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Argirò A, Ho C, Day SM, van der Velden J, Cerbai E, Saberi S, Tardiff JC, Lakdawala NK, Olivotto I. Sex-Related Differences in Genetic Cardiomyopathies. J Am Heart Assoc 2022; 11:e024947. [PMID: 35470690 PMCID: PMC9238595 DOI: 10.1161/jaha.121.024947] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Cardiomyopathies are a heterogeneous collection of diseases that have in common primary functional and structural abnormalities of the heart muscle, often genetically determined. The most effective categorization of cardiomyopathies is based on the presenting phenotype, with hypertrophic, dilated, arrhythmogenic, and restrictive cardiomyopathy as the prototypes. Sex modulates the prevalence, morpho-functional manifestations and clinical course of cardiomyopathies. Aspects as diverse as ion channel expression and left ventricular remodeling differ in male and female patients with myocardial disease, although the reasons for this are poorly understood. Moreover, clinical differences may also result from complex societal/environmental discrepancies between sexes that may disadvantage women. This review provides a state-of-the-art appraisal of the influence of sex on cardiomyopathies, highlighting the many gaps in knowledge and open research questions.
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Affiliation(s)
- Alessia Argirò
- Cardiomyopathy UnitCareggi University HospitalFlorenceItaly
- Department of Experimental and Clinical MedicineUniversity of FlorenceItaly
- Division of General CardiologyCareggi University HospitalFlorenceItaly
| | - Carolyn Ho
- Cardiovascular DivisionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
| | - Sharlene M. Day
- Division of Cardiovascular MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPA
| | - Jolanda van der Velden
- Department of PhysiologyAmsterdam Cardiovascular SciencesAmsterdam University Medical CenterVrije UniversiteitAmsterdamNetherlands
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child HealthUniversity of FlorenceItaly
| | - Sara Saberi
- Division of Cardiovascular MedicineDepartment of Internal MedicineUniversity of MichiganMichigan MedicineAnn ArborMI
| | - Jil C. Tardiff
- Department of Biomedical EngineeringThe University of ArizonaTucsonAZ
| | - Neal K. Lakdawala
- Cardiovascular DivisionBrigham and Women's HospitalHarvard Medical SchoolBostonMA
| | - Iacopo Olivotto
- Cardiomyopathy UnitCareggi University HospitalFlorenceItaly
- Department of Experimental and Clinical MedicineUniversity of FlorenceItaly
- Division of General CardiologyCareggi University HospitalFlorenceItaly
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2
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The regulation of the small-conductance calcium-activated potassium current and the mechanisms of sex dimorphism in J wave syndrome. Pflugers Arch 2021; 473:491-506. [PMID: 33411079 DOI: 10.1007/s00424-020-02500-3] [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] [Received: 09/04/2020] [Revised: 11/20/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
Apamin-sensitive small-conductance calcium-activated potassium (SK) current (IKAS) plays an important role in cardiac repolarization under a variety of physiological and pathological conditions. The regulation of cardiac IKAS relies on SK channel expression, intracellular Ca2+, and interaction between SK channel and intracellular Ca2+. IKAS activation participates in multiple types of arrhythmias, including atrial fibrillation, ventricular tachyarrhythmias, and automaticity and conduction abnormality. Recently, sex dimorphisms in autonomic control have been noticed in IKAS activation, resulting in sex-differentiated action potential morphology and arrhythmogenesis. This review provides an update on the Ca2+-dependent regulation of cardiac IKAS and the role of IKAS on arrhythmias, with a special focus on sex differences in IKAS activation. We propose that sex dimorphism in autonomic control of IKAS may play a role in J wave syndrome.
