1
|
Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. Circ J 2024; 88:1509-1595. [PMID: 37690816 DOI: 10.1253/circj.cj-22-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center
| | - Masaomi Chinushi
- School of Health Sciences, Niigata University School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
| | - Kaoru Tanno
- Cardiology Division, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of Cardiology, Tokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hirotaka Yada
- Department of Cardiology, International University of Health and Welfare, Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| |
Collapse
|
2
|
Luna-Alcala S, Garcia-Cardenas M, Guerra EC, Martinez-Dominguez P, Cabello-Ganem A, Proaño-Bernal L, Chava-Ponte CA, Hernandez-Pacherres A, Espinola-Zavaleta N. Ventricular predominance in biventricular arrhythmogenic cardiomyopathy: Should new subtype criteria be recognized? Radiol Case Rep 2024; 19:2457-2463. [PMID: 38585407 PMCID: PMC10998062 DOI: 10.1016/j.radcr.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Arrhythmogenic cardiomyopathy is a biventricular disease in which the effect on the left ventricle can be either equivalent to or more severe than that on the right ventricle. It is a rare disease due to its low reported prevalence and typically becomes clinically evident during the second to fourth decade of life. It represents 4% of sudden cardiac death cases referred for autopsy and 10% of cases of unexplained cardiac arrest. We present a challenging case report of a 68-year-old man who arrived at the emergency room with chest discomfort, palpitations, and light-headedness before a syncopal episode with urinary incontinence. During monitoring, ventricular tachycardia was detected and was treated with cardioversion. However, a follow-up electrocardiogram revealed low QRS voltages in limb leads and T-wave inversion in the left precordial leads. The patient underwent a transthoracic echocardiogram and a gadolinium-based magnetic resonance imaging study to evaluate the possibility of acute decompensated heart failure. Both imaging studies revealed low ejection fraction and systolic dysfunction in both right and left ventricles. Furthermore, in the late gadolinium enhancement study, extensive left ventricular subepicardial enhancement with septal predominance in a ring pattern and an irregular morphology of the right ventricular free wall were observed. A diagnosis of biventricular arrhythmogenic cardiomyopathy was established based on the 2020 Padua Criteria. Although there is not a recognized classification within these criteria to establish its subtype, in our case there was a left ventricular predominance due to the presence of additional left ventricular categories.
Collapse
Affiliation(s)
- Santiago Luna-Alcala
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | - Enrique C. Guerra
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
- MD–PhD (PECEM) Program, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Pavel Martinez-Dominguez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Aldo Cabello-Ganem
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Leonardo Proaño-Bernal
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | | | | | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| |
Collapse
|
3
|
Grimault D, Serfaty JM, Guyomarch B, Marteau L, Goudal A, Schmitt S, Warin-Fresse K, Clero S, Fellah I, Thollet A, Probst V, Le Tourneau T, Trochu JN, Piriou N. Description of the Two-Dimensional Layer-Specific Strain Echocardiography Phenotype of Arrhythmogenic Left Ventricular Cardiomyopathy. J Am Soc Echocardiogr 2024:S0894-7317(24)00268-2. [PMID: 38823601 DOI: 10.1016/j.echo.2024.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Arrhythmogenic left ventricular cardiomyopathy (ALVC) is characterized by fibrofatty myocardial replacement demonstrated on cardiac magnetic resonance by late gadolinium enhancement (LGE) mainly involving the subepicardium. The aims of this study were to describe the layer-specific strain (LSS) echocardiography phenotype of ALVC and to compare it with LGE features. METHODS All consecutive ALVC pathogenic genetic variant carriers and noncarrier relatives were separated into four prespecified groups (overt ALVC [group 1], isolated LGE [group 2], pathogenic genetic variant carrier without ALVC phenotype [group 3], and no genetic variant carrier [group 4]) and studied accordingly using cardiac magnetic resonance and LSS echocardiography. RESULTS Eighty-five individuals were included. Endocardial global longitudinal strain (GLS)-epicardial GLS (GLSepi) gradient was altered predominantly in group 1, illustrating transmural strain alteration in overt ALVC (3.8 ± 1.1 in group 1, 4.3 ± 2.2 in group 2, 5.2 ± 1.2 in group 3, and 5.4 ± 1.6 in group 4; P = .0017), whereas GLSepi was impaired predominantly in group 2 (endocardial GLS and GLSepi were 15.0 ± 4.1% and 11.2 ± 3.3%, respectively, in group 1; 20.5 ± 2.8% and 16.2 ± 5.5% in group 2; 23.4 ± 3.3% and 18.2 ± 2.7% in group 3; and 24.6 ± 2.8% and 19.2 ± 1.9% in group 4; P < .0001 for all). GLSepi was able to detect subepicardial LGE in genetic variant carriers without overt ALVC with an area under curve of 0.84 (95% CI, 0.73-0.95). However, segmental epicardial and endocardial strain behaved similarly and showed comparable diagnostic values for segmental LGE detection (areas under the curve, 0.72; [95% CI, 0.69-0.76] and 0.73 [95% CI, 0.70-0.76], respectively, P = .40). CONCLUSIONS LSS alteration in ALVC progresses from the epicardium to the endocardium along with disease severity. Irrespective of LSS analysis, which did not provide incremental diagnostic value for the detection and localization of LGE, strain echocardiography was shown to be a potential surrogate marker of LGE, including in apparently healthy individuals with isolated LV fibrosis.
Collapse
Affiliation(s)
- Dimitri Grimault
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France
| | - Jean-Michel Serfaty
- Nantes Université, CHU Nantes, Radiology Department, Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - Béatrice Guyomarch
- Nantes Université, CHU Nantes, Plateforme de Méthodologie et Biostatistique, Nantes, France
| | - Lara Marteau
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, Radiology Department, Nantes, France
| | - Adeline Goudal
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, Genetics Department, Nantes, France
| | - Sébastien Schmitt
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, Genetics Department, Nantes, France
| | | | - Sophie Clero
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France
| | - Imen Fellah
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France
| | - Aurélie Thollet
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - Vincent Probst
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - Jean-Noël Trochu
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France; Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France
| | - Nicolas Piriou
- Nantes Université, CHU Nantes, INSERM, Cardiology Department, CIC 1413, l'Institut du Thorax, Nantes, France.
| |
Collapse
|
4
|
García-Cano L, Miguel Martín-Torres J, García-Fernández A, Feliu-Rey E, Gabriel Martínez-Martínez J, Miguel Ruiz-Nodar J. Prognostic impact of the findings of the genetic test in left dominant arrhythmogenic cardiomyopathy. IJC HEART & VASCULATURE 2024; 51:101367. [PMID: 38435382 PMCID: PMC10907150 DOI: 10.1016/j.ijcha.2024.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/04/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024]
Abstract
Background The diagnosis of left dominant arrhythmogenic cardiomyopathy (LDAC) is sometimes complex. The Padua group recently published a document with criteria to identify patients with LDAC, requiring a compatible genetic variant for diagnosis. Due to the gaps in the knowledge of the role of genetics in its pathogenesis, our objective is to describe the findings of the genetic test in patients with LDAC in our center and its prognostic impact. Methods Single-center prospective cohort study, in which we recruited 77 patients diagnosed with LDAC or biventricular arrhythmogenic cardiomyopathy according to the criteria of Sen-Chowdhry et al. Results We obtained a positive result in the genetic test in 53.2 %. The desmoplakin gene was the most affected (16.9 %). The mean value of left ventricular (LV) ejection fraction was 45.6 ± 13.1 %, with no significant differences in the severity of the dysfunction according to genetics (p = 0.187). Among the patients with positive genetics there was a greater number of segments in the LV affected by fibrosis (p = 0.043). Regarding fatty infiltration in the LV and number of affected segments, there were no significant differences between groups (p = 0.144). MACE was recorded in 23 patients (29.9 %). The positive result in the genetic test was not significantly associated with the occurrence of MACE (p = 0.902). Conclusion In our study, we did not find mutations responsible for the disease in practically half of the cases. Despite the existence of a high proportion of MACE during follow-up, there were no prognostic differences according to the result of the genetic test.
Collapse
Affiliation(s)
- Laura García-Cano
- Cardiology Department, General University Hospital Dr. Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | | | - Amaya García-Fernández
- Cardiology Department, General University Hospital Dr. Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Eloísa Feliu-Rey
- Radiology Service, General University Hospital Dr. Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Juan Gabriel Martínez-Martínez
- Cardiology Department, General University Hospital Dr. Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
| | - Juan Miguel Ruiz-Nodar
- Cardiology Department, General University Hospital Dr. Balmis of Alicante, Institute of Sanitary and Biomedical Research of Alicante (ISABIAL), Alicante, Spain
- Department of Clinical Medicine, Miguel Hernández University, Alicante, Spain
| |
Collapse
|
5
|
Galizia MS, Attili AK, Truesdell WR, Smith ED, Helms AS, Sulaiman AMA, Madamanchi C, Agarwal PP. Imaging Features of Arrhythmogenic Cardiomyopathies. Radiographics 2024; 44:e230154. [PMID: 38512728 PMCID: PMC10995833 DOI: 10.1148/rg.230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 03/23/2024]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic disease characterized by replacement of ventricular myocardium with fibrofatty tissue, predisposing the patient to ventricular arrhythmias and/or sudden cardiac death. Most cases of ACM are associated with pathogenic variants in genes that encode desmosomal proteins, an important cell-to-cell adhesion complex present in both the heart and skin tissue. Although ACM was first described as a disease predominantly of the right ventricle, it is now acknowledged that it can also primarily involve the left ventricle or both ventricles. The original right-dominant phenotype is traditionally diagnosed using the 2010 task force criteria, a multifactorial algorithm divided into major and minor criteria consisting of structural criteria based on two-dimensional echocardiographic, cardiac MRI, or right ventricular angiographic findings; tissue characterization based on endomyocardial biopsy results; repolarization and depolarization abnormalities based on electrocardiographic findings; arrhythmic features; and family history. Shortfalls in the task force criteria due to the modern understanding of the disease have led to development of the Padua criteria, which include updated criteria for diagnosis of the right-dominant phenotype and new criteria for diagnosis of the left-predominant and biventricular phenotypes. In addition to incorporating cardiac MRI findings of ventricular dilatation, systolic dysfunction, and regional wall motion abnormalities, the new Padua criteria emphasize late gadolinium enhancement at cardiac MRI as a key feature in diagnosis and imaging-based tissue characterization. Conditions to consider in the differential diagnosis of the right-dominant phenotype include various other causes of right ventricular dilatation such as left-to-right shunts and variants of normal right ventricular anatomy that can be misinterpreted as abnormalities. The left-dominant phenotype can mimic myocarditis at imaging and clinical examination. Additional considerations for the differential diagnosis of ACM, particularly for the left-dominant phenotype, include sarcoidosis and dilated cardiomyopathy. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
Collapse
Affiliation(s)
- Mauricio S. Galizia
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Anil K. Attili
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - William R. Truesdell
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Eric D. Smith
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Adam S. Helms
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Abdulbaset M. A. Sulaiman
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Chaitanya Madamanchi
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Prachi P. Agarwal
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| |
Collapse
|
6
|
Mauriello A, Roma AS, Ascrizzi A, Molinari R, Loffredo FS, D’Andrea A, Russo V. Arrhythmogenic Left Ventricular Cardiomyopathy: From Diagnosis to Risk Management. J Clin Med 2024; 13:1835. [PMID: 38610600 PMCID: PMC11012337 DOI: 10.3390/jcm13071835] [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: 02/12/2024] [Revised: 03/13/2024] [Accepted: 03/16/2024] [Indexed: 04/14/2024] Open
Abstract
PURPOSE OF REVIEW Left ventricular arrhythmogenic cardiomyopathy (ALVC) is a rare and poorly characterized cardiomyopathy that has recently been reclassified in the group of non-dilated left ventricular cardiomyopathies. This review aims to summarize the background, diagnosis, and sudden cardiac death risk in patients presenting this cardiomyopathy. RECENT FINDINGS Although there is currently a lack of data on this condition, arrhythmogenic left ventricular dysplasia can be considered a specific disease of the left ventricle (LV). We have collected the latest evidence about the management and the risks associated with this cardiomyopathy. SUMMARY Left ventricular arrhythmogenic cardiomyopathy is still poorly characterized. ALVC is characterized by fibrofatty replacement in the left ventricular myocardium, with variable phenotypic expression. Diagnosis is based on a multiparametric approach, including cardiac magnetic resonance (CMR) and genetic testing, and is important for sudden cardiac death (SCD) risk stratification and management. Recent guidelines have improved the management of left ventricular arrhythmogenic cardiomyopathy. Further studies are necessary to improve knowledge of this cardiomyopathy.
