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Faga V, Ruiz Cueto M, Viladés Medel D, Moreno-Weidmann Z, Dallaglio PD, Diez Lopez C, Roura G, Guerra JM, Leta Petracca R, Gomez-Hospital JA, Comin Colet J, Anguera I, Di Marco A. Diagnostic and Prognostic Value of Right Ventricular Fat Quantification from Computed Tomography in Arrhythmogenic Right Ventricular Cardiomyopathy. J Clin Med 2024; 13:3674. [PMID: 38999240 PMCID: PMC11242505 DOI: 10.3390/jcm13133674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/15/2024] [Accepted: 06/21/2024] [Indexed: 07/14/2024] Open
Abstract
Background: In arrhythmogenic right ventricular cardiomyopathy (ARVC) non-invasive scar evaluation is not included among the diagnostic criteria or the predictors of ventricular arrhythmias (VA) and sudden death (SD). Computed tomography (CT) has excellent spatial resolution and allows a clear distinction between myocardium and fat; thus, it has great potential for the evaluation of myocardial scar in ARVC. Objective: The objective of this study is to evaluate the feasibility, and the diagnostic and prognostic value of semi-automated quantification of right ventricular (RV) fat replacement from CT images. Methods: An observational case-control study was carried out including 23 patients with a definite (19) or borderline (4) ARVC diagnosis and 23 age- and sex-matched controls without structural heart disease. All patients underwent contrast-enhanced cardiac CT. RV images were semi-automatically reconstructed with the ADAS-3D software (ADAS3D Medical, Barcelona, Spain). A fibrofatty scar was defined as values of Hounsfield Units (HU) <-10. Within the scar, a border zone (between -10 HU and -50 HU) and dense scar (<-50 HU) were distinguished. Results: All ARVC patients had an RV scar and all scar-related measurements were significantly higher in ARVC cases than in controls (p < 0.001). The total scar area and dense scar area showed no overlapping values between cases and controls, achieving perfect diagnostic performance (sensitivity and specificity of 100%). Among ARVC patients, 16 (70%) had experienced sustained VA or aborted SD. Among all clinical, ECG and imaging parameters, the dense scar area was the only one with a statistically significant association with VA and SD (p = 0.003). Conclusions: In ARVC, RV myocardial fat quantification from CT is feasible and may have considerable diagnostic and prognostic value.
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Affiliation(s)
- Valentina Faga
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - María Ruiz Cueto
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - David Viladés Medel
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Cardiac Imaging Unit, Hospital de la Creu Blanca, 08034 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | | | - Paolo D. Dallaglio
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Carles Diez Lopez
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Gerard Roura
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Jose M. Guerra
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Institut de Recerca Sant Pau, 08041 Barcelona, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Rubén Leta Petracca
- Cardiology Department, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Cardiac Imaging Unit, Hospital de la Creu Blanca, 08034 Barcelona, Spain
| | - Joan Antoni Gomez-Hospital
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Josep Comin Colet
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Innovation, Research and Universities Department, Gerència Territorial Metropolitana Sud, Institut Català de la Salut, Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
| | - Ignasi Anguera
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Andrea Di Marco
- Cardiology Department, Bellvitge University Hospital, Hospitalet de Llobregat, 08907 Barcelona, Spain
- BIOHEART Group, Cardiovascular, Respiratory and Systemic Disease and Cellular Aginf Program, Institut d’Investigación Biomèdica de Bellvitge (IDIBELL), Hospitalet de Llobregat, 08907 Barcelona, Spain
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2
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Joy G, Lopes LR, Webber M, Ardissino AM, Wilson J, Chan F, Pierce I, Hughes RK, Moschonas K, Shiwani H, Jamieson R, Velazquez PP, Vijayakumar R, Dall'Armellina E, Macfarlane PW, Manisty C, Kellman P, Davies RH, Tome M, Koncar V, Tao X, Guger C, Rudy Y, Hughes AD, Lambiase PD, Moon JC, Orini M, Captur G. Electrophysiological Characterization of Subclinical and Overt Hypertrophic Cardiomyopathy by Magnetic Resonance Imaging-Guided Electrocardiography. J Am Coll Cardiol 2024; 83:1042-1055. [PMID: 38385929 PMCID: PMC10945386 DOI: 10.1016/j.jacc.2024.01.006] [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] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Ventricular arrhythmia in hypertrophic cardiomyopathy (HCM) relates to adverse structural change and genetic status. Cardiovascular magnetic resonance (CMR)-guided electrocardiographic imaging (ECGI) noninvasively maps cardiac structural and electrophysiological (EP) properties. OBJECTIVES The purpose of this study was to establish whether in subclinical HCM (genotype [G]+ left ventricular hypertrophy [LVH]-), ECGI detects early EP abnormality, and in overt HCM, whether the EP substrate relates to genetic status (G+/G-LVH+) and structural phenotype. METHODS This was a prospective 211-participant CMR-ECGI multicenter study of 70 G+LVH-, 104 LVH+ (51 G+/53 G-), and 37 healthy volunteers (HVs). Local activation time (AT), corrected repolarization time, corrected activation-recovery interval, spatial gradients (GAT/GRTc), and signal fractionation were derived from 1,000 epicardial sites per participant. Maximal wall thickness and scar burden were derived from CMR. A support vector machine was built to discriminate G+LVH- from HV and low-risk HCM from those with intermediate/high-risk score or nonsustained ventricular tachycardia. RESULTS Compared with HV, subclinical HCM showed mean AT prolongation (P = 0.008) even with normal 12-lead electrocardiograms (ECGs) (P = 0.009), and repolarization was more spatially heterogenous (GRTc: P = 0.005) (23% had normal ECGs). Corrected activation-recovery interval was prolonged in overt vs subclinical HCM (P < 0.001). Mean AT was associated with maximal wall thickness; spatial conduction heterogeneity (GAT) and fractionation were associated with scar (all P < 0.05), and G+LVH+ had more fractionation than G-LVH+ (P = 0.002). The support vector machine discriminated subclinical HCM from HV (10-fold cross-validation accuracy 80% [95% CI: 73%-85%]) and identified patients at higher risk of sudden cardiac death (accuracy 82% [95% CI: 78%-86%]). CONCLUSIONS In the absence of LVH or 12-lead ECG abnormalities, HCM sarcomere gene mutation carriers express an aberrant EP phenotype detected by ECGI. In overt HCM, abnormalities occur more severely with adverse structural change and positive genetic status.
