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Laurita KR, Piktel JS, Irish L, Nassal M, Cheng A, McCauley M, Pawlowski G, Dennis AT, Suen Y, Almahameed S, Ziv O, Gourdie RG, Wilson LD. Spontaneous Repolarization Alternans Causes VT/VF Rearrest That Is Suppressed by Preserving Gap Junctions. JACC Clin Electrophysiol 2024; 10:1271-1286. [PMID: 38752959 DOI: 10.1016/j.jacep.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Ventricular tachycardia (VT)/ventricular fibrillation (VF) rearrest after successful resuscitation is common, and survival is poor. A mechanism of VT/VF, as demonstrated in ex vivo studies, is when repolarization alternans becomes spatially discordant (DIS ALT), which can be enhanced by impaired gap junctions (GJs). However, in vivo spontaneous DIS ALT-induced VT/VF has never been demonstrated, and the effects of GJ on DIS ALT and VT/VF rearrest are unknown. OBJECTIVES This study aimed to determine whether spontaneous VT/VF rearrest induced by DIS ALT occurs in vivo, and if it can be suppressed by preserving Cx43-mediated GJ coupling and/or connectivity. METHODS We used an in vivo porcine model of resuscitation from ischemia-induced cardiac arrest combined with ex vivo optical mapping in porcine left ventricular wedge preparations. RESULTS In vivo, DIS ALT frequently preceded VT/VF and paralleled its incidence at normal (37°C, n = 9) and mild hypothermia (33°C, n = 8) temperatures. Maintaining GJs in vivo with rotigaptide (n = 10) reduced DIS ALT and VT/VF incidence, especially during mild hypothermia, by 90% and 60%, respectively (P < 0.001; P < 0.013). Ex vivo, both rotigaptide (n = 5) and αCT11 (n = 7), a Cx43 mimetic peptide that promotes GJ connectivity, significantly reduced DIS ALT by 60% and 100%, respectively (P < 0.05; P < 0.005), and this reduction was associated with reduced intrinsic heterogeneities of action potential duration rather than changes in conduction velocity restitution. CONCLUSIONS These results provide the strongest in vivo evidence to date suggesting a causal relationship between spontaneous DIS ALT and VT/VF in a clinically realistic scenario. Furthermore, our results suggest that preserving GJs during resuscitation can suppress VT/VF rearrest.
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Affiliation(s)
- Kenneth R Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA.
| | - Joseph S Piktel
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Laken Irish
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Michelle Nassal
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Aurelia Cheng
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Matthew McCauley
- Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Gary Pawlowski
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Adrienne T Dennis
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yi Suen
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Soufian Almahameed
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ohad Ziv
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
| | - Robert G Gourdie
- Fralin Biomedical Research Institute, Virginia Tech University, Roanoke, Virginia, USA
| | - Lance D Wilson
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA; Department of Emergency Medicine, MetroHealth Campus, Case Western Reserve University, Cleveland, Ohio, USA
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2
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Kon FC, Scheimberg I, Haini M, Cohen MC. Cardiovascular-related death in infancy and childhood: a clinicopathological study of two referral institutions in England. Forensic Sci Med Pathol 2024; 20:423-433. [PMID: 37233944 PMCID: PMC10214348 DOI: 10.1007/s12024-023-00630-5] [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] [Accepted: 04/08/2023] [Indexed: 05/27/2023]
Abstract
To review post-mortem findings among deaths presenting as sudden and/or unexpected deaths in two centers in the UK during a 16-year period in order to identify those related to cardiovascular conditions. The post-mortem databases of two tertiary referral institutions were searched, and all reports were reviewed. Histological features and results of ancillary investigations were noted. All cases of sudden and/or unexpected cardiac deaths (SCD) between 2003 and 2018 were identified. The study was PRISMA compliant and approved by clinical governance. 68/1129 cases of SCD (6.0%) were identified in one center and 83/753 cases (11%) in the other. These 151 cases constituted the study cohort. The mean annual incidence of SCD was 0.3 per 100,000 persons/annum. The three most prevalent groups of cardiac pathology were cardiac malformations (51/151; 33.8%), cardiomyopathies (32/151; 21.2%), and myocarditis (31/151; 20.5%). Mean age at death was 3.4 years. Prematurity was predominantly associated with deaths related to cardiac malformations (p < 0.001). Symptoms had been present for a mean of 3.8, 3.0, and 3.5 days before death for myocarditis, cardiomyopathy, and cardiac malformations/complications post-surgery. This retrospective comparative study represents the largest autopsy series of SCD in infants and children in the UK. Some entities are very infrequent. Several diseases could have been identified earlier in life allowing for the possibility of intervention. Limitation includes the retrospective nature of the study and that, as arrhythmogenic gene mutations are not yet routinely performed in unexplained deaths, the incidence of SCD in infants and children is most likely underestimated.
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MESH Headings
- Humans
- Infant
- Male
- Child, Preschool
- Female
- Child
- England/epidemiology
- Myocarditis/pathology
- Myocarditis/mortality
- Retrospective Studies
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/etiology
- Incidence
- Infant, Newborn
- Cardiomyopathies/pathology
- Cardiomyopathies/mortality
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/pathology
- Adolescent
- Cardiovascular Diseases/mortality
- Cause of Death
- Tertiary Care Centers
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Affiliation(s)
- Fu Chuen Kon
- Department of Pathology, Sheffield Children's Hospital NHS F.T., University of Sheffield, Western Bank, Sheffield, UK
| | - Irene Scheimberg
- Department of Pathology, Royal London Hospital, Barts Health NHS T., Tower Hamlets, London, UK
| | - Mohammad Haini
- Department of Pathology, Royal London Hospital, Barts Health NHS T., Tower Hamlets, London, UK
| | - Marta C Cohen
- Department of Pathology, Sheffield Children's Hospital NHS F.T., University of Sheffield, Western Bank, Sheffield, UK.
- Department of Oncology and Metabolism, University of Sheffield, Western Bank, Sheffield, UK.
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3
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Primo J. Idiopathic ventricular fibrillation: A never ending "clinical" history. Rev Port Cardiol 2024; 43:337-339. [PMID: 38825367 DOI: 10.1016/j.repc.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Affiliation(s)
- João Primo
- Unidade Local de Saúde Gaia/Espinho,E.P.E., Vila Nova de Gaia, Portugal; Hospital Luz Arrábida, Vila Nova de Gaia, Portuga.
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4
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Paulino ET. Development of the cardioprotective drugs class based on pathophysiology of myocardial infarction: A comprehensive review. Curr Probl Cardiol 2024; 49:102480. [PMID: 38395114 DOI: 10.1016/j.cpcardiol.2024.102480] [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: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
The cardiovascular system is mainly responsible for the transport of substances necessary to cellular metabolism. However, for the good performance of this function, there is need for adequate control of blood pressure levels of tissue perfusion and systemic arterial. Acute myocardial infarction is one of the complications of the cardiovascular system, that most affects the population around the world. This condition can be defined as a disease generated by an imbalance of oxygen concentrations used in cardiovascular metabolism, this change usually occurs because coronary occlusion, which prevents myocardial blood flow. The diagnosis is based on the set of clinical and laboratory investigations, which are in the release of cardiac enzyme biomarkers, cardiovascular and hemodynamic changes and cardiac accommodations. The treatment consists in the use of concomitant cardiovascular drugs, such as: antihypertensive, antiplatelet and hypolipidemic. Despite improvements in clinical and pharmacological management, acute myocardial infarction remains the leading cause of death worldwide. This finding encourages the scientific research of new drugs for the treatment of myocardial infarction or supporting therapies aimed at reducing the levels of deaths and comorbities generated by cardiovascular diseases.
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Affiliation(s)
- Emanuel Tenório Paulino
- Cardiovascular Pharmacology Laboratory, Institute of Pharmaceutical Sciences, Federal University of Alagoas, Av. Lourival Melo Mota, S/N. Postal Box Code: 57.072.900, Brazil.
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5
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Gutiérrez LK, Moreno-Manuel AI, Jalife J. Kir2.1-Na V1.5 channelosome and its role in arrhythmias in inheritable cardiac diseases. Heart Rhythm 2024; 21:630-646. [PMID: 38244712 DOI: 10.1016/j.hrthm.2024.01.017] [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: 11/20/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Sudden cardiac death in children and young adults is a relatively rare but tragic event whose pathophysiology is unknown at the molecular level. Evidence indicates that the main cardiac sodium channel (NaV1.5) and the strong inward rectifier potassium channel (Kir2.1) physically interact and form macromolecular complexes (channelosomes) with common partners, including adapter, scaffolding, and regulatory proteins that help them traffic together to their eventual membrane microdomains. Most important, dysfunction of either or both ion channels has direct links to hereditary human diseases. For example, certain mutations in the KCNJ2 gene encoding the Kir2.1 protein result in Andersen-Tawil syndrome type 1 and alter both inward rectifier potassium and sodium inward currents. Similarly, trafficking-deficient mutations in the gene encoding the NaV1.5 protein (SCN5A) result in Brugada syndrome and may also disturb both inward rectifier potassium and sodium inward currents. Moreover, gain-of-function mutations in KCNJ2 result in short QT syndrome type 3, which is extremely rare but highly arrhythmogenic, and can modify Kir2.1-NaV1.5 interactions in a mutation-specific way, further highlighting the relevance of channelosomes in ion channel diseases. By expressing mutant proteins that interrupt or modify Kir2.1 or NaV1.5 function in animal models and patient-specific pluripotent stem cell-derived cardiomyocytes, investigators are defining for the first time the mechanistic framework of how mutation-induced dysregulation of the Kir2.1-NaV1.5 channelosome affects cardiac excitability, resulting in arrhythmias and sudden death in different cardiac diseases.
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Affiliation(s)
- Lilian K Gutiérrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan.
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6
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Haberl C, Crean AM, Zelt JGE, Redpath CJ, deKemp RA. Role of Nuclear Imaging in Cardiac Stereotactic Body Radiotherapy for Ablation of Ventricular Tachycardia. Semin Nucl Med 2024; 54:427-437. [PMID: 38658301 DOI: 10.1053/j.semnuclmed.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Abstract
Ventricular tachycardia (VT) is a life-threatening arrhythmia common in patients with structural heart disease or nonischemic cardiomyopathy. Many VTs originate from regions of fibrotic scar tissue, where delayed electrical signals exit scar and re-enter viable myocardium. Cardiac stereotactic body radiotherapy (SBRT) has emerged as a completely noninvasive alternative to catheter ablation for the treatment of recurrent or refractory ventricular tachycardia. While there is no common consensus on the ideal imaging workflow, therapy planning for cardiac SBRT often combines information from a plurality of imaging modalities including MRI, CT, electroanatomic mapping and nuclear imaging. MRI and CT provide detailed anatomic information, and late enhancement contrast imaging can indicate regions of fibrosis. Electroanatomic maps indicate regions of heterogenous conduction voltage or early activation which are indicative of arrhythmogenic tissue. Some early clinical adopters performing cardiac SBRT report the use of myocardial perfusion and viability nuclear imaging to identify regions of scar. Nuclear imaging of hibernating myocardium, inflammation and sympathetic innervation have been studied for ventricular arrhythmia prognosis and in research relating to catheter ablation of VT but have yet to be studied in their potential applications for cardiac SBRT. The integration of information from these many imaging modalities to identify a target for ablation can be challenging. Multimodality image registration and dedicated therapy planning tools may enable higher target accuracy, accelerate therapy planning workflows and improve patient outcomes. Understanding the pathophysiology of ventricular arrhythmias, and localizing the arrhythmogenic tissues, is vital for successful ablation with cardiac SBRT. Nuclear imaging provides an arsenal of imaging strategies to identify regional scar, hibernation, inflammation, and sympathetic denervation with some advantages over alternative imaging strategies.
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Affiliation(s)
- Connor Haberl
- University of Ottawa Heart Institute, Ottawa, ON; Carleton University, Ottawa, ON
| | - Andrew M Crean
- University of Ottawa Heart Institute, Ottawa, ON; North West Heart Center, University of Manchester Foundation NHS Trust, Manchester, UK
| | - Jason G E Zelt
- The Ottawa Hospital, Ottawa, ON; Department of Medicine, University of Ottawa, Ottawa, ON
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7
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Marimpouy N, Guilbeau-Frugier C, Ferrières J, Balen F, Ramirez A, Delmas C, Biendel C, Beneyto M, Cherbi M, Foltran D, Mondoly P, Bongard V, Minville V, Delasnerie H, Rollin A, Maury P. The real incidence of sudden death: Fair estimations or futile speculations? Arch Cardiovasc Dis 2024; 117:244-248. [PMID: 38490843 DOI: 10.1016/j.acvd.2024.01.003] [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: 10/21/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The true incidence of sudden death remains undetermined, with controversial results from various publications over time and countries. AIM To investigate if different estimations would reach the values usually reported for France. METHODS Three different kinds of estimations were used. First, the number of resuscitated sudden deaths and necropsies for sudden death in the Haute-Garonne French administrative department (i.e. county) over the last 10years was expanded to the national level. Second, sudden death coding of death certificates was collected at the national level. Third, the total number of out-of-hospital cardiac arrests leading to any emergency call (with/without intervention) in Haute-Garonne over the last 10years was expanded to the national level. RESULTS There was a mean of 26 resuscitated sudden deaths and 145 necropsies for sudden death each year in Haute-Garonne, i.e. 12 to 14 sudden deaths for 100,000 inhabitants, and 7700 to 9400 sudden deaths yearly when related to the whole French population, according to the year of inclusion. Based on death certificates, a mean of 6584 sudden deaths was registered each year in France. Finally, there were about 600 yearly calls/interventions for out-of-hospital cardiac arrests in Haute-Garonne, i.e. 40 to 50 sudden deaths for 100,000 inhabitants, and 16,000 to 27,000 sudden deaths yearly for the whole French territory, according to the year of inclusion. CONCLUSIONS The incidence of sudden death ranges from 6500 to 27,000 in France according to the calculation methods. This huge difference raises the question of the true current incidence of sudden death, which may have been overestimated previously or may be underestimated in France. More straight prospective surveys are needed to solve this question, because of relevant implications for priorities that should be given to sudden death.
