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Jian K, Li C, Hancox JC, Zhang H. Pro-Arrhythmic Effects of Discontinuous Conduction at the Purkinje Fiber-Ventricle Junction Arising From Heart Failure-Induced Ionic Remodeling - Insights From Computational Modelling. Front Physiol 2022; 13:877428. [PMID: 35547576 PMCID: PMC9081695 DOI: 10.3389/fphys.2022.877428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/18/2022] [Indexed: 11/18/2022] Open
Abstract
Heart failure is associated with electrical remodeling of the electrical properties and kinetics of the ion channels and transporters that are responsible for cardiac action potentials. However, it is still unclear whether heart failure-induced ionic remodeling can affect the conduction of excitation waves at the Purkinje fiber-ventricle junction contributing to pro-arrhythmic effects of heart failure, as the complexity of the heart impedes a detailed experimental analysis. The aim of this study was to employ computational models to investigate the pro-arrhythmic effects of heart failure-induced ionic remodeling on the cardiac action potentials and excitation wave conduction at the Purkinje fiber-ventricle junction. Single cell models of canine Purkinje fiber and ventricular myocytes were developed for control and heart failure. These single cell models were then incorporated into one-dimensional strand and three-dimensional wedge models to investigate the effects of heart failure-induced remodeling on propagation of action potentials in Purkinje fiber and ventricular tissue and at the Purkinje fiber-ventricle junction. This revealed that heart failure-induced ionic remodeling of Purkinje fiber and ventricular tissue reduced conduction safety and increased tissue vulnerability to the genesis of the unidirectional conduction block. This was marked at the Purkinje fiber-ventricle junction, forming a potential substrate for the genesis of conduction failure that led to re-entry. This study provides new insights into proarrhythmic consequences of heart failure-induced ionic remodeling.
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Affiliation(s)
- Kun Jian
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
| | - Chen Li
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
| | - Jules C. Hancox
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
- School of Physiology, Pharmacology and Neuroscience, Medical Sciences Building, University Walk, Bristol, United Kingdom
| | - Henggui Zhang
- Biological Physics Group, Department of Physics and Astronomy, The University of Manchester, Manchester, United Kingdom
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, China
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Xiao H, Ali S, Zhang Z, Sarfraz MS, Zhang F, Faisal M. Big Data, Extracting Insights, Comprehension, and Analytics in Cardiology: An Overview. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:6635463. [PMID: 33604008 PMCID: PMC7868142 DOI: 10.1155/2021/6635463] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 01/09/2021] [Accepted: 01/20/2021] [Indexed: 11/23/2022]
Abstract
Healthcare system facilitates the treatment of patients with the support of wearable, smart, and handheld devices, as well as many other devices. These devices are producing a huge bulk of data that need to be moulded for extracting meaningful insights from them for the useful use of researchers and practitioners. Various approaches, methods, and tools are in use for doing so and to extract meaningful information in the field of healthcare. This information is being used as evidence to further analyze the data for the early care of patient and to devise treatment. Early care and treatment can facilitate healthcare and the treatment of the patient and can have immense potentiality of dropping the care cost and quality refining of care and can decrease waste and chances of error. To facilitate healthcare in general and cardiology in specific, the proposed study presents an overview of the available literature associated with big data, its insights, and analytics. The presented report will help practitioners and researchers to devise new solutions for early care in healthcare and in cardiology.
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Affiliation(s)
- Hui Xiao
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Sikandar Ali
- Department of Computer Science and Technology, China University of Petroleum-Beijing, Beijing 102249, China
| | - Zhen Zhang
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Muhammad Shahzad Sarfraz
- Department of Computer Science, National University of Computer and Emerging Sciences Islamabad, Chiniot-Faisalabad Campus, Chiniot, Pakistan
| | - Fang Zhang
- Zhongnan Hospital of Wuhan University, Information Center, Wuhan 430071, China
| | - Mohammad Faisal
- Department of Computer Science and Information Technology, University of Malakand, Chakdara, Pakistan
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Functional evaluation of gene mutations in Long QT Syndrome: strength of evidence from in vitro assays for deciphering variants of uncertain significance. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Genetic screening is now commonplace for patients suspected of having inherited cardiac conditions. Variants of uncertain significance (VUS) in disease-associated genes pose problems for the diagnostician and reliable methods for evaluating VUS function are required. Although function is difficult to interrogate for some genes, heritable channelopathies have established mechanisms that should be amenable to well-validated evaluation techniques.
