrophysiological measurements used to study the above. Studies examining the effects of exercise on congenital or acquired LQTS in human subjects of all ages were included. Systematic searches were performed on 1 October 2021, through PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and ISI Web of Science, and limited to articles written in English or French. A total of 1986 LQTS patients and 2560 controls were included in the 49 studies. Studies were mainly case-control studies (n = 41) and examined exercise stress and/or postural change interventions (n = 48). One study used a 3-month exercise training program. Results suggest that LQTS patients have subtype-specific repolarization responses to sympathetic stress. Measurement methods and quality were found to be very heterogeneous, which makes inter-study comparisons difficult. In the absence of randomized controlled trials, the current recommendations may have long-term risks for LQTS patients who are discouraged from performing physical activity, rendering its associated health benefits out of range. Future research should focus on discovering the most appropriate levels of exercise training that promote ventricular repolarization normalization in LQTS.
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Affiliation(s)
- Audrey Harvey
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Philippe Dodin
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Sylvia Abadir
- Department of Pediatric Cardiology, Sainte-Justine University Health Center, Montreal, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxime Caru
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Das B, Ramasubbu SK, Agnihotri A, Kumar B, Rawat VS. Leading 20 drug-drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients. Ther Adv Cardiovasc Dis 2021; 15:17539447211058892. [PMID: 34841978 PMCID: PMC8641120 DOI: 10.1177/17539447211058892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. RESULTS A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with 'known', 'possible', and 'conditional risk of TdP', respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. CONCLUSION Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Virbhadra Road, Rishikesh 249 203, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Akash Agnihotri
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
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Olgar Y, Durak A, Bitirim CV, Tuncay E, Turan B. Insulin acts as an atypical KCNQ1/KCNE1-current activator and reverses long QT in insulin-resistant aged rats by accelerating the ventricular action potential repolarization through affecting the β 3 -adrenergic receptor signaling pathway. J Cell Physiol 2021; 237:1353-1371. [PMID: 34632595 DOI: 10.1002/jcp.30597] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/13/2022]
Abstract
Insufficient-heart function is associated with myocardial insulin resistance in the elderly, particularly associated with long-QT, in a dependency on dysfunctional KCNQ1/KCNE1-channels. So, we aimed to examine the contribution of alterations in KCNQ1/KCNE1-current (IKs ) to the aging-related remodeling of the heart as well as the role of insulin treatment on IKs in the aged rats. Prolonged late-phase action potential (AP) repolarization of ventricular cardiomyocytes from insulin-resistant 24-month-old rats was significantly reversed by in vitro treatment of insulin or PKG inhibitor (in vivo, as well) via recovery in depressed IKs . Although the protein level of either KCNQ1 or KCNE1 in cardiomyocytes was not affected with aging, PKG level was significantly increased in those cells. The inhibited IKs in β3 -ARs-stimulated cells could be reversed with a PKG inhibitor, indicating the correlation between PKG-activation and β3 -ARs activation. Furthermore, in vivo treatment of aged rats, characterized by β3 -ARs activation, with either insulin or a PKG inhibitor for 2 weeks provided significant recoveries in IKs , prolonged late phases of APs, prolonged QT-intervals, and low heart rates without no effect on insulin resistance. In vivo insulin treatment provided also significant recovery in increased PKG and decreased PIP2 level, without the insulin effect on the KCNQ1 level in β3 -ARs overexpressed cells. The inhibition of IKs in aged-rat cardiomyocytes seems to be associated with activated β3 -ARs dependent remodeling in the interaction between KCNQ1 and KCNE1. Significant recoveries in ventricular-repolarization of insulin-treated aged cardiomyocytes via recovery in IKs strongly emphasize two important issues: (1) IKs can be a novel target in aging-associated remodeling in the heart and insulin may be a cardioprotective agent in the maintenance of normal heart function during the aging process. (2) This study is one of the first to demonstrate insulin's benefits on long-QT in insulin-resistant aged rats by accelerating the ventricular AP repolarization through reversing the depressed IKs via affecting the β3 -ARs signaling pathway and particularly affecting activated PKG.
