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Aimo A, Morfino P, Arzilli C, Vergaro G, Spini V, Fabiani I, Castiglione V, Rapezzi C, Emdin M. Disease features and management of cardiomyopathies in women. Heart Fail Rev 2024; 29:663-674. [PMID: 38308002 PMCID: PMC11035404 DOI: 10.1007/s10741-024-10386-x] [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] [Accepted: 01/24/2024] [Indexed: 02/04/2024]
Abstract
Over the last years, there has been a growing interest in the clinical manifestations and outcomes of cardiomyopathies in women. Peripartum cardiomyopathy is the only women-specific cardiomyopathy. In cardiomyopathies with X-linked transmission, women are not simply healthy carriers of the disorder, but can show a wide spectrum of clinical manifestations ranging from mild to severe manifestations because of heterogeneous patterns of X-chromosome inactivation. In mitochondrial disorders with a matrilinear transmission, cardiomyopathy is part of a systemic disorder affecting both men and women. Even some inherited cardiomyopathies with autosomal transmission display phenotypic and prognostic differences between men and women. Notably, female hormones seem to exert a protective role in hypertrophic cardiomyopathy (HCM) and variant transthyretin amyloidosis until the menopausal period. Women with cardiomyopathies holding high-risk features should be referred to a third-level center and evaluated on an individual basis. Cardiomyopathies can have a detrimental impact on pregnancy and childbirth because of the associated hemodynamic derangements. Genetic counselling and a tailored cardiological evaluation are essential to evaluate the likelihood of transmitting the disease to the children and the possibility of a prenatal or early post-natal diagnosis, as well as to estimate the risk associated with pregnancy and delivery, and the optimal management strategies.
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Affiliation(s)
- Alberto Aimo
- Scuola Superiore Sant'Anna, Pisa, Italy.
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | | | - Chiara Arzilli
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Valentina Spini
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Iacopo Fabiani
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - Claudio Rapezzi
- Cardiologic Centre, University of Ferrara, Ferrara, Italy
- Maria Cecilia Hospital, GVM Care & Research, Cotignola (Ravenna), Ravenna, Italy
| | - Michele Emdin
- Scuola Superiore Sant'Anna, Pisa, Italy
- Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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2
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Kyriakopoulou E, Versteeg D, de Ruiter H, Perini I, Seibertz F, Döring Y, Zentilin L, Tsui H, van Kampen SJ, Tiburcy M, Meyer T, Voigt N, Tintelen VJP, Zimmermann WH, Giacca M, van Rooij E. Therapeutic efficacy of AAV-mediated restoration of PKP2 in arrhythmogenic cardiomyopathy. NATURE CARDIOVASCULAR RESEARCH 2023; 2:1262-1276. [PMID: 38665939 PMCID: PMC11041734 DOI: 10.1038/s44161-023-00378-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/27/2023] [Indexed: 04/28/2024]
Abstract
Arrhythmogenic cardiomyopathy is a severe cardiac disorder characterized by lethal arrhythmias and sudden cardiac death, with currently no effective treatment. Plakophilin 2 (PKP2) is the most frequently affected gene. Here we show that adeno-associated virus (AAV)-mediated delivery of PKP2 in PKP2c.2013delC/WT induced pluripotent stem cell-derived cardiomyocytes restored not only cardiac PKP2 levels but also the levels of other junctional proteins, found to be decreased in response to the mutation. PKP2 restoration improved sodium conduction, indicating rescue of the arrhythmic substrate in PKP2 mutant induced pluripotent stem cell-derived cardiomyocytes. Additionally, it enhanced contractile function and normalized contraction kinetics in PKP2 mutant engineered human myocardium. Recovery of desmosomal integrity and cardiac function was corroborated in vivo, by treating heterozygous Pkp2c.1755delA knock-in mice. Long-term treatment with AAV9-PKP2 prevented cardiac dysfunction in 12-month-old Pkp2c.1755delA/WT mice, without affecting wild-type mice. These findings encourage clinical exploration of PKP2 gene therapy for patients with PKP2 haploinsufficiency.
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Affiliation(s)
- Eirini Kyriakopoulou
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
| | - Danielle Versteeg
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
| | - Hesther de Ruiter
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
| | - Ilaria Perini
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
| | - Fitzwilliam Seibertz
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cluster of Excellence ‘Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells’ (MBExC), University of Göttingen, Göttingen, Germany
- Nanion Technologies GmbH, Munich, Germany
| | - Yannic Döring
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Lorena Zentilin
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Hoyee Tsui
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
| | | | - Malte Tiburcy
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Tim Meyer
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cluster of Excellence ‘Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells’ (MBExC), University of Göttingen, Göttingen, Germany
| | | | - Wolfram H. Zimmermann
- Institute of Pharmacology and Toxicology, University Medical Center Gottingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Cluster of Excellence ‘Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells’ (MBExC), University of Göttingen, Göttingen, Germany
- German Center for Neurodegenerative Diseases (DZNE), Göttingen, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Göttingen, Germany
| | - Mauro Giacca
- International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
- British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, King’s College London, London, UK
| | - Eva van Rooij
- Hubrecht Institute-KNAW and Utrecht University Medical Center, Utrecht, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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3
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Reisqs JB, Moreau A, Sleiman Y, Boutjdir M, Richard S, Chevalier P. Arrhythmogenic cardiomyopathy as a myogenic disease: highlights from cardiomyocytes derived from human induced pluripotent stem cells. Front Physiol 2023; 14:1191965. [PMID: 37250123 PMCID: PMC10210147 DOI: 10.3389/fphys.2023.1191965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by the replacement of myocardium by fibro-fatty infiltration and cardiomyocyte loss. ACM predisposes to a high risk for ventricular arrhythmias. ACM has initially been defined as a desmosomal disease because most of the known variants causing the disease concern genes encoding desmosomal proteins. Studying this pathology is complex, in particular because human samples are rare and, when available, reflect the most advanced stages of the disease. Usual cellular and animal models cannot reproduce all the hallmarks of human pathology. In the last decade, human-induced pluripotent stem cells (hiPSC) have been proposed as an innovative human cellular model. The differentiation of hiPSCs into cardiomyocytes (hiPSC-CM) is now well-controlled and widely used in many laboratories. This hiPSC-CM model recapitulates critical features of the pathology and enables a cardiomyocyte-centered comprehensive approach to the disease and the screening of anti-arrhythmic drugs (AAD) prescribed sometimes empirically to the patient. In this regard, this model provides unique opportunities to explore and develop new therapeutic approaches. The use of hiPSC-CMs will undoubtedly help the development of precision medicine to better cure patients suffering from ACM. This review aims to summarize the recent advances allowing the use of hiPSCs in the ACM context.
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Affiliation(s)
- J. B. Reisqs
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - A. Moreau
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - Y. Sleiman
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - M. Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
- Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Health Sciences University, NY, United States
- Department of Medicine, New York University School of Medicine, NY, United States
| | - S. Richard
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - P. Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
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4
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Arrhythmogenic cardiomyopathy and differential diagnosis with physiological right ventricular remodelling in athletes using cardiovascular magnetic resonance. Int J Cardiovasc Imaging 2022; 38:2723-2732. [DOI: 10.1007/s10554-022-02684-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
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Risk Factors for Sudden Death in Athletes, Is There a Role for Screening? CURRENT CARDIOVASCULAR RISK REPORTS 2022; 16:97-109. [PMID: 35813032 PMCID: PMC9251040 DOI: 10.1007/s12170-022-00697-9] [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] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
Purpose of Review Sudden cardiac death (SCD) in a young athlete is an infrequent yet devastating event often associated with substantial media attention. Screening athletes for conditions associated with SCD is a controversial topic with debate surrounding virtually each component including the ideal subject, method, and performer/interpreter of such screens. In fact, major medical societies such as the American College of Cardiology/American Heart Association and the European Society of Cardiology have discrepant recommendations on the matter, and major sporting associations have enacted a wide range of screening policies, highlighting the confusion on this subject. This review seeks to summarize the literature in this area to address the complex and disputed subject of screening young athletes for SCD. Recent Findings The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can cause myocarditis, which is one acquired cardiac disease associated with SCD. The coronavirus 2019 (COVID-19) pandemic has therefore resulted in an increased incidence of an otherwise less common condition, providing an expanded dataset for further study of this condition. Recent findings indicate that cardiac complications of athletes with myocardial involvement of SARS-CoV-2 infection are rare. Other contemporary work in SCD screening has been focused on the implementation of various screening protocols and measuring their effectiveness. Summary No universal consensus exists for athlete screening for conditions associated with SCD with varying guidelines and protocols across cardiology and sport-specific organizations. No screening program will prevent all SCD; however, small programs managed by physicians familiar with the examination of an athlete that carefully personalize screening to the individual may maximize detection of dangerous cardiac conditions while minimizing false positives.