Collapse
Affiliation(s)
- Alfredo Mauriello
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
- Unit of Cardiology, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
| | - Anna Selvaggia Roma
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Antonia Ascrizzi
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Riccardo Molinari
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Francesco S. Loffredo
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| | - Antonello D’Andrea
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
- Unit of Cardiology, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy
| | - Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Science, University of Campania “Luigi Vanvitelli”—“V. Monaldi” Hospital, 80126 Naples, Italy; (A.S.R.); (A.A.); (R.M.); (F.S.L.); (A.D.); (V.R.)
| |
Collapse
|
7
|
Santoro F, Vitale E, Ragnatela I, Cetera R, Leopzzi A, Mallardi A, Matera A, Mele M, Correale M, Brunetti ND. Multidisciplinary approach in cardiomyopathies: From genetics to advanced imaging. Heart Fail Rev 2024; 29:445-462. [PMID: 38041702 DOI: 10.1007/s10741-023-10373-8] [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] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Cardiomyopathies are myocardial diseases characterized by mechanical and electrical dysfunction of the heart muscle which could lead to heart failure and life-threatening arrhythmias. Certainly, an accurate anamnesis, a meticulous physical examination, and an ECG are cornerstones in raising the diagnostic suspicion. However, cardiovascular imaging techniques are indispensable to diagnose a specific cardiomyopathy, to stratify the risk related to the disease and even to track the response to the therapy. Echocardiography is often the first exam that the patient undergoes, because of its non-invasiveness, wide availability, and cost-effectiveness. Cardiac magnetic resonance imaging allows to integrate and implement the information obtained with the echography. Furthermore, cardiomyopathies' genetic basis has been investigated over the years and the list of genetic mutations deemed potentially pathogenic is expected to grow further. The aim of this review is to show echocardiographic, cardiac magnetic resonance imaging, and genetic features of several cardiomyopathies: dilated cardiomyopathy (DMC), hypertrophic cardiomyopathy (HCM), arrhythmogenic cardiomyopathy (ACM), left ventricular noncompaction cardiomyopathy (LVNC), myocarditis, and takotsubo cardiomyopathy.
Collapse
Affiliation(s)
- Francesco Santoro
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
| | - Enrica Vitale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Ilaria Ragnatela
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Rosa Cetera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | | | | | - Annalisa Matera
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Marco Mele
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Sciences, Cardiology Unit, Policlinico "Riuniti", University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy
| |
Collapse
|
8
|
Bariani R, Rigato I, Celeghin R, Marinas MB, Cipriani A, Zorzi A, Pergola V, Iliceto S, Basso C, Marra MP, Corrado D, Gregori D, Pilichou K, Bauce B. Phenotypic Expression and Clinical Outcomes in Patients With Arrhythmogenic Cardiomyopathies. J Am Coll Cardiol 2024; 83:797-807. [PMID: 38383094 DOI: 10.1016/j.jacc.2023.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/20/2023] [Accepted: 12/20/2023] [Indexed: 02/23/2024]
Abstract
BACKGROUND In recent years, it has become evident that arrhythmogenic cardiomyopathy (ACM) displays a wide spectrum of ventricular involvement. Furthermore, the influence of various clinical phenotypes on the prognosis of the disease is currently being assessed. OBJECTIVES The purpose of this study was to evaluate the impact of phenotypic expression in ACM on patient outcomes. METHODS We conducted an analysis of 446 patients diagnosed with ACM. These patients were categorized into 3 groups based on their phenotype: arrhythmogenic right ventricular cardiomyopathy (ARVC) (right-dominant ACM), arrhythmogenic left ventricular cardiomyopathy (ALVC) (left-dominant ACM), and biventricular arrhythmogenic cardiomyopathy (BIV). We compared clinical, instrumental, and genetic findings among these groups and also evaluated their outcomes RESULTS: Overall, 44% of patients were diagnosed with ARVC, 23% with ALVC, and 33% with BIV forms. Subjects showing with ARVC and BIV phenotype had a significantly higher incidence of life-threatening ventricular arrhythmias compared with ALVC (P < 0.001). On the other hand, heart failure, heart transplantation, and death caused by cardiac causes were more frequent in individuals with BIV forms compared to those with ALVC and ARVC (P < 0.001). Finally, patients with an ALVC phenotype had a higher incidence of hot phases compared with those with ARVC and BIV forms (P = 0.013). CONCLUSIONS The comparison of ACM phenotypes demonstrated that patients with right ventricular involvement, such as ARVC and BIV forms, exhibit a higher incidence of life-threatening ventricular arrhythmias. Conversely, ACM forms characterized by left ventricular involvement, such as ALVC and BIV, show a higher incidence of heart failure, heart transplantation, and hot phases.
Collapse
Affiliation(s)
- Riccardo Bariani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Ilaria Rigato
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Rudy Celeghin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Maria Bueno Marinas
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
| |
Collapse
|
9
|
Lan Y, Wei L, Pan C, Lin T, Yan Y. A case report of isolated arrhythmogenic left ventricular cardiomyopathy: phenotypes, diagnosis, and treatment. Eur Heart J Case Rep 2024; 8:ytad581. [PMID: 38328600 PMCID: PMC10849070 DOI: 10.1093/ehjcr/ytad581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/07/2023] [Accepted: 11/16/2023] [Indexed: 02/09/2024]
Abstract
Background Isolated arrhythmogenic left ventricular cardiomyopathy (IALVC) is a hereditary cardiomyopathy that is characterized by the replacement of left ventricular (LV) cardiomyocytes with fibrous and adipose tissue. Case summary A 55-year-old male patient presented with recurrent chest pain and palpitations characterized by episodes of monomorphic ventricular tachycardia and T-wave inversion. Coronary angiography was conducted to rule out myocardial ischaemia as the cause of chest pain. Echocardiography results revealed ventricular aneurysm formation at the apex of the left ventricle. Structural alterations of the cardiac magnetic resonance were consistent with the diagnosis of arrhythmogenic left ventricular cardiomyopathy with LV alterations without right ventricular involvement. Pathological staining of the lesion area further confirmed the diagnosis of IALVC. The TTN1 c.17617 C>A mutation in arrhythmogenic cardiomyopathy was identified using whole exome sequencing. His symptoms improved by the treatments including implantable cardioverter defibrillator (ICD) implantation, radiofrequency ablation, and ventricular aneurysm resection. Discussion The patient presented with IALVC with apical fibrofatty displacement and underwent surgical management, highlighting the importance of multimodal imaging, gene analysis, and histopathological findings for timely diagnosis, and emphasizing the benefits of life-saving therapy, including ICD implantation, radiofrequency ablation, and ventricular aneurysm resection. These findings contribute to a deeper understanding of the clinical presentation and outcome of IALVC.
Collapse
Affiliation(s)
- Yang Lan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tzuchun Lin
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
- Department of Cardiology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Yan Yan
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, Shanghai 200032, China
| |
Collapse
|
10
|
Corrado D, Anastasakis A, Basso C, Bauce B, Blomström-Lundqvist C, Bucciarelli-Ducci C, Cipriani A, De Asmundis C, Gandjbakhch E, Jiménez-Jáimez J, Kharlap M, McKenna WJ, Monserrat L, Moon J, Pantazis A, Pelliccia A, Perazzolo Marra M, Pillichou K, Schulz-Menger J, Jurcut R, Seferovic P, Sharma S, Tfelt-Hansen J, Thiene G, Wichter T, Wilde A, Zorzi A. Proposed diagnostic criteria for arrhythmogenic cardiomyopathy: European Task Force consensus report. Int J Cardiol 2024; 395:131447. [PMID: 37844667 DOI: 10.1016/j.ijcard.2023.131447] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/18/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heart muscle disease characterized by prominent "non-ischemic" myocardial scarring predisposing to ventricular electrical instability. Diagnostic criteria for the original phenotype, arrhythmogenic right ventricular cardiomyopathy (ARVC), were first proposed in 1994 and revised in 2010 by an international Task Force (TF). A 2019 International Expert report appraised these previous criteria, finding good accuracy for diagnosis of ARVC but a lack of sensitivity for identification of the expanding phenotypic disease spectrum, which includes left-sided variants, i.e., biventricular (ABVC) and arrhythmogenic left ventricular cardiomyopathy (ALVC). The ARVC phenotype together with these left-sided variants are now more appropriately named ACM. The lack of diagnostic criteria for the left ventricular (LV) phenotype has resulted in clinical under-recognition of ACM patients over the 4 decades since the disease discovery. In 2020, the "Padua criteria" were proposed for both right- and left-sided ACM phenotypes. The presently proposed criteria represent a refinement of the 2020 Padua criteria and have been developed by an expert European TF to improve the diagnosis of ACM with upgraded and internationally recognized criteria. The growing recognition of the diagnostic role of CMR has led to the incorporation of myocardial tissue characterization findings for detection of myocardial scar using the late‑gadolinium enhancement (LGE) technique to more fully characterize right, biventricular and left disease variants, whether genetic or acquired (phenocopies), and to exclude other "non-scarring" myocardial disease. The "ring-like' pattern of myocardial LGE/scar is now a recognized diagnostic hallmark of ALVC. Additional diagnostic criteria regarding LV depolarization and repolarization ECG abnormalities and ventricular arrhythmias of LV origin are also provided. These proposed upgrading of diagnostic criteria represents a working framework to improve management of ACM patients.
Collapse
Affiliation(s)
- Domenico Corrado
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy.