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Affiliation(s)
- Yusuf Olgar
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Aysegul Durak
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | | | - Erkan Tuncay
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Belma Turan
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey.,Department of Biophysics, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
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Wu CM, Zhang WS, Liu J, Zhang WY, Ke BW. Efficacy and Safety of Fospropofol Disodium for Injection in General Anesthesia Induction for Adult Patients: A Phase 3 Trial. Front Pharmacol 2021; 12:687894. [PMID: 34588977 PMCID: PMC8473892 DOI: 10.3389/fphar.2021.687894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/25/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Fospropofol disodium for injection (FospropofolFD) is a prodrug that is metabolized into propofol to produce a general anesthesia effect when administered intravenously. Objective: This study aimed to assess the efficacy and safety of FospropofolFD in comparison with propofol medium/long-chain fat emulsion injections (propofol-MCT/LCT) for general anesthesia induction in adult patients undergoing elective surgeries. Setting: Nine academic medical centers in China. Method: This multicenter, randomized, double-blind, double-simulated, controlled, and non-inferiority trial evaluated 540 eligible adult patients randomly assigned (2:1) to the intervention (20 mg/kg FospropofolFD) or control (2 mg/kg propofol-MCT/LCT) groups. Main Outcome Measure: The primary efficacy endpoint was the success rate, defined as a Modified Observer’s Assessment of Alertness/Sedation Scale score of 1 within 5 min after study drug administration. The safety endpoints consisted of adverse events (AEs) related to consciousness, cognitive function, hemodynamic status, liver and kidney function, and blood tests. Results: A total of 347 (96.3%) and 175 (97.2%) patients in the intervention and control groups, respectively, completed the study. The success rate for the primary outcome was 97.7% for both study drugs. The most frequent AEs in the intervention group were abnormal feeling (62.0%), blood pressure reduction (13.5%), and injection site pain (13.3%). No AEs related to consciousness and mental and cognitive functions or serious adverse events were reported. Conclusion: FospropofolFD (20 mg/kg) is not inferior to propofol-MCT/LCT (2 mg/kg) in general anesthesia induction for American Society of Anesthesiologists (ASA) physical status I-II adult patients undergoing elective surgeries. It is safe and effective for clinical use under anesthesiologist monitoring. Impact on Practice Statement: FospropofolFD can produce a general anesthesia effect and reduce the incidence of pain at the site of injection.
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Affiliation(s)
- Chao-Meng Wu
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Science, Chengdu, China
| | - Wen-Sheng Zhang
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, China
| | - Jin Liu
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Science, Chengdu, China.,Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, China
| | - Wei-Yi Zhang
- Department of Anesthesiology, West China Hospital of Sichuan University and The Research Units of West China, Chinese Academy of Medical Science, Chengdu, China
| | - Bo-Wen Ke
- Laboratory of Anesthesia and Critical Care Medicine, Translational Neuroscience Center, West China Hospital of Sichuan University, Chengdu, China
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Mangona E, Sandonato E, Brothers TN, Pawasauskas J. Drug-Induced QTc Prolongation: What We Know and Where We Are Going. Curr Drug Saf 2021; 17:100-113. [PMID: 34551700 DOI: 10.2174/1574886316666210922153059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/17/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
Drug-induced QTc prolongation is a concerning electrocardiogram (ECG) abnormality. This cardiac disturbance carries a 10% risk of sudden cardiac death due to the malignant arrhythmia, Torsades de Pointes. The Arizona Center for Education and Research on Therapeutics (AzCERT) has classified QTc prolonging therapeutic classes such as antiarrhythmics, antipsychotics, anti-infectives, and others. AzCERT criteria categorizes medications into three risk categories: "known," "possible," and "conditional risk" of QTc prolongation and Torsades de Pointes. The list of QTc prolonging medications continues to expand as new drug classes are approved and studied. Risk factors for QTc prolongation can be delineated into modifiable or non-modifiable. A validated risk scoring tool may be utilized to predict the likelihood of prolongation in patients receiving AzCERT classified medication. The resultant risk score may be applied to a clinical decision support system which offers mitigation strategies. Mitigation strategies including discontinuation of possible offending agents with selection of an alternative agent, assessment of potential drug interactions or dose adjustments through pharmacokinetic and pharmacodynamic monitoring, and initiation of both ECG and electrolyte monitoring are essential to prevent a drug-induced arrhythmia. The challenges presented by the COVID-19 pandemic have led to the development of innovative continuous monitoring technology, increasing protection for both patients and healthcare workers. Early intervention strategies may reduce adverse events and improve clinical outcomes in patients identified to be at risk of QTc prolongation.