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Affiliation(s)
- George Joy
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
| | - Luis R Lopes
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Matthew Webber
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - James Wilson
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Fiona Chan
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Rebecca K Hughes
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Konstantinos Moschonas
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Robert Jamieson
- Electrocardiology Section, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Paula P Velazquez
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Cardiology Clinical and Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ramya Vijayakumar
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri, USA
| | - Erica Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Peter W Macfarlane
- Electrocardiology Section, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Charlotte Manisty
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, DHHS, Bethesda, Maryland, USA
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Maite Tome
- Cardiology Clinical and Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Vladan Koncar
- École Nationale Supérieure des Arts et Industries Textiles, University of Lille, Lille, France
| | - Xuyuan Tao
- École Nationale Supérieure des Arts et Industries Textiles, University of Lille, Lille, France
| | | | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St Louis, Missouri, USA
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, London, United Kingdom; Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom
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3
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Webber M, Joy G, Bennett J, Chan F, Falconer D, Shiwani H, Davies RH, Krausz G, Tanackovic S, Guger C, Gonzalez P, Martin E, Wong A, Rapala A, Direk K, Kellman P, Pierce I, Rudy Y, Vijayakumar R, Chaturvedi N, Hughes AD, Moon JC, Lambiase PD, Tao X, Koncar V, Orini M, Captur G. Technical development and feasibility of a reusable vest to integrate cardiovascular magnetic resonance with electrocardiographic imaging. J Cardiovasc Magn Reson 2023; 25:73. [PMID: 38044439 PMCID: PMC10694972 DOI: 10.1186/s12968-023-00980-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/12/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND Electrocardiographic imaging (ECGI) generates electrophysiological (EP) biomarkers while cardiovascular magnetic resonance (CMR) imaging provides data about myocardial structure, function and tissue substrate. Combining this information in one examination is desirable but requires an affordable, reusable, and high-throughput solution. We therefore developed the CMR-ECGI vest and carried out this technical development study to assess its feasibility and repeatability in vivo. METHODS CMR was prospectively performed at 3T on participants after collecting surface potentials using the locally designed and fabricated 256-lead ECGI vest. Epicardial maps were reconstructed to generate local EP parameters such as activation time (AT), repolarization time (RT) and activation recovery intervals (ARI). 20 intra- and inter-observer and 8 scan re-scan repeatability tests. RESULTS 77 participants were recruited: 27 young healthy volunteers (HV, 38.9 ± 8.5 years, 35% male) and 50 older persons (77.0 ± 0.1 years, 52% male). CMR-ECGI was achieved in all participants using the same reusable, washable vest without complications. Intra- and inter-observer variability was low (correlation coefficients [rs] across unipolar electrograms = 0.99 and 0.98 respectively) and scan re-scan repeatability was high (rs between 0.81 and 0.93). Compared to young HV, older persons had significantly longer RT (296.8 vs 289.3 ms, p = 0.002), ARI (249.8 vs 235.1 ms, p = 0.002) and local gradients of AT, RT and ARI (0.40 vs 0.34 ms/mm, p = 0,01; 0.92 vs 0.77 ms/mm, p = 0.03; and 1.12 vs 0.92 ms/mm, p = 0.01 respectively). CONCLUSION Our high-throughput CMR-ECGI solution is feasible and shows good reproducibility in younger and older participants. This new technology is now scalable for high throughput research to provide novel insights into arrhythmogenesis and potentially pave the way for more personalised risk stratification. CLINICAL TRIAL REGISTRATION Title: Multimorbidity Life-Course Approach to Myocardial Health-A Cardiac Sub-Study of the MRC National Survey of Health and Development (NSHD) (MyoFit46). National Clinical Trials (NCT) number: NCT05455125. URL: https://clinicaltrials.gov/ct2/show/NCT05455125?term=MyoFit&draw=2&rank=1.