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Affiliation(s)
- Nathan Marimpouy
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | | | - Jean Ferrières
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France; Department of Epidemiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Frederic Balen
- Department of Emergency Medicine, University Hospital Rangueil, 31059 Toulouse, France
| | - Anthony Ramirez
- Department of médecine légale, University Hospital Rangueil, 31059 Toulouse, France
| | - Clement Delmas
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Caroline Biendel
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Miloud Cherbi
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Deborah Foltran
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Vanina Bongard
- Department of Epidemiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Vincent Minville
- Department of Emergency Medicine, University Hospital Rangueil, 31059 Toulouse, France
| | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France; I2MC, Inserm UMR 1297, 31432 Toulouse, France.
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8
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Zaher W, Della Rocca DG, Pannone L, Boveda S, de Asmundis C, Chierchia GB, Sorgente A. Anti-Arrhythmic Effects of Heart Failure Guideline-Directed Medical Therapy and Their Role in the Prevention of Sudden Cardiac Death: From Beta-Blockers to Sodium-Glucose Cotransporter 2 Inhibitors and Beyond. J Clin Med 2024; 13:1316. [PMID: 38592135 PMCID: PMC10931968 DOI: 10.3390/jcm13051316] [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: 01/10/2024] [Revised: 02/14/2024] [Accepted: 02/21/2024] [Indexed: 04/10/2024] Open
Abstract
Sudden cardiac death (SCD) accounts for a substantial proportion of mortality in heart failure with reduced ejection fraction (HFrEF), frequently triggered by ventricular arrhythmias (VA). This review aims to analyze the pathophysiological mechanisms underlying VA and SCD in HFrEF and evaluate the effectiveness of guideline-directed medical therapy (GDMT) in reducing SCD. Beta-blockers, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists have shown significant efficacy in reducing SCD risk. While angiotensin-converting enzyme inhibitors and angiotensin receptor blockers exert beneficial impacts on the renin-angiotensin-aldosterone system, their direct role in SCD prevention remains less clear. Emerging treatments like sodium-glucose cotransporter 2 inhibitors show promise but necessitate further research for conclusive evidence. The favorable outcomes of those molecules on VA are notably attributable to sympathetic nervous system modulation, structural remodeling attenuation, and ion channel stabilization. A multidimensional pharmacological approach targeting those pathophysiological mechanisms offers a complete and synergy approach to reducing SCD risk, thereby highlighting the importance of optimizing GDMT for HFrEF. The current landscape of HFrEF pharmacotherapy is evolving, with ongoing research needed to clarify the full extent of the anti-arrhythmic benefits offered by both existing and new treatments.
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Affiliation(s)
- Wael Zaher
- Department of Cardiology, Centre Hospitalier EpiCURA, Route de Mons 63, 7301 Hornu, Belgium;
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Serge Boveda
- Heart Rhythm Management Department, Clinique Pasteur, 31076 Toulouse, France;
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
| | - Antonio Sorgente
- Department of Cardiology, Centre Hospitalier EpiCURA, Route de Mons 63, 7301 Hornu, Belgium;
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklan 101, Jette, 1090 Brussels, Belgium; (D.G.D.R.); (L.P.); (C.d.A.); (G.-B.C.)
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9
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Choi HM, Hwang IC, Choi HJ, Yoon YE, Lee HJ, Park JB, Lee SP, Kim HK, Kim YJ, Cho GY. Irreversible myocardial injury attenuates the benefits of sacubitril/valsartan in heart failure patients. Int J Cardiol 2024; 397:131611. [PMID: 38030041 DOI: 10.1016/j.ijcard.2023.131611] [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: 07/20/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Despite the established benefits of angiotensin receptor-neprilysin inhibitor (ARNI) in heart failure with reduced ejection fraction (HFrEF) across various etiologies, there are controversies regarding the effects of ARNI in patients with irreversible myocardial injury. The aim of this study is to investigate the impact of irreversible myocardial injury on the benefits of ARNI treatment in patients with HFrEF, consisted of both ischemic and non-ischemic etiologies. METHODS AND RESULTS We conducted a retrospective single-center study including 409 consecutive patients with HFrEF treated with ARNI between March 2017 and May 2020. Irreversible myocardial injury was defined as nonviable myocardium without contractile reserve, which suggests a limited potential for recovery of left ventricular function and geometry. At baseline, irreversible myocardial injury was observed in 129 (31.5%) patients. Composite outcome was cardiovascular death or hospitalization for heart failure, which occurred in 56 (43.4%) and 61 (21.8%) patients with and without irreversible myocardial injury, respectively. On multivariable analysis, irreversible injury presence, but not ischemic etiology, was an independent predictor of composite outcome (hazard ratio 2.16, 95% confidence interval 1.33-3.49). Mediation analysis revealed that the increased risk of the composite outcome due to irreversible myocardial injury was mediated by attenuated LV reverse remodeling (Z value = 2.02, P = 0.043). CONCLUSIONS The presence of irreversible myocardial injury was significantly associated with the response to ARNI treatment in patients with HFrEF, regardless of etiology.
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Affiliation(s)
- Hong-Mi Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea.
| | - Hye Jung Choi
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyun-Jung Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Republic of Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, 82 Gumi-ro-173-gil, Bundang, Seongnam, Gyeonggi 13620, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, 103 Daehak-ro Jongno-gu, Seoul 03080, Republic of Korea
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10
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van Weperen VYH, Hoang JD, Jani NR, Khaky A, Herring N, Smith C, Vaseghi M. Circulating noradrenaline leads to release of neuropeptide Y from cardiac sympathetic nerve terminals via activation of β-adrenergic receptors. J Physiol 2024. [PMID: 38352977 DOI: 10.1113/jp285945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/25/2024] [Indexed: 03/03/2024] Open
Abstract
Cardiac disease is marked by sympathoexcitation and elevated levels of noradrenaline (NA) and cotransmitter neuropeptide Y (NPY). Increased NPY levels are associated with a greater risk of ventricular arrhythmias and mortality. Nonetheless, the factors that cause NPY release remain poorly understood. We hypothesized that circulating catecholamines might lead to NPY release from myocardial sympathetic nerve terminals via a β-receptor-mediated mechanism that enhances sympathoexcitation. Ventricular interstitial NA and NPY levels were measured in six Yorkshire pigs after i.v. administration of NA (1 mg) and before and after propranolol infusion (1 mg/kg). Real-time interstitial NPY levels were measured using ventricular capacitive immunoprobes (CIs) affixed with NPY antibodies and quantified as the change in CI input current (INPY ) upon binding of NPY. Interstitial NA was measured with adjacent fast-scan cyclic voltammetry probes (INA ). A left ventricular pressure catheter and continuous ECGs were used for haemodynamic recordings, and an epicardial 56-electrode sock was used for measurements of activation recovery interval, a surrogate of action potential duration. Upon administration of NA, heart rate and left ventricular pressure increased, and activation recovery interval shortened. Notably, NA significantly increased interstitial myocardial NPY levels. After propranolol, changes in heart rate and activation recovery interval were largely mitigated. The INA increased to a similar extent post-propranolol vs. pre-propranolol, but changes in INPY were significantly reduced post-propranolol. Coronary sinus plasma analyses confirmed fast-scan cyclic voltammetry and CI findings. Hence, this study demonstrates that circulating NA induces NPY release from ventricular sympathetic nerve terminals, the mechanism for which is mediated via β-adrenergic receptors and can be blocked by the non-selective β-blocker, propranolol. KEY POINTS: Cardiovascular disease is characterized by sympathovagal imbalance, with increased plasma noradrenaline (NA) and neuropeptide Y (NPY) concentrations. Increased NPY levels are associated with increased ventricular arrhythmias and mortality in heart failure. Limited data are available on the specific factors that cause NPY release. In this study, fast-scan cyclic voltammetry and capacitive immunoprobes were used to allow for real-time in vivo measurements of interstitial myocardial neurotransmitters and neuropeptides, respectively. Using an in vivo porcine model with cardiac fast-scan cyclic voltammetry and capacitive immunoprobes, it was shown that systemic NA can increase ventricular interstitial NPY levels, suggesting that NA induces NPY release from postganglionic sympathetic nerves. The release of NPY was blocked by administration of the non-selective β-blocker propranolol, suggesting that release of NPY is dependent on activation of β-adrenergic receptors by NA.
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Affiliation(s)
- Valerie Y H van Weperen
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, CA, USA
- Neurocardiology Research Center of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jonathan D Hoang
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, CA, USA
- Neurocardiology Research Center of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
| | - Neil R Jani
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, CA, USA
- Neurocardiology Research Center of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
| | - Artin Khaky
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, CA, USA
- Neurocardiology Research Center of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
| | - Neil Herring
- Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK
| | - Corey Smith
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH, USA
| | - Marmar Vaseghi
- University of California, Los Angeles Cardiac Arrhythmia Center, Los Angeles, CA, USA
- Neurocardiology Research Center of Excellence, University of California, Los Angeles, Los Angeles, CA, USA
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11
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Iellamo F. Acute responses and chronic adaptations to exercise in humans: a look from the autonomic nervous system window. J Sports Med Phys Fitness 2024; 64:137-150. [PMID: 37791830 DOI: 10.23736/s0022-4707.23.15353-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
The objective of this review was to give an overview on the current knowledge on the neural mechanisms of cardiovascular regulation during acute exercise and the autonomic adaptations brought about by chronic exercise, that is, exercise training. Evidence derived mainly from human studies, which supports the contribution of the different control mechanisms, namely the centralcommand, the reflex drive from active muscles and the arterial baroreflex, with the attendant modifications in autonomic nervous system activity, in determining the acute cardiovascular responses to exercise are discussed, along with some controversial issues and evolving concepts in exercise physiology. In particular, data that show how the various neural mechanisms involved in cardiovascular regulation during exercise are differently modulated by factors related to the muscular activity being performed, such as the type and intensity of exercise and the size of the active muscle masses are presented, stressing the plasticity of the neural network. Thereafter, the clinical implications pertaining neural cardiovascular adaptations to exercise training are presented and discussed, in the context of cardiac diseases. In particular, I will summarize a series of investigations performed in our laboratory that utilized a new training methodology and different exercise formats to quantify the training load in cardiac patients. The way by which individualized exercise training doses affects the autonomic nervous system and the cardiorespiratory adaptations is highlighted.
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Affiliation(s)
- Ferdinando Iellamo
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy -
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12
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Hermida A, Ader F, Millat G, Jedraszak G, Maury P, Cador R, Catalan PA, Clerici G, Combes N, De Groote P, Dupin-Deguine D, Eschalier R, Faivre L, Garcia P, Guillon B, Janin A, Kugener B, Lackmy M, Laredo M, Le Guillou X, Lesaffre F, Lucron H, Milhem A, Nadeau G, Nguyen K, Palmyre A, Perdreau E, Picard F, Rebotier N, Richard P, Rooryck C, Seitz J, Verloes A, Vernier A, Winum P, Yabeta GAD, Bouchot O, Chevalier P, Charron P, Gandjbakhch E. NEXN Gene in Cardiomyopathies and Sudden Cardiac Deaths: Prevalence, Phenotypic Expression, and Prognosis. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004285. [PMID: 38059363 DOI: 10.1161/circgen.123.004285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/05/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Few clinical data are available on NEXN mutation carriers, and the gene's involvement in cardiomyopathies or sudden death has not been fully established. Our objectives were to assess the prevalence of putative pathogenic variants in NEXN and to describe the phenotype and prognosis of patients carrying the variants. METHODS DNA samples from consecutive patients with cardiomyopathy or sudden cardiac death/sudden infant death syndrome/idiopathic ventricular fibrillation were sequenced with a custom panel of genes. Index cases carrying at least one putative pathogenic variant in the NEXN gene were selected. RESULTS Of the 9516 index patients sequenced, 31 were carriers of a putative pathogenic variant in NEXN only, including 2 with double variants and 29 with a single variant. Of the 29 unrelated probands with a single variant (16 males; median age at diagnosis, 32.0 [26.0-49.0] years), 21 presented with dilated cardiomyopathy (prevalence, 0.33%), and 3 presented with hypertrophic cardiomyopathy (prevalence, 0.14%). Three patients had idiopathic ventricular fibrillation, and there were 2 cases of sudden infant death syndrome (prevalence, 0.46%). For patients with dilated cardiomyopathy, the median left ventricle ejection fraction was 37.5% (26.25-50.0) at diagnosis and improved with treatment in 13 (61.9%). Over a median follow-up period of 6.0 years, we recorded 3 severe arrhythmic events and 2 severe hemodynamic events. CONCLUSIONS Putative pathogenic NEXN variants were mainly associated with dilated cardiomyopathy; in these individuals, the prognosis appeared to be relatively good. However, severe and early onset phenotypes were also observed-especially in patients with double NEXN variants. We also detected NEXN variants in patients with hypertrophic cardiomyopathy and sudden infant death syndrome/idiopathic ventricular fibrillation, although a causal link could not be established.