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Affiliation(s)
- Erinn Mangona
- Department of Pharmacy Practice, University of Rhode Island, Kingston. United States
| | - Elisa Sandonato
- Department of Pharmacy Practice, University of Rhode Island, Kingston. United States
| | - Todd N Brothers
- Department of Pharmacy Practice, University of Rhode Island, Kingston. United States
| | - Jayne Pawasauskas
- Department of Pharmacy Practice, University of Rhode Island, Kingston. United States
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Baracaldo-Santamaría D, Llinás-Caballero K, Corso-Ramirez JM, Restrepo CM, Dominguez-Dominguez CA, Fonseca-Mendoza DJ, Calderon-Ospina CA. Genetic and Molecular Aspects of Drug-Induced QT Interval Prolongation. Int J Mol Sci 2021; 22:8090. [PMID: 34360853 PMCID: PMC8347245 DOI: 10.3390/ijms22158090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
Long QT syndromes can be either acquired or congenital. Drugs are one of the many etiologies that may induce acquired long QT syndrome. In fact, many drugs frequently used in the clinical setting are a known risk factor for a prolonged QT interval, thus increasing the chances of developing torsade de pointes. The molecular mechanisms involved in the prolongation of the QT interval are common to most medications. However, there is considerable inter-individual variability in drug response, thus making the application of personalized medicine a relevant aspect in long QT syndrome, in order to evaluate the risk of every individual from a pharmacogenetic standpoint.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Kevin Llinás-Caballero
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
- Institute for Immunological Research, University of Cartagena, Cartagena 130014, Colombia
| | - Julián Miguel Corso-Ramirez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Carlos Martín Restrepo
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | | | - Dora Janeth Fonseca-Mendoza
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | - Carlos Alberto Calderon-Ospina
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
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Ding J, Liu W, Guan H, Feng Y, Bao Y, Li H, Wang X, Zhou Z, Chen Z. Corrected QT interval in hospitalized patients with coronavirus disease 2019: Focus on drugs therapy. Medicine (Baltimore) 2021; 100:e26538. [PMID: 34260531 PMCID: PMC8284736 DOI: 10.1097/md.0000000000026538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 06/15/2021] [Indexed: 12/22/2022] Open
Abstract
Corrected QT (QTc) interval prolongation has been associated with poor patient prognosis. In this study, we assessed the effects of different drugs and cardiac injury on QTc interval prolongation in patients with coronavirus disease 2019 (COVID-19).The study cohort consisted of 395 confirmed COVID-19 cases from the Wuhan Union Hospital West Campus. All hospitalized patients were treated with chloroquine/hydroxychloroquine (CQ/HCQ), lopinavir/ritonavir (LPV/r), quinolones, interferon, Arbidol, or Qingfei Paidu decoction (QPD) and received at least 1 electrocardiogram after drug administration.Fifty one (12.9%) patients exhibited QTc prolongation (QTc ≥ 470 ms). QTc interval prolongation was associated with COVID-19 severity and mortality (both P < .001). Administration of CQ/HCQ (odds ratio [OR], 2.759; 95% confidence interval [CI], 1.318-5.775; P = .007), LPV/r (OR, 2.342; 95% CI, 1.152-4.760; P = .019), and quinolones (OR, 2.268; 95% CI, 1.171-4.392; P = .015) increased the risk of QTc prolongation. In contrast, the administration of Arbidol, interferon, or QPD did not increase the risk of QTc prolongation. Notably, patients treated with QPD had a shorter QTc duration than those without QPD treatment (412.10 [384.39-433.77] vs 420.86 [388.19-459.58]; P = .042). The QTc interval was positively correlated with the levels of cardiac biomarkers (creatine kinase-MB fraction [rho = 0.14, P = .016], high-sensitivity troponin I [rho = .22, P < .001], and B-type natriuretic peptide [rho = 0.27, P < .001]).In conclusion, QTc prolongation was associated with COVID-19 severity and mortality. The risk of QTc prolongation was higher in patients receiving CQ/HCQ, LPV/r, and quinolones. QPD had less significant effects on QTc prolongation than other antiviral agents.
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Zheng N, Christensen SB, Dowell C, Purushottam L, Skalicky JJ, McIntosh JM, Chou DHC. Discovery of Methylene Thioacetal-Incorporated α-RgIA Analogues as Potent and Stable Antagonists of the Human α9α10 Nicotinic Acetylcholine Receptor for the Treatment of Neuropathic Pain. J Med Chem 2021; 64:9513-9524. [PMID: 34161094 DOI: 10.1021/acs.jmedchem.1c00802] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
α9-Containing nicotinic acetylcholine receptors (nAChRs) are key targets for the treatment of neuropathic pain. α-Conotoxin RgIA4 is a peptide antagonist of human α9α10 nAChRs with high selectivity. However, structural rearrangement reveals a potential liability for clinical applications. We herein report our designer RgIA analogues stabilized by methylene thioacetal as nonopioid analgesic agents. We demonstrate that replacing disulfide loop I [CysI-CysIII] with methylene thioacetal in the RgIA skeleton results in activity loss, whereas substitution of loop II [CysII-CysIV] can be accommodated. The lead molecule, RgIA-5524, exhibits highly selective inhibition of α9α10 nAChRs with an IC50 of 0.9 nM and much reduced degradation in human serum. In vivo studies showed that RgIA-5524 relieves chemotherapy-induced neuropathic pain in wild type but not α9 knockout mouse models, demonstrating that α9-containing nAChRs are necessary for the therapeutic effects. This work highlights the application of methylene thioacetal as a disulfide surrogate in conotoxin-based, disulfide-rich peptide drugs.