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Bennett
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Hunain Shiwani
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Pablo Gonzalez
- ELEM Biotech, S.L, Barcelona, Spain
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
- Department of Information and Communication Technologies, Physense, Universitat Pempeu Fabra, Barcrlona, Spain
| | - Emma Martin
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Kenan Direk
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Ramya Vijayakumar
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - Nishi Chaturvedi
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Xuyuan Tao
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Vladan Koncar
- École Nationale Supérieure des Arts et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix CEDEX 1, France
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
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4
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Bisignani A, Pannone L, Del Monte A, Eltsov I, Cappello IA, Sieira J, Monaco C, Bala G, Mouram S, Della Rocca DG, Ströker E, Overeinder I, Almorad A, Pappaert G, Gauthey A, de Ravel T, Van Dooren S, Sorgente A, La Meir M, Sarkozy A, Brugada P, Chierchia GB, de Asmundis C. Atrial Abnormalities in Brugada Syndrome: Evaluation With ECG Imaging. JACC Clin Electrophysiol 2023; 9:2096-2105. [PMID: 37565952 DOI: 10.1016/j.jacep.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Patients with Brugada syndrome (BrS) have an increased risk of arrhythmias, including atrial tachyarrhythmias (ATas). OBJECTIVES The purpose of this study was to assess underlying atrial cardiomyopathy in BrS and the effect of ajmaline (AJM) test on the atrium of BrS patients using electrocardiogram imaging (ECGI). METHODS All consecutive patients diagnosed with BrS in a monocentric registry were screened and included if they met the following criteria: 1) BrS diagnosed following current recommendations; and 2) ECGI map performed before and after AJM with a standard protocol. Consecutive patients with no structural heart disease or BrS who had undergone ECGI were included as a control group. Genetic analysis for SCN5A was performed in all BrS patients. Total atrial conduction time (TACT) and local atrial conduction time (LACT) were calculated from atrial ECGI. The primary endpoint was ATas during follow-up. RESULTS Forty-three consecutive BrS patients and 40 control patients were included. Both TACT and LACT were significantly prolonged in BrS patients compared with control patients. Furthermore, TACT and LACT were significantly higher after AJM administration and in BrS patients who were carriers of a pathogenic/likely pathogenic SCN5A variant. After a mean follow-up of 40.9 months, 6 patients experienced a first ATa occurrence (all in the BrS group, 13.9%). TACT was the only independent predictor of ATas with a cutoff of >138.5 ms (sensitivity 0.92 [95% CI: 0.83-0.98], specificity 0.70 [95% CI: 0.59-0.81]). CONCLUSIONS ECGI-calculated TACT and LACT are significantly prolonged in BrS patients compared with control patients, and in BrS patients after AJM. This may be consistent with a concealed atrial cardiomyopathy in BrS.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium; Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy. https://twitter.com/AntBisignani_MD
| | - Luigi Pannone
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium. https://twitter.com/LuigipannoneM
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Eltsov
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ida Anna Cappello
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thomy de Ravel
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sonia Van Dooren
- Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium; Clinical Sciences, Research Group Reproduction and Genetics, Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium.
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Alblaihed L, Kositz C, Brady WJ, Al-Salamah T, Mattu A. Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Am J Emerg Med 2023; 65:146-153. [PMID: 36638611 DOI: 10.1016/j.ajem.2022.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America.
| | - Christine Kositz
- Depratment of Emergency Medicine, University of Maryland Shore Medical Center at Easton, 219 S Washington St, Easton, MD 21601, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America
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6
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Quintella Sangiorgi Olivetti N, Sacilotto L, Wulkan F, D'Arezzo Pessente G, Lombardi Peres de Carvalho M, Moleta D, Tessariol Hachul D, Veronese P, Hardy C, Pisani C, Wu TC, Vieira MLC, de França LA, de Souza Freitas M, Rochitte CE, Bueno SC, Bastos Lovisi V, Krieger JE, Scanavacca M, da Costa Pereira A, da Costa Darrieux F. Clinical Features, Genetic Findings, and Risk Stratification in Arrhythmogenic Right Ventricular Cardiomyopathy: Data From a Brazilian Cohort. Circ Arrhythm Electrophysiol 2023; 16:e011391. [PMID: 36720007 DOI: 10.1161/circep.122.011391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC), a rare inherited disease, causes ventricular tachycardia, sudden cardiac death, and heart failure (HF). We investigated ARVC clinical features, genetic findings, natural history, and the occurrence of life-threatening arrhythmic events (LTAEs), HF death, or heart transplantation (HF-death/HTx) to identify risk factors. METHODS The clinical course of 111 consecutive patients with definite ARVC, predictors of LTAE, HF-death/HTx, and combined events were analyzed in the entire cohort and in a subgroup of 40 patients without sustained ventricular arrhythmia before diagnosis. RESULTS The 5-year cumulative probability of LTAE was 30% and HF-death/HTx was 10%. Predictors of HF-death/HTx were reduced right ventricle ejection fraction (HR: 0.93; P=0.010), HF symptoms (HR: 4.37; P=0.010), epsilon wave (HR: 4.99; P=0.015), and number of leads with low QRS voltage (HR: 1.28; P=0.001). Each additional lead with low QRS voltage increased the risk of HF-death/HTx by 28%. Predictors of LTAE were prior syncope (HR: 1.81; P=0.040), number of leads with T wave inversion (HR: 1.17; P=0.039), low QRS voltage (HR: 1.12; P=0.021), younger age (HR: 0.97; P=0.006), and prior ventricular arrhythmia/ventricular fibrillation (HR: 2.45; P=0.012). Each additional lead with low QRS voltage increased the risk of LTAE by 17%. In patients without ventricular arrhythmia before clinical diagnosis of ARVC, the number of leads with low QRS voltage (HR: 1.68; P=0.023) was independently associated with HF-death/HTx. CONCLUSIONS Our study demonstrated the characteristics of a specific cohort with a high prevalence of arrhythmic burden at presentation, male predominance, younger age and HF severe outcomes. Our main results suggest that the presence and extension of low QRS voltage can be a risk predictor for HF-death/HTx in ARVC patients, regardless of the arrhythmic risk. This study can contribute to the global ARVC risk stratification, adding new insights to the international current scientific knowledge.