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Affiliation(s)
- Alexis Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service (A.H.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
| | - Flavie Ader
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Université Paris Cité (F.A.)
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | - Gilles Millat
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | - Guillaume Jedraszak
- Molecular Genetics Laboratory (G.J.), Amiens-Picardie University Hospital
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens (A.H., G.J.)
| | | | - Romain Cador
- Service de Cardiologie, Hôpital Saint Joseph, Paris (R.C.)
| | | | - Gaël Clerici
- Service de Cardiologie, Centre hospitalier universitaire, Saint Pierre, La Réunion (G.C.)
| | - Nicolas Combes
- Service de Cardiologie, Clinique Pasteur, Toulouse (N.C.)
| | - Pascal De Groote
- France CHU Lille, Service de Cardiologie & Inserm U1167, Institut Pasteur de Lille (P.D.G.)
| | | | | | | | - Patricia Garcia
- Unité Mort Inattendue du Nourrisson, Hôpital de la Conception, APHM, Marseille (P.G.)
| | | | - Alexandre Janin
- Service de Génétique Moléculaire, Hospices Civils de Lyon (G.M., A.J.)
| | | | - Marylin Lackmy
- Unité de Génétique Clinique, CHU de Guadeloupe, Pointe à Pitre (M. Lackmy)
| | - Mikael Laredo
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | | | - Hugues Lucron
- Service de Cardiologie pédiatrique, CHU Martinique, Fort-de-France (H.L.)
| | | | - Gwenaël Nadeau
- Service de génétique clinique CH Métropole Savoie, Chambéry (G.N.)
| | | | - Aurélien Palmyre
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Elodie Perdreau
- Département médico chirurgical de cardiologie pédiatrique (E.P.), Hôpital Louis Pradel, HCL, Lyon
| | - François Picard
- Service de Cardiologie, Hôpital Cardiologique Haut Leveque, Bordeaux (F.P.)
| | | | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP-Sorbonne Université, Pitié-Salpêtrière -Charles Foix (F.A., P.R.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
| | | | - Julien Seitz
- Service de Cardiologie, Hôpital Saint Joseph, Marseille (J.S.)
| | - Alain Verloes
- Departement de génétique, Hôpital Robert Debré, APHP (A. Verloes)
| | | | | | - Grace-A-Dieu Yabeta
- Service de Cardiologie, CH Ouest Guyane, Saint-Laurent-du-Maroni (G.-A.-D.Y.)
| | - Océane Bouchot
- Service de Cardiologie, CH Annecy Genevois, Annecy, France (O.B.)
| | | | - Philippe Charron
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
- APHP, Ambroise Paré Hospital, Department of Genetics and Referral center for cardiac hereditary cardiac diseases, Boulogne-Billancourt (A.P., P. Charron)
| | - Estelle Gandjbakhch
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition (A.H., M. Laredo, P. Charron, E.G.)
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital (A.H., P. Charron, E.G.)
- Sorbonne Université, INSERM 1166, Paris (F.A., M. Laredo, P.R., P. Charron, E.G.)
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13
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Cianci V, Forzese E, Sapienza D, Cardia L, Cianci A, Germanà A, Tornese L, Ieni A, Gualniera P, Asmundo A, Mondello C. Morphological and Genetic Aspects for Post-Mortem Diagnosis of Hypertrophic Cardiomyopathy: A Systematic Review. Int J Mol Sci 2024; 25:1275. [PMID: 38279275 PMCID: PMC10816624 DOI: 10.3390/ijms25021275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is one of the most common genetic cardiovascular diseases, and it shows an autosomal dominant pattern of inheritance. HCM can be clinically silent, and sudden unexpected death due to malignant arrhythmias may be the first manifestation. Thus, the HCM diagnosis could be performed at a clinical and judicial autopsy and offer useful findings on morphological features; moreover, it could integrate the knowledge on the genetic aspect of the disease. This review aims to systematically analyze the literature on the main post-mortem investigations and the related findings of HCM to reach a well-characterized and stringent diagnosis; the review was performed using PubMed and Scopus databases. The articles on the post-mortem evaluation of HCM by gross and microscopic evaluation, imaging, and genetic test were selected; a total of 36 studies were included. HCM was described with a wide range of gross findings, and there were cases without morphological alterations. Myocyte hypertrophy, disarray, fibrosis, and small vessel disease were the main histological findings. The post-mortem genetic tests allowed the diagnosis to be reached in cases without morpho-structural abnormalities; clinical and forensic pathologists have a pivotal role in HCM diagnosis; they contribute to a better definition of the disease and also provide data on the genotype-phenotype correlation, which is useful for clinical research.
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Affiliation(s)
- Vincenzo Cianci
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Elena Forzese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Daniela Sapienza
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Luigi Cardia
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Via C. Valeria 1, 98125 Messina, Italy; (L.C.); (A.I.)
| | - Alessio Cianci
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy;
| | - Antonino Germanà
- Zebrafish Neuromorphology Laboratory, Department of Veterinary Sciences, University of Messina, Via Palatucci snc, 98168 Messina, Italy;
| | - Lorenzo Tornese
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Antonio Ieni
- Department of Human Pathology of Adult and Childhood “Gaetano Barresi”, University of Messina, Via C. Valeria 1, 98125 Messina, Italy; (L.C.); (A.I.)
| | - Patrizia Gualniera
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Alessio Asmundo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
| | - Cristina Mondello
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Via Consolare Valeria 1, 98125 Messina, Italy; (V.C.); (E.F.); (D.S.); (L.T.); (P.G.)
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14
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Ata F. Atrioventricular block in patients with hyperthyroidism: a narrative review. J Int Med Res 2024; 52:3000605231223040. [PMID: 38206211 PMCID: PMC10785734 DOI: 10.1177/03000605231223040] [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: 07/20/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Atrioventricular block (AVB) is a rare cardiac manifestation of hyperthyroidism (HTH). The scientific literature contains multiple reports of AVB in patients with HTH, ranging from subclinical to overt HTH and even thyroid storm. However, much remains unknown about the true prevalence, clinical course, optimal management, and outcomes of AVB in patients with HTH. Such patients are possibly overtreated with pacemakers because of a lack of understanding that AVB might be secondary to the hyperthyroid state and thus reversible. This narrative review discusses the pathophysiology of AVB in patients with HTH in the context of the available evidence.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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15
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Giovachini L, Laghlam D, Geri G, Picard F, Varenne O, Marijon E, Dumas F, Cariou A. Prolonged follow-up after apparently unexplained sudden cardiac arrest: A retrospective study. Resuscitation 2024; 194:110095. [PMID: 38103858 DOI: 10.1016/j.resuscitation.2023.110095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND We hypothesized that a prolonged follow-up of survivors of unexplained sudden cardiac arrest (USCA) would subsequently unmask electrical heart disorders in a significant proportion of cases. PATIENTS AND METHODS We retrospectively analyzed all out-of-hospital cardiac arrest (OHCA) admitted alive in our cardiac arrest center over 20-years (2002-2022). The diagnosis of USCA was made when no etiology was found after thorough initial hospital investigations. We identified all the new diagnoses established during follow-up, and compared outcomes according to underlying heart diseases. RESULTS Out of the 2482 OHCA patients, 68 (2.7%) were initially classified as USCA and 30 (1.2%) with electrical heart disorders. Compared to other cardiac etiologies of OHCA, both USCA and electrical heart disorders patients were younger (mean age 48.5 and 43.5 year-old respectively, versus 62.5 year-old; p < 0.0001), with a higher rate of family history of SCA (17.6 and 23.3% respectively versus 9.2%; p = 0.003). Six patients in each group were lost to follow-up at discharge (6/68, 8.8% in the USCA group, 6/30 20% in the electrical heart disorders group). During a mean follow-up of 8.1 ± 6.3 years, a diagnosis was eventually established in 24.3% of USCA patients (9/35), most of them as electrical heart disorders (55.6%, 5/9). No post-discharge death occurred in both USCA and electrical heart disorders groups, with approximately 10% of appropriate therapy delivered by the implantable cardioverter defibrillator. CONCLUSION Our findings emphasized that approximately a quarter of patients who had been initially considered as having apparently USCA after index hospital stay actually reveal heart conditions, especially electrical heart disorders.
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Affiliation(s)
- Louis Giovachini
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France.
| | - Driss Laghlam
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Guillaume Geri
- Department of Cardiology and Critical Care, CMC Ambroise Paré-Hartmann, 48 Ter Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Fabien Picard
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Olivier Varenne
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Eloi Marijon
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France; Cardiology, European Georges Pompidou Hospital, AP-HP Centre Université Paris Cité, Paris, France
| | - Florence Dumas
- Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France
| | - Alain Cariou
- Medical Intensive Care Unit, Cochin Hospital, AP-HP Centre Université Paris Cité, Paris, France; Université Paris Cité, Faculté de Santé, UFR de Médecine, Paris, France
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16
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Kolk MZH, Ruipérez-Campillo S, Alvarez-Florez L, Deb B, Bekkers EJ, Allaart CP, Van Der Lingen ALCJ, Clopton P, Išgum I, Wilde AAM, Knops RE, Narayan SM, Tjong FVY. Dynamic prediction of malignant ventricular arrhythmias using neural networks in patients with an implantable cardioverter-defibrillator. EBioMedicine 2024; 99:104937. [PMID: 38118401 PMCID: PMC10772563 DOI: 10.1016/j.ebiom.2023.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Risk stratification for ventricular arrhythmias currently relies on static measurements that fail to adequately capture dynamic interactions between arrhythmic substrate and triggers over time. We trained and internally validated a dynamic machine learning (ML) model and neural network that extracted features from longitudinally collected electrocardiograms (ECG), and used these to predict the risk of malignant ventricular arrhythmias. METHODS A multicentre study in patients implanted with an implantable cardioverter-defibrillator (ICD) between 2007 and 2021 in two academic hospitals was performed. Variational autoencoders (VAEs), which combine neural networks with variational inference principles, and can learn patterns and structure in data without explicit labelling, were trained to encode the mean ECG waveforms from the limb leads into 16 variables. Supervised dynamic ML models using these latent ECG representations and clinical baseline information were trained to predict malignant ventricular arrhythmias treated by the ICD. Model performance was evaluated on a hold-out set, using time-dependent receiver operating characteristic (ROC) and calibration curves. FINDINGS 2942 patients (61.7 ± 13.9 years, 25.5% female) were included, with a total of 32,129 ECG recordings during a mean follow-up of 43.9 ± 35.9 months. The mean time-varying area under the ROC curve for the dynamic model was 0.738 ± 0.07, compared to 0.639 ± 0.03 for a static (i.e. baseline-only model). Feature analyses indicated dynamic changes in latent ECG representations, particularly those affecting the T-wave morphology, were of highest importance for model predictions. INTERPRETATION Dynamic ML models and neural networks effectively leverage routinely collected longitudinal ECG recordings for personalised and updated predictions of malignant ventricular arrhythmias, outperforming static models. FUNDING This publication is part of the project DEEP RISK ICD (with project number 452019308) of the research programme Rubicon which is (partly) financed by the Dutch Research Council (NWO). This research is partly funded by the Amsterdam Cardiovascular Sciences (personal grant F.V.Y.T).
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Affiliation(s)
- Maarten Z H Kolk
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Samuel Ruipérez-Campillo
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology Zurich (ETHz), Gloriastrasse 35, Zurich, Switzerland; ITACA Institute, Universtitat Politècnica de València, Camino de Vera S/n, Valencia, Spain
| | - Laura Alvarez-Florez
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Brototo Deb
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Erik J Bekkers
- Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Location VU Medical Center, De Boelelaan 1118, Amsterdam, the Netherlands
| | | | - Paul Clopton
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Sanjiv M Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fleur V Y Tjong
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands.