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Affiliation(s)
- Nan Zheng
- Department of Biochemistry, University of Utah, Salt Lake City, Utah 84112, United States
| | - Sean B Christensen
- School of Biological Science, University of Utah, Salt Lake City, Utah 84112, United States
| | - Cheryl Dowell
- School of Biological Science, University of Utah, Salt Lake City, Utah 84112, United States
| | - Landa Purushottam
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, California 94305, United States
| | - Jack J Skalicky
- Department of Biochemistry, University of Utah, Salt Lake City, Utah 84112, United States
| | - J Michael McIntosh
- School of Biological Science, University of Utah, Salt Lake City, Utah 84112, United States.,George E. Whalen Veterans Affairs Medical Center, Salt Lake City, Utah 84108, United States.,Department of Psychiatry, University of Utah, Salt Lake City, Utah 84112, United States
| | - Danny Hung-Chieh Chou
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, California 94305, United States
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Zequn Z, Jiangfang L. Molecular Insights Into the Gating Kinetics of the Cardiac hERG Channel, Illuminated by Structure and Molecular Dynamics. Front Pharmacol 2021; 12:687007. [PMID: 34168566 PMCID: PMC8217747 DOI: 10.3389/fphar.2021.687007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
The rapidly activating delayed rectifier K+ current generated by the cardiac hERG potassium channel encoded by KCNH2 is the most important reserve current for cardiac repolarization. The unique inward rectification characteristics of the hERG channel depend on the gating regulation, which involves crucial structural domains and key single amino acid residues in the full-length hERG channel. Identifying critical molecules involved in the regulation of gating kinetics for the hERG channel requires high-resolution structures and molecular dynamics simulation models. Based on the latest progress in hERG structure and molecular dynamics simulation research, summarizing the molecules involved in the changes in the channel state helps to elucidate the unique gating characteristics of the channel and the reason for its high affinity to cardiotoxic drugs. In this review, we aim to summarize the significant advances in understanding the voltage gating regulation of the hERG channel based on its structure obtained from cryo-electron microscopy and computer simulations, which reveal the critical roles of several specific structural domains and amino acid residues.
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Affiliation(s)
- Zheng Zequn
- Department of Cardiovascular, Medical College, Ningbo University, Ningbo, China
| | - Lian Jiangfang
- Department of Cardiovascular, Lihuili Hospital Affiliated to Ningbo University, Ningbo, China
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Qi Z, Yang S, Li M, Qu J, Han Q, Zheng J, Wang H. Risk factors and predictors of QTc prolongation in critically ill Chinese patients. Am J Emerg Med 2021; 49:24-28. [PMID: 34051398 DOI: 10.1016/j.ajem.2021.05.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To recognize and validate the predictor of risk factors for ICU patients with QTc intervals ≥500 ms. METHODS We retrospectively reviewed 160 ICU patients with their medical electronic records including all demographic data, diagnosis measurements, ECGs and medication from March 1, 2018 to December 1, 2018. All information of patients' baseline, comorbidities, electrolytes and Long QT syndrome (LQTS)-inducing medications of patients with QT interval corrected (QTc) ≥ 500 ms (n = 80) and <500 ms (n = 80) were collected and analyzed using univariate and multivariate analyses to find predictors. RESULTS Comparing to patients with QTc < 500 ms, patients with QTc ≥ 500 ms had increased SOFA (P = 0.010) and APACHE II scores (P = 0.002), longer lengths of ICU stays (P < 0.001), greater incidence of congestive heart failure (P = 0.005) and more preset risk factors (P < 0.001). The frequency of administration of mosapride (P = 0.015), amiodarone (P = 0.027) and number of combined LQTS-inducing medications (P = 0.012) were greater in patients with QTc ≥ 500 ms than in those with QTc < 500 ms. But after multivariate analysis, we found that risk factors related to a QTc ≥ 500 ms were only congestive heart failure (OR: 5.28), number of combined LQTS-inducing medications (OR: 1.60) and APACHE II score (OR: 1.08). CONCLUSIONS For critically ill patients, congestive heart failure, number of combined LQTS-inducing medications and APACHE II score are proved as risk factors associated with QTc > 500 ms.
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Affiliation(s)
- Zhidong Qi
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Sibo Yang
- Department of Pediatrics, The 1st Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming Li
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingdong Qu
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Qiuyuan Han
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junbo Zheng
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Huaiquan Wang
- Department of Critical Care, The 2nd Affiliated Hospital of Harbin Medical University, Harbin, China.
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Gavioli EM, Guardado N, Haniff F, Deiab N, Vider E. The Risk of QTc Prolongation with Antiemetics in the Palliative Care Setting: A Narrative Review. J Pain Palliat Care Pharmacother 2021; 35:125-135. [PMID: 33974499 DOI: 10.1080/15360288.2021.1900491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Nausea and vomiting are common within the palliative care population. Antiemetic agents may help control symptoms, but may also place patients at risk for QTc prolongation. This article reviews pharmacotherapy agents including anticholinergics, antihistamines, antidopaminergics, 5-HT3 receptor antagonists, dronabinol, and medical marijuana and their associated risk of QTc prolongation. A clinical treatment pathway is provided to help guide clinicians in choosing the most appropriate antiemetic based upon patient specific factors for QTc prolongation.