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Cristina Basso
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Barbara Bauce
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Carina Blomström-Lundqvist
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Alberto Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis, Brussel - Vrije Universiteit Brussel, Belgium
| | - Estelle Gandjbakhch
- Sorbonne Universitè, APHP, Centre de Référence des Maladies Cardiaques héréditaires Groupe Hospitalier Pitié Salpêtrière-Charles Foix, Paris, France
| | | | - Maria Kharlap
- Department of cardiac arrhythmias, National Centre for Therapy and Preventive Medicine, Moscow, Petroverigsky, Russia
| | - William J McKenna
- Institute of Cardiovascular Science, University College London, United Kingdom
| | - Lorenzo Monserrat
- Cardiovascular Genetics, Medical Department, Dilemma Solutions SL, A Coruña, Spain
| | - James Moon
- CMR Service, Barts Heart Centre, University College London, United Kingdom
| | - Antonis Pantazis
- Inherited Cardiovascular Conditions services, The Royal Brompton and Harefield Hospitals, London, United Kingdom
| | | | - Martina Perazzolo Marra
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Kalliopi Pillichou
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| | - Jeanette Schulz-Menger
- Charité, Universitätsmedizin Berlin, Campus Buch - ECRC and Helios Clinics, DZHK Partnersite Berlin, Germany
| | - Ruxandra Jurcut
- Expert Center for Rare Genetic Cardiovascular Diseases, Institute for Cardiovascular Diseases "Prof.dr.C.C.Iliescu", UMF "Carol Davila", Bucharest, Romania
| | - Petar Seferovic
- University of Belgrade, Faculty of Medicine and Heart Failure Center, Belgrade University Medical Center, Belgrade
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London, United Kingdom
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gaetano Thiene
- University of Padua Medical School, ARCA Associazione Ricerche Cardiopatie Aritmiche ETS, Padova, Italy
| | - Thomas Wichter
- Dept. of Internal Medicine / Cardiology, Heart Center Osnabrück - Bad Rothenfelde, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Osnabrück, Germany
| | - Arthur Wilde
- Amsterdam UMC location University of Amsterdam, Department of Cardiology, Amsterdam, the Netherlands
| | - Alessandro Zorzi
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua Medical School, Italy
| |
Collapse
|
11
|
Varrenti M, Preda A, Frontera A, Baroni M, Gigli L, Vargiu S, Colombo G, Carbonaro M, Paolucci M, Giordano F, Guarracini F, Mazzone P. Arrhythmogenic Cardiomyopathy: Definition, Classification and Arrhythmic Risk Stratification. J Clin Med 2024; 13:456. [PMID: 38256590 PMCID: PMC10816644 DOI: 10.3390/jcm13020456] [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: 12/14/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heart disease characterized by a fibrotic replacement of myocardial tissue and a consequent predisposition to ventricular arrhythmic events, especially in the young. Post-mortem studies and the subsequent diffusion of cardiac MRI have shown that left ventricular involvement in arrhythmogenic cardiomyopathy is common and often develops early. Regarding the arrhythmic risk stratification, the current scores underestimate the arrhythmic risk of patients with arrhythmogenic cardiomyopathy with left involvement. Indeed, the data on arrhythmic risk stratification in this group of patients are contradictory and not exhaustive, with the consequence of not correctly identifying patients at a high arrhythmic risk who deserve protection from arrhythmic death. We propose a literature review on arrhythmic risk stratification in patients with ACM and left involvement to identify the main features associated with an increased arrhythmic risk in this group of patients.
Collapse
Affiliation(s)
- Marisa Varrenti
- Electrophysiology Unit, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy (M.C.); (F.G.); (P.M.)
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Javed W, Malhotra A, Swoboda P. Cardiac magnetic resonance assessment of athletic myocardial fibrosis; Benign bystander or malignant marker? Int J Cardiol 2024; 394:131382. [PMID: 37741350 DOI: 10.1016/j.ijcard.2023.131382] [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: 06/28/2023] [Revised: 08/24/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
The benefits of exercise are irrefutable with a well-established dose-dependent relationship between exercise intensity and reduction in cardiovascular disease. Differentiating the physiological adaptation to exercise, termed the "athlete's heart" from cardiomyopathies, has been advanced by the advent of more sophisticated imaging modalities such as cardiac magnetic resonance imaging (CMR). Myocardial fibrosis on CMR is a mutual finding amongst seemingly healthy endurance athletes and individuals with cardiomyopathy. As a substrate for arrhythmias, fibrosis is traditionally associated with increased cardiovascular risk. In this article, we discuss the aetiologies, distribution and potential implications of myocardial fibrosis in athletes.
Collapse
Affiliation(s)
- Wasim Javed
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aneil Malhotra
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Institute of Sport, Manchester Metropolitan University, Manchester, UK
| | - Peter Swoboda
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
| |
Collapse
|
13
|
Matos J, Helle E, Care M, Moayedi Y, Gollob MH, Thavendiranathan P, Spears D, Hanneman K. Cardiac MRI and Clinical Outcomes in TMEM43 Arrhythmogenic Cardiomyopathy. Radiol Cardiothorac Imaging 2023; 5:e230155. [PMID: 38166344 PMCID: PMC11163247 DOI: 10.1148/ryct.230155] [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: 06/09/2023] [Revised: 10/27/2023] [Accepted: 11/09/2023] [Indexed: 01/04/2024]
Abstract
Arrhythmogenic cardiomyopathy is an inherited cardiomyopathy that can involve both ventricles. Several genes have been identified as pathogenic in arrhythmogenic cardiomyopathy, including TMEM43. However, there are limited data on cardiac MRI findings in patients with TMEM43 variants to date. In this case series, cardiac MRI findings and clinical outcomes are described in 14 patients with TMEM43 variants, including eight (57%) with the pathogenic p.Ser358Leu variant (six female patients; mean age, 33 years ± 15 [SD]) and six (43%) with a TMEM43 variant of unknown significance (three female patients; mean age, 38 years ± 11). MRI findings demonstrated left ventricular systolic dysfunction in eight (57%) patients and right ventricular dysfunction in four (29%) patients. Among the nine patients with late gadolinium enhancement imaging, left ventricular late gadolinium enhancement was present in seven (78%; all subepicardial) patients. In summary, TMEM43 variants are associated with high prevalence of subepicardial late gadolinium enhancement and left ventricular dysfunction. Keywords: Arrhythmogenic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy, TMEM43, Cardiac MRI, Genetic Variants Supplemental material is available for this article.
Collapse
Affiliation(s)
- João Matos
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Emmi Helle
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Melanie Care
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Yasbanoo Moayedi
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Michael H. Gollob
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Paaladinesh Thavendiranathan
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Danna Spears
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| | - Kate Hanneman
- From the Department of Medical Imaging (J.M., P.T., K.H.) and
Division of Cardiology (E.H., M.C., Y.M., M.H.G., P.T., D.S.), Peter Munk
Cardiac Centre, Toronto General Hospital, University Health Network (UHN),
University of Toronto, 585 University Ave, 1 PMB-298, Toronto, ON, Canada M5G
2N2; Department of Paediatrics, Labatt Family Heart Centre, The Hospital for
Sick Children, University of Toronto, Toronto, Canada (E.H.); Stem Cells and
Metabolism Research Program, Faculty of Medicine, University of Helsinki,
Helsinki, Finland (E.H.); Department of Molecular Genetics, University of
Toronto, Toronto, Canada (M.C.); and Toronto General Hospital Research
Institute, University Health Network (UHN), University of Toronto, Toronto,
Canada (M.H.G., P.T., K.H.)
| |
Collapse
|
14
|
Cha MJ, Hong YJ, Park CH, Cha YJ, Kim TH, Kim C, Park CH. Utilities and Limitations of Cardiac Magnetic Resonance Imaging in Dilated Cardiomyopathy. Korean J Radiol 2023; 24:1200-1220. [PMID: 38016680 PMCID: PMC10700999 DOI: 10.3348/kjr.2023.0531] [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: 06/05/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/30/2023] Open
Abstract
Dilated cardiomyopathy (DCM) is one of the most common types of non-ischemic cardiomyopathy. DCM is characterized by left ventricle (LV) dilatation and systolic dysfunction without coronary artery disease or abnormal loading conditions. DCM is not a single disease entity and has a complex historical background of revisions and updates to its definition because of its diverse etiology and clinical manifestations. In cases of LV dilatation and dysfunction, conditions with phenotypic overlap should be excluded before establishing a DCM diagnosis. The differential diagnoses of DCM include ischemic cardiomyopathy, valvular heart disease, burned-out hypertrophic cardiomyopathy, arrhythmogenic cardiomyopathy, and non-compaction. Cardiac magnetic resonance (CMR) imaging is helpful for evaluating DCM because it provides precise measurements of cardiac size, function, mass, and tissue characterization. Comprehensive analyses using various sequences, including cine imaging, late gadolinium enhancement imaging, and T1 and T2 mapping, may help establish differential diagnoses, etiological work-up, disease stratification, prognostic determination, and follow-up procedures in patients with DCM phenotypes. This article aimed to review the utilities and limitations of CMR in the diagnosis and assessment of DCM.
Collapse
Affiliation(s)
- Min Jae Cha
- Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Republic of Korea
| | - Yoon Jin Cha
- Department of Pathology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae Hoon Kim
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea.
| | - Chul Hwan Park
- Department of Radiology and Research Institute of Radiological Science, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
15
|
Azimi A, Pourirahim M, Houshmand G, Adimi S, Maleki M, Kalayinia S. Arrhythmogenic left ventricular cardiomyopathy caused by a novel likely pathogenic DSP mutation, p.K1165Rfs*8, in a family with sudden cardiac death. BMC Med Genomics 2023; 16:266. [PMID: 37885024 PMCID: PMC10601356 DOI: 10.1186/s12920-023-01701-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/14/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE We conducted an investigation into the clinical and molecular characteristics of Arrhythmogenic left ventricular cardiomyopathy (ALVC) caused by a novel likely pathogenic mutation in an Iranian pedigree with sudden cardiac death (SCD). BACKGROUND ALVC is a genetically inherited myocardial disease characterized by the substitution of fibro-fatty tissue in the left ventricular myocardium, predominantly inherited in an autosomal dominant pattern and is commonly associated with genes involved in encoding desmosomal proteins, specifically Desmoplakin (DSP). METHODS The patient and available family members underwent a comprehensive clinical assessment, including Cardiac magnetic resonance (CMR) imaging, along with Whole-exome sequencing (WES). The identified variant was confirmed and segregated by Polymerase chain reaction (PCR) and Sanger sequencing in the family members. RESULTS A novel likely pathogenic heterozygous variant, DSP (NM_004415.4), c.3492_3498del, p.K1165Rfs*8 was discovered in the proband. This variant is likely to be the primary reason for ALVC in this specific family. This variant was confirmed by Sanger sequencing and segregated in other affected members of the family. CONCLUSION We identified a novel likely pathogenic variant in the DSP gene, which has been identified as the cause of ALVC in an Iranian family. Our investigation underscores the importance of genetic testing, specifically WES, for individuals suspected of ALVC and have a family history of SCD.