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17
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Bostani A, Mirzaeibonehkhater M, Najafi H, Mehrtash M, Alizadehsani R, Tan RS, Acharya UR. MLP-RL-CRD: diagnosis of cardiovascular risk in athletes using a reinforcement learning-based multilayer perceptron. Physiol Meas 2023; 44:125012. [PMID: 38081126 DOI: 10.1088/1361-6579/ad1459] [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: 06/29/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Abstract
Objective.Pre-participation medical screening of athletes is necessary to pinpoint individuals susceptible to cardiovascular events.Approach.The article presents a reinforcement learning (RL)-based multilayer perceptron, termed MLP-RL-CRD, designed to detect cardiovascular risk among athletes. The model underwent training using a publicized dataset that included the anthropological measurements (such as height and weight) and biomedical metrics (covering blood pressure and pulse rate) of 26 002 athletes. To address the data imbalance, a novel RL-based technique was adopted. The problem was framed as a series of sequential decisions in which an agent classified a received instance and received a reward at each level. To resolve the insensitivity to the initialization of conventional gradient-based learning methods, a mutual learning-based artificial bee colony (ML-ABC) was proposed.Main Results.The model outcomes were validated against positive (P) and negative (N) ECG findings that had been labeled by experts to signify individuals 'at risk' and 'not at risk,' respectively. The MLP-RL-CRD approach achieves superior outcomes (F-measure 87.4%; geometric mean 89.6%) compared with other deep models and traditional machine learning techniques. Optimal values for crucial parameters, including the reward function, were identified for the model based on experiments on the study dataset. Ablation studies, which omitted elements of the suggested model, affirmed the autonomous, positive, stepwise influence of these components on performing the model.Significance.This study introduces a novel, effective method for early cardiovascular risk detection in athletes, merging reinforcement learning and multilayer perceptrons, advancing medical screening and predictive healthcare. The results could have far-reaching implications for athlete health management and the broader field of predictive healthcare analytics.
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Affiliation(s)
- Arsam Bostani
- Department of exercise physiology & health science, university of tehran, Iran
| | - Marzieh Mirzaeibonehkhater
- Electrical and Computer Engineering Indiana University-Purdue University Indianapolis, United States of America
| | - Hamidreza Najafi
- Biomedical Engineering Department, School of Electrical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Mohammad Mehrtash
- Faculty of Physical Education and Sport Science, Shahid Bahonar University, Kerman, Iran
| | - Roohallah Alizadehsani
- Institute for Intelligent Systems Research and Innovation (IISRI) Deakin University, Waurn Ponds, Australia
| | | | - U Rajendra Acharya
- School of Mathematics, Physics and Computing, University of Southern Queensland, Springfield, Australia
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18
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Hakami KM, Alhazmi AH, Zaalah S, Shubayli S, Darraj H, Hamdi S, Alfaifi S, Sayed AI, Hakami A, Oraibi O, Alhazmi L. The Impact of Heart Attack and Sudden Cardiac Death Risk Perception on Lifestyle Modification Intention Among Adults in Jazan Province. Patient Prefer Adherence 2023; 17:3353-3365. [PMID: 38106367 PMCID: PMC10725636 DOI: 10.2147/ppa.s427202] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/14/2023] [Indexed: 12/19/2023] Open
Abstract
Purpose This study aimed to assess the perception of sudden cardiac death (SCD) and heart attack risk and its influence on the intention to adopt healthy lifestyle behaviors among the general population in Jazan province, Saudi Arabia. SCD refers to an abrupt and unexpected loss of heart function resulting in death, and its incidence has been alarmingly increasing worldwide. Several factors, including smoking, hypertension, diabetes, obesity, and specific medications, have been associated with an elevated risk of SCD. Methods A descriptive cross-sectional study was conducted using a pretested questionnaire distributed among the general population in Jazan province. Descriptive statistics, chi-square, and t-tests were employed for data analysis. Results The study included 974 participants with a mean age of 27.90 ± 9.32 years, of whom 56% were female. More than half of the participants perceived themselves as highly susceptible to SCD, and all participants demonstrated a moderate willingness and readiness to modify their unhealthy lifestyle behaviors. Age, gender, marital status, body mass index (BMI), history of hypertension, dyslipidemia, medication use, physical exercise, and family history of chronic diseases and SCD were statistically associated with the perception of SCD. Conclusion The study revealed a high-risk perception and a moderate readiness to adopt lifestyle modifications. These findings can inform the development of effective strategies and support programs aimed at reducing the burden of SCD.
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Affiliation(s)
- Khalid M Hakami
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | | | - Shaden Zaalah
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Sahar Shubayli
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Hussam Darraj
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Sulaiman Hamdi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Samar Alfaifi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Ahmed I Sayed
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | | | - Omar Oraibi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
| | - Luai Alhazmi
- Faculty of Medicine, Jazan University, Jazan, 45142, Saudi Arabia
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19
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Prana Jagannatha GN, Antara IMPS, Kosasih AM, de Liyis BG, Labi NPT, Aji WC, Deantri F, Wibawa IMBC, Wibawa IBS, Adrian J. Future direction of substrate-based catheter ablation in Brugada syndrome and other inherited primary arrhythmia syndromes: Systematic review and meta-analysis. J Arrhythm 2023; 39:909-927. [PMID: 38045449 PMCID: PMC10692854 DOI: 10.1002/joa3.12947] [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: 06/22/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Inherited Primary Arrhythmias Syndromes (IPAS), especially Brugada syndrome (BrS), have been associated with arrhythmogenic substrates that can be targeted through ablation. This meta-analysis evaluated the outcomes of catheter ablation (CA) in different types of IPAS based on procedural guidance and location. Methods A systematic search was conducted across multiple databases to identify studies reporting on ventricular arrhythmia (VA) events before and after CA in IPAS, including BrS, Long-QT syndrome (LQTS), Early repolarization syndrome (ERS), and Idiopathic ventricular fibrillation (IVF). The primary outcomes were VA recurrence and VA burden, evaluated through conditional subgroup analysis. Procedural data were collected as secondary outcomes. Results A total of 21 studies involving 584 IPAS patients who underwent CA were included. Following a mean follow-up duration of 33.5 months, substrate-based ablation demonstrated efficacy in reducing VA recurrence across all types of IPAS [RR 0.23; 95% CI (0.13-0.39); p < .001; I 2 = 74%]. However, activation guidance ablation was found to be effective only in IVF cases. Although recurrences still occurred, CA was successful in reducing VA burden [MD -4.70; 95% CI (-6.11-(-3.29); p < .001; I 2 = 74%]. The mean size of arrhythmogenic substrate was 15.70 cm2 [95% CI (12.34-19.99 cm2)], predominantly distributed in the epicardial right ventricular outflow tract (RVOT) in BrS cases and LQTS [Proportion 0.99; 95% CI (0.96-1.00) and Proportion 0.82; 95% CI ( 0.59-1.00), respectively]. Conclusion Substrate-based CA has demonstrated effective prevention of VA and reduction in VA burden in IPAS cases.
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Affiliation(s)
| | - I Made Putra Swi Antara
- Division of Electrophysiology and Cardiac PacingDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Udayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Anastasya Maria Kosasih
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Bryan Gervais de Liyis
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | | | - Wingga Chrisna Aji
- Faculty of MedicineMuhammadiyah Yogyakarta UniversityYogyakartaIndonesia
| | - Fanny Deantri
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - I Made Bagus Cahya Wibawa
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Ida Bagus Satriya Wibawa
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
| | - Jonathan Adrian
- Faculty of MedicineUdayana University/Prof. dr. I.G.N.G Ngoerah General HospitalDenpasarBaliIndonesia
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20
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Borchert W, Grady ST, Chen J, DeVille NV, Roscoe C, Chen F, Mita C, Holland I, Wilt GE, Hu CR, Mehta U, Nethery RC, Albert CM, Laden F, Hart JE. Air Pollution and Temperature: a Systematic Review of Ubiquitous Environmental Exposures and Sudden Cardiac Death. Curr Environ Health Rep 2023; 10:490-500. [PMID: 37845484 PMCID: PMC11016309 DOI: 10.1007/s40572-023-00414-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Environmental exposures have been associated with increased risk of cardiovascular mortality and acute coronary events, but their relationship with out-of-hospital cardiac arrest (OHCA) and sudden cardiac death (SCD) remains unclear. SCD is an important contributor to the global burden of cardiovascular disease worldwide. RECENT FINDINGS Current literature suggests a relationship between environmental exposures and cardiovascular disease, but their relationship with OHCA/SCD remains unclear. A literature search was conducted in PubMed, Embase, Web of Science, and Global Health. Of 5138 studies identified by our literature search, this review included 30 studies on air pollution, 42 studies on temperature, 6 studies on both air pollution and temperature, and 1 study on altitude exposure and OHCA/SCD. Particulate matter air pollution, ozone, and both hot and cold temperatures are associated with increased risk of OHCA/SCD. Pollution and other exposures related to climate change play an important role in OHCA/SCD incidence.
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Affiliation(s)
- William Borchert
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA.
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA.
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Stephanie T Grady
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Jie Chen
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Nicole V DeVille
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Charlotte Roscoe
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Futu Chen
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
| | - Carol Mita
- Countway Library, Harvard Medical School, Boston, MA, USA
| | - Isabel Holland
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Grete E Wilt
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Cindy R Hu
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Unnati Mehta
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Harvard Kenneth C. Griffin Graduate School of Arts and Sciences, Cambridge, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Rachel C Nethery
- Department of Biostatistics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
- Division of Preventative Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Francine Laden
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
| | - Jaime E Hart
- Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1301, Boston, MA, 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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21
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Suna G, Mellor GJ. Explaining the Unexplained: A Practical Approach to Investigating the Cardiac Arrest Survivor. Arrhythm Electrophysiol Rev 2023; 12:e27. [PMID: 38124802 PMCID: PMC10731537 DOI: 10.15420/aer.2023.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common cause of death. The majority of SCA is caused by ventricular arrhythmia due to underlying CHD. Aborted SCA with no apparent diagnosis after initial assessment with ECG, echocardiography and coronary assessment is referred to as unexplained cardiac arrest (UCA). Systematic evaluation of such patients may reveal a specific diagnosis in up to half of patients before a diagnosis of idiopathic VF is assigned. Specific diagnoses include inherited cardiac conditions, such as latent cardiomyopathies or inherited primary electrical disease. Identifying the cause of UCA is therefore not only critical for appropriate management of the SCA survivors to prevent recurrence, but also for their family members who may be at risk of the same condition. This review provides a tiered, systematic approach for the investigation of UCA.
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Affiliation(s)
- Gonca Suna
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Greg J Mellor
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
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22
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Jeong JH, Kim YG, Oh SK, Lee HS, Choi YY, Min K, Shim J, Park YM, Kim JH, Oh YS, Kim NH, Pak HN, On YK, Park HW, Hwang GS, Kim DK, Park YA, Park HS, Cho Y, Oh S, Choi JI, Kim YH. Identification of concealed cardiomyopathy using next-generation sequencing-based genetic testing in Korean patients initially diagnosed with idiopathic ventricular fibrillation. Europace 2023; 25:euad313. [PMID: 37949661 PMCID: PMC10639093 DOI: 10.1093/europace/euad313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/16/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Idiopathic ventricular fibrillation (IVF) is a disease in which the cause of ventricular fibrillation cannot be identified despite comprehensive clinical evaluation. This study aimed to investigate the clinical yield and implications of genetic testing for IVF. METHODS AND RESULTS This study was based on the multi-centre inherited arrhythmia syndrome registry in South Korea from 2014 to 2017. Next-generation sequencing-based genetic testing was performed that included 174 genes previously linked to cardiovascular disease. A total of 96 patients were clinically diagnosed with IVF. The mean age of the onset was 41.2 ± 12.7 years, and 79 patients were males (82.3%). Of these, 74 underwent genetic testing and four (5.4%) of the IVF probands had pathogenic or likely pathogenic variants (each having one of MYBPC3, MYH7, DSP, and TNNI3). All pathogenic or likely pathogenic variants were located in genes with definite evidence of a cardiomyopathy phenotype, either hypertrophic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. CONCLUSION Next-generation sequencing-based genetic testing identified pathogenic or likely pathogenic variants in 5.4% of patients initially diagnosed with IVF, suggesting that genetic testing with definite evidence genes of cardiomyopathy may enable molecular diagnosis in a minority of patients with IVF. Further clinical evaluation and follow-up of patients with IVF with positive genotypes are needed to unveil concealed phenotypes, such as the pre-clinical phase of cardiomyopathy.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Incheon Sejong General Hospital, Incheon, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Yae Min Park
- Department of Internal Medicine, Gachon University Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
| | - Yong-Seog Oh
- Department of Internal Medicine, Seoul St.Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nam-Ho Kim
- Department of Internal Medicine, Wonkwang University Hospital, Wonkwang University School of Medicine, Iksan, Korea
| | - Hui-Nam Pak
- Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Keun On
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung Wook Park
- Department of Cardiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju, Korea
| | - Gyo-Seung Hwang
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Dae-Kyeong Kim
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Young-Ah Park
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyoung-Seob Park
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital and Seoul National University College of Medicine, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, 73, Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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23
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Rohrer CT, Lager AM, Brooks EG, Horner VL. Postmortem genetic testing in sudden unexplained death: A public health laboratory experience. J Forensic Sci 2023; 68:2065-2075. [PMID: 37614113 DOI: 10.1111/1556-4029.15366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
Sudden unexplained death in the young poses a diagnostically challenging situation for practicing autopsy pathologists, especially in the absence of anatomic and toxicological findings. Postmortem genetic testing may identify pathogenic variants in the deceased of such cases, including those associated with arrhythmogenic channelopathies and cardiomyopathies. The Wisconsin State Laboratory of Hygiene (WSLH) is a state-run public health laboratory which performs postmortem genetic testing at no cost to Wisconsin medical examiners and coroners. The current study examines sequencing data from 18 deceased patients (ages 2 months to 49 years, 5 females) submitted to WSLH, from 2016 to 2021. Panel-based analysis was performed on 10 cases, and whole exome sequencing was performed on the most recent 8 cases. Genetic variants were identified in 14 of 18 decedents (77.8%), including 7 with pathogenic or likely pathogenic variants (38.9%). Whole exome sequencing was more likely to yield a positive result, more variants per decedent, and a larger number of variants of uncertain significance. While panel-based testing may offer definitive pathogenic variants in some cases, less frequent variants may be excluded. Whole exome testing may identify rare variants missed by panels, but increased yield of variants of uncertain significance may be difficult to interpret. Postmortem genetic testing in young decedents of sudden unexplained death can provide invaluable information to autopsy pathologists to establish accurate cause and manner of death and to decedent's relatives to allow appropriate management. A public health laboratory model may be a financially advisable alternative to commercial laboratories for medical examiner's/coroner's offices.