The cellular electrophysiology techniques of ‘voltage-’ and ‘patch-’ clamp have a long history of successful use and have been central to identifying both the roles of genes involved in different forms of congenital Long QT Syndrome (LQTS) and the mechanisms by which mutations lead to aberrant ion channel function underlying clinical phenotypes. This is particularly evident for KCNQ1, KCNH2 and SCN5A, mutations in which underlie > 90% of genotyped LQTS cases (the LQT1-LQT3 subtypes). Recent studies utilizing high throughput (HT) planar patch-clamp recording have shown it to discriminate effectively between rare benign and pathological variants, studied through heterologous expression of recombinant channels. In combination with biochemical methods for evaluating channel trafficking and supported by biophysical modelling, patch clamp also provides detailed mechanistic insight into the functional consequences of identified mutations. Whilst potentially powerful, patient-specific stem-cell derived cardiomyocytes and genetically modified animal models are currently not well-suited to high throughput VUS study.
Conclusion
The widely adopted 2015 American College of Medical Genetics (ACMG) and Association for Molecular Pathology (AMP) guidelines for the interpretation of sequence variants include the PS3 criterion for consideration of evidence from well-established in vitro or in vivo assays. The wealth of information on underlying mechanisms of LQT1-LQT3 and recent HT patch clamp data support consideration of patch clamp data together (for LQT1 and LQT2) with information from biochemical trafficking assays as meeting the PS3 criterion of well established assays, able to provide ‘strong’ evidence for functional pathogenicity of identified VUS.
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Cedilnik N, Duchateau J, Dubois R, Sacher F, Jaïs P, Cochet H, Sermesant M. Fast personalized electrophysiological models from computed tomography images for ventricular tachycardia ablation planning. Europace 2019; 20:iii94-iii101. [PMID: 30476056 DOI: 10.1093/europace/euy228] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/18/2018] [Indexed: 11/12/2022] Open
Abstract
Aims Clinical application of patient-specific cardiac computer models requires fast and robust processing pipelines that can be seamlessly integrated into clinical workflows. We aim at building such a pipeline from computed tomography (CT) images to personalized cardiac electrophysiology (EP) model. The simulation output could be useful in the context of post-infarct ventricular tachycardia (VT) radiofrequency ablation (RFA) planning for pre-operative targets prediction. Methods and results The support for model personalization is a patient-specific virtual three-dimensional heart obtained from CT images. Here, the scar is identified as thinning of the myocardial wall on automatically computed thickness maps. We then use an Eikonal model of wave front propagation with reduced velocity in the damaged areas. An image-based vessel enhancement algorithm can automatically identify VT isthmuses. The personalized model is used for virtual pacing. We obtained a very fast pipeline that enables simulations in only a few minutes. It is fully automated starting from the semi-automated image segmentation phase. The computational time frame is compatible with the construction of a virtual pacing tool. In this tool, onset points and an optional directional block could be interactively selected. The directional block is a simple way to model tissue refractoriness. Output activation maps are compared with EP data acquired pre-operatively. We show that this framework allows the reproduction of recorded re-entrant VT activation patterns. Conclusion Our simulation framework has an application in VT RFA intervention planning. It could be used to guide EP explorations and even predict ablation targets pre-operatively. This could reduce intervention duration and improve success rate.
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Affiliation(s)
- Nicolas Cedilnik
- Université Côte d'Azur, Inria, Epione, Sophia Antipolis, France & Liryc Institute, Bordeaux, France
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Devi R, Tyagi HK, Kumar D. A novel multi-class approach for early-stage prediction of sudden cardiac death. Biocybern Biomed Eng 2019. [DOI: 10.1016/j.bbe.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Trayanova NA, Pashakhanloo F, Wu KC, Halperin HR. Imaging-Based Simulations for Predicting Sudden Death and Guiding Ventricular Tachycardia Ablation. Circ Arrhythm Electrophysiol 2019; 10:CIRCEP.117.004743. [PMID: 28696219 DOI: 10.1161/circep.117.004743] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Natalia A Trayanova
- From the Institute for Computational Medicine and Department of Biomedical Engineering (N.A.T., F.P.) and Departments of Radiology and Biomedical Engineering (H.R.H.), Johns Hopkins University, Baltimore, MD; and Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (K.C.W., H.R.H.).
| | - Farhad Pashakhanloo
- From the Institute for Computational Medicine and Department of Biomedical Engineering (N.A.T., F.P.) and Departments of Radiology and Biomedical Engineering (H.R.H.), Johns Hopkins University, Baltimore, MD; and Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (K.C.W., H.R.H.)
| | - Katherine C Wu
- From the Institute for Computational Medicine and Department of Biomedical Engineering (N.A.T., F.P.) and Departments of Radiology and Biomedical Engineering (H.R.H.), Johns Hopkins University, Baltimore, MD; and Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (K.C.W., H.R.H.)
| | - Henry R Halperin
- From the Institute for Computational Medicine and Department of Biomedical Engineering (N.A.T., F.P.) and Departments of Radiology and Biomedical Engineering (H.R.H.), Johns Hopkins University, Baltimore, MD; and Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD (K.C.W., H.R.H.)