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Gasperetti A, Cappelletto C, Carrick R, Targetti M, Tichnell C, Martino A, Murray B, Compagnucci P, Stolfo D, Bisson J, Gilotra N, Carbucicchio C, Olivotto I, Tandri H, Dello Russo A, Cadrin-Tourigny J, Calò L, Tondo C, Sinagra G, James CA, Casella M, Calkins H. Association of Premature Ventricular Contraction Burden on Serial Holter Monitoring With Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. JAMA Cardiol 2022; 7:378-385. [PMID: 35195686 PMCID: PMC8867390 DOI: 10.1001/jamacardio.2021.6016] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE A high burden of premature ventricular contractions (PVCs) at disease diagnosis has been associated with an overall higher risk of ventricular arrhythmias in arrhythmogenic right ventricular cardiomyopathy (ARVC). Data regarding dynamic modification of PVC burden at follow-up with Holter monitoring and its impact on arrhythmic risk in ARVC are scarce. OBJECTIVE To describe changes in the PVC burden and to assess whether serial Holter monitoring is dynamically associated with sustained ventricular arrhythmias during follow-up in patients with ARVC. DESIGN, SETTINGS, AND PARTICIPANTS In this cohort study, patients with a definite ARVC diagnosis, available Holter monitoring results at disease diagnosis, and at least 2 additional results of Holter monitoring during follow-up were enrolled from 6 ARVC registries in North America and Europe. Data were collected from June 1 to September 15, 2021. MAIN OUTCOMES AND MEASURES The association between prespecified variables retrieved at each Holter monitoring follow-up (ie, overall PVC burden; presence of sudden PVC spikes, defined as absolute increase in PVC burden ≥5000 per 24 hours or a relative ≥75% increase, with an absolute increase of ≥1000 PVCs; presence of nonsustained ventricular tachycardia [NSVT]; and use of β-blockers and class III antiarrhythmic drugs) and sustained ventricular arrhythmias occurring within 12 months after that Holter examination was assessed using a mixed logistical model. RESULTS In 169 enrolled patients with ARVC (mean [SD] age, 36.3 [15.0] years; 95 men [56.2%]), a total of 723 Holter examinations (median, 4 [IQR, 4-5] per patient) were performed during a median follow-up of 54 (IQR, 42-63) months and detected 75 PVC spikes and 67 sustained ventricular arrhythmias. The PVC burden decreased significantly from the first to the second Holter examination (mean, 2906 [95% CI, 1581-4231] PVCs per 24 hours; P < .001). A model including 24-hour PVC burden (odds ratio [OR] 1.50 [95% CI, 1.10-2.03]; P = .01), PVC spikes (OR, 6.20 [95 CI, 2.74-13.99]; P < .001), and NSVT (OR, 2.29 [95% CI, 1.10-4.51]; P = .03) at each follow-up Holter examination was associated with sustained ventricular arrhythmia occurrence in the following 12 months. CONCLUSIONS AND RELEVANCE These findings suggest that in patients with ARVC, changes in parameters derived from each Holter examination performed during follow-up are associated with the risk of sustained ventricular arrhythmias within 12 months of disease diagnosis.
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Chiara Cappelletto
- Cardiothoracovascular Department, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Richard Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I–Lancisi–Salesi,” Ancona, Italy
| | - Davide Stolfo
- Cardiothoracovascular Department, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Jasmine Bisson
- Cardiovascular Genetics Center, Montreal Heart Center, Montreal, Quebec, Canada
| | - Nisha Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corrado Carbucicchio
- Heart Rhythm Center, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I–Lancisi–Salesi,” Ancona, Italy
| | | | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Cattinara Hospital, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital “Ospedali Riuniti Umberto I–Lancisi–Salesi,” Ancona, Italy
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pathology of sudden death, cardiac arrhythmias, and conduction system. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Kohela A, van Rooij E. Fibro-fatty remodelling in arrhythmogenic cardiomyopathy. Basic Res Cardiol 2022; 117:22. [PMID: 35441328 PMCID: PMC9018639 DOI: 10.1007/s00395-022-00929-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/31/2023]
Abstract
Arrhythmogenic cardiomyopathy (AC) is an inherited disorder characterized by lethal arrhythmias and a risk to sudden cardiac death. A hallmark feature of AC is the progressive replacement of the ventricular myocardium with fibro-fatty tissue, which can act as an arrhythmogenic substrate further exacerbating cardiac dysfunction. Therefore, identifying the processes underlying this pathological remodelling would help understand AC pathogenesis and support the development of novel therapies. In this review, we summarize our knowledge on the different models designed to identify the cellular origin and molecular pathways underlying cardiac fibroblast and adipocyte cell differentiation in AC patients. We further outline future perspectives and how targeting the fibro-fatty remodelling process can contribute to novel AC therapeutics.
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Affiliation(s)
- Arwa Kohela
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, The Netherlands
| | - Eva van Rooij
- Hubrecht Institute, Royal Netherlands Academy of Arts and Sciences (KNAW), Utrecht, The Netherlands ,Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Casella M, Bergonti M, Dello Russo A, Maragna R, Gasperetti A, Compagnucci P, Catto V, Trombara F, Frappampina A, Conte E, Fogante M, Sommariva E, Rizzo S, De Gaspari M, Giovagnoni A, Andreini D, Pompilio G, Di Biase L, Natale A, Basso C, Tondo C. Endomyocardial Biopsy: The Forgotten Piece in the Arrhythmogenic Cardiomyopathy Puzzle. J Am Heart Assoc 2021; 10:e021370. [PMID: 34569251 PMCID: PMC8649151 DOI: 10.1161/jaha.121.021370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Endomyocardial biopsy (EMB) is part of 2010 Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC). However, its usage has been curtailed because of its low presumed diagnostic yield, and it is now a poorly used tool. This study aims to analyze the contribution of EMB to the final diagnosis of ARVC. Methods and Results We included 104 consecutive patients evaluated for a suspicion of ARVC, who were referred for EMB. Patients with suspected left dominant pattern were excluded from the primary analysis. Subjects were initially stratified according to TFC without considering EMB. After EMB, patients were reclassified accordingly, and the reclassification rate was calculated. EMB yielded a diagnostic finding in 92 patients (85.5%). After including EMB evaluation, 20 (43%) more patients "at risk" received a definite diagnosis of ARVC. Overall, 59 patients received a definite diagnosis of ARVC, 34% only after EMB. EMB appeared to be the better-performing exam with respect to the final diagnosis (β, 2.2; area uder the curve, 0.73; P<0.05). The reclassification improvement after EMB measured 28%. TFC score increased from 3.5±1.3 to 4.3±1.4 (P<0.001). Notably, active inflammation was present in 6 (10%) patients. Minor complications were reported in only 2% of the cohort. In patients with suspected left-dominant disease, conventional TFC performed poorly. Conclusions Electroanatomic voltage mapping-guided EMB was safe and yielded an optimal diagnostic yield. It allowed upgrading of the diagnosis of nearly one-third of the patients considered "at risk." Classical TFC without EMB performed poorly in patients with the left dominant form of ARVC.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Marco Bergonti
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Riccardo Maragna
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Biomedical Sciences and Public Health University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy
| | - Valentina Catto
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Filippo Trombara
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Antonio Frappampina
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit Monzino Cardiology CenterIRCCS Milano Italy
| | - Marco Fogante
- Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Radiology University Hospital "Umberto I -Lancisi - Salesi" Ancona Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine Monzino Cardiology CenterIRCCS Milano Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Monica De Gaspari
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences University Hospital "Umberto I -Lancisi - Salesi"Marche Polytechnic University Ancona Italy.,Department of Radiology University Hospital "Umberto I -Lancisi - Salesi" Ancona Italy
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit Monzino Cardiology CenterIRCCS Milano Italy.,Department of Clinical Sciences and Community Health University of Milan Milano Italy
| | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine Monzino Cardiology CenterIRCCS Milano Italy
| | - Luigi Di Biase
- Montefiore Medical Center Albert-Einstein College of Medicine Bronx NY
| | - Andrea Natale
- Texas Cardiac Arrhyhtmia Institute (TCAI)St. David's Hospital Austin TX
| | - Cristina Basso
- Cardiovascular Pathology Unit Department of Cardiac, Thoracic, Vascular Sciences and Public Health Azienda Ospedaliera-University of Padua Padova Italy
| | - Claudio Tondo