Collapse
Affiliation(s)
- Amir Azimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Pourirahim
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Golnaz Houshmand
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Sara Adimi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
16
|
Cabral M, Fernandes S, Ruivo C, Martins H, Morais J. Recognizing a "Hot Phase" of An Arrhythmogenic Left Ventricular Cardiomyopathy: A Case Report. J Saudi Heart Assoc 2023; 35:232-234. [PMID: 37881594 PMCID: PMC10597597 DOI: 10.37616/2212-5043.1348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
A 35-year-old male, with a medical history of acute myocarditis, presented with palpitations. Further investigation revealed non-sustained ventricular tachycardia and a slightly reduced left ventricular systolic function. Cardiac magnetic resonance showed extended late gadolinium enhancement of the left ventricle and fat infiltration. Genetic testing was positive for a pathogenic desmoplakin mutation, fulfilling the criteria of arrhythmogenic left ventricular cardiomyopathy. In conclusion, the authors described a case of a mimicked acute myocarditis at a young age in a patient with an arrhythmogenic left ventricular cardiomyopathy. Therefore, the genetic study is essential for both diagnosis and management.
Collapse
Affiliation(s)
| | - Sara Fernandes
- Cardiology Department, Santo Antonio University Hospital Center, Porto,
Portugal
| | - Catarina Ruivo
- Cardiology Department, Leiria Hospital Centre, Leiria,
Portugal
| | - Hélia Martins
- Cardiology Department, Leiria Hospital Centre, Leiria,
Portugal
| | - João Morais
- Cardiology Department, Leiria Hospital Centre, Leiria,
Portugal
- CiTechCare (Center for Innovative Care and Health Technology), Leiria,
Portugal
| |
Collapse
|
17
|
Basharat SA, Hsiung I, Garg J, Alsaid A. Arrhythmogenic Cardiomyopathy: Evolving Diagnostic Criteria and Insight from Cardiac Magnetic Resonance Imaging. Heart Fail Clin 2023; 19:429-444. [PMID: 37714585 DOI: 10.1016/j.hfc.2023.03.006] [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] [Indexed: 09/17/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an umbrella term encompassing a wide variety of overlapping hereditary and nonhereditary disorders that can result in malignant ventricular arrhythmias and sudden cardiac death. Cardiac MRI plays a critical role in accurate diagnosis of various ACM entities and is increasingly showing promise in risk stratification that can further guide management particularly in decisions regarding use of implantable cardioverter defibrillator. Genotyping plays an important role in cascade testing but challenges remain due to incomplete penetrance and wide phenotypic variability of ACM as well as the presence of gene-elusive cases.
Collapse
Affiliation(s)
- Sohaib Ahmad Basharat
- Division of Cardiology, Loma Linda University Medical Center, 11234 Anderson Street, MC2426, Loma Linda, CA 92354, USA
| | - Ingrid Hsiung
- Department of Cardiology, Baylor Scott & White The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, USA
| | - Jalaj Garg
- Division of Cardiology, Loma Linda University Medical Center, 11234 Anderson Street, MC2426, Loma Linda, CA 92354, USA. https://twitter.com/drjalajgarg
| | - Amro Alsaid
- Department of Cardiology, Baylor Scott & White The Heart Hospital, 1100 Allied Drive, Plano, TX 75093, USA.
| |
Collapse
|
18
|
Zinkovsky D, Sood MR. Isolated JUP plakoglobin gene mutation with left ventricular fibrosis in familial arrhythmogenic right ventricular cardiomyopathy. J Cardiovasc Electrophysiol 2023; 34:2112-2121. [PMID: 37717241 DOI: 10.1111/jce.16044] [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: 02/18/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited disorder usually affecting the right ventricle (RV), characterized by fibro-fatty tissue replacement of the healthy ventricular myocardium. It often predisposes young patients to ventricular tachycardia, heart failure, and/or sudden cardiac death. However, recent studies have suggested predominantly left ventricle (LV) involvement with variable and/or atypical manifestations. Cardiac magnetic resonance (CMR) imaging has emerged as the noninvasive gold standard for the diagnosis of ARVC. CASE SUMMARY A 21-year-old athletic male with a family history of unknown ventricular arrhythmias, presented with near syncope, chest pain, and exertional palpitations. He had an initial work-up that was grossly unremarkable including an electrocardiogram (ECG), echocardiogram and a CMR study. Six months later, he presented again with recurrent symptoms of presyncope during exercise and his ECG demonstrated new findings of a terminal activation delay in his precordial leads. He had markedly elevated cardiac biomarkers, (troponin I > 100 ng/dl, normal value < 0.04 ng/dl) and demonstrated ventricular tachycardia with a right bundle branch morphology. An endomyocardial biopsy did not reveal any pathology. A follow-up CMR demonstrated the new development and prominent left ventricular epicardial scar in the lateral wall. The patient underwent familial genetic testing, which confirmed the presence of an isolated junction plakoglobin (JUP) gene mutation and showed multiple genes consistent with ARVC in his mother. Thus, he manifested a partial transmission of only one abnormal gene for ARVC and exhibited a markedly different expression in his disease without evidence of typical right-sided heart pathology. A third CMR study was performed, which showed partial improvement in myocardial fibrosis after exercise cessation. CONCLUSION We present a case of a young athletic male with a newly diagnosed isolated JUP gene mutation and a genetically diagnosed family history of ARVC. During his course, he demonstrated the progression of new, atypical, left ventricular fibrosis. This case demonstrates a complex interplay between genetic penetrance, phenotypical heterogeneity, and lifestyle factors such as exercise in disease progression and provides insight into the natural course of an isolated JUP mutation. Although rare, clinicians should have a high threshold for the clinical suspicion of ARVC or variants of this disorder even in the absence of classic right-sided pathologies.
Collapse
Affiliation(s)
- Daniel Zinkovsky
- Mount Sinai South Nassau, Oceanside, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Michael R Sood
- Mount Sinai South Nassau, Oceanside, New York, USA
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Mount Sinai Heart-Mount Sinai South Nassau, Oceanside, New York, USA
| |
Collapse
|
19
|
Lemus Barrios GA, Lopez‐Lopez JP, Barbosa‐Balaguera S, Correa AM. Left-dominant arrhythmogenic cardiomyopathy due to desmoplakin mutation: a case report. ESC Heart Fail 2023; 10:3190-3194. [PMID: 37632291 PMCID: PMC10567658 DOI: 10.1002/ehf2.14504] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 07/07/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The case of a 49-year-old man with acute onset of heart failure is presented. The initial work-up showed a dilated cardiomyopathy with severely reduced left ventricular ejection fraction. In the differential diagnostic process, hypertensive, ischaemic, and valvular aetiologies were discarded. Subsequently, a cardiac magnetic resonance revealed global hypokinesis and inferior and anterior subepicardial fibrosis. Once differential diagnoses of subepicardial fibrosis (myocarditis, sarcoidosis, and Chagas disease) were discarded, a genetic panel was performed, resulting in a heterozygous mutation of desmoplakin (DSP) gene c.6697_6698del. A left-dominant DSP arrhythmogenic cardiomyopathy mutation was diagnosed. Structural myocardial abnormalities and ventricular arrhythmias characterize arrhythmogenic cardiomyopathy. Up to 50% of cases are associated with mutations in DSP genes (JUP, DSP, and PKP2). DSP is the fundamental component of the desmosome structure and provides structural support through intercellular adhesion. Therefore, when frequent differential diagnoses are discarded, genetic studies for dilated cardiomyopathy and DSP mutation should be considered.
Collapse
Affiliation(s)
- Gustavo A. Lemus Barrios
- Cardiology UnitHospital Universitario San IgnacioBogotáColombia
- Faculty of MedicinePontificia Universidad JaverianaBogotáColombia
| | - Jose P. Lopez‐Lopez
- Cardiology UnitHospital Universitario San IgnacioBogotáColombia
- Faculty of MedicinePontificia Universidad JaverianaBogotáColombia
| | - Stephany Barbosa‐Balaguera
- Cardiology UnitHospital Universitario San IgnacioBogotáColombia
- Faculty of MedicinePontificia Universidad JaverianaBogotáColombia
| | - Alejandro Mariño Correa
- Cardiology UnitHospital Universitario San IgnacioBogotáColombia
- Faculty of MedicinePontificia Universidad JaverianaBogotáColombia
| |
Collapse
|
20
|
El Ouartassi H, Faraj R, Laraichi Z, Ezzahraoui R, Bourouhou Z, Doghmi N, Cherti M. Biventricular arrhythmogenic cardiomyopathy diagnosed in a young patient: A case report with literature review. Radiol Case Rep 2023; 18:3248-3251. [PMID: 37520387 PMCID: PMC10375373 DOI: 10.1016/j.radcr.2023.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/13/2023] [Accepted: 06/16/2023] [Indexed: 08/01/2023] Open
Abstract
Arrhythmogenic cardiomyopathy is a genetic heart muscle disease that typically affects the right ventricle. However, 2 other phenotypes affecting the left ventricle were recently discovered. Here, we report the case of an 18-year-old patient with biventricular arrhythmogenic cardiomyopathy, highlighting the challenges encountered in establishing this diagnosis. Diagnostic criteria for the left-sided phenotypic variants of arrhythmogenic cardiomyopathy were only introduced in 2020 by an international expert consensus document, known as the "Padua criteria," they are divided in 6 categories with an emphasis on morpho-functional ventricular abnormalities and structural myocardial tissue alterations to diagnose biventricular arrhythmogenic cardiomyopathy.
Collapse
Affiliation(s)
- Hajar El Ouartassi
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Raid Faraj
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Zakariae Laraichi
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Rhita Ezzahraoui
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Zaineb Bourouhou
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Nawal Doghmi
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| | - Mohamed Cherti
- Cardiology B Department, Ibn Sina University Hospital Center, Rabat, Morocco
- Mohammed V university Rabat
| |
Collapse
|
21
|
Gama M, Cardoso I, Palma Anselmo M, Aguiar Rosa S, Gaspar da Costa P, Fortuna P. Arrhythmogenic Left Ventricular Cardiomyopathy: A Successful Case of Extracorporeal Cardiopulmonary Resuscitation. ACTA MEDICA PORT 2023; 36:598-602. [PMID: 37658721 DOI: 10.20344/amp.19624] [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: 02/07/2023] [Accepted: 05/03/2023] [Indexed: 09/03/2023]
Abstract
A 24-year-old man suffered a witnessed cardiac arrest after a padel game. Basic life support was immediately provided. The pre-hospital emergency services team continued the resuscitation efforts, and the patient was accepted for extracorporeal cardiopulmonary resuscitation. The return of spontaneous circulation was achieved in 45 minutes. The initial assessment revealed a ST-segment elevation in leads V4-V6 and a dilated left ventricle with severe systolic dysfunction. Coronary angiography was normal. An improvement in left ventricular systolic function was observed and extracorporeal cardiac support was discontinued after 48 hours. Cardiovascular magnetic resonance imaging demonstrated hypokinesia and subepicardial fatty infiltration of the left ventricle lateral wall. Genetic testing detected a variant of uncertain significance in the ANK2 gene. The diagnosis of arrhythmogenic left ventricular myocardiopathy did not fulfill all the current diagnostic criteria, but it is a very likely diagnosis. An implantable cardioverter-defibrillator was placed. The patient was discharged without physical or cognitive impairment.