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Affiliation(s)
- Natália Quintella Sangiorgi Olivetti
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.).,Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Luciana Sacilotto
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Fanny Wulkan
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Gabrielle D'Arezzo Pessente
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Danilo Moleta
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Denise Tessariol Hachul
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Pedro Veronese
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Carina Hardy
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Cristiano Pisani
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Tan Chen Wu
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Marcelo Luiz Campos Vieira
- Echocardiogram Imaging Unit (D.B.M., M.L.C.V.).,Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Lucas Arraes de França
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein. São Paulo, Brazil (D.B.M., M.L.C.V., L.A.d.F.)
| | - Matheus de Souza Freitas
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Carlos Eduardo Rochitte
- Division of Cardiovascular Magnetic Ressonance Imaging, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil (M.d.S.F., C.E.R.)
| | - Sávia Christina Bueno
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - Vitor Bastos Lovisi
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | - José Eduardo Krieger
- Laboratory of Genetics and Molecular Cardiology (LGMC) (N.Q.S.O., F.W., M.L.P.d.C., J.E.K., A.d.C.P.)
| | - Maurício Scanavacca
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
| | | | - Francisco da Costa Darrieux
- Arrhythmia Unit (N.Q.S.O., L.S., G.D.P., D.T.H., P.V., C.H., C.P., T.C.W., S.C.B., V.B.L., M.S., F.d.C.D.)
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Boonstra M, Kloosterman M, van der Schaaf I, Roudijk R, van Dam P, Loh P. ECG-based techniques to enhance clinical practice in cardiac genetic disease management. J Electrocardiol 2023; 76:55-60. [PMID: 36436475 DOI: 10.1016/j.jelectrocard.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/10/2022] [Accepted: 10/22/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Inherited cardiomyopathies are associated with a broad spectrum of potentially lethal phenotypes characterized by structural and electrical myocardial remodeling. Increased awareness and genetic cascade screening lead to more genotype-positive, yet phenotype-negative individuals to be evaluated and followed up. The predictive value of genetic testing is hampered by incomplete penetrance and high variability in disease onset, progression and severity. CLINICAL CHALLENGES Dilated cardiomyopathy usually manifests with symptoms of heart failure and ventricular arrhythmias (VA) develop in advanced disease. In arrhythmogenic cardiomyopathy (ACM), electrical remodeling can precede structural and functional changes and life-threatening VA can be the first disease manifestation. Early signs and symptoms may be subtle and go unnoticed. Physicians are in great need of appropriate screening and risk-stratification strategies. Task Force Criteria (TFC) were established to standardize the clinical diagnosis of ACM but risk-stratification remains challenging. Accurate prediction of disease progression in variation carriers is currently beyond the capabilities of diagnostic tests. PROPOSED DIAGNOSTIC TECHNIQUES We propose three ECG-based techniques; isopotential mapping, inverse ECG and CineECG, to enhance risk-stratification in ACM. With the use of isopotential mapping abnormal spatio-temporal activation and repolarization may be identified. Furthermore, by combining subject specific ≥12‑lead ECG data with cardiothoracic imaging using inverse ECG techniques, the direct link between ECG and cardiac anatomy can be obtained. CONCLUSION New ECG techniques may prove more sensitive to detect early de- and repolarization abnormalities in yet asymptomatic variation carriers. Early electrical signs of disease progression may be identified prior to symptoms. Furthermore, individualized risk-stratification may be enhanced.
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Affiliation(s)
- Machteld Boonstra
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Manon Kloosterman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Iris van der Schaaf
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rob Roudijk
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Peter van Dam
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Loh
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
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8
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Kommata V, Sciaraffia E, Blomström-Lundqvist C. Epicardial conduction abnormalities in patients with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) and mutation positive healthy family members - A study using electrocardiographic imaging. PLoS One 2023; 18:e0280111. [PMID: 36603020 PMCID: PMC9815642 DOI: 10.1371/journal.pone.0280111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) in early stages is challenging. The aim of this study was therefore to investigate whether electrocardiographic imaging (ECGI) can detect epicardial conduction changes in ARVC patients and healthy mutation-carriers (M-carriers). METHOD Twelve ARVC patients, 20 M-carriers and 8 controls underwent 12-lead ECG, signal-averaged ECG, 2-dimensional echocardiography, 24-hours Holter monitoring and ECGI (body surface mapping and computer tomography with offline analysis of reconstructed epicardial signals). Total and Right Ventricular Activation Time (tVAT and RVAT respectively), area of Ventricular Activation during the terminal 20 milliseconds (aVAte20) and the activation patterns were compared between groups. RESULTS In ARVC patients the locations of aVAte20 were scattered or limited to smaller parts of the right ventricle (RV) versus in controls, in whom aVAte20 was confined to right ventricular outflow tract (RVOT) and left ventricle (LV) base (+/- RV base). ARVC patients had smaller aVAte20 (35cm2 vs 87cm2, p<0.05), longer tVAT (99msec vs 58msec, p<0.05) and longer RVAT (66msec vs 43msec, p<0.05) versus controls. In 10 M-carriers (50%), the locations of aVAte20 were also eccentric. This sub-group presented smaller aVAte20 (53cm2 vs 87cm2, p = 0.009), longer RVAT (55msec vs 48msec, p = 0.043), but similar tVAT (65msec vs 60msec, p = 0.529) compared with the M-carriers with normal activation pattern. CONCLUSIONS ECGI can detect epicardial conduction abnormalities in ARVC patients. Moreover, the observation of localized delayed RV epicardial conduction in M-carriers suggests an early stage of ARVC and may be a useful diagnostic marker enhancing an early detection of the disease.
