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Gąsior JS, Zamunér AR, Madeyska M, Tomik A, Niszczota C, Williams CA, Werner B. Heart Rate Variability in Individuals with Down Syndrome: A Scoping Review with Methodological Considerations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:941. [PMID: 36673696 PMCID: PMC9859252 DOI: 10.3390/ijerph20020941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/31/2022] [Accepted: 01/01/2023] [Indexed: 06/17/2023]
Abstract
Individuals with Down syndrome (DS) present similar heart rate variability (HRV) parameters at rest but different responses to selected movement maneuvers in comparison to individuals without DS, which indicates reduced vagal regulation. The present study undertakes a scoping review of research on HRV in individuals with DS, with special attention paid to the compliance of the studies with standards and methodological paper guidelines for HRV assessment and interpretation. A review was performed using PubMed, Web of Science and CINAHL databases to search for English language publications from 1996 to 2020 with the MESH terms "heart rate variability" and "down syndrome", with the additional inclusion criteria of including only human participants and empirical investigations. From 74 studies, 15 were included in the review. None of the reviewed studies met the recommendations laid out by the standards and guidelines for providing the acquisition of RR intervals and necessary details on HRV analysis. Since authors publishing papers on this research topic do not adhere to the prescribed standards and guidelines when constructing the methodology, results of the research papers on the topic are not directly comparable. Authors need to design the study methodology more robustly by following the aforementioned standards, guidelines and recommendations.
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Affiliation(s)
- Jakub S. Gąsior
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Margaret Madeyska
- Pediatric Cardiology and General Pediatrics Clinic, Jan Polikarp Brudziński Pediatric Hospital, 02-091 Warsaw, Poland
| | - Anna Tomik
- Faculty of Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Cezary Niszczota
- Pediatric Cardiology and General Pediatrics Clinic, Jan Polikarp Brudziński Pediatric Hospital, 02-091 Warsaw, Poland
| | - Craig A. Williams
- Children’s Health & Exercise Research Centre, Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter EX1 2LU, UK
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland
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Calcagni G, Pugnaloni F, Digilio MC, Unolt M, Putotto C, Niceta M, Baban A, Piceci Sparascio F, Drago F, De Luca A, Tartaglia M, Marino B, Versacci P. Cardiac Defects and Genetic Syndromes: Old Uncertainties and New Insights. Genes (Basel) 2021; 12:genes12071047. [PMID: 34356063 PMCID: PMC8307133 DOI: 10.3390/genes12071047] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/29/2021] [Accepted: 07/05/2021] [Indexed: 02/02/2023] Open
Abstract
Recent advances in understanding the genetic causes and anatomic subtypes of cardiac defects have revealed new links between genetic etiology, pathogenetic mechanisms and cardiac phenotypes. Although the same genetic background can result in different cardiac phenotypes, and similar phenotypes can be caused by different genetic causes, researchers’ effort to identify specific genotype–phenotype correlations remains crucial. In this review, we report on recent advances in the cardiac pathogenesis of three genetic diseases: Down syndrome, del22q11.2 deletion syndrome and Ellis–Van Creveld syndrome. In these conditions, the frequent and specific association with congenital heart defects and the recent characterization of the underlying molecular events contributing to pathogenesis provide significant examples of genotype–phenotype correlations. Defining these correlations is expected to improve diagnosis and patient stratification, and it has relevant implications for patient management and potential therapeutic options.
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Affiliation(s)
- Giulio Calcagni
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.U.); (A.B.); (F.D.)
- Correspondence: ; Tel.: +39-06-68594096
| | - Flaminia Pugnaloni
- Department of Pediatrics, Obstetrics and Gynecology, “Sapienza” University, 00161 Rome, Italy; (F.P.); (C.P.); (B.M.); (P.V.)
| | - Maria Cristina Digilio
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (M.N.); (M.T.)
| | - Marta Unolt
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.U.); (A.B.); (F.D.)
| | - Carolina Putotto
- Department of Pediatrics, Obstetrics and Gynecology, “Sapienza” University, 00161 Rome, Italy; (F.P.); (C.P.); (B.M.); (P.V.)
| | - Marcello Niceta
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (M.N.); (M.T.)
| | - Anwar Baban
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.U.); (A.B.); (F.D.)
| | - Francesca Piceci Sparascio
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (F.P.S.); (A.D.L.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.U.); (A.B.); (F.D.)
| | - Alessandro De Luca
- Medical Genetics Division, Fondazione IRCCS Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Italy; (F.P.S.); (A.D.L.)
| | - Marco Tartaglia
- Genetics and Rare Diseases Research Division, Ospedale Pediatrico Bambino Gesù, IRCCS, 00165 Rome, Italy; (M.C.D.); (M.N.); (M.T.)
| | - Bruno Marino
- Department of Pediatrics, Obstetrics and Gynecology, “Sapienza” University, 00161 Rome, Italy; (F.P.); (C.P.); (B.M.); (P.V.)
| | - Paolo Versacci
- Department of Pediatrics, Obstetrics and Gynecology, “Sapienza” University, 00161 Rome, Italy; (F.P.); (C.P.); (B.M.); (P.V.)