Collapse
Affiliation(s)
- Mafalda Gama
- Unidade de Urgência Médica. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Isabel Cardoso
- Serviço de Cardiologia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | | | - Sílvia Aguiar Rosa
- Serviço de Cardiologia. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Pedro Gaspar da Costa
- Unidade de Urgência Médica. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| | - Philip Fortuna
- Unidade de Urgência Médica. Centro Hospitalar Universitário de Lisboa Central. Lisbon. Portugal
| |
Collapse
|
22
|
Denq W, Oshlag B. Cardiac Emergency in the Athlete. Clin Sports Med 2023; 42:355-371. [PMID: 37208052 DOI: 10.1016/j.csm.2023.02.003] [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: 05/21/2023]
Abstract
Cardiac-related deaths are the leading nontraumatic cause of death in the young athlete. Although there are multiple causes for cardiac arrest in athletes, sideline evaluation and management does not vary. Recognition, immediate high-quality chest compressions, and time to defibrillation are the greatest factors affecting survival. This article reviews the approach to the collapsed athlete, causes for select cardiac emergencies in athletes, preparedness for cardiac emergencies, and return to play considerations and recommendations.
Collapse
Affiliation(s)
- William Denq
- University of Arizona, 1501 North Campbell Avenue, Tucson, P.O. Box 245057, AZ 85724, USA.
| | - Ben Oshlag
- White Plains Hospital, 41 East Post Road, White Plains, NY 10601, USA
| |
Collapse
|
23
|
Silvetti E, Lanza O, Romeo F, Martino A, Fedele E, Lanzillo C, Crescenzi C, Fanisio F, Calò L. The pivotal role of ECG in cardiomyopathies. Front Cardiovasc Med 2023; 10:1178163. [PMID: 37404739 PMCID: PMC10315483 DOI: 10.3389/fcvm.2023.1178163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Cardiomyopathies are a heterogeneous group of pathologies characterized by structural and functional alterations of the heart. Recent technological advances in cardiovascular imaging offer an opportunity for deep phenotypic and etiological definition. Electrocardiogram (ECG) is the first-line diagnostic tool in the evaluation of both asymptomatic and symptomatic individuals. Some electrocardiographic signs are pathognomonic or fall within validated diagnostic criteria of individual cardiomyopathy such as the inverted T waves in right precordial leads (V1-V3) or beyond in individuals with complete pubertal development in the absence of complete right bundle branch block for the diagnosis of arrhythmogenic cardiomyopathy of the right ventricle (ARVC) or the presence of low voltages typically seen in more than 60% of patients with amyloidosis. Most other electrocardiographic findings such as the presence of depolarization changes including QRS fragmentation, the presence of epsilon wave, the presence of reduced or increased voltages as well as alterations in the repolarization phase including the negative T waves in the lateral leads, or the profound inversion of the T waves or downsloping of the ST tract are more non-specific signs which can however raise the clinical suspicion of cardiomyopathy in order to initiate a diagnostic procedure especially using imaging techniques for diagnostic confirmation. Such electrocardiographic alterations not only have a counterpart in imaging investigations such as evidence of late gadolinium enhancement on magnetic resonance imaging, but may also have an important prognostic value once a definite diagnosis has been made. In addition, the presence of electrical stimulus conduction disturbances or advanced atrioventricular blocks that can be seen especially in conditions such as cardiac amyloidosis or sarcoidosis, or the presence of left bundle branch block or posterior fascicular block in dilated or arrhythmogenic left ventricular cardiomyopathies are recognized as a possible expression of advanced pathology. Similarly, the presence of ventricular arrhythmias with typical patterns such as non-sustained or sustained ventricular tachycardia of LBBB morphology in ARVC or non-sustained or sustained ventricular tachycardia with an RBBB morphology (excluding the "fascicular pattern") in arrhythmogenic left ventricle cardiomyopathy could have a significant impact on the course of each disease. It is therefore clear that a learned and careful interpretation of ECG features can raise suspicion of the presence of a cardiomyopathy, identify diagnostic "red flags" useful for orienting the diagnosis toward specific forms, and provide useful tools for risk stratification. The purpose of this review is to emphasize the important role of the ECG in the diagnostic workup, describing the main ECG findings of different cardiomyopathies.
Collapse
|
24
|
de la Guía-Galipienso F, Ugedo-Alzaga K, Grazioli G, Quesada-Ocete FJ, Feliu-Rey E, Perez MV, Quesada-Dorador A, Sanchis-Gomar F. Arrhythmogenic Cardiomyopathy and Athletes - A Dangerous Relationship. Curr Probl Cardiol 2023:101799. [PMID: 37172878 DOI: 10.1016/j.cpcardiol.2023.101799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 05/07/2023] [Indexed: 05/15/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a disease characterized by a progressive replacement of myocardium by fibro-adipose material, predisposing to ventricular arrhythmias (VA) and sudden cardiac death (SCD). Its prevalence is estimated at 1:2000 to 1:5000, with a higher incidence in males, and clinical onset is usually between the 2nd and 4th decade of life. The prevalence of ACM in SCD victims is relatively high, making it one of the most common etiologies in young patients with SCD, especially if they are athletes. Cardiac events occur more frequently in individuals with ACM who participate in competitive sports and/or high-intensity training. In effect, exercise activity can worsen RV function in cases of hereditary ACM. Estimating the incidence of SCD caused by ACM in athletes remains challenging, being reported frequency ranging from 3-20%. Here, we review the potential implications of exercising on the clinical course of the classical genetic form of ACM, as well as the diagnostic tools, risk stratification, and the different therapeutic tools available for managing ACM.
Collapse
Affiliation(s)
- Fernando de la Guía-Galipienso
- From the Glorieta Policlinic, Denia, Alicante, Spain; REMA-Sports Cardiology Clinic, Denia, Alicante, Spain; Cardiology Service, Hospital HCB Benidorm, Alicante, Spain; School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain.
| | | | | | - Francisco Javier Quesada-Ocete
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Eloísa Feliu-Rey
- Magnetic Resonance Unit, Inscanner, General University Hospital of Alicante, Alicante, Spain
| | - Marco V Perez
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Aurelio Quesada-Dorador
- School of Medicine, Catholic University of Valencia San Vicente Mártir, Valencia, Spain; Arrhythmia Unit, Cardiology Service, General University Hospital Consortium of Valencia, Valencia, Spain
| | - Fabian Sanchis-Gomar
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA..
| |
Collapse
|
25
|
Corrado D, Zorzi A, Cipriani A, Bauce B, Bariani R, Brunetti G, Graziano F, De Lazzari M, Mattesi G, Migliore F, Pilichou K, Rigato I, Rizzo S, Thiene G, Perazzolo Marra M, Basso C. Scarring/arrhythmogenic cardiomyopathy. Eur Heart J Suppl 2023; 25:C144-C154. [PMID: 37125320 PMCID: PMC10132624 DOI: 10.1093/eurheartjsupp/suad017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The designation of 'arrhythmogenic cardiomyopathy' reflects the evolving concept of a heart muscle disease affecting not only the right ventricle (ARVC) but also the left ventricle (LV), with phenotypic variants characterized by a biventricular (BIV) or predominant LV involvement (ALVC). Herein, we use the term 'scarring/arrhythmogenic cardiomyopathy (S/ACM)' to emphasize that the disease phenotype is distinctively characterized by loss of ventricular myocardium due to myocyte death with subsequent fibrous or fibro-fatty scar tissue replacement. The myocardial scarring predisposes to potentially lethal ventricular arrhythmias and underlies the impairment of systolic ventricular function. S/ACM is an 'umbrella term' which includes a variety of conditions, either genetic or acquired (mostly post-inflammatory), sharing the typical 'scarring' phenotypic features of the disease. Differential diagnoses include 'non-scarring' heart diseases leading to either RV dilatation from left-to-right shunt or LV dilatation/dysfunction from a dilated cardiomyopathy. The development of 2020 upgraded criteria ('Padua criteria') for diagnosis of S/ACM reflected the evolving clinical experience with the expanding spectrum of S/ACM phenotypes and the advances in cardiac magnetic resonance (CMR) imaging. The Padua criteria aimed to improve the diagnosis of S/ACM by incorporation of CMR myocardial tissue characterization findings. Risk stratification of S/ACM patients is mostly based on arrhythmic burden and ventricular dysfunction severity, although other ECG or imaging parameters may have a role. Medical therapy is crucial for treatment of ventricular arrhythmias and heart failure. Implantable cardioverter defibrillator (ICD) is the only proven life-saving treatment, despite its significant morbidity because of device-related complications and inappropriate shocks. Selection of patients who can benefit the most from ICD therapy is one of the most challenging issues in clinical practice.
Collapse
Affiliation(s)
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Riccardo Bariani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Giulia Brunetti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Francesca Graziano
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Ilaria Rigato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via Giustiniani 2, 35121 Padova, Italy
| |
Collapse
|
26
|
Pezzato A, Milandri A, Tortorici G, Sinagra G, Merlo M. Pragmatic electrocardiogram tracings in non-ischaemic dilated cardiomyopathy: diagnostic and prognostic role. Eur Heart J Suppl 2023; 25:C162-C168. [PMID: 37125300 PMCID: PMC10132561 DOI: 10.1093/eurheartjsupp/suad018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Dilated cardiomyopathy (DCM) is a primitive heart muscle disease characterized by a great heterogeneous aetiology and prognostic outcome. Dilated cardiomyopathy is an umbrella term encompassing different aetiologies that might require specific treatments. It principally affects young and male adults, with high-risk arrhythmic competitive risk. Unfortunately, the prevention of major ventricular arrhythmic events remains a clinical challenge. In the era of advanced multimodality imaging and widely available genetic testing, electrocardiogram (ECG) continues to represent a reliable diagnostic tool, for specific work up of every single patient. However, approaching DCM patients, only a cardiomyopathy-oriented reading makes the role of ECG central in the management of DCM, both for diagnosis, prognosis, and therapeutic management. In this paper, we present four ECGs of four different DCM patients, in order to guide a cardiomyopathy-oriented ECG reading, emphasizing its impact in an early, cost-effective, and personalized diagnostic and prognostic work up in this specific setting.
Collapse
Affiliation(s)
- Andrea Pezzato
- Cardiothoracovascular Department, University of Trieste, Via Valdoni 7, 34129 Trieste, Italy
| | - Agnese Milandri
- Cardiovascular Department, Bentivoglio Hospital, Via Marconi 35, 40010 Bologna, Italy
| | - Gianfranco Tortorici
- Cardiovascular Department, Bentivoglio Hospital, Via Marconi 35, 40010 Bologna, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, University of Trieste, Via Valdoni 7, 34129 Trieste, Italy
| | - Marco Merlo
- Corresponding author. Tel: +39 0403994477, Fax: +39 0403994878,
| |
Collapse
|
27
|
Brandão M, Bariani R, Rigato I, Bauce B. Desmoplakin Cardiomyopathy: Comprehensive Review of an Increasingly Recognized Entity. J Clin Med 2023; 12:jcm12072660. [PMID: 37048743 PMCID: PMC10095332 DOI: 10.3390/jcm12072660] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/20/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023] Open
Abstract
Desmoplakin (DSP) is a desmosomal protein that plays an essential role for cell-to-cell adhesion within the cardiomyocytes. The first association between DSP genetic variants and the presence of a myocardial disease referred to patients with Carvajal syndrome. Since then, several reports have linked the DSP gene to familial forms of arrhythmogenic (ACM) and dilated cardiomyopathies. Left-dominant ACM is the most common phenotype in individuals carrying DSP variants. More recently, a new entity—“Desmoplakin cardiomyopathy”—was described as a distinct form of cardiomyopathy characterized by frequent left ventricular involvement with extensive fibrosis, high arrhythmic risk, and episodes of acute myocardial injury. The purpose of this review was to summarize the available evidence on DSP cardiomyopathy and to identify existing gaps in knowledge that need clarification from upcoming research.