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Machuki JO, Zhang HY, Geng J, Fu L, Adzika GK, Wu L, Shang W, Wu J, Kexue L, Zhao Z, Sun H. Estrogen regulation of cardiac cAMP-L-type Ca 2+ channel pathway modulates sex differences in basal contraction and responses to β 2AR-mediated stress in left ventricular apical myocytes. Cell Commun Signal 2019; 17:34. [PMID: 30987657 PMCID: PMC6466778 DOI: 10.1186/s12964-019-0346-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 03/27/2019] [Indexed: 12/16/2022] Open
Abstract
Backgrounds/Aim Male and female hearts have many structural and functional differences. Here, we investigated the role of estrogen (E2) in the mechanisms of sex differences in contraction through the cAMP-L-type Ca2+channel pathway in adult mice left ventricular (LV) apical myocytes at basal and stress state. Methods Isolated LV apical myocytes from male, female (Sham) and ovariectomised mice (OVX) were used to investigate contractility, Ca2+ transients and L-type Ca2+ channel (LTCC) function. The levels of β2AR, intracellular cAMP, phosphodiesterase (PDE 3 and PDE 4), RyR2, PLB, SLN, and SERCA2a were compared among the experimental groups. Results We found that (1) intracellular cAMP, ICaL density, contraction and Ca2+ transient amplitudes were larger in Sham and OVX + E2 myocytes compared to male and OVX. (2) The mRNA expression of PDE 3 and 4 were lower in Sham and OVX + E2 groups compared with male and OVX groups. Treatment of myocytes with IBMX (100 μM) increased contraction and Ca2+ transient amplitude in both sexes and canceled differences between them. (3) β2AR-mediated stress decreased cAMP concentration and peak contraction and Ca2+ transient amplitude only in male and OVX groups but not in Sham or OVX + E2 groups suggesting a cardioprotective role of E2 in female mice. (4) Pretreatment of OVX myocytes with GPR30 antagonist G15 (100 nM) abolished the effects of E2, but ERα and ERβ antagonist ICI 182,780 (1 μM) did not. Moreover, activation of GPR30 with G1 (100 nM) replicated the effects of E2 on cAMP, contraction and Ca2+ transient amplitudes suggesting that the acute effects of E2 were mediated by GPR30 via non-genomic signaling. (5) mRNA expression of RyR2 was higher in myocytes from Sham than those of male while PLB and SLN were higher in male than Sham but no sex differences were observed in the mRNA of SERCA2a. Conclusion Collectively, these results demonstrate that E2 modulates the expression of genes related to the cAMP-LTCC pathway and contributes to sex differences in cardiac contraction and responses to stress. We also show that estrogen confers cardioprotection against cardiac stress by non-genomic acute signaling via GPR30.
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Affiliation(s)
| | - Hong-Yuan Zhang
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.,Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, 221002, China
| | - Juan Geng
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.,Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, 221002, China
| | - Lu Fu
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Gabriel Komla Adzika
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Lijuan Wu
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.,Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, 221002, China
| | - Wenkang Shang
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, 221002, China
| | - Jinxia Wu
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Li Kexue
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Zhiwei Zhao
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, 221002, China
| | - Hong Sun
- Physiology Department, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
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Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, Gillis AM, Haugaa KH, Lip GYH, Van Gelder I, Malik M, Poole J, Potpara T, Savelieva I, Sarkozy A. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018; 20:1565-1565ao. [PMID: 29961863 DOI: 10.1093/europace/euy067] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | | | | | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | | | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Thrombosis Research Unit, Aalborg University, Denmark
| | - Isabelle Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London
| | - Jeannie Poole
- University of Washington Medical center, Seattle, Washington, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Irina Savelieva
- St. George's, University of London, Cranmer Terrace, London, UK
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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Verkerk AO, Amin AS, Remme CA. Disease Modifiers of Inherited SCN5A Channelopathy. Front Cardiovasc Med 2018; 5:137. [PMID: 30327767 PMCID: PMC6174200 DOI: 10.3389/fcvm.2018.00137] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/10/2018] [Indexed: 12/19/2022] Open
Abstract
To date, a large number of mutations in SCN5A, the gene encoding the pore-forming α-subunit of the primary cardiac Na+ channel (NaV1.5), have been found in patients presenting with a wide range of ECG abnormalities and cardiac syndromes. Although these mutations all affect the same NaV1.5 channel, the associated cardiac syndromes each display distinct phenotypical and biophysical characteristics. Variable disease expressivity has also been reported, where one particular mutation in SCN5A may lead to either one particular symptom, a range of various clinical signs, or no symptoms at all, even within one single family. Additionally, disease severity may vary considerably between patients carrying the same mutation. The exact reasons are unknown, but evidence is increasing that various cardiac and non-cardiac conditions can influence the expressivity and severity of inherited SCN5A channelopathies. In this review, we provide a summary of identified disease entities caused by SCN5A mutations, and give an overview of co-morbidities and other (non)-genetic factors which may modify SCN5A channelopathies. A comprehensive knowledge of these modulatory factors is not only essential for a complete understanding of the diverse clinical phenotypes associated with SCN5A mutations, but also for successful development of effective risk stratification and (alternative) treatment paradigms.