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Turner JR, Rodriguez I, Mantovani E, Gintant G, Kowey PR, Klotzbaugh RJ, Prasad K, Sager PT, Stockbridge N, Strnadova C. Drug-induced Proarrhythmia and Torsade de Pointes: A Primer for Students and Practitioners of Medicine and Pharmacy. J Clin Pharmacol 2018; 58:997-1012. [PMID: 29672845 DOI: 10.1002/jcph.1129] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 03/05/2018] [Indexed: 12/11/2022]
Abstract
Multiple marketing withdrawals due to proarrhythmic concerns occurred in the United States, Canada, and the United Kingdom in the late 1980s to early 2000s. This primer reviews the clinical implications of a drug's identified proarrhythmic liability, the issues associated with these safety-related withdrawals, and the actions taken by the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and by regulatory agencies in terms of changing drug development practices and introducing new nonclinical and clinical tests to asses proarrhythmic liability. ICH Guidelines S7B and E14 were released in 2005. Since then, they have been adopted by many regional regulatory authorities and have guided nonclinical and clinical proarrhythmic cardiac safety assessments during drug development. While this regulatory paradigm has been successful in preventing drugs with unanticipated potential for inducing the rare but potentially fatal polymorphic ventricular arrhythmia torsade de pointes from entering the market, it has led to the termination of drug development programs for other potentially useful medicines because of isolated results from studies with limited predictive value. Research efforts are now exploring alternative approaches to better predict potential proarrhythmic liabilities. For example, in the domain of human electrocardiographic assessments, concentration-response modeling conducted during phase 1 clinical development has recently become an accepted alternate primary methodology to the ICH E14 "thorough QT/QTc" study for defining a drug's corrected QT interval prolongation liability under certain conditions. When a drug's therapeutic benefit is considered important at a public health level but there is also an identified proarrhythmic liability that may result from administration of the single drug in certain individuals and/or drug-drug interactions, marketing approval will be accompanied by appropriate directions in the drug's prescribing information. Health-care professionals in the fields of medicine and pharmacy need to consider the prescribing information in conjunction with individual patients' clinical characteristics and concomitant medications when prescribing and dispensing such drugs.
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Affiliation(s)
- J Rick Turner
- Campbell University College of Pharmacy & Health Sciences, Buies Creek, NC, USA
| | - Ignacio Rodriguez
- Cardiac Safety Research Consortium, Roche TCRC, Inc., New York, NY, USA
| | - Emily Mantovani
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, USA
| | | | - Peter R Kowey
- Lankenau Heart Institute and Jefferson Medical College, Philadelphia, PA, USA
| | - Ralph J Klotzbaugh
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Krishna Prasad
- Medicines and Healthcare Products Regulatory Agency, London, UK
| | - Philip T Sager
- Sager Consulting and Stanford University, San Francisco, CA, USA
| | - Norman Stockbridge
- Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Colette Strnadova
- Therapeutic Products Directorate, Health Canada, Ottawa, Ontario, Canada
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Affiliation(s)
- Peter J Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Nicolas P Smith
- Faculty of Engineering, University of Auckland, Auckland, New Zealand
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Vandenberg JI, Perry MD, Hill AP. Recent advances in understanding and prevention of sudden cardiac death. F1000Res 2017; 6:1614. [PMID: 29026525 PMCID: PMC5583740 DOI: 10.12688/f1000research.11855.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/01/2023] Open
Abstract
There have been tremendous advances in the diagnosis and treatment of heart disease over the last 50 years. Nevertheless, it remains the number one cause of death. About half of heart-related deaths occur suddenly, and in about half of these cases the person was unaware that they had underlying heart disease. Genetic heart disease accounts for only approximately 2% of sudden cardiac deaths, but as it typically occurs in younger people it has been a particular focus of activity in our quest to not only understand the underlying mechanisms of cardiac arrhythmogenesis but also develop better strategies for earlier detection and prevention. In this brief review, we will highlight trends in the recent literature focused on sudden cardiac death in genetic heart diseases and how these studies are contributing to a broader understanding of sudden death in the community.
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Affiliation(s)
- Jamie I Vandenberg
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Matthew D Perry
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
| | - Adam P Hill
- St Vincent's Clinical School, University of New South Wales, Darlinghurst, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Australia
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George CH, Edwards DH. Decoding Ca2+ Signals as a Non-electrophysiological Method for Assessing Drug Toxicity in Stem Cell-Derived Cardiomyocytes. METHODS IN PHARMACOLOGY AND TOXICOLOGY 2017. [DOI: 10.1007/978-1-4939-6661-5_9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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