- Heart Rhythm Center Department of Clinical Electrophysiology and Cardiac Pacing Monzino Cardiology CenterIRCCS Milano Italy.,Department of Biochemical Surgical and Dentist Sciences University of Milan Milano Italy
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Wichter T, Milberg P, Wichter HD, Dechering DG. Pregnancy in arrhythmogenic cardiomyopathy. Herzschrittmacherther Elektrophysiol 2021; 32:186-198. [PMID: 34032905 PMCID: PMC8166670 DOI: 10.1007/s00399-021-00770-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022]
Abstract
Arrhythmogenic cardiomyopathy (AC) is a rare heart muscle disease with a genetic background and autosomal dominant mode of transmission. The clinical manifestation is characterized by ventricular arrhythmias (VA), heart failure (HF) and the risk of sudden cardiac death (SCD). Pregnancy in young female patients with AC represents a challenging condition for the life and family planning of young affected women. In addition to genetic mechanisms that influence the complex pathophysiology of AC, experimental and clinical data have confirmed the pathogenetic role of strenuous exercise and competitive sports in the early onset and rapid progression of AC symptoms and complications. Pregnancy and exercise share a number of physiological aspects of adaptation. In AC, both result in ventricular volume overload and myocardial stretch. Therefore, pregnancy has been postulated as a potential risk factor for HF, VA, SCD, and pregnancy-related obstetric complications in patients with AC. However, the available evidence on pregnancy in AC does not confirm this hypothesis. In most women with AC, pregnancies are well tolerated, uneventful, and follow a benign course. Pregnancy-related symptoms (VA, syncope, HF) and mortality, as well as obstetric complications, are uncommon in AC patients and range in the order of background populations and cohorts with AC and no pregnancy. The number of completed pregnancies is not associated with an acceleration of AC pathology or an increased risk of VA or HF during pregnancy and follow-up. Accordingly, there is no medical indication to advise against pregnancy in patients with AC. Preconditions include stability of rhythm and hemodynamics at baseline, as well as clinical follow-ups and the availability of multidisciplinary expert consultation during pregnancy and postpartum. Genetic counseling is recommended prior to pregnancy for all couples and their families affected by AC.
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Affiliation(s)
- Thomas Wichter
- Klinik für Innere Medizin / Kardiologie, Niels-Stensen-Kliniken, Marienhospital Osnabrück, Herzzentrum Osnabrück/Bad Rothenfelde, Bischofsstr. 1, 49074, Osnabrück, Germany.
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11
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Muser D, Santangeli P. Why does catheter ablation of premature ventricular contractions in arrhythmogenic right ventricular cardiomyopathy fail? J Cardiovasc Electrophysiol 2021; 32:1675-1677. [PMID: 33783894 DOI: 10.1111/jce.15022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Daniele Muser
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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12
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Fonseca AC, Almeida AG, Santos MO, Ferro JM. Neurological complications of cardiomyopathies. HANDBOOK OF CLINICAL NEUROLOGY 2021; 177:91-109. [PMID: 33632460 DOI: 10.1016/b978-0-12-819814-8.00001-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
There is a multifaceted relationship between the cardiomyopathies and a wide spectrum of neurological disorders. Severe acute neurological events, such as a status epilepticus and aneurysmal subarachnoid hemorrhage, may result in an acute cardiomyopathy the likes of Takotsubo cardiomyopathy. Conversely, the cardiomyopathies may result in a wide array of neurological disorders. Diagnosis of a cardiomyopathy may have already been established at the time of the index neurological event, or the neurological event may have prompted subsequent cardiac investigations, which ultimately lead to the diagnosis of a cardiomyopathy. The cardiomyopathies belong to one of the many phenotypes of complex genetic diseases or syndromes, which may also involve the central or peripheral nervous systems. A number of exogenous agents or risk factors such as diphtheria, alcohol, and several viruses may result in secondary cardiomyopathies accompanied by several neurological manifestations. A variety of neuromuscular disorders, such as myotonic dystrophy or amyloidosis, may demonstrate cardiac involvement during their clinical course. Furthermore, a number of genetic cardiomyopathies phenotypically incorporate during their clinical evolution, a gamut of neurological manifestations, usually neuromuscular in nature. Likewise, neurological complications may be the result of diagnostic procedures or medications for the cardiomyopathies and vice versa. Neurological manifestations of the cardiomyopathies are broad and include, among others, transient ischemic attacks, ischemic strokes, intracranial hemorrhages, syncope, muscle weakness and atrophy, myotonia, cramps, ataxia, seizures, intellectual developmental disorder, cognitive impairment, dementia, oculomotor palsies, deafness, retinal involvement, and headaches.
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Affiliation(s)
- Ana Catarina Fonseca
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Ana G Almeida
- Cardiology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - Miguel Oliveira Santos
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal
| | - José M Ferro
- Neurology Service, Hospital Santa Maria, Centro Hospitalar Lisboa Norte and Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
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13
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Khosla J, Golamari R, Cai A, Benson J, Aronow WS, Jain R, Jain R. Evidence-based management of arrhythmogenic right ventricular cardiomyopathy in pregnancy. Future Cardiol 2020; 17:693-703. [PMID: 33089714 DOI: 10.2217/fca-2020-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder resulting in fibrofatty replacement of the myocardium. Genetic mutations in genes encoding for desmosome proteins result in a ventricular myocardium prone to arrhythmias and heart failure. Although ARVC is known for a few decades, most of the outcomes in pregnancy are reported recently. Pregnancy leads to significant physiological changes with excess mechanical stress on the myocardium. All the retrospective studies suggest that pregnancy is well tolerated in these patients despite the high risk of arrhythmias and heart failure. Our review focuses on the most up-to-date evidence on the management of ARVC patients during the antepartum and postpartum period.
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Affiliation(s)
- Jagjit Khosla
- Department of Internal Medicine, Westchester Medical Center, Valhalla, New York, NY 10595, USA
| | - Reshma Golamari
- Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, USA
| | - Alice Cai
- Penn State University College of Medicine, PA 17033, USA
| | - Jamal Benson
- Penn State University College of Medicine, PA 17033, USA
| | - Wilbert S Aronow
- Department of Cardiology, Westchester Medical Center, Valhalla, NY 10595, USA
| | - Rahul Jain
- Department of Cardiology, Indiana University, IN 46202, USA
| | - Rohit Jain
- Penn State Health Milton S Hershey Medical Center, Hershey, PA 17033, USA
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14
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Casella M, Dello Russo A, Bergonti M, Catto V, Conte E, Sommariva E, Gasperetti A, Vettor G, Tundo F, Sicuso R, Rizzo S, Mushtaq S, Della Rocca D, Pompilio G, Di Biase L, Andreini D, Natale A, Basso C, Tondo C. Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies. Circulation 2020; 142:1249-1260. [PMID: 32791857 DOI: 10.1161/circulationaha.120.046900] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Electroanatomic voltage mapping (EVM) is a promising modality for guiding endomyocardial biopsies (EMBs). However, few data support its feasibility and safety. We now report the largest cohort of patients undergoing EVM-guided EMBs to show its diagnostic yield and to compare it with a cardiac magnetic resonance (CMR)-guided approach. METHODS We included 162 consecutive patients undergoing EMB at our institution from 2010 to 2019. EMB was performed in pathological areas identified at EVM and CMR. CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated according to EMB results. RESULTS Preoperative CMR showed late gadolinium enhancement in 70% of the patients, whereas EVM identified areas of low voltage in 61%. Right (73%), left (19%), or both ventricles (8%) underwent sampling. EVM proved to have sensitivity similar to CMR (74% versus 77%), with specificity being 70% and 47%, respectively. In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas that had been undetected at CMR evaluation. Sensitivity of pooled EVM and CMR was as high as 95%. EMB analysis allowed us to reach a new diagnosis, different from the suspected clinical diagnosis, in 39% of patients. The complications rate was low, mostly related to vascular access, with no patients requiring urgent management. CONCLUSIONS EVM proved to be a promising tool for targeted EMB because of its sensitivity and specificity for identification of myocardial pathological substrates. EVM was demonstrated to have accuracy similar to CMR. EVM and CMR together conferred a positive predictive value of 89% on EMB.