Collapse
Affiliation(s)
- Mariana Brandão
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, 4430-000 Vila Nova de Gaia, Portugal
| | - Riccardo Bariani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| | - Ilaria Rigato
- Azienda Ospedaliera/Universita’ di Padova, Via Giustiniani, 2-Padova, 35128 Padova, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy
| |
Collapse
|
28
|
Genetically determined cardiomyopathies at autopsy: the pivotal role of the pathologist in establishing the diagnosis and guiding family screening. Virchows Arch 2023; 482:653-669. [PMID: 36897369 PMCID: PMC10067659 DOI: 10.1007/s00428-023-03523-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 03/11/2023]
Abstract
Cardiomyopathies (CMP) comprise a heterogenous group of diseases affecting primarily the myocardium, either genetic and/or acquired in origin. While many classification systems have been proposed in the clinical setting, there is no internationally agreed pathological consensus concerning the diagnostic approach to inherited CMP at autopsy. A document on autopsy diagnosis of CMP is needed because the complexity of the pathologic backgrounds requires proper insight and expertise. In cases presenting with cardiac hypertrophy and/or dilatation/scarring with normal coronary arteries, a suspicion of inherited CMP must be considered, and a histological examination is essential. Establishing the actual cause of the disease may require a number of tissue-based and/or fluid-based investigations, be it histological, ultrastructural, or molecular. A history of illicit drug use must be looked for. Sudden death is frequently the first manifestation of disease in case of CMP, especially in the young. Also, during routine clinical or forensic autopsies, a suspicion of CMP may arise based on clinical data or pathological findings at autopsy. It is thus a challenge to make a diagnosis of a CMP at autopsy. The pathology report should provide the relevant data and a cardiac diagnosis which can help the family in furthering investigations, including genetic testing in case of genetic forms of CMP. With the explosion in molecular testing and the concept of the molecular autopsy, the pathologist should use strict criteria in the diagnosis of CMP, and helpful for clinical geneticists and cardiologists who advise the family as to the possibility of a genetic disease.
Collapse
|
29
|
Russo V, Ciabatti M, Brunacci M, Dendramis G, Santobuono V, Tola G, Picciolo G, Teresa LM, D'Andrea A, Nesti M. Opportunities and drawbacks of the subcutaneous defibrillator across different clinical settings. Expert Rev Cardiovasc Ther 2023; 21:151-164. [PMID: 36847583 DOI: 10.1080/14779072.2023.2184350] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION The subcutaneous implantable cardioverter-defibrillator (S-ICD) is an established therapy for the prevention of sudden cardiac death (SCD) and an alternative to a transvenous implantable cardioverter-defibrillator system in selected patients. Beyond randomized clinical trials, many observational studies have described the clinical performance of S-ICD across different subgroups of patients. AREAS COVERED Our review aimed to describe the opportunities and drawbacks of the S-ICD, focusing on their use in special populations and across different clinical settings. EXPERT OPINION The choice to implant S-ICD should be based on the patient's tailored approach, which takes into account the adequate S-ICD screening at rest or during stress, the infective risk, the ventricular arrhythmia susceptibility, the progressive nature of the underlying disease, the work or sports activity, and the risk of lead-related complications.
Collapse
Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, University of Campania 'Luigi Vanvitelli' - Monaldi Hospital, Naples, Italy
| | | | | | | | | | | | | | | | | | - Martina Nesti
- Cardiology Unit, San Donato Hospital, Arezzo (FI), Italy
| |
Collapse
|
30
|
Role of cardiac magnetic resonance in the differential diagnosis between arrhythmogenic cardiomyopathy with left ventricular involvement and previous infectious myocarditis. Int J Cardiol 2023; 374:120-126. [PMID: 36535562 DOI: 10.1016/j.ijcard.2022.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 11/25/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
AIMS Arrhythmogenic cardiomyopathy with left ventricular involvement (ACM-LV), particularly in case of isolated left ventricular involvement (i.e. left dominant arrhythmogenic cardiomyopathy, LDAC) and previous infectious myocarditis (pIM) may have overlapping clinical and cardiac magnetic resonance (CMR) features. To date, there are no validated CMR criteria for the differential diagnosis between these conditions. The present study aimed to identify CMR characteristics to distinguish ACM-LV from pIM. METHODS AND RESULTS This observational, retrospective, single-centre study included 30 pIM patients and 30 ACM-LV patients. In ACM-LV patients CMR was performed at diagnosis; in patients with pIM, CMR was performed six months after acute infection. CMR analysis included quantitative assessment of left ventricle (LV) volumes, systolic function and wall thicknesses, qualitative and quantitative assessment of late gadolinium enhancement (LGE) sequences. Compared with pIM, ACM-LV patients showed slightly larger LV volumes, more frequent regional wall motion anomalies and reduced wall thicknesses. ACM-LV patients had higher amounts of LV LGE and extension. Notably, the LDAC subgroup had the highest amount of LV LGE. LV LGE amount > 15 g and a LV LGE percentage > 30% of LV mass discriminated ACM-LV from pIM with a 100% specificity. LGE segmental distribution was superimposable among the groups, except for septal segments that were more frequently involved in ACM-LV and LDAC patients. CONCLUSIONS A great extension of LV LGE (a cut-off of LGE >15 g and a percentage above 30% of LV LGE in relation to total myocardial mass) discriminates ACM-LV from pIM with extremely high specificity.
Collapse
|
31
|
Monda E, Rubino M, Palmiero G, Verrillo F, Lioncino M, Diana G, Cirillo A, Fusco A, Dongiglio F, Caiazza M, Altobelli I, Mauriello A, Guarnaccia N, Scatteia A, Cesaro A, Pacileo G, Sarubbi B, Frisso G, Bauce B, D’Andrea A, Dellegrottaglie S, Russo MG, Calabrò P, Limongelli G. Multimodality Imaging in Arrhythmogenic Left Ventricular Cardiomyopathy. J Clin Med 2023; 12:jcm12041568. [PMID: 36836107 PMCID: PMC9966192 DOI: 10.3390/jcm12041568] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/31/2023] [Accepted: 02/10/2023] [Indexed: 02/18/2023] Open
Abstract
The term arrhythmogenic cardiomyopathy (ACM) describes a large spectrum of myocardial diseases characterized by progressive fibrotic or fibrofatty replacement, which gives the substrate for the occurrence of ventricular tachyarrhythmias and the development of ventricular dysfunction. This condition may exclusively affect the left ventricle, leading to the introduction of the term arrhythmogenic left ventricular cardiomyopathy (ALVC). The clinical features of ALVC are progressive fibrotic replacement with the absence or mild dilation of the LV and the occurrence of ventricular arrhythmias within the left ventricle. In 2019, the diagnostic criteria for the diagnosis of ALVC, based on family history and clinical, electrocardiographic, and imaging features, have been proposed. However, since the significant clinical and imaging overlap with other cardiac diseases, genetic testing with the demonstration of a pathogenic variant in an ACM-related gene is required for diagnostic confirmation. In ALVC, the multimodality imaging approach comprises different imaging techniques, such as echocardiography, cardiac magnetic resonance, and cardiac nuclear imaging. It provides essential information for the diagnosis, differential diagnosis, sudden cardiac death risk stratification, and management purposes. This review aims to elucidate the current role of the different multimodality imaging techniques in patients with ALVC.
Collapse
Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew’s Hospital, London WC1E 6DD, UK
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Michele Lioncino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Ippolita Altobelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Alfredo Mauriello
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Natale Guarnaccia
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | | | - Arturo Cesaro
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Pacileo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Berardo Sarubbi
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giulia Frisso
- Dipartimento di Medicina Molecolare e Biotecnologie Mediche, University of Naples “Federico II”, 80138 Naples, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | | | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Paolo Calabrò
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy
- Institute of Cardiovascular Sciences, University College of London and St. Bartholomew’s Hospital, London WC1E 6DD, UK
- Correspondence: ; Tel.: +39-0817062815
| |
Collapse
|
32
|
Quintella Sangiorgi Olivetti N, Sacilotto L, Wulkan F, D'Arezzo Pessente G, Lombardi Peres de Carvalho M, Moleta D, Tessariol Hachul D, Veronese P, Hardy C, Pisani C, Wu TC, Vieira MLC, de França LA, de Souza Freitas M, Rochitte CE, Bueno SC, Bastos Lovisi V, Krieger JE, Scanavacca M, da Costa Pereira A, da Costa Darrieux F. Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort. Circ Arrhythm Electrophysiol 2023; 16:e011391. [PMID: 36720007 DOI: 10.1161/circep.122.011391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. METHODS The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. RESULTS The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. CONCLUSIONS Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
Collapse
Affiliation(s)
- Natália Quintella Sangiorgi Olivetti
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.).,Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Luciana Sacilotto
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Fanny Wulkan
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Gabrielle D'Arezzo Pessente
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Danilo Moleta
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Denise Tessariol Hachul
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Pedro Veronese
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Carina Hardy
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Cristiano Pisani
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Tan Chen Wu
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Marcelo Luiz Campos Vieira
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Lucas Arraes de França
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Matheus de Souza Freitas
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Carlos Eduardo Rochitte
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Sávia Christina Bueno
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Vitor Bastos Lovisi
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Maurício Scanavacca
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Francisco da Costa Darrieux
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| |
Collapse
|
33
|
DSP-Related Cardiomyopathy as a Distinct Clinical Entity? Emerging Evidence from an Italian Cohort. Int J Mol Sci 2023; 24:ijms24032490. [PMID: 36768812 PMCID: PMC9916412 DOI: 10.3390/ijms24032490] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Variants in desmoplakin gene (DSP MIM *125647) have been usually associated with Arrhythmogenic Cardiomyopathy (ACM), or Dilated Cardiomyopathy (DCM) inherited in an autosomal dominant manner. A cohort of 18 probands, characterized as heterozygotes for DSP variants by a target Next Generation Sequencing (NGS) cardiomyopathy panel, was analyzed. Cardiological, genetic data, and imaging features were retrospectively collected. A total of 16 DSP heterozygous pathogenic or likely pathogenic variants were identified, 75% (n = 12) truncating variants, n = 2 missense variants, n = 1 splicing variant, and n = 1 duplication variant. The mean age at diagnosis was 40.61 years (IQR 31-47.25), 61% of patients being asymptomatic (n = 11, New York Heart Association (NYHA) class I) and 39% mildly symptomatic (n = 7, NYHA class II). Notably, 39% of patients (n = 7) presented with a clinical history of presumed myocarditis episodes, characterized by chest pain, myocardial enzyme release, 12-lead electrocardiogram abnormalities with normal coronary arteries, which were recurrent in 57% of cases (n = 4). About half of the patients (55%, n = 10) presented with a varied degree of left ventricular enlargement (LVE), four showing biventricular involvement. Eleven patients (61%) underwent implantable cardioverter defibrillator (ICD) implantation, with a mean age of 46.81 years (IQR 36.00-64.00). Cardiac magnetic resonance imaging (CMRI) identified in all 18 patients a delayed enhancement (DE) area consistent with left ventricular (LV) myocardial fibrosis, with a larger localization and extent in patients presenting with recurrent episodes of myocardial injury. These clinical and genetic data confirm that DSP-related cardiomyopathy may represent a distinct clinical entity characterized by a high arrhythmic burden, variable degrees of LVE, Late Gadolinium Enhancement (LGE) with subepicardial distribution and episodes of myocarditis-like picture.