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Affiliation(s)
- Elizabeth M Gavioli
- Elizabeth M. Gavioli, PharmD., Nerli Guardado, BA, Farah Haniff, BS, Nouran Deiab, BPS, and Etty Vider, PharmD, are with Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, New York, USA
| | - Nerli Guardado
- Elizabeth M. Gavioli, PharmD., Nerli Guardado, BA, Farah Haniff, BS, Nouran Deiab, BPS, and Etty Vider, PharmD, are with Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, New York, USA
| | - Farah Haniff
- Elizabeth M. Gavioli, PharmD., Nerli Guardado, BA, Farah Haniff, BS, Nouran Deiab, BPS, and Etty Vider, PharmD, are with Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, New York, USA
| | - Nouran Deiab
- Elizabeth M. Gavioli, PharmD., Nerli Guardado, BA, Farah Haniff, BS, Nouran Deiab, BPS, and Etty Vider, PharmD, are with Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, New York, USA
| | - Etty Vider
- Elizabeth M. Gavioli, PharmD., Nerli Guardado, BA, Farah Haniff, BS, Nouran Deiab, BPS, and Etty Vider, PharmD, are with Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Brooklyn, New York, USA
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Gutierrez G, Wamboldt R, Baranchuk A. The Impact of Testosterone on the QT Interval: A Systematic Review. Curr Probl Cardiol 2021; 47:100882. [PMID: 34103195 DOI: 10.1016/j.cpcardiol.2021.100882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/02/2021] [Indexed: 11/03/2022]
Abstract
Humans and mammals have sex-specific differences in cardiac electrophysiology, linked to the action of sex hormones in the cardiac muscle. These hormones can upregulate or downregulate the expression of ionic channels modulating the cardiac cycle through genomic and non-genomic interactions. Systematic search in PubMed, Medline and EMBASE including keywords pertaining to testosterone and QT interval. Included experimental studies and observation studies and case reports presenting the results of testosterone administration, excess or deficiency in humans and animals. Testosterone has been shown to shorten the action potential duration, by enhancing the expression of K+ channels and downregulating ICaL increasing the repolarization reserve of the cardiac muscle. This effect has been observed in both genders and animals. Testosterone deficient states can promote arrhythmogenesis. The evidence in this paper may be used to guide clinical considerations, such as increased clinical surveillance of patients in testosterone deficient states using ECG.
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Affiliation(s)
- Gilmar Gutierrez
- Faculty of Health Sciences, School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Rachel Wamboldt
- Division of Internal Medicine, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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Saad NA, Elberry AA, Samy Matar H, Hussein RRS. Effect of ciprofloxacin vs levofloxacin on QTc-interval and dysglycemia in diabetic and non-diabetic patients. Int J Clin Pract 2021; 75:e14072. [PMID: 33559294 DOI: 10.1111/ijcp.14072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 02/03/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Levofloxacin and ciprofloxacin are more commonly used amongst fluoroquinolone class and the question of cardiac safety and glucose hemostasis of this class has been raised. OBJECTIVE To compare intravenous levofloxacin and ciprofloxacin regarding their risk on QTc prolongation and dysglycemia in diabetic and non-diabetic patients. METHODS A randomised prospective study at Beni-Suef university hospital was conducted on 200 adult patients over 6 months. The patients received intravenous levofloxacin 750mg once daily or ciprofloxacin 400mg twice daily. Electrocardiogram and fasting blood glucose were obtained from each patient before starting the antibiotic, 24 hours, 72 hours after the first dose, and 72 hours after antibiotics cessation. RESULTS The results of the current study showed the relative risk for QTc prolongation with levofloxacin was more than ciprofloxacin by about 4 and 1.5 times in diabetic and non-diabetic patients, respectively. The relative risk for dysglycemia with levofloxacin was 2.28 and 1.39 times more than ciprofloxacin in diabetic and non-diabetic patients, respectively. CONCLUSION The present study showed that the risk for QTc prolongation and hyperglycemia was greater with levofloxacin than ciprofloxacin in diabetic and non-diabetic patients. In addition, the risk for hypoglycemia was greater with levofloxacin than ciprofloxacin in non-diabetic patients.