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Affiliation(s)
- Michela Casella
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Cardiology and Arrhythmology Clinic, Department of Clinical, Special and Dental Sciences(M.C.), University Hospital "Umberto I - Lancisi - Salesi," Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health(A.D.R.), University Hospital "Umberto I - Lancisi - Salesi," Marche Polytechnic University, Ancona, Italy
| | - Marco Bergonti
- Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Valentina Catto
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Edoardo Conte
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Elena Sommariva
- Unit of Vascular Biology and Regenerative Medicine(E.S., G.P.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Alessio Gasperetti
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Giulia Vettor
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Fabrizio Tundo
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Rita Sicuso
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Stefania Rizzo
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy(S.R., C.B.)
| | - Saima Mushtaq
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy
| | | | - Giulio Pompilio
- Unit of Vascular Biology and Regenerative Medicine(E.S., G.P.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Luigi Di Biase
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York(L.D.B.)
| | - Daniele Andreini
- Cardiovascular Computed Tomography and Radiology Unit(E.C., S.M., D.A.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
| | - Andrea Natale
- Texas Cardiac Arrhyhtmia Institute, St David's Hospital, Austin(D.D.R., A.N.)
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Azienda Ospedaliera-University of Padua, Padova, Italy(S.R., C.B.)
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Pacing(M.C., V.C., A.G., G.V., F.T., R.S., C.T.), Centro Cardiologico Monzino IRCCS, Milano, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Italy(M.B., G.P., D.A., C.T.)
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15
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Arrhythmogenic Cardiomyopathy: Molecular Insights for Improved Therapeutic Design. J Cardiovasc Dev Dis 2020; 7:jcdd7020021. [PMID: 32466575 PMCID: PMC7345706 DOI: 10.3390/jcdd7020021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited disorder characterized by structural and electrical cardiac abnormalities, including myocardial fibro-fatty replacement. Its pathological ventricular substrate predisposes subjects to an increased risk of sudden cardiac death (SCD). ACM is a notorious cause of SCD in young athletes, and exercise has been documented to accelerate its progression. Although the genetic culprits are not exclusively limited to the intercalated disc, the majority of ACM-linked variants reside within desmosomal genes and are transmitted via Mendelian inheritance patterns; however, penetrance is highly variable. Its natural history features an initial “concealed phase” that results in patients being vulnerable to malignant arrhythmias prior to the onset of structural changes. Lack of effective therapies that target its pathophysiology renders management of patients challenging due to its progressive nature, and has highlighted a critical need to improve our understanding of its underlying mechanistic basis. In vitro and in vivo studies have begun to unravel the molecular consequences associated with disease causing variants, including altered Wnt/β-catenin signaling. Characterization of ACM mouse models has facilitated the evaluation of new therapeutic approaches. Improved molecular insight into the condition promises to usher in novel forms of therapy that will lead to improved care at the clinical bedside.
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16
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Hsia HH, Xiong N. Mapping and Ablation of Ventricular Arrhythmias in Cardiomyopathies. Card Electrophysiol Clin 2019; 11:635-655. [PMID: 31706471 DOI: 10.1016/j.ccep.2019.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Mapping and ablation of ventricular arrhythmias in patients with nonischemic cardiomyopathies remain a major challenge. The electroanatomic abnormalities are frequently inaccessible to conventional endocardial ablations. Diagnostic diligence with a thorough understanding of the potential mechanisms/substrate, coupled with detailed electroanatomic mapping, is essential. Careful procedural planning, advanced imaging, and unipolar recordings help to formulate ablation strategy, facilitate work flow, and improve outcomes. Inaccessibility of arrhythmogenic substrate and disease progression are important causes of ablation failure. Early intervention may help to improve outcome and minimize complications. Several novel adjunctive ablation techniques are capable of serving as alternative options in refractory cases.
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Affiliation(s)
- Henry H Hsia
- Cardiac Electrophysiology Service, University of California, San Francisco, MUE436, 400 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Nanqing Xiong
- Department of Cardiology, Huashan Hospital Fudan University, No.12 Wulumuqizhong Road, Shanghai 200040, China
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17
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Blusztein DI, Zentner D, Thompson T, Jayadeva P, Liang D, Wang R, Winship I, James PA, Trainer AH, Kalman JM, Vohra J. Arrhythmogenic Right Ventricular Cardiomyopathy: A Review of Living and Deceased Probands. Heart Lung Circ 2019; 28:1034-1041. [DOI: 10.1016/j.hlc.2018.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/26/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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18
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Pilichou K, Basso C. Heart failure in arrhythmogenic cardiomyopathy: is phenotypic variability just a matter of genetics? Eur J Heart Fail 2019; 21:801-802. [PMID: 30933411 DOI: 10.1002/ejhf.1456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/16/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kalliopi Pilichou
- Cardiovascular Pathology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
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19
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Verkerk AO, Amin AS, Remme CA. Disease Modifiers of Inherited SCN5A Channelopathy. Front Cardiovasc Med 2018; 5:137. [PMID: 30327767 PMCID: PMC6174200 DOI: 10.3389/fcvm.2018.00137] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 09/10/2018] [Indexed: 12/19/2022] Open
Abstract
To date, a large number of mutations in SCN5A, the gene encoding the pore-forming α-subunit of the primary cardiac Na+ channel (NaV1.5), have been found in patients presenting with a wide range of ECG abnormalities and cardiac syndromes. Although these mutations all affect the same NaV1.5 channel, the associated cardiac syndromes each display distinct phenotypical and biophysical characteristics. Variable disease expressivity has also been reported, where one particular mutation in SCN5A may lead to either one particular symptom, a range of various clinical signs, or no symptoms at all, even within one single family. Additionally, disease severity may vary considerably between patients carrying the same mutation. The exact reasons are unknown, but evidence is increasing that various cardiac and non-cardiac conditions can influence the expressivity and severity of inherited SCN5A channelopathies. In this review, we provide a summary of identified disease entities caused by SCN5A mutations, and give an overview of co-morbidities and other (non)-genetic factors which may modify SCN5A channelopathies. A comprehensive knowledge of these modulatory factors is not only essential for a complete understanding of the diverse clinical phenotypes associated with SCN5A mutations, but also for successful development of effective risk stratification and (alternative) treatment paradigms.
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Affiliation(s)
- Arie O Verkerk
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands.,Department of Medical Biology, Academic Medical Center, Amsterdam, Netherlands
| | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, Netherlands
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20
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Li G, Khandekar A, Yin T, Hicks SC, Guo Q, Takahashi K, Lipovsky CE, Brumback BD, Rao PK, Weinheimer CJ, Rentschler SL. Differential Wnt-mediated programming and arrhythmogenesis in right versus left ventricles. J Mol Cell Cardiol 2018; 123:92-107. [PMID: 30193957 DOI: 10.1016/j.yjmcc.2018.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/17/2018] [Accepted: 09/02/2018] [Indexed: 12/19/2022]
Abstract
Several inherited arrhythmias, including Brugada syndrome and arrhythmogenic cardiomyopathy, primarily affect the right ventricle and can lead to sudden cardiac death. Among many differences, right and left ventricular cardiomyocytes derive from distinct progenitors, prompting us to investigate how embryonic programming may contribute to chamber-specific conduction and arrhythmia susceptibility. Here, we show that developmental perturbation of Wnt signaling leads to chamber-specific transcriptional regulation of genes important in cardiac conduction that persists into adulthood. Transcriptional profiling of right versus left ventricles in mice deficient in Wnt transcriptional activity reveals global chamber differences, including genes regulating cardiac electrophysiology such as Gja1 and Scn5a. In addition, the transcriptional repressor Hey2, a gene associated with Brugada syndrome, is a direct target of Wnt signaling in the right ventricle only. These transcriptional changes lead to perturbed right ventricular cardiac conduction and cellular excitability. Ex vivo and in vivo stimulation of the right ventricle is sufficient to induce ventricular tachycardia in Wnt transcriptionally inactive hearts, while left ventricular stimulation has no effect. These data show that embryonic perturbation of Wnt signaling in cardiomyocytes leads to right ventricular arrhythmia susceptibility in the adult heart through chamber-specific regulation of genes regulating cellular electrophysiology.