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Affiliation(s)
- Arie O Verkerk
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands.,Department of Medical Biology, Academic Medical Center, Amsterdam, Netherlands
| | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands
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Mercuro G, Bassareo PP, Mariucci E, Deidda M, Zedda AM, Bonvicini M. Sex differences in congenital heart defects and genetically induced arrhythmias. J Cardiovasc Med (Hagerstown) 2015; 15:855-63. [PMID: 23422886 DOI: 10.2459/jcm.0b013e32835ec828] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sex medicine can be applied to define the effect of male or female sex-associated differences on the prevalence of congenital heart defects (CHDs), on clinical manifestation of the latter, on means of dealing with the defects and facing consequent surgical treatment, as well as on the success of surgery. The widespread use of modern databases has undoubtedly enhanced the possibility of these observations compared to the past, when findings were limited to case series from single cardiology or paediatric heart surgery units. The aim of the present review is to assess all publications present in the literature on sex differences and CHD, placing particular emphasis on both contradictory aspects and less acknowledged issues. Furthermore, a section of the review is devoted to the effect of sex differences on cardiac arrhythmias, particularly the largely genetically predetermined electrophysiological differences observed between men and women.
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Affiliation(s)
- Giuseppe Mercuro
- aDepartment of Medical Sciences 'Mario Aresu', University of Cagliari, Cagliari bPediatric Cardiology and Adult Congenital Unit, University of Bologna, Bologna, Italy
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Shabani P, Ghazizadeh Z, Pahlavan S, Hashemizadeh S, Baharvand H, Aghdami N, Doosti M. Exogenous treatment with eicosapentaenoic acid supports maturation of cardiomyocytes derived from embryonic stem cells. Biochem Biophys Res Commun 2015; 461:281-6. [PMID: 25871791 DOI: 10.1016/j.bbrc.2015.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 11/29/2022]
Abstract
Embryonic stem cells offer multiple advantages over adult stem cells in terms of achieving acceptable number of functional cardiomyocytes to be exploited in cell therapy. However, differentiation efficacy is still a major issue to be solved before moving to regenerative medicine. Although a vast number of chemical compounds have been tested on efficiency of cardiac differentiation, the effect of fish oil components, such as eicosapentaenoic acid (EPA) on developmental bioenergetics, and hence cardiac differentiation, remained unstudied. EPA has been reported to have several cardioprotective effects, but there is no study addressing its role in cardiac differentiation. After mesoderm induction of embryoid bodies (EBs) derived from mouse embryonic stem cells (mESCs) in hanging drops initiated by ascorbic acid, they were treated with various concentrations of EPA. Gene and protein expression and functional properties of cardiomyocytes derived from ESCs were evaluated following treatment with various concentrations of EPA. Exposure to low concentrations of EPA (10 μM) increased percentage of beating colonies and beating area. This treatment also resulted in up to 3 fold increase in expression of NKX2-5, MEF2C, MYH6, TNNT2 and CX43. FACS analysis confirmed gene expression analysis with increased percentage of MYH6 positive cells in EPA-treated group compared to the control group. In contrast, the expression of genes coding for cardiac differentiation, remained constant or even declined with higher concentrations of EPA. In conclusion, we have demonstrated that treatment of mESCs undergoing cardiac differentiation with low concentration, but not high concentration of EPA up-regulate transcription of genes associated with cardiac development.