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Affiliation(s)
- Nada A Saad
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed A Elberry
- Pharmacology Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Hazem Samy Matar
- Internal Medicine Department, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Raghda R S Hussein
- Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
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Gajendragadkar PR, Von Ende A, Ibrahim M, Valdes-Marquez E, Camm CF, Murgia F, Stiby A, Casadei B, Hopewell JC. Assessment of the causal relevance of ECG parameters for risk of atrial fibrillation: A mendelian randomisation study. PLoS Med 2021; 18:e1003572. [PMID: 33983917 PMCID: PMC8118296 DOI: 10.1371/journal.pmed.1003572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 02/23/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Atrial electrical and structural remodelling in older individuals with cardiovascular risk factors has been associated with changes in surface electrocardiographic (ECG) parameters (e.g., prolongation of the PR interval) and higher risks of atrial fibrillation (AF). However, it has been difficult to establish whether altered ECG parameters are the cause or a consequence of the myocardial substrate leading to AF. This study aimed to examine the potential causal relevance of ECG parameters on risk of AF using mendelian randomisation (MR). METHODS AND FINDINGS Weighted genetic scores explaining lifelong differences in P-wave duration, PR interval, and QT interval were constructed, and associations between these ECG scores and risk of AF were estimated among 278,792 UK Biobank participants (mean age: 57 years at recruitment; 19,132 AF cases). The independent genetic variants contributing to each of the separate ECG scores, and their corresponding weights, were based on published genome-wide association studies. In UK Biobank, genetic scores representing a 5 ms longer P-wave duration or PR interval were significantly associated with lower risks of AF (odds ratio [OR] 0.91; 95% confidence interval [CI]: 0.87-0.96, P = 2 × 10-4 and OR 0.94; 95% CI: 0.93-0.96, P = 2 × 10-19, respectively), while longer QT interval was not significantly associated with AF. These effects were independently replicated among a further 17,931 AF cases from the AFGen Consortium. Investigation of potential mechanistic pathways showed that differences in ECG parameters associated with specific ion channel genes had effects on risk of AF consistent with the overall scores, while the overall scores were not associated with changes in left atrial size. Limitations of the study included the inherent assumptions of MR, restriction to individuals of European ancestry, and possible restriction of results to the normal ECG ranges represented in UK Biobank. CONCLUSIONS In UK Biobank, we observed evidence suggesting a causal relationship between lifelong differences in ECG parameters (particularly PR interval) that reflect longer atrial conduction times and a lower risk of AF. These findings, which appear to be independent of atrial size and concomitant cardiovascular comorbidity, support the relevance of varying mechanisms underpinning AF and indicate that more individualised treatment strategies warrant consideration.
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Affiliation(s)
- Parag Ravindra Gajendragadkar
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Adam Von Ende
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Maysson Ibrahim
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Elsa Valdes-Marquez
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Christian Fielder Camm
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Federico Murgia
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Alexander Stiby
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Barbara Casadei
- Division of Cardiovascular Medicine, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | - Jemma C. Hopewell
- CTSU, Nuffield Department of Population Health, BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
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Abstract
Cirrhotic cardiomyopathy (CCM) connotes systolic and/or diastolic dysfunction in patients with end-stage liver disease in the absence of prior heart disease. Its prevalence is variable across different studies but recent data suggest that CCM may affect up to one third of liver transplant candidates. The etiology of CCM is multifactorial. CCM defining features were recently revised to improve the diagnostic and prognostic yield of CCM criteria and inform candidate selection for liver transplantation. CCM appears to increase the risk for unfavorable outcomes pre- and post-transplant. Close clinical and echocardiographic follow-up of patients with CCM may mitigate adverse cardiac outcomes.
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Affiliation(s)
- MANHAL J IZZY
- Assistant Professor, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University School of Medicine, Nashville, TN
| | - LISA B VANWAGNER
- Assistant Professor, Department of Medicine, Division of Gastroenterology and Hepatology,Department of Preventive Medicine, Division of Epidemiology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Popa SL, Barsan M, Caziuc A, Pop C, Muresan L, Popa LC, Perju-Dumbrava L. Life-threatening complications of hyperemesis gravidarum. Exp Ther Med 2021; 21:642. [PMID: 33968173 PMCID: PMC8097228 DOI: 10.3892/etm.2021.10074] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/01/2021] [Indexed: 01/16/2023] Open
Abstract
Hyperemesis gravidarum (HG) refers to severe nausea and emesis noted during pregnancy. However, no consensus exists on the specific diagnostic criteria that can be used for this condition. The aim of the present systematic review was to summarize the available evidence regarding the severe complications observed during HG with a heightened risk of fatality. A systematic search was conducted on PubMed, Cochrane Library, EMBASE and WILEY databases for the relevant publications regarding the severe and life-threatening complications of HG. The search terms were as follows: '(Hyperemesis gravidarum)' AND ('complications' OR 'severe' OR 'adverse pregnancy outcomes' OR 'stroke' OR 'seizures' OR 'Wernicke's encephalopathy' OR 'arrhythmias' OR 'pneumomediastinum' OR 'coagulopathy' OR 'electrolytic imbalance'). Abstracts, conference presentations, letters to the editor, studies written in languages other than English and editorials were all excluded. This search identified 43 studies analyzing life-threatening complications of HG, of which 11, seven, eight and 17 articles analyzed neurological, cardiovascular, thoracic and systemic complications, respectively. Reports on life-threatening complications were exceptionally rare in HG. The most frequent severe complications noted were Wernicke's encephalopathy, electrolyte imbalance and vitamin K deficiency. The low mortality rate for patients with HG over the last decade could be explained by the high efficiency of modern therapy, and the precise management of every complication according to current guidelines.