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Affiliation(s)
- Gang Li
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Aditi Khandekar
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Tiankai Yin
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Stephanie C Hicks
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Qiusha Guo
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Kentaro Takahashi
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Catherine E Lipovsky
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Brittany D Brumback
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Praveen K Rao
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Carla J Weinheimer
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA
| | - Stacey L Rentschler
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Biomedical Engineering, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University in St. Louis, 660 S Euclid Avenue, St. Louis, MO 63110, USA.
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21
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Lin Y, Huang J, Zhao T, He S, Huang Z, Chen X, Fei H, Luo H, Liu H, Wu S, Lin X. Compound and heterozygous mutations of DSG2 identified by Whole Exome Sequencing in arrhythmogenic right ventricular cardiomyopathy/dysplasia with ventricular tachycardia. J Electrocardiol 2018; 51:837-843. [DOI: 10.1016/j.jelectrocard.2018.06.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 06/14/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
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22
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Finocchiaro G, Papadakis M, Dhutia H, Zaidi A, Malhotra A, Fabi E, Cappelletto C, Brook J, Papatheodorou E, Ensam B, Miles CJ, Bastiaenen R, Attard V, Homfray T, Sharma R, Tome M, Carr-White G, Merlo M, Behr ER, Sinagra G, Sharma S. Electrocardiographic differentiation between ‘benign T-wave inversion’ and arrhythmogenic right ventricular cardiomyopathy. Europace 2018; 21:332-338. [DOI: 10.1093/europace/euy179] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gherardo Finocchiaro
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Michael Papadakis
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Harshil Dhutia
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Abbas Zaidi
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Aneil Malhotra
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Elena Fabi
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Joe Brook
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Efstathios Papatheodorou
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Bode Ensam
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Christopher J Miles
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Rachel Bastiaenen
- Cardiovascular Department, Guy’s and St. Thomas’s Hospital, London, UK
| | - Virginia Attard
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Tessa Homfray
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Rajan Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Maite Tome
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gerald Carr-White
- Cardiovascular Department, Guy’s and St. Thomas’s Hospital, London, UK
| | - Marco Merlo
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Elijah R Behr
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
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23
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Basso C, Pilichou K, Bauce B, Corrado D, Thiene G. Diagnostic Criteria, Genetics, and Molecular Basis of Arrhythmogenic Cardiomyopathy. Heart Fail Clin 2018. [DOI: 10.1016/j.hfc.2018.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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24
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Cunningham SM, Sweeney JT, MacGregor J, Barton BA, Rush JE. Clinical Features of English Bulldogs with Presumed Arrhythmogenic Right Ventricular Cardiomyopathy: 31 Cases (2001–2013). J Am Anim Hosp Assoc 2018; 54:95-102. [DOI: 10.5326/jaaha-ms-6550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an important cause of sudden death in people and boxer dogs that has recently been described in English bulldogs. The objective of this retrospective study was to describe the clinical characteristics of English bulldogs with presumed ARVC. The medical records were searched for English bulldogs examined between 2001 and 2013 with a clinical diagnosis of ARVC. The average age of the 31 dogs identified was 9.2 ± 1.6 yr (range 7–13 yr). Males were overrepresented by a factor of 2.9 to 1. At initial presentation, 5 dogs had subclinical arrhythmia, 10 dogs had clinical signs attributable to arrhythmia, and 16 dogs had congestive heart failure. Eighteen dogs (58%) had ventricular tachycardia and five (16%) also had supraventricular arrhythmias. Four dogs experienced sudden death, 2 dogs died from congestive heart failure, 11 dogs were euthanized for cardiac causes, and 2 dogs died or were euthanized for noncardiac causes. Kaplan-Meier analysis showed a median survival time of 8.3 mo. This is the first study to describe the clinical characteristics of a population of English bulldogs with presumed ARVC. Further studies are needed to better characterize the clinical features of the disease in this breed.
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Affiliation(s)
- Suzanne M. Cunningham
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Joseph T. Sweeney
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John MacGregor
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - Bruce A. Barton
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
| | - John E. Rush
- From the Department of Clinical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts (S.M.C., J.E.R.); MedVet Columbus, Worthington, Ohio (J.T.S.); New England Veterinary Cardiology, Portland, Maine (J.M.); and Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts (B.A.B.)
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Affiliation(s)
- Ying Liu
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, Indianapolis, IN 46202, USA
| | - Vincent H S Chen
- Department of Medicine, Krannert Heart Institute, Indiana University School of Medicine, 1801 North Senate Ave, Indianapolis, IN 46202, USA
| | - Weinian Shou
- Department of Pediatrics, Herman B Wells Center for Pediatric Research, Indiana University School of Medicine, 1044 West Walnut Street, Indianapolis, IN 46202, USA
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Bermúdez-Jiménez FJ, Carriel V, Brodehl A, Alaminos M, Campos A, Schirmer I, Milting H, Abril BÁ, Álvarez M, López-Fernández S, García-Giustiniani D, Monserrat L, Tercedor L, Jiménez-Jáimez J. Novel Desmin Mutation p.Glu401Asp Impairs Filament Formation, Disrupts Cell Membrane Integrity, and Causes Severe Arrhythmogenic Left Ventricular Cardiomyopathy/Dysplasia. Circulation 2017; 137:1595-1610. [PMID: 29212896 DOI: 10.1161/circulationaha.117.028719] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 11/09/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Desmin (DES) mutations cause severe skeletal and cardiac muscle disease with heterogeneous phenotypes. Recently, DES mutations were described in patients with inherited arrhythmogenic right ventricular cardiomyopathy/dysplasia, although their cellular and molecular pathomechanisms are not precisely known. Our aim is to describe clinically and functionally the novel DES-p.Glu401Asp mutation as a cause of inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia. METHODS We identified the novel DES mutation p.Glu401Asp in a large Spanish family with inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia and a high incidence of adverse cardiac events. A full clinical evaluation was performed on all mutation carriers and noncarriers to establish clinical and genetic cosegregation. In addition, desmin, and intercalar disc-related proteins expression were histologically analyzed in explanted cardiac tissue affected by the DES mutation. Furthermore, mesenchymal stem cells were isolated and cultured from 2 family members with the DES mutation (1 with mild and 1 with severe symptomatology) and a member without the mutation (control) and differentiated ex vivo to cardiomyocytes. Then, important genes related to cardiac differentiation and function were analyzed by real-time quantitative polymerase chain reaction. Finally, the p.Glu401Asp mutated DES gene was transfected into cell lines and analyzed by confocal microscopy. RESULTS Of the 66 family members screened for the DES-p.Glu401Asp mutation, 23 of them were positive, 6 were obligate carriers, and 2 were likely carriers. One hundred percent of genotype-positive patients presented data consistent with inherited arrhythmogenic cardiomyopathy/dysplasia phenotype with variable disease severity expression, high-incidence of sudden cardiac death, and absence of skeletal myopathy or conduction system disorders. Immunohistochemistry was compatible with inherited arrhythmogenic cardiomyopathy/dysplasia, and the functional study showed an abnormal growth pattern and cellular adhesion, reduced desmin RNA expression, and some other membrane proteins, as well, and desmin aggregates in transfected cells expressing the mutant desmin. CONCLUSIONS The DES-p.Glu401Asp mutation causes predominant inherited left ventricular arrhythmogenic cardiomyopathy/dysplasia with a high incidence of adverse clinical events in the absence of skeletal myopathy or conduction system disorders. The pathogenic mechanism probably corresponds to an alteration in desmin dimer and oligomer assembly and its connection with membrane proteins within the intercalated disc.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/genetics
- Arrhythmias, Cardiac/physiopathology
- Cardiomyopathies/diagnosis
- Cardiomyopathies/genetics
- Cardiomyopathies/physiopathology
- Cell Differentiation/genetics
- Cells, Cultured
- Child
- Desmin/genetics
- Desmin/metabolism
- Electrocardiography
- Female
- Genetic Predisposition to Disease
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/genetics
- Heart Defects, Congenital/physiopathology
- Heart Ventricles/abnormalities
- Heart Ventricles/metabolism
- Heart Ventricles/physiopathology
- Heredity
- Heterozygote
- Humans
- Magnetic Resonance Imaging
- Male
- Mesenchymal Stem Cells/metabolism
- Mesenchymal Stem Cells/pathology
- Middle Aged
- Mutation
- Myocytes, Cardiac/metabolism
- Myocytes, Cardiac/pathology
- Pedigree
- Phenotype
- Spain
- Young Adult
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Affiliation(s)
- Francisco José Bermúdez-Jiménez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.).