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Affiliation(s)
- Varvara Kommata
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- * E-mail:
| | - Elena Sciaraffia
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Carina Blomström-Lundqvist
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Cardiology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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9
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Vasireddi SK, Sattayaprasert P, Yang D, Dennis AT, Bektik E, Fu JD, Mackall JA, Laurita KR. Adipogenic Signaling Promotes Arrhythmia Substrates before Structural Abnormalities in TMEM43 ARVC. J Pers Med 2022; 12:1680. [PMID: 36294819 PMCID: PMC9604824 DOI: 10.3390/jpm12101680] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of desmosomal and structural proteins that is characterized by fibro-fatty infiltrate in the ventricles and fatal arrhythmia that can occur early before significant structural abnormalities. Most ARVC mutations interfere with β-catenin-dependent transcription that enhances adipogenesis; however, the mechanistic pathway to arrhythmogenesis is not clear. We hypothesized that adipogenic conditions play an important role in the formation of arrhythmia substrates in ARVC. Cardiac myocyte monolayers co-cultured for 2-4 days with mesenchymal stem cells (MSC) were derived from human-induced pluripotent stem cells with the ARVC5 TMEM43 p.Ser358Leu mutation. The TMEM43 mutation in myocyte co-cultures alone had no significant effect on impulse conduction velocity (CV) or APD. In contrast, when co-cultures were exposed to pro-adipogenic factors for 2-4 days, CV and APD were significantly reduced compared to controls by 49% and 31%, respectively without evidence of adipogenesis. Additionally, these arrhythmia substrates coincided with a significant reduction in IGF-1 expression in MSCs and were mitigated by IGF-1 treatment. These findings suggest that the onset of enhanced adipogenic signaling may be a mechanism of early arrhythmogenesis, which could lead to personalized treatment for arrhythmias associated with TMEM43 and other ARVC mutations.
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Affiliation(s)
- Sunil K. Vasireddi
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH 44106, USA
- Stanford Cardiovascular Institute, Department of Medicine, Stanford University, Palo Alto, CA 94305, USA
| | | | - Dandan Yang
- The Dorothy M. Davis Heart and Lung Research Institute, Frick Center for Heart Failure and Arrhythmia, Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH 43210, USA
| | - Adrienne T. Dennis
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Emre Bektik
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Ji-dong Fu
- The Dorothy M. Davis Heart and Lung Research Institute, Frick Center for Heart Failure and Arrhythmia, Department of Physiology and Cell Biology, The Ohio State University, Columbus, OH 43210, USA
| | - Judith A. Mackall
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Kenneth R. Laurita
- Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH 44106, USA
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10
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van Opbergen CJM, Bagwan N, Maurya SR, Kim JC, Smith AN, Blackwell DJ, Johnston JN, Knollmann BC, Cerrone M, Lundby A, Delmar M. Exercise Causes Arrhythmogenic Remodeling of Intracellular Calcium Dynamics in Plakophilin-2-Deficient Hearts. Circulation 2022; 145:1480-1496. [PMID: 35491884 PMCID: PMC9086182 DOI: 10.1161/circulationaha.121.057757] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exercise training, and catecholaminergic stimulation, increase the incidence of arrhythmic events in patients affected with arrhythmogenic right ventricular cardiomyopathy correlated with plakophilin-2 (PKP2) mutations. Separate data show that reduced abundance of PKP2 leads to dysregulation of intracellular Ca2+ (Ca2+i) homeostasis. Here, we study the relation between excercise, catecholaminergic stimulation, Ca2+i homeostasis, and arrhythmogenesis in PKP2-deficient murine hearts. METHODS Experiments were performed in myocytes from a cardiomyocyte-specific, tamoxifen-activated, PKP2 knockout murine line (PKP2cKO). For training, mice underwent 75 minutes of treadmill running once per day, 5 days each week for 6 weeks. We used multiple approaches including imaging, high-resolution mass spectrometry, electrocardiography, and pharmacological challenges to study the functional properties of cells/hearts in vitro and in vivo. RESULTS In myocytes from PKP2cKO animals, training increased sarcoplasmic reticulum Ca2+ load, increased the frequency and amplitude of spontaneous ryanodine receptor (ryanodine receptor 2)-mediated Ca2+ release events (sparks), and changed the time course of sarcomeric shortening. Phosphoproteomics analysis revealed that training led to hyperphosphorylation of phospholamban in residues 16 and 17, suggesting a catecholaminergic component. Isoproterenol-induced increase in Ca2+i transient amplitude showed a differential response to β-adrenergic blockade that depended on the purported ability of the blockers to reach intracellular receptors. Additional experiments showed significant reduction of isoproterenol-induced Ca2+i sparks and ventricular arrhythmias in PKP2cKO hearts exposed to an experimental blocker of ryanodine receptor 2 channels. CONCLUSIONS Exercise disproportionately affects Ca2+i homeostasis in PKP2-deficient hearts in a manner facilitated by stimulation of intracellular β-adrenergic receptors and hyperphosphorylation of phospholamban. These cellular changes create a proarrhythmogenic state that can be mitigated by ryanodine receptor 2 blockade. Our data unveil an arrhythmogenic mechanism for exercise-induced or catecholaminergic life-threatening arrhythmias in the setting of PKP2 deficit. We suggest that membrane-permeable β-blockers are potentially more efficient for patients with arrhythmogenic right ventricular cardiomyopathy, highlight the potential for ryanodine receptor 2 channel blockers as treatment for the control of heart rhythm in the population at risk, and propose that PKP2-dependent and phospholamban-dependent arrhythmogenic right ventricular cardiomyopathy-related arrhythmias have a common mechanism.