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Affiliation(s)
- Stefan L Popa
- Second Medical Department, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Maria Barsan
- Department of Occupational Health, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Alexandra Caziuc
- Department of Surgery, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400000, Romania
| | - Cristina Pop
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400349, Romania
| | - Lucian Muresan
- Department of Cardiology, 'Emile Muller' Hospital, Mulhouse, 68200 Mulhouse, France
| | - Luminita Celia Popa
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
| | - Lacramioara Perju-Dumbrava
- Department of Neurology, 'Iuliu Hatieganu' University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca 400012, Romania
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Abstract
OBJECTIVE Ventricular repolarisation changes may lead to sudden cardiac death in obese individuals. We aimed to investigate the relationship between ventricular repolarisation changes, echocardiographic parameters, anthropometric measures, and metabolic syndrome laboratory parameters in obese children. METHODS The study involved 81 obese and 82 normal-weight healthy children with a mean age of 12.3 ± 2.7 years. Anthropometric measurements of participants were evaluated according to nomograms. Obese patients were subdivided into two groups; metabolic syndrome and non-metabolic syndrome obese. Fasting plasma glucose, fasting insulin, and lipid profile were measured. QT/QTc interval, QT/QTc dispersions were measured, and left ventricular systolic and diastolic measurements were performed. RESULTS Body weight, body mass index, relative body mass index, waist/hip circumference ratio, and systolic and diastolic blood pressures were significantly higher in obese children. QT and QTc dispersions were significantly higher in obese children and also obese children with metabolic syndrome had significantly higher QT and QTc dispersions compared to non-metabolic syndrome obese children (p < 0.001) and normal-weight healthy children (p < 0.001). Waist/hip circumference ratio, body mass index, and relative body mass index were the most important determinant of QT and QTc dispersions. Left ventricular wall thickness (left ventricular posterior wall thickness at end-diastole, left ventricular posterior wall thickness at end-systole, interventricular septal thickness at end-diastole) and left ventricular mass index were significantly higher and ejection fraction was lower in obese children. Left ventricular mass index and interventricular septal thickness at end-diastole were positively correlated with QT and QTc dispersions. CONCLUSIONS Our study demonstrated that QT/ QTc interval prolongation and increase in QT and QTc dispersion on electrocardiogram may be found at an early age in obese children.
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Antimisiaris D, McHolan B, Moga D, Mospan C. Depression Part 3: Medication Related Problems. Sr Care Pharm 2021; 36:68-82. [PMID: 33509330 DOI: 10.4140/tcp.n.2021.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
When selecting and managing psychoactive medications in older people, it is equally important to focus on avoidance of toxicity as it is to focus on efficacy. Higher psychoactive medication load is associated with increased rate and risk of all cause hospitalization. The medication classes used to treat depression and related comorbidities include antidepressants, antipsychotics, stimulants, mood stabilizers, lithium, anxiolytics and sedative hypnotics. This discussion will examine considerations to help avoid medication related problems relevant to medications used to treat depression in the antidepressant pharmacological class.
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Affiliation(s)
- Demetra Antimisiaris
- 1University of Louisville, Schools of Public Health and Medicine, Louisville, Kentucky
| | - Brittany McHolan
- 2University of Kentucky, College of Pharmacy, Louisville, Kentucky
| | - Daniela Moga
- 3University of Kentucky, Colleges of Pharmacy and Public Health and Sanders-Brown Center on Aging, Lexington, Kentucky
| | - Cortney Mospan
- 4Wingate School of Pharmacy, Levine College of Health Sciences, Wingate, North Carolina
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Shibata M, Ito I, Tawada H, Taniguchi S. QT Prolongation in Dialysis Patients: An Epidemiological Study with a Focus on Malnutrition. Blood Purif 2021:1-8. [PMID: 33498053 DOI: 10.1159/000512961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS QT prolongation is a known risk factor for ventricular fibrillation and ventricular tachycardia. Therefore, more refined management is necessary to reduce sudden cardiac death secondary to such arrhythmias. METHODS Electrocardiographic findings were reviewed in 224 patients, and the associations of QT prolongation with various clinical parameters were examined, including the nutritional state. Correlations were also examined between QT prolongation and body composition measurements determined by multifrequency bioelectrical impedance analysis. RESULTS Prolongation of the corrected QT (QTc) interval over 0.44 s was seen in 140 patients (62.5%). QT prolongation was independent of age and dialysis therapy duration and was more frequent in diabetics (70.1%) than in nondiabetics (54.2%, p = 0.014) and more frequent in women (78.8%) than in men (53.5%, p < 0.001). Serum levels of albumin (p < 0.001) and Cr (p < 0.001) and the Geriatric Nutritional Risk Index (GNRI, p < 0.001) were negatively correlated with QTc interval; no significant correlation was noted with total protein, urea nitrogen, or uric acid. Negative correlations with QTc interval were found for BMI(p < 0.01), percent total body water (%TBW; p < 0.05), and percent intracellular water (%ICW; p < 0.01) but not with the percent extracellular water/TBW ratio or edema ratio. The longer the QTc interval, the lower the fat-free mass (FFM; p < 0.01) and muscle mass (MM; p < 0.01), but there was no significant correlation with percent fat. CONCLUSION These results suggest that QT prolongation is a common complication and is more frequent in women and diabetic patients. The decreases in serum albumin and Cr levels, GNRI, BMI, %TBW, %ICW, FFM, and MM together coincided with malnutrition and thus suggest a close relationship of QT prolongation with malnutrition. Management of QT prolongation may be achieved better in the future by understanding these biochemical and biophysical changes, particularly those regarding malnutrition.