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Affiliation(s)
- Parisa Shabani
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran; Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Zaniar Ghazizadeh
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Sara Pahlavan
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Shiva Hashemizadeh
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Hossein Baharvand
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Nasser Aghdami
- Department of Stem Cells and Developmental Biology at Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran.
| | - Mahmood Doosti
- Department of Clinical Biochemistry, Faculty of Medicine, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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8
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Cieniawa J, Baszak J, Olchowik G, Widomska J. Modeling gender effects on electrical activity of single ventricular myocytes. Comput Biol Med 2013; 43:1063-72. [PMID: 23726761 DOI: 10.1016/j.compbiomed.2013.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 04/08/2013] [Accepted: 05/01/2013] [Indexed: 10/26/2022]
Abstract
In this study we investigate the mechanisms underlying gender differences in the generation of arrhythmias in the long QT and Brugada syndromes. Simulations were conducted at the single myocyte level using a detailed mathematical model of human ventricular myocytes. Given the scarce human data on the gender-related differences in single cardiac cells, we assumed gender-related differences in five ionic-current systems: fast sodium current (INa), slowly inactivating late sodium current (INal), transient outward potassium current (Ito), slow delayed rectifier potassium current (IKs), and calcium current through the L-type channel (ICa(L)), based on experimental results obtained in canine myocytes. Our modeling results suggest that in left ventricular myocytes, enhanced INal under conditions of reduced repolarization reserve results in sex-dependent development of early afterdepolarizations (EADs) in the post-pause action potentials (APs). Moreover, this modeling study demonstrates increased propensity for the development of the loss of the AP dome in male epicardial myocytes of the right ventricle compared with other types of myocytes from the left and right ventricles. Finally, we also found a slight effect of INal on gender-dependent loss of AP dome in epicardial right ventricular myocytes. In conclusion, at the cellular level, gender differences in the development of EADs and the propensity to develop the loss of the AP dome can be attributed to male/female related differences in INa, INal, Ito, IKs, and ICa(L).
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Affiliation(s)
- Jerzy Cieniawa
- Department of Biophysics, Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland.
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9
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Osadchii OE. Electrophysiological determinants of arrhythmic susceptibility upon endocardial and epicardial pacing in guinea-pig heart. Acta Physiol (Oxf) 2012; 205:494-506. [PMID: 22356273 DOI: 10.1111/j.1748-1716.2012.02428.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Revised: 11/23/2011] [Accepted: 02/14/2012] [Indexed: 12/01/2022]
Abstract
AIM Endocardial pacing instituted to treat symptomatic bradycardia may nevertheless promote tachyarrhythmia in some pacemaker-implanted patients. We sought to determine the contributing electrophysiological mechanisms. METHODS Left ventricular (LV) monophasic action potential duration (APD(90)) and effective refractory periods were determined in perfused guinea-pig hearts along with volume-conducted ECG recordings during epicardial and endocardial stimulations. RESULTS Consistent with electrotonic modulation of repolarization, APD(90) at a given (either epicardial or endocardial) recording site tended to be longer while pacing from the ipsilateral LV site as compared to stimulations applied at the opposite side of ventricular wall. As a result, the intrinsic transmural repolarization gradient was amplified during endocardial pacing while being significantly reduced upon epicardial stimulations. The maximum slope of APD(90) restitution was greater upon endocardial than epicardial pacing. The excitability was found to recur at earlier repolarization time point at endocardium than epicardium, thereby contributing to increased endocardial critical intervals for re-excitation. Premature extrasystolic beats could have been elicited at shorter coupling stimulation intervals and propagated with greater transmural conduction delay upon endocardial than epicardial stimulations. Endocardial site exhibited lower ventricular fibrillation thresholds and greater inducibility of tachyarrhythmia upon extrasystolic stimulations as compared to epicardium. CONCLUSION Arrhythmic susceptibility in guinea-pig heart is greater during endocardial than epicardial pacing because of greater transmural APD(90) dispersion, steeper electrical restitution slopes, greater critical intervals for LV re-excitation and slower transmural conduction of the earliest premature ectopic beats. Further studies are warranted to determine whether these effects may contribute to proarrhythmia in paced human patients.