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Affiliation(s)
- Chantal JM van Opbergen
- The Leon Charney Division of Cardiology, New York University Grossmann School of Medicine, New York, NY, USA
| | - Navratan Bagwan
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Svetlana R Maurya
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Joon-Chul Kim
- The Leon Charney Division of Cardiology, New York University Grossmann School of Medicine, New York, NY, USA
| | - Abigail N Smith
- Department of Chemistry & Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Daniel J Blackwell
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jeffrey N Johnston
- Department of Chemistry & Vanderbilt Institute of Chemical Biology, Vanderbilt University, Nashville, TN, USA
| | - Björn C Knollmann
- Vanderbilt Center for Arrhythmia Research and Therapeutics, Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marina Cerrone
- The Leon Charney Division of Cardiology, New York University Grossmann School of Medicine, New York, NY, USA
| | - Alicia Lundby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mario Delmar
- The Leon Charney Division of Cardiology, New York University Grossmann School of Medicine, New York, NY, USA
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11
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Graham AJ, Orini M, Zacur E, Dhillon G, Jones D, Prabhu S, Pugliese F, Lowe M, Ahsan S, Earley MJ, Chow A, Sporton S, Dhinoja M, Hunter RJ, Schilling RJ, Lambiase PD. Assessing Noninvasive Delineation of Low-Voltage Zones Using ECG Imaging in Patients With Structural Heart Disease. JACC Clin Electrophysiol 2022; 8:426-436. [PMID: 35450597 DOI: 10.1016/j.jacep.2021.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study sought to assess the association between electrocardiographic imaging (ECGI) parameters and voltage from simultaneous electroanatomic mapping (EAM). BACKGROUND ECGI offers noninvasive assessment of electrophysiologic features relevant for mapping ventricular arrhythmia and its substrate, but the accuracy of ECGI in the delineation of scar is unclear. METHODS Sixteen patients with structural heart disease underwent simultaneous ECGI (CardioInsight, Medtronic) and contact EAM (CARTO, Biosense-Webster) during ventricular tachycardia catheter ablation, with 7 mapped epicardially. ECGI and EAM geometries were coregistered using anatomic landmarks. ECGI points were paired to the closest site on the EAM within 10 mm. The association between EAM voltage and ECGI features from reconstructed epicardial unipolar electrograms was assessed by mixed-effects regression models. The classification of low-voltage regions was performed using receiver-operating characteristic analysis. RESULTS A total of 9,541 ECGI points (median: 596; interquartile range: 377-737 across patients) were paired to an EAM site. Epicardial EAM voltage was associated with ECGI features of signal fractionation and local repolarization dispersion (N = 7; P < 0.05), but they poorly classified sites with bipolar voltage of <1.5 mV or <0.5 mV thresholds (median area under the curve across patients: 0.50-0.62). No association was found between bipolar EAM voltage and low-amplitude reconstructed epicardial unipolar electrograms or ECGI-derived bipolar electrograms. Similar results were found in the combined cohort (n = 16), including endocardial EAM voltage compared to epicardial ECGI features (n = 9). CONCLUSIONS Despite a statistically significant association between ECGI features and EAM voltage, the accuracy of the delineation of low-voltage zones was modest. This may limit ECGI use for pr-procedural substrate analysis in ventricular tachycardia ablation, but it could provide value in risk assessment for ventricular arrhythmias.
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Affiliation(s)
- Adam J Graham
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Michele Orini
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Ernesto Zacur
- Institute of Biomedical Engineering, University of Oxford, Oxford, United Kingdom
| | - Gurpreet Dhillon
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Daniel Jones
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Sandeep Prabhu
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
| | - Francesca Pugliese
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Martin Lowe
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Syed Ahsan
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Mark J Earley
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Anthony Chow
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Simon Sporton
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Mehul Dhinoja
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Ross J Hunter
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Richard J Schilling
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health National Health Service Trust, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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12
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Webber M, Falconer D, AlFarih M, Joy G, Chan F, Davie C, Hamill Howes L, Wong A, Rapala A, Bhuva A, Davies RH, Morton C, Aguado-Sierra J, Vazquez M, Tao X, Krausz G, Tanackovic S, Guger C, Xue H, Kellman P, Pierce I, Schott J, Hardy R, Chaturvedi N, Rudy Y, Moon JC, Lambiase PD, Orini M, Hughes AD, Captur G. Study protocol: MyoFit46-the cardiac sub-study of the MRC National Survey of Health and Development. BMC Cardiovasc Disord 2022; 22:140. [PMID: 35365075 PMCID: PMC8972905 DOI: 10.1186/s12872-022-02582-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The life course accumulation of overt and subclinical myocardial dysfunction contributes to older age mortality, frailty, disability and loss of independence. The Medical Research Council National Survey of Health and Development (NSHD) is the world's longest running continued surveillance birth cohort providing a unique opportunity to understand life course determinants of myocardial dysfunction as part of MyoFit46-the cardiac sub-study of the NSHD. METHODS We aim to recruit 550 NSHD participants of approximately 75 years+ to undertake high-density surface electrocardiographic imaging (ECGI) and stress perfusion cardiovascular magnetic resonance (CMR). Through comprehensive myocardial tissue characterization and 4-dimensional flow we hope to better understand the burden of clinical and subclinical cardiovascular disease. Supercomputers will be used to combine the multi-scale ECGI and CMR datasets per participant. Rarely available, prospectively collected whole-of-life data on exposures, traditional risk factors and multimorbidity will be studied to identify risk trajectories, critical change periods, mediators and cumulative impacts on the myocardium. DISCUSSION By combining well curated, prospectively acquired longitudinal data of the NSHD with novel CMR-ECGI data and sharing these results and associated pipelines with the CMR community, MyoFit46 seeks to transform our understanding of how early, mid and later-life risk factor trajectories interact to determine the state of cardiovascular health in older age. TRIAL REGISTRATION Prospectively registered on ClinicalTrials.gov with trial ID: 19/LO/1774 Multimorbidity Life-Course Approach to Myocardial Health- A Cardiac Sub-Study of the MCRC National Survey of Health and Development (NSHD).