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Víctor Carriel
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Andreas Brodehl
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Miguel Alaminos
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Antonio Campos
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Ilona Schirmer
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Hendrik Milting
- Erich and Hanna Klessmann Institute for Cardiovascular Research and Development, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany (A.B., I.S., H.M.)
| | - Beatriz Álvarez Abril
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Miguel Álvarez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Silvia López-Fernández
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | | | - Lorenzo Monserrat
- Cardiology Department, Health in Code, A Coruña, Spain (D.G.-G., L.M.)
| | - Luis Tercedor
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
| | - Juan Jiménez-Jáimez
- Cardiology Department, Virgen de las Nieves University Hospital, Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F., L.T., J.J.-J.)
- Department of Histology, Tissue Engineering Group, Faculty of Medicine, University of Granada, Spain (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
- Instituto de Investigación Biosanitaria (F.J.B.-J., B.A.A., M. Álvarez, S.L.-F, L.T., J.J.-J., V.C., M. Alaminos, A.C.)
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Pathak RK, Garcia FC. Ablation of Ventricular Tachycardia in Arrhythmogenic Right Ventricular Dysplasia. Card Electrophysiol Clin 2017; 9:99-106. [PMID: 28167090 DOI: 10.1016/j.ccep.2016.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Endocardial and epicardial electroanatomical mapping and ablation is a safe and effective therapy in the treatment of right ventricle arrhythmias occurring in the setting of arrhythmogenic right ventricular cardiomyopathy (ARVD). Careful mapping and ablation plans must be tailored for each patient based on comorbidities and ventricular tachycardia morphologies. This review focuses on the catheter ablation for ventricular arrhythmias in patients with ARVD.
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Affiliation(s)
- Rajeev K Pathak
- Clinical Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Fermin C Garcia
- Clinical Cardiac Electrophysiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, 9 Founders Pavilion - Cardiology, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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29
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Abstract
Cardiac arrhythmias can follow disruption of the normal cellular electrophysiological processes underlying excitable activity and their tissue propagation as coherent wavefronts from the primary sinoatrial node pacemaker, through the atria, conducting structures and ventricular myocardium. These physiological events are driven by interacting, voltage-dependent, processes of activation, inactivation, and recovery in the ion channels present in cardiomyocyte membranes. Generation and conduction of these events are further modulated by intracellular Ca2+ homeostasis, and metabolic and structural change. This review describes experimental studies on murine models for known clinical arrhythmic conditions in which these mechanisms were modified by genetic, physiological, or pharmacological manipulation. These exemplars yielded molecular, physiological, and structural phenotypes often directly translatable to their corresponding clinical conditions, which could be investigated at the molecular, cellular, tissue, organ, and whole animal levels. Arrhythmogenesis could be explored during normal pacing activity, regular stimulation, following imposed extra-stimuli, or during progressively incremented steady pacing frequencies. Arrhythmic substrate was identified with temporal and spatial functional heterogeneities predisposing to reentrant excitation phenomena. These could arise from abnormalities in cardiac pacing function, tissue electrical connectivity, and cellular excitation and recovery. Triggering events during or following recovery from action potential excitation could thereby lead to sustained arrhythmia. These surface membrane processes were modified by alterations in cellular Ca2+ homeostasis and energetics, as well as cellular and tissue structural change. Study of murine systems thus offers major insights into both our understanding of normal cardiac activity and its propagation, and their relationship to mechanisms generating clinical arrhythmias.
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Affiliation(s)
- Christopher L-H Huang
- Physiological Laboratory and the Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
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30
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Herman AR, Gardner M, Steinberg C, Yeung-Lai-Wah JA, Healey JS, Leong-Sit P, Krahn AD, Chakrabarti S. Long-term right ventricular implantable cardioverter-defibrillator lead performance in arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2016; 13:1964-70. [DOI: 10.1016/j.hrthm.2016.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Indexed: 11/26/2022]
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31
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Potentially Lethal Ventricular Arrhythmias and Heart Failure in Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2016; 2:546-555. [DOI: 10.1016/j.jacep.2016.02.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 02/23/2016] [Accepted: 02/25/2016] [Indexed: 11/19/2022]
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32
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Akdis D, Brunckhorst C, Duru F, Saguner AM. Arrhythmogenic Cardiomyopathy: Electrical and Structural Phenotypes. Arrhythm Electrophysiol Rev 2016; 5:90-101. [PMID: 27617087 PMCID: PMC5013177 DOI: 10.15420/aer.2016.4.3] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/03/2016] [Indexed: 12/12/2022] Open
Abstract
This overview gives an update on the molecular mechanisms, clinical manifestations, diagnosis and therapy of arrhythmogenic cardiomyopathy (ACM). ACM is mostly hereditary and associated with mutations in genes encoding proteins of the intercalated disc. Three subtypes have been proposed: the classical right-dominant subtype generally referred to as ARVC/D, biventricular forms with early biventricular involvement and left-dominant subtypes with predominant LV involvement. Typical symptoms include palpitations, arrhythmic (pre)syncope and sudden cardiac arrest due to ventricular arrhythmias, which typically occur in athletes. At later stages, heart failure may occur. Diagnosis is established with the 2010 Task Force Criteria (TFC). Modern imaging tools are crucial for ACM diagnosis, including both echocardiography and cardiac magnetic resonance imaging for detecting functional and structural alternations. Of note, structural findings often become visible after electrical alterations, such as premature ventricular beats, ventricular fibrillation (VF) and ventricular tachycardia (VT). 12-lead ECG is important to assess for depolarisation and repolarisation abnormalities, including T-wave inversions as the most common ECG abnormality. Family history and the detection of causative mutations, mostly affecting the desmosome, have been incorporated in the TFC, and stress the importance of cascade family screening. Differential diagnoses include idiopathic right ventricular outflow tract (RVOT) VT, sarcoidosis, congenital heart disease, myocarditis, dilated cardiomyopathy, athlete's heart, Brugada syndrome and RV infarction. Therapeutic strategies include restriction from endurance and competitive sports, β-blockers, antiarrhythmic drugs, heart failure medication, implantable cardioverter-defibrillators and endocardial/epicardial catheter ablation.
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Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland; Center for Integrative Human Physiology, University of Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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Carmosino M, Gerbino A, Schena G, Procino G, Miglionico R, Forleo C, Favale S, Svelto M. The expression of Lamin A mutant R321X leads to endoplasmic reticulum stress with aberrant Ca 2+ handling. J Cell Mol Med 2016; 20:2194-2207. [PMID: 27421120 PMCID: PMC5082401 DOI: 10.1111/jcmm.12926] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 06/07/2016] [Indexed: 01/13/2023] Open
Abstract
Mutations in the Lamin A/C gene (LMNA), which encodes A‐type nuclear Lamins, represent the most frequent genetic cause of dilated cardiomyopathy (DCM). This study is focused on a LMNA nonsense mutation (R321X) identified in several members of an Italian family that produces a truncated protein isoform, which co‐segregates with a severe form of cardiomyopathy with poor prognosis. However, no molecular mechanisms other than nonsense mediated decay of the messenger and possible haploinsufficiency were proposed to explain DCM. Aim of this study was to gain more insights into the disease‐causing mechanisms induced by the expression of R321X at cellular level. We detected the expression of R321X by Western blotting from whole lysate of a mutation carrier heart biopsy. When expressed in HEK293 cells, GFP‐ (or mCherry)‐tagged R321X mislocalized in the endoplasmic reticulum (ER) inducing the PERK‐CHOP axis of the ER stress response. Of note, confocal microscopy showed phosphorylation of PERK in sections of the mutation carrier heart biopsy. ER mislocalization of mCherry‐R321X also induced impaired ER Ca2+ handling, reduced capacitative Ca2+ entry at the plasma membrane and abnormal nuclear Ca2+ dynamics. In addition, expression of R321X by itself increased the apoptosis rate. In conclusion, R321X is the first LMNA mutant identified to date, which mislocalizes into the ER affecting cellular homeostasis mechanisms not strictly related to nuclear functions.