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Affiliation(s)
- Masanori Shibata
- Japan Association for Clinical Engineers, Tokyo, Japan, .,Department of Hemodialysis, Koujukai Rehabilitation Hospital, Kita-Nagoya, Japan,
| | - Isao Ito
- Department of Hemodialysis, Koujukai Rehabilitation Hospital, Kita-Nagoya, Japan
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Abstract
Schwere Arzneimittelnebenwirkungen stellen mit 5–7 % einen häufigen Grund für eine Krankenhauseinweisung dar. Die Prävalenz von unerwünschten Arzneimittelwirkungen (UAW) während eines stationären Aufenthaltes liegt sogar bei etwa 11,5 %. Die Ursache sind oftmals Medikamentenwechselwirkungen, bedingt durch die Polypharmazie der multimorbiden älteren Patienten. So nimmt ein 65-jähriger Patient im Durchschnitt 5 Medikamente gleichzeitig ein. Aufgrund des zunehmenden Einsatzes von Systemtherapeutika in der Dermatologie und der gleichzeitig zunehmenden Polypharmazie ist das Wissen um Medikamenteninteraktionen für den Dermatologen zur Vermeidung schwerer Arzneimittelnebenwirkungen wesentlich. Dieser Beitrag soll eine Hilfestellung bieten, Patienten und Medikamente mit einem hohen Risiko für schwerwiegende Interaktionen zu identifizieren und dadurch das Auftreten unerwünschter Wirkungen oder auch die Verminderung des therapeutischen Effektes von Wirkstoffen zu vermeiden. Wir möchten darauf hinweisen, dass die folgende Arbeit einzelne Aspekte behandelt und nicht von der Überprüfung einzelner Arzneimittelinteraktionen mittels Interaktionsprogrammen entbindet. Nicht außer Acht gelassen werden sollte, dass neben verschreibungspflichtigen Medikamenten auch Nahrungsmittel, Nahrungsergänzungsmittel und Kräuter zu Interaktionen mit Medikamenten führen können.
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Affiliation(s)
- Kristina Krause
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Jahn
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Bernhard Homey
- Klinik für Dermatologie, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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Zequn Z, Yujia W, Dingding Q, Jiangfang L. Off-label use of chloroquine, hydroxychloroquine, azithromycin and lopinavir/ritonavir in COVID-19 risks prolonging the QT interval by targeting the hERG channel. Eur J Pharmacol 2020; 893:173813. [PMID: 33345848 PMCID: PMC7746509 DOI: 10.1016/j.ejphar.2020.173813] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 11/29/2020] [Accepted: 12/11/2020] [Indexed: 12/20/2022]
Abstract
Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses an enormous challenge to the medical system, especially the lack of safe and effective COVID-19 treatment methods, forcing people to look for drugs that may have therapeutic effects as soon as possible. Some old drugs have shown clinical benefits after a few small clinical trials that attracted great attention. Clinically, however, many drugs, including those currently used in COVID-19, such as chloroquine, hydroxychloroquine, azithromycin, and lopinavir/ritonavir, may cause cardiotoxicity by acting on cardiac potassium channels, especially hERG channel through their off-target effects. The blocking of the hERG channel prolongs QT intervals on electrocardiograms; thus, it might induce severe ventricular arrhythmias and even sudden cardiac death. Therefore, while focusing on the efficacy of COVID-19 drugs, the fact that they block hERG channels to cause arrhythmias cannot be ignored. To develop safer and more effective drugs, it is necessary to understand the interactions between drugs and the hERG channel and the molecular mechanism behind this high affinity. In this review, we focus on the biochemical and molecular mechanistic aspects of drug-related blockade of the hERG channel to provide insights into QT prolongation caused by off-label use of related drugs in COVID-19, and hope to weigh the risks and benefits when using these drugs.
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Affiliation(s)
- Zheng Zequn
- Medical College, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Wu Yujia
- Medical College, Ningbo University, Ningbo, Zhejiang, 315000, China
| | - Qian Dingding
- Department of Cardiovascular, Lihuili Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, 315211, China
| | - Lian Jiangfang
- Department of Cardiovascular, Lihuili Hospital Affiliated to Ningbo University, Ningbo, Zhejiang, 315211, China.
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Das B, Ramasubbu SK, Kumar B, Rawat VS. Top 20 drug - drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients. J Family Med Prim Care 2020; 9:6023-6040. [PMID: 33681037 PMCID: PMC7928114 DOI: 10.4103/jfmpc.jfmpc_1060_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. RESULTS A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. CONCLUSIONS Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
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