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Affiliation(s)
- Matthew Webber
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Debbie Falconer
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK
| | - Mashael AlFarih
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - George Joy
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Fiona Chan
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Clare Davie
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Lee Hamill Howes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Andrew Wong
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alicja Rapala
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Anish Bhuva
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Institute of Health Informatics, UCL, Euston Road, London, UK
| | - Rhodri H Davies
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | | | - Jazmin Aguado-Sierra
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Mariano Vazquez
- ELEM Biotech, S.L, Bristol, BS1 6QH, UK
- Barcelona Supercomputing Center (BSC), 08034, Barcelona, Spain
| | - Xuyuan Tao
- École Nationale Supérieure Des Arts Et Industries Textiles, 2 allée Louise et Victor Champier, 59056, Roubaix Cedex 1, France
| | - Gunther Krausz
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | | | - Christoph Guger
- g.Tec Medical Engineering GmbH, Siernigtrabe 14, 4521, Schiedlberg, Austria
| | - Hui Xue
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Iain Pierce
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Jonathan Schott
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | | | - Nishi Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO, 63130, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO, 63130, USA
| | - James C Moon
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Pier D Lambiase
- Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, ECIA 7BE, UK
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gabriella Captur
- Institute of Cardiovascular Science, University College London, Huntley Street, London, WC1E 6DD, UK.
- Centre for Inherited Heart Muscle Conditions, Department of Cardiology, Royal Free London NHS Foundation Trust, Pond Street, London, NW3 2QG, UK.
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London, WC1E 7HB, UK.
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13
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Melgarejo-Meseguer FM, Everss-Villalba E, Gutierrez-Fernandez-Calvillo M, Munoz-Romero S, Gimeno-Blanes FJ, Garcia-Alberola A, Rojo-Alvarez JL. Generalization and Regularization for Inverse Cardiac Estimators. IEEE Trans Biomed Eng 2022; 69:3029-3038. [PMID: 35294340 DOI: 10.1109/tbme.2022.3159733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Electrocardiographic Imaging (ECGI) aims to estimate the intracardiac potentials noninvasively, hence allowing the clinicians to better visualize and understand many arrhythmia mechanisms. Most of the estimators of epicardial potentials use a signal model based on an estimated spatial transfer matrix together with Tikhonov regularization techniques, which works well specially in simulations, but it can give limited accuracy in some real data. Based on the quasielectrostatic potential superposition principle, we propose a simple signal model that supports the implementation of principled out-of-sample algorithms for several of the most widely used regularization criteria in ECGI problems, hence improving the generalization capabilities of several of the current estimation methods. Experiments on simple cases (cylindrical and Gaussian shapes scrutinizing fast and slow changes, respectively) and on real data (examples of torso tank measurements available from Utah University, and an animal torso and epicardium measurements available from Maastricht University, both in the EDGAR public repository) show that the superposition-based out-of-sample tuning of regularization parameters promotes stabilized estimation errors of the unknown source potentials, while slightly increasing the re-estimation error on the measured data, as natural in non-overfitted solutions. The superposition signal model can be used for designing adequate out-of-sample tuning of Tikhonov regularization techniques, and it can be taken into account when using other regularization techniques in current commercial systems and research toolboxes on ECGI.
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14
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Kommata V, Sciaraffia E, Blomström-Lundqvist C. Repolarisation abnormalities unmasked with a 252-lead BSM system in patients with ARVC and healthy Gene Carriers. Pacing Clin Electrophysiol 2022; 45:509-518. [PMID: 35077593 PMCID: PMC9314798 DOI: 10.1111/pace.14456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/26/2021] [Accepted: 01/23/2022] [Indexed: 11/30/2022]
Abstract
Background: Diagnosing arrhythmogenic right ventricular cardiomyopathy (ARVC) at an early stage can be challenging even after ECG recording and a combination of several imaging techniques. The purpose of this study was to explore if a body surface mapping (BSM) system with 252‐leads could identify repolarization abnormalities and thereby diagnose early stages of ARVC. Methods: ARVC patients, gene carriers without signs of ARVC and controls underwent a 12‐lead resting ECG, signal‐averaged ECG, echocardiography, 24‐hours Holter monitoring, and BSM with electrocardiographic imaging (ECGI). All 252‐leads, divided into four quadrants of the vest, were analyzed regarding concordances between T wave polarity and QRS main vector. Results: Of 40 patients included there were 12 ARVC patients, 20 gene carriers, and 8 controls. The ARVC patients had two different repolarization patterns, one with more pronounced negative T waves at the lower left panel and another with mixed changes that clearly differed from the controls, all of whom had a normal 12 lead ECGs and consistent repolarization patterns on their BSM recordings. The patterns observed in ARVC patients were also present in 5/20 (25%) gene carriers, three of whom had normal resting ECG. A novel repolarization index successfully detected all ARVC patients and 88% of gene carriers with pathologic repolarization pattern. Conclusions: The finding that abnormal repolarization patterns could be unmasked by BSM in 25% of healthy gene carriers, suggests that it may potentially be a useful tool for identifying early manifestations of ARVC. Further and larger studies are warranted to assess its diagnostic accuracy.