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Affiliation(s)
- Charles T Rohrer
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Angela M Lager
- Department of Pathology, University of Chicago, Chicago, Illinois, USA
| | - Erin G Brooks
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Vanessa L Horner
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Wisconsin State Laboratory of Hygiene, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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24
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Razavi AC, Whelton SP, Blumenthal RS, Sperling LS, Blaha MJ, Dzaye O. Coronary artery calcium and sudden cardiac death: current evidence and future directions. Curr Opin Cardiol 2023; 38:509-514. [PMID: 37581228 PMCID: PMC10908356 DOI: 10.1097/hco.0000000000001081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/16/2023]
Abstract
PURPOSE OF REVIEW To provide a summary of the current evidence and highlight future directions regarding coronary artery calcium (CAC) and risk of sudden cardiac death (SCD). RECENT FINDINGS Although up to 80% of all SCD is attributed to coronary heart disease (CHD), the subclinical atherosclerosis markers that help to improve SCD risk prediction are largely unknown. Recent observational data have demonstrated that, after adjustment for traditional risk factors, there is a stepwise higher risk for SCD across increasing CAC burden such that asymptomatic patients without overt atherosclerotic cardiovascular disease (ASCVD) experience a three-fold to five-fold higher SCD risk beginning at CAC at least 100 when compared with CAC = 0. Although the mechanisms underlying increasing CAC and SCD risk have yet to be fully elucidated, risk for myocardial infarction and scar, and/or exercise-induced ischemia may be potential mediators. SUMMARY High CAC burden is an important risk factor for SCD in asymptomatic middle-aged adults, suggesting that SCD risk stratification can begin in the early stages of CHD via measurement of calcific plaque on noncontrast computed tomography. Despite the clinical inertia for downstream functional cardiac testing after detecting high CAC, comprehensive ASCVD prevention strategies should be the primary focus for SCD risk reduction.
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Affiliation(s)
- Alexander C. Razavi
- Emory Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, Georgia
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Seamus P. Whelton
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S. Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Laurence S. Sperling
- Emory Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, Georgia
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Michael J. Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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25
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Junho CVC, Frisch J, Soppert J, Wollenhaupt J, Noels H. Cardiomyopathy in chronic kidney disease: clinical features, biomarkers and the contribution of murine models in understanding pathophysiology. Clin Kidney J 2023; 16:1786-1803. [PMID: 37915935 PMCID: PMC10616472 DOI: 10.1093/ckj/sfad085] [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: 11/21/2022] [Indexed: 11/03/2023] Open
Abstract
The cardiorenal syndrome (CRS) is described as a multi-organ disease encompassing bidirectionally heart and kidney. In CRS type 4, chronic kidney disease (CKD) leads to cardiac injury. Different pathological mechanisms have been identified to contribute to the establishment of CKD-induced cardiomyopathy, including a neurohormonal dysregulation, disturbances in the mineral metabolism and an accumulation of uremic toxins, playing an important role in the development of inflammation and oxidative stress. Combined, this leads to cardiac dysfunction and cardiac pathophysiological and morphological changes, like left ventricular hypertrophy, myocardial fibrosis and cardiac electrical changes. Given that around 80% of dialysis patients suffer from uremic cardiomyopathy, the study of cardiac outcomes in CKD is clinically highly relevant. The present review summarizes clinical features and biomarkers of CKD-induced cardiomyopathy and discusses underlying pathophysiological mechanisms recently uncovered in the literature. It discloses how animal models have contributed to the understanding of pathological kidney-heart crosstalk, but also provides insights into the variability in observed effects of CKD on the heart in different CKD mouse models, covering both "single hit" as well as "multifactorial hit" models. Overall, this review aims to support research progress in the field of CKD-induced cardiomyopathy.
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Affiliation(s)
| | - Janina Frisch
- Department of Biophysics, Center for Integrative Physiology and Molecular Medicine, Medical Faculty, Saarland University, Center for Human and Molecular Biology, Homburg/Saar, Germany
| | - Josefin Soppert
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
- Department of Anesthesiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Julia Wollenhaupt
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
| | - Heidi Noels
- Institute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH Aachen, Aachen, Germany
- Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
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26
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Oh IY. Multicenter Cohort Analysis Unveil Inherited Arrhythmia in Korea. Korean Circ J 2023; 53:708-709. [PMID: 37880831 PMCID: PMC10625853 DOI: 10.4070/kcj.2023.0214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023] Open
Affiliation(s)
- Il-Young Oh
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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27
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Kook Kang J, Kalra A, Ameen Ahmad S, Kumar Menta A, Rando HJ, Chinedozi I, Darby Z, Spann M, Keller SP, J. R. Whitman G, Cho SM. A recommended preclinical extracorporeal cardiopulmonary resuscitation model for neurological outcomes: A scoping review. Resusc Plus 2023; 15:100424. [PMID: 37719942 PMCID: PMC10500026 DOI: 10.1016/j.resplu.2023.100424] [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: 04/28/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 09/19/2023] Open
Abstract
Background Despite the high prevalence of neurological complications and mortality associated with extracorporeal cardiopulmonary resuscitation (ECPR), neurologically-focused animal models are scarce. Our objective is to review current ECPR models investigating neurological outcomes and identify key elements for a recommended model. Methods We searched PubMed and four other engines for animal ECPR studies examining neurological outcomes. Inclusion criteria were: animals experiencing cardiac arrest, ECPR/ECMO interventions, comparisons of short versus long cardiac arrest times, and neurological outcomes. Results Among 20 identified ECPR animal studies (n = 442), 13 pigs, 4 dogs, and 3 rats were used. Only 10% (2/20) included both sexes. Significant heterogeneity was observed in experimental protocols. 90% (18/20) employed peripheral VA-ECMO cannulation and 55% (11/20) were survival models (median survival = 168 hours; ECMO duration = 60 minutes). Ventricular fibrillation (18/20, 90%) was the most common method for inducing cardiac arrest with a median duration of 15 minutes (IQR = 6-20). In two studies, cardiac arrests exceeding 15 minutes led to considerable mortality and neurological impairment. Among seven studies utilizing neuromonitoring tools, only four employed multimodal devices to evaluate cerebral blood flow using Transcranial Doppler ultrasound and near-infrared spectroscopy, brain tissue oxygenation, and intracranial pressure. None examined cerebral autoregulation or neurovascular coupling. Conclusions The substantial heterogeneity in ECPR preclinical model protocols leads to limited reproducibility and multiple challenges. The recommended model includes large animals with both sexes, standardized pre-operative protocols, a cardiac arrest time between 10-15 minutes, use of multimodal methods to evaluate neurological outcomes, and the ability to survive animals after conducting experiments.
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Affiliation(s)
- Jin Kook Kang
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Andrew Kalra
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Syed Ameen Ahmad
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, USA
| | - Arjun Kumar Menta
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Hannah J. Rando
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Ifeanyi Chinedozi
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Zachary Darby
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Marcus Spann
- Informationist Services, Johns Hopkins School of Medicine, Baltimore, USA
| | - Steven P. Keller
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, USA
| | - Glenn J. R. Whitman
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
| | - Sung-Min Cho
- Division of Cardiac Surgery, Department of Surgery, Johns Hopkins Hospital, Baltimore, USA
- Division of Neurosciences Critical Care, Department of Neurology, Neurosurgery, Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, USA
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins Hospital, Baltimore, USA
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28
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Giussani G, Falcicchio G, La Neve A, Costagliola G, Striano P, Scarabello A, Mostacci B, Beghi E. Sudden unexpected death in epilepsy: A critical view of the literature. Epilepsia Open 2023; 8:728-757. [PMID: 36896633 PMCID: PMC10472423 DOI: 10.1002/epi4.12722] [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: 06/17/2022] [Accepted: 03/04/2023] [Indexed: 03/11/2023] Open
Abstract
Sudden unexpected death in epilepsy (SUDEP) is a sudden, unexpected, witnessed or unwitnessed, non-traumatic and non-drowning death, occurring in benign circumstances, in an individual with epilepsy, with or without evidence for a seizure and excluding documented status epilepticus in which postmortem examination does not reveal other causes of death. Lower diagnostic levels are assigned when cases met most or all of these criteria, but data suggested more than one possible cause of death. The incidence of SUDEP ranged from 0.09 to 2.4 per 1000 person-years. Differences can be attributed to the age of the study populations (with peaks in the 20-40-year age group) and the severity of the disease. Young age, disease severity (in particular, a history of generalized TCS), having symptomatic epilepsy, and the response to antiseizure medications (ASMs) are possible independent predictors of SUDEP. The pathophysiological mechanisms are not fully known due to the limited data available and because SUDEP is not always witnessed and has been electrophysiologically monitored only in a few cases with simultaneous assessment of respiratory, cardiac, and brain activity. The pathophysiological basis of SUDEP may vary according to different circumstances that make that particular seizure, in that specific moment and in that patient, a fatal event. The main hypothesized mechanisms, which could contribute to a cascade of events, are cardiac dysfunction (included potential effects of ASMs, genetically determined channelopathies, acquired heart diseases), respiratory dysfunction (included postictal arousal deficit for the respiratory mechanism, acquired respiratory diseases), neuromodulator dysfunction, postictal EEG depression and genetic factors.
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Affiliation(s)
- Giorgia Giussani
- Laboratory of Neurological Disorders, Mario Negri Institute for Pharmacological Research IRCCSMilanItaly
| | - Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of BariBariItaly
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense OrgansUniversity of BariBariItaly
| | | | - Pasquale Striano
- IRCCS Istituto “Giannina Gaslini”GenovaItaly
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child HealthUniversity of GenovaGenovaItaly
| | - Anna Scarabello
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Barbara Mostacci
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Ettore Beghi
- Laboratory of Neurological Disorders, Mario Negri Institute for Pharmacological Research IRCCSMilanItaly
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29
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Danon S. Chest Pain, Palpitations, and Syncope: Preventing Sudden Cardiac Death in Children. Adv Pediatr 2023; 70:171-185. [PMID: 37422295 DOI: 10.1016/j.yapd.2023.04.003] [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: 07/10/2023]
Abstract
Sudden cardiac death is defined as an abrupt, unexpected death of cardiovascular cause with loss of consciousness within 1 hour of onset of symptoms. In an effort to prevent these events, clinicians need to recognize symptoms to identify at risk patients. There is often an overlap in symptoms of chest pain, palpitations, and syncope. The workup depends on the characteristics of these symptoms. The history and physical examination often provide adequate information, but additional testing and referral to pediatric cardiology are sometimes indicated.
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Affiliation(s)
- Saar Danon
- Pediatric Cardiology and Congenital Cardiac Catheterization, Miller Children's and Women's Hospital Long Beach, 2701 Atlantic Avenue, Long Beach, CA 90806, USA; University of California, Irvine, CA, USA.
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30
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Boshen Y, Yuankang Z, Xinjie Z, Taixi L, Kaifan N, Zhixiang W, Juan S, Junli D, Suiji L, Xia L, Chengxing S. Triglyceride-glucose index is associated with the occurrence and prognosis of cardiac arrest: a multicenter retrospective observational study. Cardiovasc Diabetol 2023; 22:190. [PMID: 37501144 PMCID: PMC10375765 DOI: 10.1186/s12933-023-01918-0] [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] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA. METHODS In this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed. RESULTS Overall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72-9.69) vs. 8.89 (8.45-9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03-1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02-1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA. CONCLUSION Elevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.
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Affiliation(s)
- Yang Boshen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yuankang
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Xinjie
- Department of Respiratory Medicine, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Li Taixi
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niu Kaifan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Zhixiang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Juan
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Duan Junli
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Suiji
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China.
| | - Lu Xia
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shen Chengxing
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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31
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Beccacece L, Abondio P, Giorgetti A, Bini C, Pelletti G, Luiselli D, Pelotti S. A Genome-Wide Analysis of a Sudden Cardiac Death Cohort: Identifying Novel Target Variants in the Era of Molecular Autopsy. Genes (Basel) 2023; 14:1265. [PMID: 37372445 DOI: 10.3390/genes14061265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 06/29/2023] Open
Abstract
Sudden cardiac death (SCD) is an unexpected natural death due to cardiac causes, usually happening within one hour of symptom manifestation or in individuals in good health up to 24 h before the event. Genomic screening has been increasingly applied as a useful approach to detecting the genetic variants that potentially contribute to SCD and helping the evaluation of SCD cases in the post-mortem setting. Our aim was to identify the genetic markers associated with SCD, which might enable its target screening and prevention. In this scope, a case-control analysis through the post-mortem genome-wide screening of 30 autopsy cases was performed. We identified a high number of novel genetic variants associated with SCD, of which 25 polymorphisms were consistent with a previous link to cardiovascular diseases. We ascertained that many genes have been already linked to cardiovascular system functioning and diseases and that the metabolisms most implicated in SCD are the lipid, cholesterol, arachidonic acid, and drug metabolisms, suggesting their roles as potential risk factors. Overall, the genetic variants pinpointed herein might be useful markers of SCD, but the novelty of these results requires further investigations.