Collapse
|
34
|
Mishra D, Shankar O, Aggarwal V. Varied Presentation of Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy (ARVD/C): A Case Series. Cureus 2023; 15:e33883. [PMID: 36819412 PMCID: PMC9934937 DOI: 10.7759/cureus.33883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Arrhythmogenic right ventricular dysplasia (ARVD) is a genetically predisposed form of cardiomyopathy that mainly affects young individuals resulting in fatal ventricular arrhythmias leading to sudden cardiac death. ARVD has 50% of cases that involve both the right ventricle (RV) and left ventricle (LV), but only a small number of cases involve an isolated left ventricle. In this case series, five patients (four males and one female) with a diagnosis of ARVD presented to our center with varied clinical presentations across a wide range of age groups. The MRI of all five cases showed dilated right atrium (RA)/RV with right ventricular free wall dyskinesia. Two-dimensional (2D) MRI showed aneurysmal outpouching with diffuse free wall enhancement. Automated implantable cardioverter defibrillator (AICD) was implanted uneventfully in all five patients, and the patients were discharged with oral medications such as low-dose diuretics, beta-blockers, spironolactone, angiotensin-converting enzymes (ACE) inhibitors, amiodarone, and anxiolytics. Until now, the patients were doing well on follow-up visits. The therapeutic management of patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) has evolved over the years and continues to be an important challenge. To further improve risk stratification and treatment of patients, more information is needed on natural history, long-term prognosis, and risk assessment. Special attention should be focused on the identification of patients who would benefit from implantable cardioverter-defibrillator (ICD) implantation in comparison to pharmacological and other nonpharmacological approaches.
Collapse
Affiliation(s)
- Dhananjay Mishra
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Om Shankar
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| | - Vikas Aggarwal
- Cardiology, Institute of Medical Sciences (IMS) Banaras Hindu University (BHU), Varanasi, IND
| |
Collapse
|
35
|
Bariani R, Bueno Marinas M, Rigato I, Veronese P, Celeghin R, Cipriani A, Cason M, Pergola V, Mattesi G, Deola P, Zorzi A, Limongelli G, Iliceto S, Corrado D, Basso C, Pilichou K, Bauce B. Pregnancy in Women with Arrhythmogenic Left Ventricular Cardiomyopathy. J Clin Med 2022; 11:jcm11226735. [PMID: 36431211 PMCID: PMC9698035 DOI: 10.3390/jcm11226735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 10/26/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In the last few years, a phenotypic variant of arrhythmogenic cardiomyopathy (ACM) labeled arrhythmogenic left ventricular cardiomyopathy (ALVC) has been defined and researched. This type of cardiomyopathy is characterized by a predominant left ventricular (LV) involvement with no or minor right ventricular (RV) abnormalities. Data on the specific risk and management of pregnancy in women affected by ALVC are, thus far, not available. We have sought to characterize pregnancy course and outcomes in women affected by ALVC through the evaluation of a series of childbearing patients. METHODS A series of consecutive female ALVC patients were analyzed in a cross-sectional, retrospective study. Study protocol included 12-lead ECG assessments, 24-h Holter ECG evaluations, 2D-echocardiogram tests, cardiac magnetic resonance assessments, and genetic analysis. Furthermore, the long-term disease course of childbearing patients was compared with a group of nulliparous ALVC women. RESULTS A total of 35 patients (mean age 45 ± 9 years, 51% probands) were analyzed. Sixteen women (46%) reported a pregnancy, for a total of 27 singleton viable pregnancies (mean age at first childbirth 30 ± 9 years). Before pregnancy, all patients were in the NYHA class I and none of the patients reported a previous heart failure (HF) episode. No significant differences were found between childbearing and nulliparous women regarding ECG features, LV dimensions, function, and extent of late enhancement. Overall, 7 patients (20%, 4 belonging to the childbearing group) experienced a sustained ventricular tachycardia and 2 (6%)-one for each group-showed heart failure (HF) episodes. The analysis of arrhythmia-free survival patients did not show significant differences between childbearing and nulliparous women. CONCLUSIONS In a cohort of ALVC patients without previous episodes of HF, pregnancy was well tolerated, with no significant influence on disease progression and degree of electrical instability. Further studies on a larger cohort of women with different degrees of disease extent and genetic background are needed in order to achieve a more comprehensive knowledge regarding the outcome of pregnancy in ALVC patients.
Collapse
Affiliation(s)
- Riccardo Bariani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Maria Bueno Marinas
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Ilaria Rigato
- Azienda Ospedaliera di Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Paola Veronese
- Azienda Ospedaliera di Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Rudy Celeghin
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Marco Cason
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Valeria Pergola
- Azienda Ospedaliera di Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Giulia Mattesi
- Azienda Ospedaliera di Padova, Via Giustiniani, 2, 35128 Padova, Italy
| | - Petra Deola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Giuseppe Limongelli
- Department of Translational Sciences, University della Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
| | - Kalliopi Pilichou
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
- Correspondence: (K.P.); (B.B.)
| | - Barbara Bauce
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padua, Italy
- Correspondence: (K.P.); (B.B.)
| |
Collapse
|
36
|
Piquer-Gil M, Domenech-Dauder S, Sepúlveda-Gómez M, Machí-Camacho C, Braza-Boïls A, Zorio E. Non Coding RNAs as Regulators of Wnt/β-Catenin and Hippo Pathways in Arrhythmogenic Cardiomyopathy. Biomedicines 2022; 10:2619. [PMID: 36289882 PMCID: PMC9599412 DOI: 10.3390/biomedicines10102619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/10/2022] [Accepted: 10/14/2022] [Indexed: 09/29/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy histologically characterized by the replacement of myocardium by fibrofatty infiltration, cardiomyocyte loss, and inflammation. ACM has been defined as a desmosomal disease because most of the mutations causing the disease are located in genes encoding desmosomal proteins. Interestingly, the instable structures of these intercellular junctions in this disease are closely related to a perturbed Wnt/β-catenin pathway. Imbalance in the Wnt/β-catenin signaling and also in the crosslinked Hippo pathway leads to the transcription of proadipogenic and profibrotic genes. Aiming to shed light on the mechanisms by which Wnt/β-catenin and Hippo pathways modulate the progression of the pathological ACM phenotype, the study of non-coding RNAs (ncRNAs) has emerged as a potential source of actionable targets. ncRNAs comprise a wide range of RNA species (short, large, linear, circular) which are able to finely tune gene expression and determine the final phenotype. Some share recognition sites, thus referred to as competing endogenous RNAs (ceRNAs), and ensure a coordinating action. Recent cancer research studies regarding the key role of ceRNAs in Wnt/β-catenin and Hippo pathways modulation pave the way to better understanding the molecular mechanisms underlying ACM.
Collapse
Affiliation(s)
- Marina Piquer-Gil
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
| | - Sofía Domenech-Dauder
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
| | - Marta Sepúlveda-Gómez
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
| | - Carla Machí-Camacho
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
| | - Aitana Braza-Boïls
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), 28015 Madrid, Spain
| | - Esther Zorio
- Unit of Inherited Cardiomyopathies and Sudden Death (CaFaMuSMe), Health Research Institute La Fe, 46026 Valencia, Spain
- Center for Biomedical Network Research on Cardiovascular Diseases (CIBERCV), 28015 Madrid, Spain
- Cardiology Department, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| |
Collapse
|
37
|
Muacevic A, Adler JR. Arrhythmogenic Cardiomyopathy: A Review of a Rare Case of Biventricular Phenotype. Cureus 2022; 14:e30040. [PMID: 36381856 PMCID: PMC9637405 DOI: 10.7759/cureus.30040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Arrhythmogenic cardiomyopathy is a rare hereditary structural heart disease, with various phenotypes, which mostly affects the right ventricle of the heart, resulting in fibrofatty replacement of the heart muscles and a proclivity to create spontaneous malignant cardiac arrhythmias that may lead to sudden death. Most previous reports were noted on young people. We report a case of its biventricular phenotype in a 61-year-old heavy truck driver who has a current medical history of diabetes mellitus and smoking and was incidentally diagnosed based on the Padua criteria after presenting to the hospital with complaints of lightheadedness and syncope. He eventually had an implantable cardioverter defibrillator, hence preventing death. We were able to correctly diagnose the case and prevent sudden cardiac death by instituting the necessary management.
Collapse
|
38
|
Myocarditis-like Episodes in Patients with Arrhythmogenic Cardiomyopathy: A Systematic Review on the So-Called Hot-Phase of the Disease. Biomolecules 2022; 12:biom12091324. [PMID: 36139162 PMCID: PMC9496041 DOI: 10.3390/biom12091324] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 09/01/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetically determined myocardial disease, characterized by myocytes necrosis with fibrofatty substitution and ventricular arrhythmias that can even lead to sudden cardiac death. The presence of inflammatory cell infiltrates in endomyocardial biopsies or in autoptic specimens of ACM patients has been reported, suggesting a possible role of inflammation in the pathophysiology of the disease. Furthermore, chest pain episodes accompanied by electrocardiographic changes and troponin release have been observed and defined as the “hot-phase” phenomenon. The aim of this critical systematic review was to assess the clinical features of ACM patients presenting with “hot-phase” episodes. According to PRISMA guidelines, a search was run in the PubMed, Scopus and Web of Science electronic databases using the following keywords: “arrhythmogenic cardiomyopathy”; “myocarditis” or “arrhythmogenic cardiomyopathy”; “troponin” or “arrhythmogenic cardiomyopathy”; and “hot-phase”. A total of 1433 titles were retrieved, of which 65 studies were potentially relevant to the topic. Through the application of inclusion and exclusion criteria, 9 papers reporting 103 ACM patients who had experienced hot-phase episodes were selected for this review. Age at time of episodes was available in 76% of cases, with the mean age reported being 26 years ± 14 years (min 2–max 71 years). Overall, 86% of patients showed left ventricular epicardial LGE. At the time of hot-phase episodes, 49% received a diagnosis of ACM (Arrhythmogenic left ventricular cardiomyopathy in the majority of cases), 19% of dilated cardiomyopathy and 26% of acute myocarditis. At the genetic study, Desmoplakin (DSP) was the more represented disease-gene (69%), followed by Plakophillin-2 (9%) and Desmoglein-2 (6%). In conclusion, ACM patients showing hot-phase episodes are usually young, and DSP is the most common disease gene, accounting for 69% of cases. Currently, the role of “hot-phase” episodes in disease progression and arrhythmic risk stratification remains to be clarified.