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Affiliation(s)
- O E Osadchii
- The Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, The Panum Institute, University of Copenhagen, Copenhagen N, Denmark.
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Magnani JW, Moser CB, Murabito JM, Nelson KP, Fontes JD, Lubitz SA, Sullivan LM, Ellinor PT, Benjamin EJ. Age of natural menopause and atrial fibrillation: the Framingham Heart Study. Am Heart J 2012; 163:729-34. [PMID: 22520541 DOI: 10.1016/j.ahj.2012.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2011] [Accepted: 01/09/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Early menopausal age is associated with risk of cardiovascular events including myocardial infraction, stroke, and increased mortality. Relations between menopausal age and atrial fibrillation (AF) have not been investigated. We examined the association between menopausal age and AF. METHODS Framingham Heart Study women ≥ 60 years old without prevalent AF and natural menopause were followed up for 10 years or until incident AF. Menopausal age was modeled as a continuous variable and by categories (<45, 45-53, and >53 years). We used Cox proportional hazards regression to determine associations between menopausal age and AF risk. RESULTS In 1,809 Framingham women (2,662 person-examinations, mean baseline age 71.4 ± 7.6 years, menopausal age 49.8 ± 3.6 years), there were 273 unique participants with incident AF. We did not identify a significant association between the SD of menopausal age (3.6 years) and AF (hazard ratio [HR] per SD 0.94, 95% CI 0.83-1.06; P = .29). In a multivariable model with established risk factors for AF, menopausal age was not associated with incident AF (HR per SD 0.97, 95% CI 0.86-1.09; P = .60). Examining categorical menopausal age, earlier menopausal age (<45 years) was not significantly associated with increased AF risk compared with older menopausal age >53 years (HR 1.20, 95% CI 0.74-1.94; P = .52) or menopausal age 45 to 53 years (HR 1.38, 95% CI 0.93-2.04; P = .11). CONCLUSION In our moderate-sized, community-based sample, we did not identify menopausal age as significantly increasing AF risk. However, future larger studies will need to examine whether there is a small effect of menopausal age on AF risk.
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11
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McSweeney JC, Pettey CM, Souder E, Rhoads S. Disparities in women's cardiovascular health. J Obstet Gynecol Neonatal Nurs 2011; 40:362-71. [PMID: 21477222 DOI: 10.1111/j.1552-6909.2011.01239.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death in women, and disparities affect the diagnosis, treatment, and outcomes of CVD for women. Biology, genetics, and race contribute to these disparities. Obstetric-gynecologic health care providers routinely encounter women who are at risk for developing CVD and are uniquely positioned as a point of access to intervene to improve/prevent CVD by assessing for risks and discussing healthy lifestyle changes during routine visits.
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Affiliation(s)
- Jean C McSweeney
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA
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12
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Berne P, Brugada J. Brugada Syndrome 2010. Card Electrophysiol Clin 2010; 2:533-549. [PMID: 28770717 DOI: 10.1016/j.ccep.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Brugada syndrome is a genetically determined cardiac disorder, presenting with characteristic electrocardiogram features and high risk of sudden cardiac death from polymorphic ventricular tachycardia/ventricular fibrillation in young individuals with a structurally normal heart. Scientific knowledge about the disease has grown exponentially in recent years. Two consensus reports on the disease were published (in 2002 and 2005) in an effort to state diagnostic criteria, risk stratification, and treatment indications. However, substantial controversies remain, especially considering risk stratification of asymptomatic patients. Given the enormous amount of valuable information collected by many groups since the consensus reports, current diagnostic criteria, recommended prognostic tools, and treatment must be reviewed. This article briefly reviews recent advances in understanding of Brugada syndrome and its genetic and molecular basis, arrhythmogenic mechanisms, and clinical course. An update of tools for risk stratification and treatment of the condition is also included.