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Varshney A, Chahal G, Santos L, Stolper J, Hallab JC, Nim HT, Nikolov M, Yip A, Ramialison M. Human Cardiac Transcription Factor Networks. SYSTEMS MEDICINE 2021. [DOI: 10.1016/b978-0-12-801238-3.11597-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Smith A, Molloy E, Miletin J, Curley A, Balfe J, Franklin O, El-Khuffash A. Longitudinal assessment of cardiac function in infants with Down's syndrome using novel echocardiography techniques - project protocol. HRB Open Res 2020; 3:77. [PMID: 34095748 PMCID: PMC8145226 DOI: 10.12688/hrbopenres.13168.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Down’s syndrome (DS) is the most common chromosomal abnormality globally. Ireland has one of the highest rates of DS in the western world with an incidence of 1:444 live births. Congenital heart disease (CHD) and pulmonary hypertension (PH) are the commonest morbidities affecting the cardiovascular system in DS. PH is associated with significant morbidity and an increase risk of mortality. The impact of the diagnosis of DS, the presence of CHD and the associated PH on myocardial function during transition and over the first 2 years of age in this population is not well defined and warrants further study. In particular, serial measurements of pulmonary pressures in this population over the first week of age are lacking. This study aims to characterise myocardial function and pulmonary haemodynamics in infants with Down syndrome during the transitional period (over the first week of age) and throughout the first two years of age. Methods: A prospective, observational study utilising novel echocardiography techniques to assess myocardial function and pulmonary haemodynamics over the first two years of age in infants with Down Syndrome. A population of healthy infants without CHD or a diagnosis of DS will be recruited as controls. This study will be conducted across the three Dublin maternity units. Discussion: In total, 70 babies with DS have been enrolled into this study with 292 echocardiograms performed to date. Further evaluation of cardiac performance in DS infants with and without CHD may yield more insight into the pathophysiology of cardiac dysfunction and pulmonary hypertension that are recognised features in these patients. This could aid in our ability to monitor and treat patients, as well as improve our ability to predict outcomes.
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Affiliation(s)
- Aisling Smith
- Department of Neonatology, The Rotunda Hospital, Dublin, Dublin, D01P5W9, Ireland
| | - Eleanor Molloy
- Department of Paediatrics and Child Health, Trinity College Dublin, Dublin, Dublin, D02PN40, Ireland.,Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Dublin, D08XW7X, Ireland
| | - Jan Miletin
- Department of Neonatology, Coombe Women and Infants University Hospital, Dublin, Dublin, D08XW7X, Ireland
| | - Anna Curley
- Department of Neonatology, The National Maternity Hospital, Dublin, Dublin, D02YH21, Ireland
| | - Joanne Balfe
- Department of Paediatrics, Tallaght University Hospital, Dublin, Dublin, D24NR0A, Ireland
| | - Orla Franklin
- Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Dublin, D12N512, Ireland
| | - Afif El-Khuffash
- Department of Neonatology, The Rotunda Hospital, Dublin, Dublin, D01P5W9, Ireland.,School of Medicine, Royal College of Surgeons in Ireland, Dublin, Dublin, D02P796, Ireland
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Blondiaux E, Autret G, Dhombres F, Gonzales M, Audureau E, Clément O, Jouannic JM, Houyel L. Evaluation of septal insertion of atrioventricular valves in fetuses by postmortem 4.7 Tesla cardiac MRI: A feasibility study. Diagn Interv Imaging 2018; 100:109-116. [PMID: 30527913 DOI: 10.1016/j.diii.2018.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/18/2018] [Accepted: 11/12/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to compare non-invasive high-spatial-resolution postmortem cardiac magnetic resonance imaging (MRI) and autopsy findings for evaluating the septal insertion of atrioventricular valves in fetuses. MATERIALS AND METHODS Five fetal heart specimens including two normal hearts, one heart with complete atrioventricular septal defect (AVSD) and two hearts with linear insertion of atrioventricular valves (LIAVV; gestational age 17 to 34 weeks) were studied with cardiac MRI using a 4.7 T MRI scanner without sample preparation. Three (3D) and two-dimensional (2D) turbo-RARE (rapid imaging with refocused echoes) sequences in four-chamber and left-ventricular long-axis planes were obtained with a minimal isotropic/in-plane resolution of 156μm. Nonparametric tests were performed to compare the distance between insertions of medial leaflets of the atrioventricular valves and the inlet/outlet distance ratio between MRI and autopsy findings in normal, complete AVSD and with linear insertion of atrioventricular valves (LIAVV) fetal hearts. RESULTS Despite apparent differences between LIAVV/normal hearts, no significant differences were found between differential insertion of medial leaflets and inlet/outlet distance ratios with both techniques. Very good to excellent reliability between both techniques was found for differential insertion (ICC: 87.2%; 95% CI: -21.7%, 99.1%) (P=0.963) and inlet/outlet distance ratio (ICC 98.3%; 95%CI: 85.2%, 99.8%) (P=0.537) measurements. CONCLUSION Postmortem cardiac MRI could replace autopsy for assessing normal or abnormal septal insertion of atrioventricular valves in fetuses without requiring specific preparation of the heart.