Collapse
|
39
|
Cheng WH, Chung FP, Lin YJ, Lo LW, Chang SL, Hu YF, Tuan TC, Chao TF, Liao JN, Lin CY, Chang TY, Kuo L, Wu CI, Liu CM, Liu SH, Chen SA. Catheter Ablation in Arrhythmic Cardiac Diseases: Endocardial and Epicardial Ablation. Rev Cardiovasc Med 2022; 23:324. [PMID: 39077706 PMCID: PMC11262352 DOI: 10.31083/j.rcm2309324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Accepted: 08/17/2022] [Indexed: 07/31/2024] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a group of arrhythmogenic disorders of the myocardium that are not caused by ischemic, hypertensive, or valvular heart disease. The clinical manifestations of ACMs may overlap those of dilated cardiomyopathy, complicating the differential diagnosis. In several ACMs, ventricular tachycardia (VT) has been observed at an early stage, regardless of the severity of the disease. Therefore, preventing recurrences of VT can be a clinical challenge. There is a wide range of efficacy and side effects associated with the use of antiarrhythmic drugs (AADs) in the treatment of VT. In addition to AADs, patients with ACM and ventricular tachyarrhythmias may benefit from catheter ablation, especially if they are drug-refractory. The differences in pathogenesis between the various types of ACMs can lead to heterogeneous distributions of arrhythmogenic substrates, non-uniform ablation strategies, and distinct ablation outcomes. Ablation has been documented to be effective in eliminating ventricular tachyarrhythmias in arrhythmogenic right ventricular dysplasia (ARVC), sarcoidosis, Chagas cardiomyopathy, and Brugada syndrome (BrS). As an entity that is rare in nature, ablation for ventricular tachycardia in certain forms of ACM may only be reported through case reports, such as amyloidosis and left ventricular noncompaction. Several types of ACMs, including ARVC, sarcoidosis, Chagas cardiomyopathy, BrS, and left ventricular noncompaction, may exhibit diseased substrates within or adjacent to the epicardium that may be accountable for ventricular arrhythmogenesis. As a result, combining endocardial and epicardial ablation is of clinical importance for successful ablation. The purpose of this article is to provide a comprehensive overview of the substrate characteristics, ablation strategies, and ablation outcomes of various types of ACMs using endocardial and epicardial approaches.
Collapse
Affiliation(s)
- Wen-Han Cheng
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital Taitung Branch, 95050 Taitung, Taiwan
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Li-Wei Lo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Shih-Lin Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Yu-Feng Hu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ta-Chuan Tuan
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Tze-Fan Chao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Jo-Nan Liao
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Chin-Yu Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ting-Yung Chang
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Ling Kuo
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Cheng-I Wu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Chih-Min Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Shin-Huei Liu
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
| | - Shih-Ann Chen
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, 11217 Taipei, Taiwan
- Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, 112304 Taipei, Taiwan
- Cardiovascular Center, Taichung Veterans General Hospital, 40705 Taichung, Taiwan
| |
Collapse
|
40
|
Narducci ML, Scacciavillani R, Pelargonio G, Borro L, Secinaro A. Combining 3-Dimensional Electroanatomic Mapping and Cardiac Magnetic Resonance. JACC Case Rep 2022; 4:1200-1202. [PMID: 36213886 PMCID: PMC9537100 DOI: 10.1016/j.jaccas.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/07/2022] [Accepted: 07/01/2022] [Indexed: 11/16/2022]
Abstract
We present the case of a 17-year-old asymptomatic boy with a diagnosis of arrhythmogenic cardiomyopathy. Merging of cardiac magnetic resonance imaging and three-dimensional electroanatomic mapping provided striking visualization of the association between structural and electrical alterations and guided the decision to implant an implantable cardioverter defibrillator. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Maria Lucia Narducci
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Address for correspondence: Dr Maria Lucia Narducci, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy, Largo Agostino Gemelli, 8 Rome 00168, Italy.
| | - Roberto Scacciavillani
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Gemma Pelargonio
- Cardiovascular Sciences Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Borro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| |
Collapse
|
41
|
Murakami H, Tanimoto Y, Tanimoto K, Inoue S, Ishikawa T, Makita N, Yamazawa K. Arrhythmogenic right ventricular cardiomyopathy in a Japanese patient with a homozygous founder variant of DSG2 in the East Asian population. Hum Genome Var 2022; 9:28. [PMID: 35941102 PMCID: PMC9360431 DOI: 10.1038/s41439-022-00206-9] [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: 05/02/2022] [Revised: 06/24/2022] [Accepted: 07/13/2022] [Indexed: 01/12/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a hereditary cardiomyopathy that results in fatal arrhythmias and heart failure. Herein, we report a Japanese patient with ARVC whose parents were blood relatives. Genetic testing identified a homozygous rare variant, c.1592T > G (p.Phe531Cys), of DSG2 that is presumed to be a founder variant among East Asians. Genetic counseling sessions with precise risk assessment and appropriate follow-up programs were provided to the patient and family members.
Collapse
Affiliation(s)
- Haruka Murakami
- Medical Genetics Center, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Yoko Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Kojiro Tanimoto
- Department of Cardiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Satomi Inoue
- Medical Genetics Center, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Taisuke Ishikawa
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kazuki Yamazawa
- Medical Genetics Center, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.
| |
Collapse
|
42
|
Genetic Background and Clinical Features in Arrhythmogenic Left Ventricular Cardiomyopathy: A Systematic Review. J Clin Med 2022; 11:jcm11154313. [PMID: 35893404 PMCID: PMC9332695 DOI: 10.3390/jcm11154313] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/16/2022] [Accepted: 07/20/2022] [Indexed: 12/16/2022] Open
Abstract
In recent years a phenotypic variant of Arrhythmogenic cardiomyopathy has been described, characterized by predominant left ventricular (LV) involvement with no or minor right ventricular abnormalities, referred to as Arrhythmogenic left ventricular cardiomyopathy (ALVC). Different disease-genes have been identified in this form, such as Desmoplakin (DSP), Filamin C (FLNC), Phospholamban (PLN) and Desmin (DES). The main purpose of this critical systematic review was to assess the level of knowledge on genetic background and clinical features of ALVC. A search (updated to April 2022) was run in the PubMed, Scopus, and Web of Science electronic databases. The search terms used were “arrhythmogenic left ventricular cardiomyopathy” OR “arrhythmogenic cardiomyopathy” and “gene” OR “arrhythmogenic dysplasia” and “gene”. The most represented disease-gene turned out to be DSP, accounting for half of published cases, followed by FLNC. Overall, ECG abnormalities were reported in 58% of patients. Major ventricular arrhythmias were recorded in 26% of cases; an ICD was implanted in 29% of patients. A total of 6% of patients showed heart failure symptoms, and 15% had myocarditis-like episodes. DSP is confirmed to be the most represented disease-gene in ALVC patients. An analysis of reported clinical features of ALVC patients show an important degree of electrical instability, which frequently required an ICD implant. Moreover, myocarditis-like episodes are common.
Collapse
|
43
|
Otto CM. Heartbeat: hypertension risk is higher when obesity onset occurs earlier in adult life. Heart 2022; 108:661-663. [PMID: 35396229 DOI: 10.1136/heartjnl-2022-321152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Catherine M Otto
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
44
|
Cicenia M, Drago F. Arrhythmogenic Cardiomyopathy: Diagnosis, Evolution, Risk Stratification and Pediatric Population-Where Are We? J Cardiovasc Dev Dis 2022; 9:98. [PMID: 35448074 PMCID: PMC9024428 DOI: 10.3390/jcdd9040098] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 03/21/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a cardiomyopathy characterized by the occurrence of a high risk of life-threatening ventricular arrhythmias and sudden cardiac death even at presentation. Diagnosis, evolution and outcomes in adults have been extensively reported, but little data in pediatric population are available. Risk stratification in this particular setting is still a matter of debate and new risk factors are needed in a model of an ever more "individualized medicine".
Collapse
Affiliation(s)
| | - Fabrizio Drago
- Pediatric Cardiology and Arrhythmia/Syncope Complex Unit, Bambino Gesù Children’s Hospital, IRCCS, 00146 Rome, Italy;
| |
Collapse
|
45
|
Bang ML, Bogomolovas J, Chen J. Understanding the molecular basis of cardiomyopathy. Am J Physiol Heart Circ Physiol 2022; 322:H181-H233. [PMID: 34797172 PMCID: PMC8759964 DOI: 10.1152/ajpheart.00562.2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/16/2021] [Accepted: 11/16/2021] [Indexed: 02/03/2023]
Abstract
Inherited cardiomyopathies are a major cause of mortality and morbidity worldwide and can be caused by mutations in a wide range of proteins located in different cellular compartments. The present review is based on Dr. Ju Chen's 2021 Robert M. Berne Distinguished Lectureship of the American Physiological Society Cardiovascular Section, in which he provided an overview of the current knowledge on the cardiomyopathy-associated proteins that have been studied in his laboratory. The review provides a general summary of the proteins in different compartments of cardiomyocytes associated with cardiomyopathies, with specific focus on the proteins that have been studied in Dr. Chen's laboratory.
Collapse
Affiliation(s)
- Marie-Louise Bang
- Institute of Genetic and Biomedical Research (IRGB), National Research Council (CNR), Milan Unit, Milan, Italy
- IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
| | - Julius Bogomolovas
- Division of Cardiovascular Medicine, Department of Medicine Cardiology, University of California, San Diego, La Jolla, California
| | - Ju Chen
- Division of Cardiovascular Medicine, Department of Medicine Cardiology, University of California, San Diego, La Jolla, California
| |
Collapse
|
46
|
Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. J Clin Med 2022; 11:578. [PMID: 35160031 PMCID: PMC8836975 DOI: 10.3390/jcm11030578] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.
Collapse
Affiliation(s)
- Guillem Casas
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
| | - José F. Rodríguez-Palomares
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
| |
Collapse
|
47
|
Hassoun R, Budde H, Mügge A, Hamdani N. Cardiomyocyte Dysfunction in Inherited Cardiomyopathies. Int J Mol Sci 2021; 22:11154. [PMID: 34681814 PMCID: PMC8541428 DOI: 10.3390/ijms222011154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/08/2021] [Accepted: 10/13/2021] [Indexed: 01/10/2023] Open
Abstract
Inherited cardiomyopathies form a heterogenous group of disorders that affect the structure and function of the heart. Defects in the genes encoding sarcomeric proteins are associated with various perturbations that induce contractile dysfunction and promote disease development. In this review we aimed to outline the functional consequences of the major inherited cardiomyopathies in terms of myocardial contraction and kinetics, and to highlight the structural and functional alterations in some sarcomeric variants that have been demonstrated to be involved in the pathogenesis of the inherited cardiomyopathies. A particular focus was made on mutation-induced alterations in cardiomyocyte mechanics. Since no disease-specific treatments for familial cardiomyopathies exist, several novel agents have been developed to modulate sarcomere contractility. Understanding the molecular basis of the disease opens new avenues for the development of new therapies. Furthermore, the earlier the awareness of the genetic defect, the better the clinical prognostication would be for patients and the better the prevention of development of the disease.
Collapse
Affiliation(s)
- Roua Hassoun
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Heidi Budde
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Andreas Mügge
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| | - Nazha Hamdani
- Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr University Bochum, 44801 Bochum, Germany
- Department of Cardiology, St. Josef-Hospital and Bergmannsheil, Ruhr University Bochum, 44801 Bochum, Germany
| |
Collapse
|