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Affiliation(s)
- Livia Beccacece
- Computational Genomics Lab, Department of Pharmacy and Biotechnology, University of Bologna, 40126 Bologna, Italy
| | - Paolo Abondio
- aDNA Lab, Department of Cultural Heritage, University of Bologna, Ravenna Campus, 48121 Ravenna, Italy
| | - Arianna Giorgetti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Carla Bini
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Donata Luiselli
- aDNA Lab, Department of Cultural Heritage, University of Bologna, Ravenna Campus, 48121 Ravenna, Italy
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
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32
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Rutledge CA, Lagranha C, Chiba T, Redding K, Stolz DB, Goetzman E, Sims-Lucas S, Kaufman BA. Metformin preconditioning protects against myocardial stunning and preserves protein translation in a mouse model of cardiac arrest. JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY PLUS 2023; 4:100034. [PMID: 37425219 PMCID: PMC10327679 DOI: 10.1016/j.jmccpl.2023.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Cardiac arrest (CA) causes high mortality due to multi-system organ damage attributable to ischemia-reperfusion injury. Recent work in our group found that among diabetic patients who experienced cardiac arrest, those taking metformin had less evidence of cardiac and renal damage after cardiac arrest when compared to those not taking metformin. Based on these observations, we hypothesized that metformin's protective effects in the heart were mediated by AMPK signaling, and that AMPK signaling could be targeted as a therapeutic strategy following resuscitation from CA. The current study investigates metformin interventions on cardiac and renal outcomes in a non-diabetic CA mouse model. We found that two weeks of metformin pretreatment protects against reduced ejection fraction and reduces kidney ischemia-reperfusion injury at 24 h post-arrest. This cardiac and renal protection depends on AMPK signaling, as demonstrated by outcomes in mice pretreated with the AMPK activator AICAR or metformin plus the AMPK inhibitor compound C. At this 24-h time point, heart gene expression analysis showed that metformin pretreatment caused changes supporting autophagy, antioxidant response, and protein translation. Further investigation found associated improvements in mitochondrial structure and markers of autophagy. Notably, Western analysis indicated that protein synthesis was preserved in arrest hearts of animals pretreated with metformin. The AMPK activation-mediated preservation of protein synthesis was also observed in a hypoxia/reoxygenation cell culture model. Despite the positive impacts of pretreatment in vivo and in vitro, metformin did not preserve ejection fraction when deployed at resuscitation. Taken together, we propose that metformin's in vivo cardiac preservation occurs through AMPK activation, requires adaptation before arrest, and is associated with preserved protein translation.
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Affiliation(s)
- Cody A. Rutledge
- Division of Cardiology, Vascular Medicine Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claudia Lagranha
- Division of Cardiology, Vascular Medicine Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Takuto Chiba
- Rangos Research Center, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School, Pittsburgh, PA, USA
| | - Kevin Redding
- Division of Cardiology, Vascular Medicine Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Donna B. Stolz
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric Goetzman
- Division of Genetic and Genomic Medicine, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sunder Sims-Lucas
- Rangos Research Center, Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Nephrology, Department of Pediatrics, University of Pittsburgh School, Pittsburgh, PA, USA
| | - Brett A. Kaufman
- Division of Cardiology, Vascular Medicine Institute, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Ueda N, Noda T, Kusano K, Yasuda S, Kurita T, Shimizu W. Use of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death in Asia. JACC. ASIA 2023; 3:335-345. [PMID: 37323866 PMCID: PMC10261895 DOI: 10.1016/j.jacasi.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 06/17/2023]
Abstract
The effectiveness of primary prevention implantable cardioverter-defibrillators (ICDs) is well established. However, there are several unsolved problems related to ICD use for primary prevention in Asia, including ICD underuse, population differences in underlying heart disease, and the rate of appropriate ICD therapy compared with Western countries. Although the prevalence of ischemic cardiomyopathy in Asia is lower than in Europe and the United States, the mortality rate of Asian patients with ischemic heart disease has been increasing recently. As for the use of ICDs for primary prevention, there have been no randomized clinical trials, and limited data are available in Asia. This review focuses on the unmet needs related to ICD use for primary prevention in Asia.
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Affiliation(s)
- Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Patel MA, Malhotra A, Mpondo FHM, Gupta V, Jain R, Gupta S, Jain R. Sudden cardiac death in the adolescent population: a narrative review. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2023; 35:36. [PMID: 37220484 PMCID: PMC10195126 DOI: 10.1186/s43162-023-00222-3] [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: 02/19/2023] [Accepted: 05/15/2023] [Indexed: 05/25/2023] Open
Abstract
Background Death from unexpected circulatory arrest within 60 min of onset of symptom is known as sudden cardiac death (SCD). In spite of the advancement in treatment and prevention strategies, SCD remains the most common cause of death worldwide especially in the young. Main body This review focuses on highlighting how different cardiovascular diseases contribute to SCD. We discuss the clinical symptoms that the patient experience prior to sudden cardiac arrest and the treatment strategies including pharmacological and surgical treatment. Conclusions We conclude that since there are many causes of SCD and very few treatment options, prevention strategies, early detection, and resuscitation of those at greatest risk is important.
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Affiliation(s)
- Meet A. Patel
- Tianjin Medical University, Tianjin, People’s Republic of China
| | | | | | - Vasu Gupta
- Dayanad Medical College & Hospital, Ludhiana, India
| | - Rahul Jain
- Avalon University School of Medicine, Willemstad, Curaçao
| | - Sachin Gupta
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA USA
| | - Rohit Jain
- Avalon University School of Medicine, Willemstad, Curaçao
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35
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Neri L, Oberdier MT, van Abeelen KCJ, Menghini L, Tumarkin E, Tripathi H, Jaipalli S, Orro A, Paolocci N, Gallelli I, Dall’Olio M, Beker A, Carrick RT, Borghi C, Halperin HR. Electrocardiogram Monitoring Wearable Devices and Artificial-Intelligence-Enabled Diagnostic Capabilities: A Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:4805. [PMID: 37430719 PMCID: PMC10223364 DOI: 10.3390/s23104805] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 07/12/2023]
Abstract
Worldwide, population aging and unhealthy lifestyles have increased the incidence of high-risk health conditions such as cardiovascular diseases, sleep apnea, and other conditions. Recently, to facilitate early identification and diagnosis, efforts have been made in the research and development of new wearable devices to make them smaller, more comfortable, more accurate, and increasingly compatible with artificial intelligence technologies. These efforts can pave the way to the longer and continuous health monitoring of different biosignals, including the real-time detection of diseases, thus providing more timely and accurate predictions of health events that can drastically improve the healthcare management of patients. Most recent reviews focus on a specific category of disease, the use of artificial intelligence in 12-lead electrocardiograms, or on wearable technology. However, we present recent advances in the use of electrocardiogram signals acquired with wearable devices or from publicly available databases and the analysis of such signals with artificial intelligence methods to detect and predict diseases. As expected, most of the available research focuses on heart diseases, sleep apnea, and other emerging areas, such as mental stress. From a methodological point of view, although traditional statistical methods and machine learning are still widely used, we observe an increasing use of more advanced deep learning methods, specifically architectures that can handle the complexity of biosignal data. These deep learning methods typically include convolutional and recurrent neural networks. Moreover, when proposing new artificial intelligence methods, we observe that the prevalent choice is to use publicly available databases rather than collecting new data.
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Affiliation(s)
- Luca Neri
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Matt T. Oberdier
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Kirsten C. J. van Abeelen
- Department of Informatics, Systems, and Communication, University of Milano-Bicocca, 20126 Milan, Italy
- Department of Internal Medicine, Radboud University Medical Center, 6525 AJ Nijmegen, The Netherlands
| | - Luca Menghini
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Ethan Tumarkin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Hemantkumar Tripathi
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Sujai Jaipalli
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Alessandro Orro
- Institute of Biomedical Technologies, National Research Council, 20054 Segrate, Italy
| | - Nazareno Paolocci
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Ilaria Gallelli
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Massimo Dall’Olio
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Amir Beker
- AccYouRate Group S.p.A., 67100 L’Aquila, Italy
| | - Richard T. Carrick
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Henry R. Halperin
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, MD 21218, USA; (L.N.)
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Department of Radiology, Johns Hopkins University, Baltimore, MD 21205, USA
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36
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Okorare O, Alugba G, Olusiji S, Evbayekha EO, Antia AU, Daniel E, Ubokudum D, Adabale OK, Ariaga A. Sudden Cardiac Death: An Update on Commotio Cordis. Cureus 2023; 15:e38087. [PMID: 37252546 PMCID: PMC10209547 DOI: 10.7759/cureus.38087] [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] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Sudden cardiac death (SCD) is one of the leading causes of cardiovascular mortality, and it is caused by a diverse array of conditions. Among these is commotio cordis, a relatively infrequent but still significant cause, often seen in young athletes involved in competitive or recreational sports. It is known to be caused by blunt trauma to the chest wall resulting in life-threatening arrhythmia (typically ventricular fibrillation). The current understanding pertains to blunt trauma to the precordium, with an outcome depending on factors such as the type of stimulus, the force of impact, the qualities of the projectile (shape, size, and density), the site of impact, and the timing of impact in relation to the cardiac cycle. In the management of commotio cordis, a history of preceding blunt chest trauma is usually encountered. Imaging is mostly unremarkable except for ECG, which may show malignant ventricular arrhythmias. Treatment is focused on emergent resuscitation with the advanced cardiac life support protocol algorithm, with extensive workup following the return of spontaneous circulation. In the absence of underlying cardiovascular pathologies, implantable cardiac defibrillator insertion is not beneficial, and patients can even resume physical activity if the workup is unremarkable. Proper follow-up is also key in the management and monitoring of re-entrant ventricular arrhythmias, which are amenable to ablative therapy. Prevention of this condition involves protecting the chest wall against blunt trauma, especially with the use of safety balls and chest protectors in certain high-risk sporting activities. This study aims to elucidate the current epidemiology and clinical management of SCD with a particular focus on a rarely explored etiology, commotio cordis.
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Affiliation(s)
- Ovie Okorare
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
| | | | - Soremi Olusiji
- Internal Medicine, New York Medical College, Metropolitan Hospital Center, New York, USA
| | | | - Akanimo U Antia
- Medicine, Lincoln Medical and Mental Health Center, New York, USA
| | | | | | | | - Anderson Ariaga
- Internal Medicine, Nuvance Health Vassar Brothers Medical Center, New York, USA
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Lin J, Qu Z, Huang X. Bifurcations to transient and oscillatory excitations in inhomogeneous excitable media: Insights into arrhythmogenesis in long QT syndrome. Phys Rev E 2023; 107:034402. [PMID: 37073009 PMCID: PMC10583175 DOI: 10.1103/physreve.107.034402] [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: 09/01/2022] [Accepted: 02/21/2023] [Indexed: 04/20/2023]
Abstract
Ventricular arrhythmias are the leading cause of sudden cardiac death. Understanding the mechanisms of arrhythmia initiation is important for developing effective therapeutics for prevention. Arrhythmias can be induced via premature external stimuli or occur spontaneously via dynamical instabilities. Computer simulations have shown that a large repolarization gradient due to regional prolongation of the action potential duration can result in instabilities leading to premature excitations and arrhythmias, but the bifurcation remains to be elucidated. In this study we carry out numerical simulations and linear stability analyses using a one-dimensional heterogeneous cable consisting of the FitzHugh-Nagumo model. We show that a Hopf bifurcation leads to local oscillations, which, once their amplitudes are large enough, lead to spontaneous propagating excitations. Depending on the degree of heterogeneities, these excitations can range from one to many and to be sustained oscillations, manifesting as premature ventricular contractions (PVCs) and sustained arrhythmias. The dynamics depends on the repolarization gradient and the length of the cable. Complex dynamics is also induced by the repolarization gradient. The mechanistic insights from the simple model may help in the understanding of the genesis of PVCs and arrhythmias in long QT syndrome.