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Affiliation(s)
- E Blondiaux
- Laboratoire d'imagerie biomédicale, CNRS 7371, Inserm 1146, department of radiology, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France.
| | - G Autret
- Inserm U970, plateforme imageries du vivant, Paris cardiovascular research center, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - F Dhombres
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - M Gonzales
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - E Audureau
- LIC EA 4393, department of public health, université Paris Est Créteil, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - O Clément
- Inserm U970, plateforme imageries du vivant, Paris cardiovascular research center, université Paris Descartes, Sorbonne Paris cité, 75015 Paris, France
| | - J-M Jouannic
- Faculté de médecine, department of fetal medicine, Sorbonne université, hôpital Trousseau, hôpitaux universitaires de l'Est parisien, AP-HP, 75012 Paris, France
| | - L Houyel
- Congenital and Pediatric Cardiology Unit, Centre de Référence Maladies Cardiaques Congénitales Complexes-M3C, hôpital Necker-Enfants Malades, AP-HP, 75006 Paris, France; Université Paris-Descartes, Sorbonne Paris Cité, 75005 Paris, France
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Abstract
PURPOSE OF REVIEW In the last 40 years, with a better understanding of cardiac defects, and with the improved results of cardiac surgery, the life expectancy of persons with Down syndrome has significantly increased. This review article reports on advances in knowledge of cardiac defects and cardiovascular system of persons with trisomy 21. RECENT FINDINGS New insights into the genetics of this syndrome have improved our understanding of the pathogenetic mechanisms of cardiac defects. Recent changes in neonatal prevalence of Down syndrome suggest a growing number of children with cardiac malformations, in particular with simple types of defects. Ethnic and sex differences of the prevalence of specific types of congenital heart disease (CHD) have also been underlined. A recent study confirmed that subclinical morphologic anomalies are present in children with trisomy 21, also in the absence of cardiac defects, representing an internal stigma of Down syndrome. The results of cardiac surgery are significantly improved in terms of immediate and long-term outcomes, but specific treatments are indicated in relation to pulmonary hypertension. Particular aspects of the cardiovascular system have been described, clarifying a reduced sympathetic response to stress but also a 'protection' from atherosclerosis and arterial hypertension in these patients. SUMMARY Continuing dedication to clinical and basic research studies is essential to further improve survival and the quality of life from childhood to adulthood of patients with trisomy 21.
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Affiliation(s)
| | | | - Maria C Digilio
- Genetics and Rare Diseases Research Division, Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Bruno Marino
- Department of Pediatrics, Sapienza University of Rome
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Kharbanda RK, Blom NA, Hazekamp MG, Yildiz P, Mulder BJ, Wolterbeek R, Weijerman ME, Schalij MJ, Jongbloed MR, Roest AA. Incidence and risk factors of post-operative arrhythmias and sudden cardiac death after atrioventricular septal defect (AVSD) correction: Up to 47 years of follow-up. Int J Cardiol 2018; 252:88-93. [DOI: 10.1016/j.ijcard.2017.09.209] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/30/2017] [Accepted: 09/28/2017] [Indexed: 12/01/2022]
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Wiegering A, Rüther U, Gerhardt C. The Role of Hedgehog Signalling in the Formation of the Ventricular Septum. J Dev Biol 2017; 5:E17. [PMID: 29615572 PMCID: PMC5831794 DOI: 10.3390/jdb5040017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 12/08/2017] [Accepted: 12/09/2017] [Indexed: 12/11/2022] Open
Abstract
An incomplete septation of the ventricles in the vertebrate heart that disturbes the strict separation between the contents of the two ventricles is termed a ventricular septal defect (VSD). Together with bicuspid aortic valves, it is the most frequent congenital heart disease in humans. Until now, life-threatening VSDs are usually treated surgically. To avoid surgery and to develop an alternative therapy (e.g., a small molecule therapy), it is necessary to understand the molecular mechanisms underlying ventricular septum (VS) development. Consequently, various studies focus on the investigation of signalling pathways, which play essential roles in the formation of the VS. In the past decade, several reports found evidence for an involvement of Hedgehog (HH) signalling in VS development. In this review article, we will summarise the current knowledge about the association between HH signalling and VS formation and discuss the use of such knowledge to design treatment strategies against the development of VSDs.