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Affiliation(s)
- Monica Carmosino
- Department of Sciences, University of Basilicata, Potenza, Italy.
| | - Andrea Gerbino
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy
| | - Giorgia Schena
- Department of Sciences, University of Basilicata, Potenza, Italy
| | - Giuseppe Procino
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy
| | | | - Cinzia Forleo
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Stefano Favale
- Cardiology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Svelto
- Department of Biosciences, Biotechnology and Biopharmaceutics, University of Bari, Bari, Italy.,Consiglio Nazionale delle Ricerche, Bari, Italy
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Pilichou K, Thiene G, Bauce B, Rigato I, Lazzarini E, Migliore F, Perazzolo Marra M, Rizzo S, Zorzi A, Daliento L, Corrado D, Basso C. Arrhythmogenic cardiomyopathy. Orphanet J Rare Dis 2016; 11:33. [PMID: 27038780 PMCID: PMC4818879 DOI: 10.1186/s13023-016-0407-1] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 03/16/2016] [Indexed: 01/16/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (AC) is a heart muscle disease clinically characterized by life-threatening ventricular arrhythmias and pathologically by an acquired and progressive dystrophy of the ventricular myocardium with fibro-fatty replacement. Due to an estimated prevalence of 1:2000-1:5000, AC is listed among rare diseases. A familial background consistent with an autosomal-dominant trait of inheritance is present in most of AC patients; recessive variants have also been reported, either or not associated with palmoplantar keratoderma and woolly hair. AC-causing genes mostly encode major components of the cardiac desmosome and up to 50 % of AC probands harbor mutations in one of them. Mutations in non-desmosomal genes have been also described in a minority of AC patients, predisposing to the same or an overlapping disease phenotype. Compound/digenic heterozygosity was identified in up to 25 % of AC-causing desmosomal gene mutation carriers, in part explaining the phenotypic variability. Abnormal trafficking of intercellular proteins to the intercalated discs of cardiomyocytes and Wnt/beta catenin and Hippo signaling pathways have been implicated in disease pathogenesis. AC is a major cause of sudden death in the young and in athletes. The clinical picture may include a sub-clinical phase; an overt electrical disorder; and right ventricular or biventricular pump failure. Ventricular fibrillation can occur at any stage. Genotype-phenotype correlation studies led to identify biventricular and dominant left ventricular variants, thus supporting the use of the broader term AC. Since there is no “gold standard” to reach the diagnosis of AC, multiple categories of diagnostic information have been combined and the criteria recently updated, to improve diagnostic sensitivity while maintaining specificity. Among diagnostic tools, contrast enhanced cardiac magnetic resonance is playing a major role in detecting left dominant forms of AC, even preceding morpho-functional abnormalities. The main differential diagnoses are idiopathic right ventricular outflow tract tachycardia, myocarditis, sarcoidosis, dilated cardiomyopathy, right ventricular infarction, congenital heart diseases with right ventricular overload and athlete heart. A positive genetic test in the affected AC proband allows early identification of asymptomatic carriers by cascade genetic screening of family members. Risk stratification remains a major clinical challenge and antiarrhythmic drugs, catheter ablation and implantable cardioverter defibrillator are the currently available therapeutic tools. Sport disqualification is life-saving, since effort is a major trigger not only of electrical instability but also of disease onset and progression. We review the current knowledge of this rare cardiomyopathy, suggesting a flowchart for primary care clinicians and geneticists.
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Affiliation(s)
- Kalliopi Pilichou
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Ilaria Rigato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Elisabetta Lazzarini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Federico Migliore
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | | | - Stefania Rizzo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Luciano Daliento
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
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Corrado D, Zorzi A, Cerrone M, Rigato I, Mongillo M, Bauce B, Delmar M. Relationship Between Arrhythmogenic Right Ventricular Cardiomyopathy and Brugada Syndrome: New Insights From Molecular Biology and Clinical Implications. Circ Arrhythm Electrophysiol 2016; 9:e003631. [PMID: 26987567 PMCID: PMC4800833 DOI: 10.1161/circep.115.003631] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Domenico Corrado
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.).
| | - Alessandro Zorzi
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Marina Cerrone
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Ilaria Rigato
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Marco Mongillo
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Barbara Bauce
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
| | - Mario Delmar
- From the Departments of Cardiac, Thoracic, and Vascular Sciences (D.C., A.Z., I.R., B.B.) and Biomedical Sciences (M.M.), University of Padua, Padova, Italy; and The Leon H. Charney Division of Cardiology, New York University School of Medicine (M.C., M.D.)
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Failure of ICD therapy in lethal arrhythmogenic right ventricular cardiomyopathy type 5 caused by the TMEM43 p.Ser358Leu mutation. HeartRhythm Case Rep 2016; 2:217-222. [PMID: 28491673 PMCID: PMC5419751 DOI: 10.1016/j.hrcr.2015.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Rigato I, Corrado D, Basso C, Zorzi A, Pilichou K, Bauce B, Thiene G. Pharmacotherapy and other therapeutic modalities for managing Arrhythmogenic Right Ventricular Cardiomyopathy. Cardiovasc Drugs Ther 2016; 29:171-7. [PMID: 25894016 DOI: 10.1007/s10557-015-6583-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a genetically determined rare cardiomyopathy (1 in 5000 to 1 in 2000 in the general population), which can lead to ventricular arrhythmias and sudden death (SD). The classic form of the disease has a predilection for the right ventricle (RV), but recognition of left-dominant and biventricular variants led to the broader term "Arrhythmogenic Cardiomyopathy". The disease affects men more frequently than women and becomes clinically overt usually from the second to the fourth decade of life. Treatment consists of restriction of physical exercise, antiarrhythmic drugs, catheter ablation and ICD implantation. These treatments have the potential to change the natural history of the disease by protecting against SD and offering a good-quality and nearly normal life-expectancy. Antiarrhythmic drugs play an important role in terms of reduction of both the number and the complexity of arrhythmias, but they do not reduce the risk of SD. The results of catheter ablation are poor because of the high rate of VT recurrence. ICD should be reserved to selected patients after an accurate risk stratification. The clinical challenge is to improve risk stratification for better identification of those patients who most benefit from the above therapies. Unfortunately, a curative therapy is not yet available.
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Affiliation(s)
- Ilaria Rigato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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Akdis D, Saguner AM, Brunckhorst CB, Duru F, Haegeli LM. Successful epicardial ablation of ventricular tachycardia in a patient with arrhythmogenic right ventricular cardiomyopathy. Int J Cardiol 2016; 211:22-4. [PMID: 26970960 DOI: 10.1016/j.ijcard.2016.02.119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 02/20/2016] [Indexed: 02/01/2023]
Affiliation(s)
- Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Corinna B Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Laurent M Haegeli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.
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Abstract
Athletes and especially elite athletes are predominantly young people and are not associated with high health risks, apart from traumatic injuries. Nevertheless, there is a significantly high incidence of sudden cardiac death (SCD), which ranges from 0.6 to 3.0/100,000 athletes per year. Often the SCD is the first manifestation of an underlying cardiac disease. Distinct structural cardiac disorders, such as hypertrophic cardiomyopathy, coronary artery anomalies (17 %), inflammatory disorders (6 %) and arrhythmogenic right ventricular cardiomyopathy as well as conditions without structural cardiac abnormalities, such as primary electrical diseases (channelopathies) are important causes of sudden death. A simple screening can help to identify athletes with these diseases and allow specific therapies or precautionary measures to be initiated.