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Affiliation(s)
- Paola Berne
- Arrhythmia Section, Cardiology Department, Thorax Institute, Hospital Clínic, Institut de Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, C/Villarroel, 170, 08036 Barcelona, Catalonia, Spain
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13
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Wu MH, Chen HC, Wang JK, Chiu HH, Huang SC, Huang SK. Population-based study of pediatric sudden death in Taiwan. J Pediatr 2009; 155:870-874.e2. [PMID: 19683252 DOI: 10.1016/j.jpeds.2009.06.038] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2009] [Revised: 04/17/2009] [Accepted: 06/18/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVES We sought to estimate the incidence of pediatric sudden death (SD) in Taiwan. STUDY DESIGN Cases of SD were identified from National Health Insurance databases, 2000 to 2006. RESULTS In the Taiwan pediatric population (age, 0 to 18 years; 5.44 million), the neonatal, infant, postneonatal infant, and under-5 years mortality rates were 3, 6, 2.81, and 8.02 per 1000 live births, and the 1 to 18 years mortality rate was 33 per 100 000 person-years. There were 1528 SDs (59% boys). In the population 1 to 18 years, annual incidence of SD was 2.7 (95% confidence interval, 2.6 to 2.9), ranging from 0.7 (11 to 12 years) to 6.1 (1 to 2 years) per 100 000. Male predominance was noted (3.2 vs 2.2 per 100 000), particularly in groups ages 16, 17, and 18 years. The proportionate mortality ratio by SD ranged from 1.8% to 12.0% (8.9 +/- 2.2%), being lowest in the group ages 11 to 12 years. In infants, the incidence of SD was 0.36 per 1000 live births, and the proportionate mortality ratio by SD was 1.0% and 11.7% in the neonates and postneonatal infants. CONCLUSIONS The incidence of pediatric SD in Taiwan, an Asian country with a child health care index comparable with that in the United States, was within the range from Western reports and indicated male predominance and a nadir around 11 to 12 years.
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Affiliation(s)
- Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Tuncay E, Seymen AA, Sam P, Gurdal H, Turan B. Effects of β-adrenergic receptor blockers on cardiac function: a comparative study in male versus female ratsThis article is one of a selection of papers from the NATO Advanced Research Workshop on Translational Knowledge for Heart Health (published in part 2 of a 2-part Special Issue). Can J Physiol Pharmacol 2009; 87:310-7. [DOI: 10.1139/y09-015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In heart disease, differences exist between women and men with respect to the impact of risk factors, symptoms, and therapeutic responses. The use of β-adrenergic receptor blockers is now well established in the treatment of mild and moderate systolic heart failure. Although there are significant differences among agents, their clinical effects are predictable. To address the question of sex disparities in the heart, however, we investigated the effect of treatment with the nonselective β-blockers timolol and propranolol on mechanical and electrical function of heart preparations from male and female rats. We examined the long-term effects of intragastric treatment with timolol (5 mg/kg per day) or propranolol (25 mg/kg per day) for 7 months on the hemodynamic and intracellular action potential parameters of the heart. Chronic administration of timolol but not propranolol produced a significant increase in the baseline activity of the left ventricular developed pressure (LVDP) in both male and female rats with no significant effect on the left ventricular end-diastolic pressure. Timolol or propranolol treatment of male rats and timolol but not propranolol treatment of female rats induced significant shortening in the repolarization phases of action potentials recorded from left ventricular papillary muscle strips of the hearts. The responses of LVDP to β-adrenergic stimulation were similar in timolol- or propranolol-treated or untreated male rats. On the other hand, timolol treatment markedly increased, and propranolol treatment significantly decreased, the responses of increase in LVDP in female rats. Our results suggest that although treatment with β-blockers for 7 months confirmed the role of the β-adrenergic pathway in heart function, there are marked differences in the effects of individual β-blockers on heart physiology. Sex differences should be taken into consideration when using β-blockers during experimental studies and clinical therapy.