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Affiliation(s)
- Antonia Wiegering
- Institute for Animal Developmental and Molecular Biology, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany.
| | - Ulrich Rüther
- Institute for Animal Developmental and Molecular Biology, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany.
| | - Christoph Gerhardt
- Institute for Animal Developmental and Molecular Biology, Heinrich-Heine University Düsseldorf, 40225 Düsseldorf, Germany.
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Dall'Asta A, Cavalli C, Galli L, Volpe N, Weiss A, Kaihura CT, Agnetti A, Frusca T, Ghi T. Is the short axis view of the fetal heart useful in improving the diagnostic accuracy of outlet ventricular septal defects? Prenat Diagn 2016; 37:156-161. [PMID: 27943388 DOI: 10.1002/pd.4981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/01/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Outlet ventricular septal defects (VSDs) are usually suspected on the five-chamber view of the fetal heart; however, postnatal confirmation occurs only in a small number of cases. The aim of this study was to evaluate if the systematic assessment of the short axis view may improve the prediction of prenatally detected outlet VSDs. METHODS Cases where isolated outlet VSD was suspected on the five-chamber view were assessed by using the short axis scanning plane for confirmation of the defect. Postnatal assessment was performed within 2 weeks from birth at our Paediatric Cardiology Unit. RESULTS An outlet VSD was suspected at five-chamber view in 23 fetuses. Postnatal confirmation of the VSD occurred in 14 cases where the defect was prenatally detected both on the five chamber and the short axis views. VSDs were not confirmed at postnatal assessment only in two cases where outlet VSD was suspected on both views, whereas all the seven cases with a suspected VSD on the five-chamber view only turned out to be false positives. CONCLUSION The short axis view of the fetal heart seems useful in confirming the presence of outlet VSDs. © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Andrea Dall'Asta
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Claudio Cavalli
- Paediatric Hospital 'P. Barilla', Neonatology Unit, University of Parma, Parma, Italy
| | - Letizia Galli
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Nicola Volpe
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Adi Weiss
- Paediatric Hospital 'P. Barilla', Neonatology Unit, University of Parma, Parma, Italy
| | - Christine Tita Kaihura
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Aldo Agnetti
- Paediatric Hospital 'P. Barilla', Neonatology Unit, University of Parma, Parma, Italy
| | - Tiziana Frusca
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
| | - Tullio Ghi
- Department of Surgical Sciences, Obstetrics and Gynaecology Unit, University of Parma, Parma, Italy
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Atrioventricular septal defect: From embryonic development to long-term follow-up. Int J Cardiol 2016; 202:784-95. [DOI: 10.1016/j.ijcard.2015.09.081] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/28/2015] [Accepted: 09/23/2015] [Indexed: 11/18/2022]
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Sánchez O, Domínguez C, Ruiz A, Ribera I, Alijotas J, Cabero L, Carreras E, Llurba E. Angiogenic Gene Expression in Down Syndrome Fetal Hearts. Fetal Diagn Ther 2015; 40:21-7. [PMID: 26513650 DOI: 10.1159/000441356] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 09/23/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Forty percent of Down syndrome (DS) fetuses have congenital heart defects (CHD). An abnormal angiogenic environment has been described in euploid fetuses with CHD. However, the underlying pathophysiologic pathway that contributes to CHD in DS remains unknown. The objective was to compare the expression of angiogenic factors and chronic hypoxia genes in heart tissue from DS and euploid fetuses with and without CHD. METHODS The gene expression profile was determined by real-time PCR quantification in heart tissue from 33 fetuses with DS, 23 euploid fetuses with CHD and 23 control fetuses. RESULTS Angiogenic factors mRNA expression was significantly increased in the DS group compared to the controls (soluble fms-like tyrosine kinase-1, 81%, p = 0.007; vascular endothelial growth factor A, 57%, p = 0.006, and placental growth factor, 32%, p = 0.0227). Significant increases in the transcript level of hypoxia-inducible factor-2α and heme oxygenase 1 were also observed in the DS group compared to the controls. The expression of angiogenic factors was similar in DS fetuses and CHD euploid fetuses with CHD. CONCLUSION Abnormal angiogenesis was detected in the hearts of DS fetuses with and without CHD. Our results suggest that DS determines an intrinsically angiogenic impairment that may be present in the fetal heart.
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Affiliation(s)
- Olga Sánchez
- Maternal and Child Health and Development Network II (SAMID II) RD12/0026, Institute of Health Carlos III, Madrid, Spain
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