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Affiliation(s)
- T Tönnis
- Kardiologie, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Deutschland,
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Kant S, Krusche CA, Gaertner A, Milting H, Leube RE. Loss of plakoglobin immunoreactivity in intercalated discs in arrhythmogenic right ventricular cardiomyopathy: protein mislocalization versus epitope masking. Cardiovasc Res 2015; 109:260-71. [PMID: 26676851 DOI: 10.1093/cvr/cvv270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/27/2015] [Indexed: 01/13/2023] Open
Abstract
AIMS To examine the relevance and cause of reduced plakoglobin IF in intercalated discs for arrhythmogenic right ventricular cardiomyopathy (ARVC) and ARVC-like disease in mouse and human. METHODS AND RESULTS Normalized semi-quantitative IF measurements were performed in a standardized format in desmoglein 2-mutant mice with an ARVC-like phenotype (n = 6) and in cardiac biopsies from humans with ARVC and non-ARVC heart disease (n = 10). Reduced plakoglobin staining was detectable in ARVC only with one antibody directed against a defined epitope but not with three other antibodies reacting with different epitopes of plakoglobin. CONCLUSIONS Reduced plakoglobin staining in intercalated discs of heart tissue from human ARVC patients and in a murine ARVC model is caused by alterations in epitope accessibility and not by protein relocalization.
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Affiliation(s)
- Sebastian Kant
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Claudia A Krusche
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Anna Gaertner
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Rudolf E Leube
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
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Mast TP, Teske AJ, vd Heijden JF, Groeneweg JA, Te Riele AS, Velthuis BK, Hauer RN, Doevendans PA, Cramer MJ. Left Ventricular Involvement in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy Assessed by Echocardiography Predicts Adverse Clinical Outcome. J Am Soc Echocardiogr 2015; 28:1103-13.e9. [DOI: 10.1016/j.echo.2015.04.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Indexed: 11/29/2022]
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Hannah-Shmouni F, Seidelmann SB, Sirrs S, Mani A, Jacoby D. The Genetic Challenges and Opportunities in Advanced Heart Failure. Can J Cardiol 2015; 31:1338-50. [PMID: 26518444 DOI: 10.1016/j.cjca.2015.07.735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 12/17/2022] Open
Abstract
The causes of heart failure are diverse. Inherited causes represent an important clinical entity and can be divided into 2 major categories: familial and metabolic cardiomyopathies. The distinct features that might be present in early disease states can become broadly overlapping with other diseases, such as in the case of inherited cardiomyopathies (ie, familial hypertrophic cardiomyopathy or mitochondrial diseases). In this review article, we focus on genetic issues related to advanced heart failure. Because of the emerging importance of this topic and its breadth, we sought to focus our discussion on the known genetic forms of heart failure syndromes, genetic testing, and newer data on pharmacogenetics and therapeutics in the treatment of heart failure, to primarily encourage clinicians to place a priority on the diagnosis and treatment of these potentially treatable conditions.
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Affiliation(s)
- Fady Hannah-Shmouni
- Advanced Heart Failure and Cardiomyopathy Program, Division of Cardiovascular Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Internal Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Cardiovascular Genetics Program, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sara B Seidelmann
- Advanced Heart Failure and Cardiomyopathy Program, Division of Cardiovascular Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Internal Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Cardiovascular Genetics Program, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sandra Sirrs
- Adult Metabolic Diseases Clinic, Division of Endocrinology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arya Mani
- Department of Internal Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Cardiovascular Genetics Program, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Genetics, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA
| | - Daniel Jacoby
- Advanced Heart Failure and Cardiomyopathy Program, Division of Cardiovascular Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA; Department of Internal Medicine, Yale-New Haven Hospital, Yale School of Medicine, New Haven, Connecticut, USA.
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Corrado D, Wichter T, Link MS, Hauer R, Marchlinski F, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NAM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015. [PMID: 26216920 PMCID: PMC4670964 DOI: 10.1093/eurheartj/ehv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Thomas Wichter
- Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany
| | - Mark S Link
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | - Richard Hauer
- ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | | | - Aris Anastasakis
- First Cardiology Department, University of Athens, Medical School, Athens, Greece
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | | | | | | | | | - Christian Schmied
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Firat Duru
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
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Corrado D, Wichter T, Link MS, Hauer RNW, Marchlinski FE, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: An International Task Force Consensus Statement. Circulation 2015. [PMID: 26216213 PMCID: PMC4521905 DOI: 10.1161/circulationaha.115.017944] [Citation(s) in RCA: 238] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Domenico Corrado
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.).
| | - Thomas Wichter
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Mark S Link
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Richard N W Hauer
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank E Marchlinski
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Aris Anastasakis
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Barbara Bauce
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Cristina Basso
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Corinna Brunckhorst
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Adalena Tsatsopoulou
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Harikrishna Tandri
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Matthias Paul
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Christian Schmied
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Antonio Pelliccia
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Firat Duru
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Nikos Protonotarios
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Na Mark Estes
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - William J McKenna
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Gaetano Thiene
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank I Marcus
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Hugh Calkins
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
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Duncker D, König T, Hohmann S, Veltmann C. [Primary and secondary prophylactic ICD therapy in congenital electrical and structural cardiomyopathies]. Herzschrittmacherther Elektrophysiol 2015; 26:82-93. [PMID: 26001359 DOI: 10.1007/s00399-015-0372-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 04/30/2015] [Indexed: 01/23/2023]
Abstract
Congenital electrical and structural cardiomyopathies are rare and associated with an increased risk for syncope and sudden cardiac death in the young. Due to the young age of the patients and the limited data available, risk stratification and especially ICD therapy are challenging. In this young patient collective, ICD therapy is associated with a high complication rate, which does not justify unreserved primary prophylactic ICD implantation. The aim of this review is to elucidate risk stratification and ICD therapy of various electrical and structural cardiomyopathies.
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Affiliation(s)
- D Duncker
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Cadrin-Tourigny J, Tadros R, Talajic M, Rivard L, Abadir S, Khairy P. Risk stratification for sudden death in arrhythmogenic right ventricular cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13:653-64. [DOI: 10.1586/14779072.2015.1043891] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Clinical and functional characterization of a novel mutation in lamin a/c gene in a multigenerational family with arrhythmogenic cardiac laminopathy. PLoS One 2015; 10:e0121723. [PMID: 25837155 PMCID: PMC4383583 DOI: 10.1371/journal.pone.0121723] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
Mutations in the lamin A/C gene (LMNA) were associated with dilated cardiomyopathy (DCM) and, recently, were related to severe forms of arrhythmogenic right ventricular cardiomyopathy (ARVC). Both genetic and phenotypic overlap between DCM and ARVC was observed; molecular pathomechanisms leading to the cardiac phenotypes caused by LMNA mutations are not yet fully elucidated. This study involved a large Italian family, spanning 4 generations, with arrhythmogenic cardiomyopathy of different phenotypes, including ARVC, DCM, system conduction defects, ventricular arrhythmias, and sudden cardiac death. Mutation screening of LMNA and ARVC-related genes PKP2, DSP, DSG2, DSC2, JUP, and CTNNA3 was performed. We identified a novel heterozygous mutation (c.418_438dup) in LMNA gene exon 2, occurring in a highly conserved protein domain across several species. This newly identified variant was not found in 250 ethnically-matched control subjects. Genotype-phenotype correlation studies suggested a co-segregation of the LMNA mutation with the disease phenotype and an incomplete and age-related penetrance. Based on clinical, pedigree, and molecular genetic data, this mutation was considered likely disease-causing. To clarify its potential pathophysiologic impact, functional characterization of this LMNA mutant was performed in cultured cardiomyocytes expressing EGFP-tagged wild-type and mutated LMNA constructs, and indicated an increased nuclear envelope fragility, leading to stress-induced apoptosis as the main pathogenetic mechanism. This study further expands the role of the LMNA gene in the pathogenesis of cardiac laminopathies, suggesting that LMNA should be included in mutation screening of patients with suspected arrhythmogenic cardiomyopathy, particularly when they have ECG evidence for conduction defects. The combination of clinical, genetic, and functional data contribute insights into the pathogenesis of this form of life-threatening arrhythmogenic cardiac laminopathy.
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Guttmann OP, Mohiddin SA, Elliott PM. Almanac 2014: cardiomyopathies. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Thiene G. The research venture in arrhythmogenic right ventricular cardiomyopathy: a paradigm of translational medicine. Eur Heart J 2015; 36:837-46. [DOI: 10.1093/eurheartj/ehu493] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 12/11/2014] [Indexed: 02/07/2023] Open
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