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Affiliation(s)
- Erkan Tuncay
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Ali Aytac Seymen
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Pinar Sam
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Hakan Gurdal
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Belma Turan
- Department of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
- Department of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Ahrens-Nicklas RC, Clancy CE, Christini DJ. Re-evaluating the efficacy of beta-adrenergic agonists and antagonists in long QT-3 syndrome through computational modelling. Cardiovasc Res 2009; 82:439-47. [PMID: 19264765 DOI: 10.1093/cvr/cvp083] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
AIMS Long QT syndrome (LQTS) is a heterogeneous collection of inherited cardiac ion channelopathies characterized by a prolonged electrocardiogram QT interval and increased risk of sudden cardiac death. Beta-adrenergic blockers are the mainstay of treatment for LQTS. While their efficacy has been demonstrated in LQTS patients harbouring potassium channel mutations, studies of beta-blockers in subtype 3 (LQT3), which is caused by sodium channel mutations, have produced ambiguous results. In this modelling study, we explore the effects of beta-adrenergic drugs on the LQT3 phenotype. METHODS AND RESULTS In order to investigate the effects of beta-adrenergic activity and to identify sources of ambiguity in earlier studies, we developed a computational model incorporating the effects of beta-agonists and beta-blockers into an LQT3 mutant guinea pig ventricular myocyte model. Beta-activation suppressed two arrhythmogenic phenomena, transmural dispersion of repolarization and early after depolarizations, in a dose-dependent manner. However, the ability of beta-activation to prevent cardiac conduction block was pacing-rate-dependent. Low-dose beta-blockade by propranolol reversed the beneficial effects of beta-activation, while high dose (which has off-target sodium channel effects) decreased arrhythmia susceptibility. CONCLUSION These results demonstrate that beta-activation may be protective in LQT3 and help to reconcile seemingly conflicting results from different experimental models. They also highlight the need for well-controlled clinical investigations re-evaluating the use of beta-blockers in LQT3 patients.
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Affiliation(s)
- Rebecca C Ahrens-Nicklas
- Greenberg Division of Cardiology, Weill Cornell Medical College, 1300 York Ave., Box 161, New York, NY 10065, USA
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Gender differences in clinical manifestations of Brugada syndrome. J Am Coll Cardiol 2008; 52:1567-73. [PMID: 19007594 DOI: 10.1016/j.jacc.2008.07.052] [Citation(s) in RCA: 194] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Accepted: 07/30/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We sought to assess differences in phenotype and prognosis between men and women in a large population of patients with Brugada syndrome. BACKGROUND A male predominance has been reported in the Brugada syndrome. No specific data are available, however, concerning gender differences in the clinical manifestations and their role in prognosis. METHODS Patients with Brugada syndrome were prospectively included in the study. Data on baseline characteristics, electrocardiogram parameters before and after pharmacological test, and events in follow-up were recorded for all patients. RESULTS Among 384 patients, 272 (70.8%) were men and 112 (29.2%) women. At inclusion, men had experienced syncope more frequently (18%) or aborted sudden cardiac death (6%) than women (14% and 1%, respectively, p = 0.04). Men also had greater rates of spontaneous type-1 electrocardiogram, greater ST-segment elevation, and greater inducibility of ventricular fibrillation (p < 0.001 for all). Conversely, conduction parameters and corrected QT intervals significantly increased more in women in response to sodium blockers (p = 0.03 and p = 0.001, respectively). During a mean follow-up of 58 +/- 48 months, sudden cardiac death or documented ventricular fibrillation occurred in 31 men (11.6%) and 3 women (2.8%; p = 0.003). The presence of previous symptoms was the most important predictor for cardiac events in men, whereas a longer PR interval was identified among those women with a greater risk in this series. CONCLUSIONS Men with Brugada syndrome present with a greater risk clinical profile than women and have a worse prognosis. Although classical risk factors identify male patients with worse outcome, conduction disturbances could be a marker of risk in the female population.
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