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Affiliation(s)
- Jianying Lin
- Department of physics, South China University of Technology, Guangzhou 510641, China
| | - Zhilin Qu
- Department of Medicine, University of California, Los Angeles, California 90095, USA
| | - Xiaodong Huang
- Department of physics, South China University of Technology, Guangzhou 510641, China
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38
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Koivunen M, Tynkkynen J, Oksala N, Eskola M, Hernesniemi J. Incidence of sudden cardiac arrest and sudden cardiac death after unstable angina pectoris and myocardial infarction. Am Heart J 2023; 257:9-19. [PMID: 36384178 DOI: 10.1016/j.ahj.2022.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac arrests (SCA) and sudden cardiac deaths (SCD) are believed to account for a large proportion of deaths due to cardiovascular causes. The purpose of this study is to provide comprehensive information on the epidemiology of SCAs and SCDs after acute coronary syndrome. METHODS The incidence of SCA (including SCDs) was studied retrospectively among 10,316 consecutive patients undergoing invasive evaluation for acute coronary syndrome (ACS) between 2007 and 2018 at Tays Heart Hospital (sole provider of specialized cardiac care for a catchment area of over 0.5 million residents). Baseline and follow-up information was collected by combining information from the hospital's electronic health records, death certificate data, and a full-disclosure review of written patient records and accounts of the circumstances leading to death. RESULTS During 12 years of follow-up, the cumulative incidence of SCAs (including SCDs) was 9.8% (0.8% annually) and that of SCDs 5.4% (0.5% annually). Cumulative incidence of SCAs in patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris were: 11.9%,10.2% and 5.7% at 12 years. SCAs accounted for 30.5% (n = 528/1,732) of all deaths due to cardiovascular causes. The vast majority of SCAs (95.6%) occurred in patients without implantable cardioverter defibrillator (ICD) devices or among patients with no recurrent hospitalizations for coronary artery disease (89.1%). CONCLUSIONS SCAs accounted for less than a third of all deaths due to cardiovascular causes among patients with previous ACS. Incidence of SCA is highest among STEMI and NSTEMI patients. After the hospital discharge, most of SCAs happen to NSTEMI patients.
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Affiliation(s)
- Minna Koivunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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39
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Kelly KL, Lin PT, Basso C, Bois M, Buja LM, Cohle SD, d'Amati G, Duncanson E, Fallon JT, Firchau D, Fishbein G, Giordano C, Leduc C, Litovsky SH, Mackey-Bojack S, Maleszewski JJ, Michaud K, Padera RF, Papadodima SA, Parsons S, Radio SJ, Rizzo S, Roe SJ, Romero M, Sheppard MN, Stone JR, Tan CD, Thiene G, van der Wal AC, Veinot JP. Sudden cardiac death in the young: A consensus statement on recommended practices for cardiac examination by pathologists from the Society for Cardiovascular Pathology. Cardiovasc Pathol 2023; 63:107497. [PMID: 36375720 DOI: 10.1016/j.carpath.2022.107497] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/13/2022] Open
Abstract
Sudden cardiac death is, by definition, an unexpected, untimely death caused by a cardiac condition in a person with known or unknown heart disease. This major international public health problem accounts for approximately 15-20% of all deaths. Typically more common in older adults with acquired heart disease, SCD also can occur in the young where the cause is more likely to be a genetically transmitted process. As these inherited disease processes can affect multiple family members, it is critical that these deaths are appropriately and thoroughly investigated. Across the United States, SCD cases in those less than 40 years of age will often fall under medical examiner/coroner jurisdiction resulting in scene investigation, review of available medical records and a complete autopsy including toxicological and histological studies. To date, there have not been consistent or uniform guidelines for cardiac examination in these cases. In addition, many medical examiner/coroner offices are understaffed and/or underfunded, both of which may hamper specialized examinations or studies (e.g., molecular testing). Use of such guidelines by pathologists in cases of SCD in decedents aged 1-39 years of age could result in life-saving medical intervention for other family members. These recommendations also may provide support for underfunded offices to argue for the significance of this specialized testing. As cardiac examinations in the setting of SCD in the young fall under ME/C jurisdiction, this consensus paper has been developed with members of the Society of Cardiovascular Pathology working with cardiovascular pathology-trained, practicing forensic pathologists.
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Affiliation(s)
| | | | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | | | | | - Emily Duncanson
- Jesse E. Edwards Registry of Cardiovascular Disease, St. Paul, MN, USA
| | | | | | | | | | | | | | | | | | - Katarzyna Michaud
- University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Switzerland
| | | | | | - Sarah Parsons
- Victorian Institute of Forensic Medicine, Melbourne, Australia
| | | | - Stefania Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
| | | | | | - Mary N Sheppard
- St. George's Medical School, University of London, London, United Kingdom
| | | | | | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - University of Padua, Padua, Italy
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Chevalier P, Moreau A, Bessière F, Richard S, Chahine M, Millat G, Morel E, Paganelli F, Lesavre N, Placide L, Montestruc F, Ankou B, Puertas RD, Asatryan B, Delinière A. Identification of Cx43 variants predisposing to ventricular fibrillation in the acute phase of ST-elevation myocardial infarction. Europace 2023; 25:101-111. [PMID: 35942675 PMCID: PMC10103570 DOI: 10.1093/europace/euac128] [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: 02/09/2022] [Accepted: 07/01/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Ventricular fibrillation (VF) occurring in the acute phase of ST-elevation myocardial infarction (STEMI) is the leading cause of sudden cardiac death worldwide. Several studies showed that reduced connexin 43 (Cx43) expression and reduced conduction velocity increase the risk of VF in acute myocardial infarction (MI). Furthermore, genetic background might predispose individuals to primary VF (PVF). The primary objective was to evaluate the presence of GJA1 variants in STEMI patients. The secondary objective was to evaluate the arrhythmogenic impact of GJA1 variants in STEMI patients with VF. METHODS AND RESULTS The MAP-IDM prospective cohort study included 966 STEMI patients and was designed to identify genetic predisposition to VF. A total of 483 (50.0%) STEMI patients with PVF were included. The presence of GJA1 variants increased the risk of VF in STEMI patients [from 49.1 to 70.8%, P = 0.0423; odds ratio (OR): 0.40; 95% confidence interval: 0.16-0.97; P = 0.04]. The risk of PVF decreased with beta-blocker intake (from 53.5 to 44.8%, P = 0.0085), atrial fibrillation (from 50.7 to 26.4%, P = 0.0022), and with left ventricular ejection fraction >50% (from 60.2 to 41.4%, P < 0.0001). Among 16 GJA1 variants, three novel heterozygous missense variants were identified in three patients: V236I, H248R, and I327M. In vitro studies of these variants showed altered Cx43 localization and decreased cellular communication, mainly during acidosis. CONCLUSION Connexin 43 variants are associated with increased VF susceptibility in STEMI patients. Restoring Cx43 function may be a potential therapeutic target to prevent PVF in patients with acute MI. CLINICAL TRIAL REGISTRATION Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT00859300.
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Affiliation(s)
- Philippe Chevalier
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Adrien Moreau
- PhyMedExp, INSERM U1046, CNRS UMR9214, Université de Montpellier, CHU Arnaud de Villeneuve, 34295 Montpellier, France
| | - Francis Bessière
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Sylvain Richard
- PhyMedExp, INSERM U1046, CNRS UMR9214, Université de Montpellier, CHU Arnaud de Villeneuve, 34295 Montpellier, France
| | | | - Gilles Millat
- Laboratoire de Cardiogénétique moléculaire, Centre de biologie et pathologie Est, Bron, France
| | - Elodie Morel
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | | | | | - Leslie Placide
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | | | - Bénédicte Ankou
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Rosa Doñate Puertas
- Signaling and Cardiovascular Pathophysiology-UMR-S 1180, Inserm, Université Paris-Saclay, Paris, France
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Antoine Delinière
- Université de Lyon, université Lyon 1, Inserm, CNRS, INMG, Lyon F-69008, France.,Hospices Civils de Lyon, Groupement Hospitalier Est, Service de Rythmologie, Hôpital Cardiologique Louis Pradel, 59 Boulevard Pinel, 69677 Bron Cedex, France
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Haugsten Hansen M, Sadredini M, Hasic A, Anderson ME, Sjaastad I, Korseberg Stokke M. CaMKII and reactive oxygen species contribute to early reperfusion arrhythmias, but oxidation of CaMKIIδ at methionines 281/282 is not a determining factor. J Mol Cell Cardiol 2023; 175:49-61. [PMID: 36528076 DOI: 10.1016/j.yjmcc.2022.12.002] [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: 07/21/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence suggest that Ca2+/calmodulin-dependent protein kinase type IIδ (CaMKIIδ) and reactive oxygen species (ROS) are important in early ischemia-reperfusion arrhythmias (IRA). Since ROS can activate CaMKIIδ by oxidation of two methionines at positions 281/282, oxidized-CaMKIIδ (Ox-CaMKIIδ) has been proposed to be important for IRA. However, direct evidence for this is missing. METHODS We exposed Langendorff-perfused hearts and ventricular cardiomyocytes from C57BL/6 mice to global and simulated ischemia, respectively, and recorded arrhythmic events during early reperfusion. Hearts were collected for immunoblotting of key phosphoproteins. We evaluated the effects of beta-adrenoceptor stimulation, inhibition of CaMKII, and reduced ROS levels with isoprenaline, KN93/AIP and N-acetylcysteine (NAC), respectively. We further tested the importance of Ox-CaMKIIδ by using hearts and cardiomyocytes from mice with CaMKIIδ resistant to oxidation of methionines 281 and 282 (MMVV). RESULTS Hearts treated with KN93, AIP or NAC had lower incidence of early IRA, and NAC-treated cardiomyocytes had lower incidence of arrhythmogenic events. However, hearts from MMVV mice had a similar incidence of early IRA to wild type mice (WT), and MMVV and WT cardiomyocytes had a similar frequency of Ca2+ waves and Ca2+ sparks. Immunoblotting confirmed high levels of oxidation in early reperfusion, but revealed no significant differences in the phosphorylation levels of Ca2+-handling proteins in MMVV and WT hearts. CONCLUSIONS Although CaMKII and ROS both contribute to early IRA, hearts from mice with CaMKII resistant to oxidation at methionines 281/282 were not protected from such arrhythmias, suggesting that oxidation at these sites is not a determining factor.
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Affiliation(s)
- Marie Haugsten Hansen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mani Sadredini
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Almira Hasic
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mark E Anderson
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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42
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Chen YY, Chung FP, Lin YJ, Chien KL, Chang WT. Exploring the Risk Factors of Sudden Cardiac Death Using an Electrocardiography and Medical Ultrasonography for the General Population Without a History of Coronary Artery Disease or Left Ventricular Ejection Fraction <35% and Aged >35 Years - A Novel Point-Based Prediction Model Based on the Chin-Shan Community Cardiovascular Cohort. Circ J 2022; 87:139-149. [PMID: 36047166 DOI: 10.1253/circj.cj-22-0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Most of the factors and prediction models of sudden cardiac death (SCD) have been developed without considering the Asia population. The purpose of this study is to construct a point-based prediction model for the general population in Asia.Methods and Results: Chin-Shan Community Cardiovascular Cohort (CCCC) is a community-based longitudinal cohort initiated between 1990 and 1991, enrolling participants aged ≥35 years and following them up until 2005. Participants with coronary artery disease (CAD) or a left ventricular ejection fraction (LVEF) of 35% were excluded from this study. The Framingham risk score function was used to derive a simple point-based prediction model. Based on bootstrapping, a novel model (CCCC-SCD-Score) was validated. A total of 2,105 participants were analyzed. The incidence rate of SCD was 0.406 per 1,000 person-years. The CCCC-SCD-Score score was calculated using age groups (maximal points=4), left ventricular hypertrophy, hypertension, left ventricular ejection fraction <40%, aortic flow rate >190 cm/s, and carotid plaque scores ≥5 (point=1 for each risk factor). The C-index of the CCCC-SCD-Score in predicting SCD risks was 0.888 (95% confidence interval: 0.807-0.969). CONCLUSIONS For the general Asian population without a history of CAD or a LVEF <35% and who are aged >35 years, the novel model-based scoring system effectively identifies the risk for SCD using the clinical factors, electrocardiographic and echocardiographic data.
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Affiliation(s)
- Yun-Yu Chen
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University.,Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming Chiao Tung University
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming Chiao Tung University
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital
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Masrouri S, Moazzeni SS, Cheraghloo N, Azizi F, Hadaegh F. The clinical value of metabolic syndrome and its components with respect to sudden cardiac death using different definitions: Two decades of follow-up from the Tehran Lipid and Glucose Study. Cardiovasc Diabetol 2022; 21:269. [PMID: 36463175 PMCID: PMC9719125 DOI: 10.1186/s12933-022-01707-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 11/23/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To evaluate the impact of different definitions of metabolic syndrome (MetS) and their components on the risk of sudden cardiac death (SCD) among the Iranian population according to the World Health Organization (WHO), International Diabetes Federation (IDF), Adult Treatment Panel III (ATP III), and Joint Interim Statement (JIS) criteria. METHODS The study population included a total of 5,079 participants (2,785 women) aged ≥ 40 years, free of cardiovascular disease (CVD) at baseline. Participants were followed for incident SCD annually up to 20 March 2018. Multivariable Cox proportional hazards regression models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MetS and its components for incident SCD. RESULTS The prevalence of MetS ranged from 27.16% to 50.81%, depending on the criteria used. Over a median of 17.9 years of follow-up, 182 SCD events occurred. The WHO, IDF, and JIS definitions were strong predictors of SCD with multivariable-adjusted HRs (95% CI) of 1.68 (1.20-2.35), 1.51 (1.12-2.03), and 1.47 (1.08-1.98), respectively; these associations significantly attenuated after further adjustment for MetS components. MetS by the ATP III definition was not associated with the risk of SCD after controlling for antihypertensive, glucose-lowering, and lipid-lowering medication use. Among the components of MetS, high blood pressure (WHO definition), high waist circumference (using the national cutoff of ≥ 95 cm), and high glucose component by the JIS/IDF definitions remained independent predictors of SCD with HRs of 1.79 (1.29-2.48), 1.46 (1.07-2.00), and 1.52 (1.12-2.05), respectively. CONCLUSIONS The constellation of MetS, except for when defined with ATP III definition, is a marker for identifying individuals at higher risk for SCD; however, not independent of its components. Among MetS components, abdominal obesity using the population-specific cutoff point, high glucose component (JIS/IDF definitions), and high blood pressure (WHO definition) were independent predictors of SCD.
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Affiliation(s)
- Soroush Masrouri
- grid.411600.2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, 1985717413 Iran
| | - Seyyed Saeed Moazzeni
- grid.411600.2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, 1985717413 Iran
| | - Neda Cheraghloo
- grid.411705.60000 0001 0166 0922Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereidoun Azizi
- grid.411600.2Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Hadaegh
- grid.411600.2Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-4763, Tehran, 1985717413 Iran
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Risk Factors of Sudden Cardiac Arrest during the Postoperative Period in Patient Undergoing Heart Valve Surgery. J Clin Med 2022; 11:jcm11237098. [PMID: 36498672 PMCID: PMC9737591 DOI: 10.3390/jcm11237098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Sudden cardiac arrest (SCA) is the sudden cessation of normal cardiac activity with hemodynamic collapse. This usually leads to sudden cardiac death (SCD) when cardiopulmonary resuscitation is not undertaken. In patients undergoing heart valve surgery, postoperative SCA is a complication with a high risk of death, cerebral hypoxia and multiple organ dysfunction syndrome (MODS). Therefore, knowledge of the predictors of postoperative SCA is extremely important as it enables the identification of patients at risk of this complication and the application of the special surveillance and therapeutic management in this group of patients. The aim of the study was to evaluate the usefulness of selected biomarkers in predicting postoperative SCA in patients undergoing heart valve surgery. METHODS This prospective study was conducted on a group of 616 consecutive patients with significant valvular heart disease that underwent elective valve surgery with or without coronary artery bypass surgery. The primary end-point at the intra-hospital follow-up was postoperative SCA. The secondary end-point was death from all causes in patients with postoperative SCA. Patients were observed until discharge from the hospital or until death. Logistic regression was used to assess the relationships between variables. RESULTS The postoperative SCA occurred in 14 patients. At multivariate analysis, only NT-proBNP (odds ratio (OR) 1.022, 95% confidence interval (CI) 1.012-1.044; p = 0.03) remained independent predictors of the primary end-point. Age and NT-proBNP were associated with an increased risk of death in patients with postoperative SCA. CONCLUSIONS The results of the presented study indicate that SCA in the early postoperative period in patients undergoing heart valve surgery is an unpredictable event with high mortality. The potential predictive ability of the preoperative NT-proBNP level for the occurrence of postoperative SCA and death in patients after SCA demonstrated in the study may indicate that the overloaded and damaged myocardium in patients undergoing heart valve surgery is particularly sensitive to non-physiological conditions prevailing in the perioperative period, which may cause serious hemodynamic disturbances in the postoperative period and lead to death.
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45
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Isbister JC, Nowak N, Yeates L, Singer ES, Sy RW, Ingles J, Raju H, Bagnall RD, Semsarian C. Concealed Cardiomyopathy in Autopsy-Inconclusive Cases of Sudden Cardiac Death and Implications for Families. J Am Coll Cardiol 2022; 80:2057-2068. [PMID: 36423990 DOI: 10.1016/j.jacc.2022.09.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/22/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Genetic testing following sudden cardiac death (SCD) is currently guided by autopsy findings, despite the inherent challenges of autopsy examination and mounting evidence that malignant arrhythmia may occur before structural changes in inherited cardiomyopathy, so-called "concealed cardiomyopathy" (CCM). OBJECTIVES The authors sought to identify the spectrum of genes implicated in autopsy-inconclusive SCD and describe the impact of identifying CCM on the ongoing care of SCD families. METHODS Using a standardized framework for adjudication, autopsy-inconclusive SCD cases were identified as having a structurally normal heart or subdiagnostic findings of uncertain significance on autopsy. Genetic variants were classified for pathogenicity using the American College of Medical Genetics and Genomics guidelines. Family follow-up was performed where possible. RESULTS Twenty disease-causing variants were identified among 91 autopsy-inconclusive SCD cases (mean age 25.4 ± 10.7 years) with a similar rate regardless of the presence or absence of subdiagnostic findings (25.5% vs 18.2%; P = 0.398). Cardiomyopathy-associated genes harbored 70% of clinically actionable variants and were overrepresented in cases with subdiagnostic structural changes at autopsy (79% vs 21%; P = 0.038). Six of the 20 disease-causing variants identified were in genes implicated in arrhythmogenic cardiomyopathy. Nearly two-thirds of genotype-positive relatives had an observable phenotype either at initial assessment or subsequent follow-up, and 27 genotype-negative first-degree relatives were released from ongoing screening. CONCLUSIONS Phenotype-directed genetic testing following SCD risks under recognition of CCM. Comprehensive evaluation of the decedent should include assessment of genes implicated in cardiomyopathy in addition to primary arrhythmias to improve diagnosis of CCM and optimize care for families.
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Affiliation(s)
- Julia C Isbister
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Natalie Nowak
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Laura Yeates
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Emma S Singer
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Raymond W Sy
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Jodie Ingles
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Hariharan Raju
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Richard D Bagnall
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
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Adolfsson E, Kling D, Gunnarsson C, Jonasson J, Gréen H, Gréen A. Whole exome sequencing of FFPE samples—expanding the horizon of forensic molecular autopsies. Int J Legal Med 2022:10.1007/s00414-022-02906-x. [PMID: 36346469 PMCID: PMC10247852 DOI: 10.1007/s00414-022-02906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Forensic molecular autopsies have emerged as a tool for medical examiners to establish the cause of death. It is particularly useful in sudden unexplained deaths where the cause of death cannot be determined with a regular medical autopsy. We provide the first study of exome data from formalin-fixed paraffin-embedded samples (FFPE) paired with data from high-quality blood samples in forensic applications. The approach allows exploration of the potential to use FFPE samples for molecular autopsies and identify variants in extensive exome data. We leverage the high uniformity of the hybridization capture approach provided by Twist Bioscience to target the complete exome and sequence the libraries on a NextSeq 550. Our findings suggest that exome sequencing is feasible for 24 out of a total of 35 included FFPE samples. When successful, the coverage across the exome is comparatively high (> 90% covered to 20X) and uniform (fold80 below 1.5). Detailed variant comparisons for matched FFPE and blood samples show high concordance with few false variants (positive predictive value of 0.98 and a sensitivity of 0.97) with no distinct FFPE artefacts. Ultimately, we apply carefully constructed forensic gene panels in a stepwise manner to find genetic variants associated with the clinical phenotype and with relevance to the sudden unexplained death.
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Carotid body stimulation as a potential intervention in sudden death in epilepsy. Epilepsy Behav 2022; 136:108918. [PMID: 36202052 PMCID: PMC10187768 DOI: 10.1016/j.yebeh.2022.108918] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 09/09/2022] [Accepted: 09/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To investigate carotid body (CB) mechanisms related to sudden death during seizure. Ictal activation of oxygen-conserving reflexes (OCRs) can trigger fatal cardiorespiratory collapse in seizing rats, which presents like human sudden unexpected death in epilepsy (SUDEP). The CB is strongly implicated in OCR pathways; we hypothesize that modulating CB activity will provide insight into these mechanisms of death. METHODS Long-Evans rats were anesthetized with urethane. Recordings included: electrocorticography, electrocardiography, respiration via nasal thermocouple, and blood pressure (BP). The mammalian diving reflex (MDR) was activated by cold water delivered through a nasal cannula. Reflex and stimulation trials were repeated up to 16 times (4 pre-intervention, 12 post-intervention) or until death. In some animals, one or both carotid bodies were denervated. In some animals, the CB was electrically stimulated, both with and without MDR. Seizures were induced with kainic acid (KA). RESULTS Animals without seizure and with no CB modulation survived all reflexes. Non-seizing animals with CB denervation survived 7.1 ± 5.4 reflexes before death, and only 1 of 7 survived past the 12-trial threshold. Electrical CB stimulation without seizure and without reflex caused significant tachypnea and hypotension. Electrical CB stimulation with seizure and without reflex required higher amplitudes to replicate the physiological responses seen outside seizure. Seizing animals without CB intervention survived 3.2 ± 3.6 trials (per-reflex survival rate 42.0% ± 44.4%), and 0 of 7 survived past the 12-trial threshold. Seizing animals with electrical CB stimulation survived 10.5 ± 4.7 ictal trials (per-reflex survival rate 86.3% ± 35.0%), and 6 of 8 survived past the 12-trial threshold. SIGNIFICANCE These results suggest that, during seizure, the ability of the CB to stimulate a restart of respiration is impaired. The CB and its afferents may be relevant to fatal ictal apnea and SUDEP in humans, and CB stimulation may be a relevant intervention technique in these deaths.
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Oknińska M, Mączewski M, Mackiewicz U. Ventricular arrhythmias in acute myocardial ischaemia-Focus on the ageing and sex. Ageing Res Rev 2022; 81:101722. [PMID: 36038114 DOI: 10.1016/j.arr.2022.101722] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 01/31/2023]
Abstract
Annually, approximately 17 million people die from cardiovascular diseases worldwide, half of them suddenly. The most common direct cause of sudden cardiac death is ventricular arrhythmia triggered by an acute coronary syndrome (ACS). The study summarizes the knowledge of the mechanisms of arrhythmia onset during ACS in humans and in animal models and factors that may influence the susceptibility to life-threatening arrhythmias during ACS with particular focus on the age and sex. The real impact of age and sex on the arrhythmic susceptibility within the setting of acute ischaemia is masked by the fact that ACSs result from coronary artery disease appearing with age much earlier among men than among women. However, results of researches show that in ageing process changes with potential pro-arrhythmic significance, such as increased fibrosis, cardiomyocyte hypertrophy, decrease number of gap junction channels, disturbances of the intracellular Ca2+ signalling or changes in electrophysiological parameters, occur independently of the development of cardiovascular diseases and are more severe in male individuals. A review of the literature also indicates a marked paucity of research in this area in female and elderly individuals. Greater awareness of sex differences in the aging process could help in the development of personalized prevention methods targeting potential pro-arrhythmic factors in patients of both sexes to reduce mortality during the acute phase of myocardial infarction. This is especially important in an era of aging populations in which women will predominate due to their longer lifespan.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
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Heart rate variability and the risk of heart failure and its subtypes in post-menopausal women: The Women's Health Initiative study. PLoS One 2022; 17:e0276585. [PMID: 36282885 PMCID: PMC9595519 DOI: 10.1371/journal.pone.0276585] [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: 05/17/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Background Low heart rate variability (HRV), a measure of autonomic imbalance, is associated with increased risk of coronary heart disease (CHD) and heart failure (HF). However, its relationship with HF subtypes; heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF) has not been studied prior. Methods and findings We conducted a longitudinal study in Women’s Health Initiative study cohort to investigate the association of baseline quartiles of resting heart rate (rHR) and HRV measures; SDNN (SD of normal-to-normal RR interval) and RMSSD (root mean square of successive difference of RR interval) measured by twelve-lead electrocardiogram (ECG) on enrollment, with the risk of hospitalized HF and its subtypes. Total of 28,603 post-menopausal women, predominantly non-Hispanic whites (69%), with a mean (SD) age of 62.6 (7.1) years, free of baseline CHD and HF were included. In a fully adjusted cox-proportional hazards regression model which adjusted for age, race, BMI, alcohol intake, education, physical activity, hyperlipidemia, hypertension, left ventricular hypertrophy, use of beta-blocker, calcium-channel blocker, hormone therapy, and time-varying incident CHD, the hazard ratios of lowest quartile of HRV (Q1) with HF risk were significant (Q1 SDNN compared to Q4 SDNN: 1.22, 95% CI 1.07, 1.39; Q1 RMSSD compared to Q4 RMSSD: 1.17, 95% CI 1.02, 1.33). On subgroup analysis of HF subtypes, low HRV was associated with elevated HFpEF risk (Q1 vs Q4 SDNN: 1.22, 95% CI 1.02, 1.47) but not with HFrEF (Q1 vs Q4 SDNN: 1.19, 95% CI 0.95, 1.50; Q1 RMSSD: 1.13, 95% CI 0.90, 1.43). Conclusion Low HRV is associated with elevated overall hospitalized HF risk and HFpEF risk in post-menopausal women. Whether interventions to increase HRV through healthy lifestyle changes will decrease HF risk warrants further investigation.
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Berberian J. Hereditary Syndromes of Sudden Cardiac Death. Emerg Med Clin North Am 2022; 40:651-662. [DOI: 10.1016/j.emc.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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