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Affiliation(s)
- Varvara Kommata
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, SE-75185, Sweden
| | - Elena Sciaraffia
- Department of Cardiology and Medical Science, Uppsala University, Uppsala, SE-75185, Sweden
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15
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OUP accepted manuscript. Eur Heart J 2022; 43:1248-1250. [DOI: 10.1093/eurheartj/ehab912] [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: 11/13/2022] Open
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16
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Kukavica D, Trancuccio A, Arnò C, Latini AC, Mazzanti A, Priori SG. Desmoplakin cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy: two distinct forms of cardiomyopathy? Minerva Cardiol Angiol 2021; 70:217-237. [PMID: 34338490 DOI: 10.23736/s2724-5683.21.05804-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The confirmation of a hypothesis that desmoplakin-related (DSP) cardiomyopathy could represent a distinct clinical entity from the classical, RV-dominant, form of arrhythmogenic cardiomyopathy (ACM), most frequently caused by PKP2 mutations, would without any shadow of doubt signify a turning point in the history of this disease. The concept of gene-specific diseases underneath the umbrella diagnosis of ACM would bring fundamental changes not only in the clinical, diagnostic and therapeutic approach, but also in terms of risk stratification, pushing the scientific community towards a more patient-centred view of the disease, similarly to what has already been done in other inherited arrhythmogenic disease (e.g., Long QT Syndrome; LQTS). We provide a state-of-the-art review, starting with a brief historical framework to give the necessary context and better focus the question. Then, we proceed with a novel, genotype-tophenotype-based comparison of the most important aspects of DSP-related cardiomyopathy with the classical, RV-dominant ACM: this allows us to ascertain not only that the differences between the forms exist, but are also clinically relevant and actionable, leading to the underrecognition of the atypical, DSP-related, LV-dominant forms when applying the current diagnostic criteria. These findings will usher an exciting era, in which the scientific community will try to answer a range of questions, starting from the reasons why different desmosomal mutations cause such different phenotypes.
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Affiliation(s)
- Deni Kukavica
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Alessandro Trancuccio
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Carlo Arnò
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Alessia C Latini
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Silvia G Priori
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy - .,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Molecular Cardiology, Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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17
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Excitation and Contraction of the Failing Human Heart In Situ and Effects of Cardiac Resynchronization Therapy: Application of Electrocardiographic Imaging and Speckle Tracking Echo-Cardiography. HEARTS 2021. [DOI: 10.3390/hearts2030027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Despite the success of cardiac resynchronization therapy (CRT) for treating heart failure (HF), the rate of nonresponders remains 30%. Improvements to CRT require understanding of reverse remodeling and the relationship between electrical and mechanical measures of synchrony. The objective was to utilize electrocardiographic imaging (ECGI, a method for noninvasive cardiac electrophysiology mapping) and speckle tracking echocardiography (STE) to study the physiology of HF and reverse remodeling induced by CRT. We imaged 30 patients (63% male, mean age 63.7 years) longitudinally using ECGI and STE. We quantified CRT-induced remodeling of electromechanical parameters and evaluated a novel index, the electromechanical delay (EMD, the delay from activation to peak contraction). We also measured dyssynchrony using ECGI and STE and compared their effectiveness for predicting response to CRT. EMD values were elevated in HF patients compared to controls. However, the EMD values were dependent on the activation sequence (CRT-paced vs. un-paced), indicating that the EMD is not intrinsic to the local tissue, but is influenced by factors such as opposing wall contractions. After 6 months of CRT, patients had increased contraction in native rhythm compared to baseline pre-CRT (baseline: −8.55%, 6 months: −10.14%, p = 0.008). They also had prolonged repolarization at the location of the LV pacing lead. The pre-CRT delay between mean lateral LV and RV electrical activation time was the best predictor of beneficial reduction in LV end systolic volume by CRT (Spearman’s Rho: −0.722, p < 0.001); it outperformed mechanical indices and 12-lead ECG criteria. HF patients have abnormal EMD. The EMD depends upon the activation sequence and is not predictive of response to CRT. ECGI-measured LV activation delay is an effective index for CRT patient selection. CRT causes persistent improvements in contractile function.
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18
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Chaumont C, Suffee N, Gandjbakhch E, Balse E, Anselme F, Hatem SN. Epicardial origin of cardiac arrhythmias: clinical evidences and pathophysiology. Cardiovasc Res 2021; 118:1693-1702. [PMID: 34152392 PMCID: PMC9215195 DOI: 10.1093/cvr/cvab213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Recent developments in imaging, mapping, and ablation techniques have shown that the epicardial region of the heart is a key player in the occurrence of ventricular arrhythmic events in several cardiac diseases, such as Brugada syndrome, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy. At the atrial level as well, the epicardial region has emerged as an important determinant of the substrate of atrial fibrillation, pointing to common underlying pathophysiological mechanisms. Alteration in the gradient of repolarization between myocardial layers favouring the occurrence of re-entry circuits has largely been described. The fibro-fatty infiltration of the subepicardium is another shared substrate between ventricular and atrial arrhythmias. Recent data have emphasized the role of the epicardial reactivation in the formation of this arrhythmogenic substrate. There are new evidences supporting this structural remodelling process to be regulated by the recruitment of epicardial progenitor cells that can differentiate into adipocytes or fibroblasts under various stimuli. In addition, immune-inflammatory processes can also contribute to fibrosis of the subepicardial layer. A better understanding of such ‘electrical fragility’ of the epicardial area will open perspectives for novel biomarkers and therapeutic strategies. In this review article, a pathophysiological scheme of epicardial-driven arrhythmias will be proposed.
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Affiliation(s)
- Corentin Chaumont
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Nadine Suffee
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Estelle Gandjbakhch
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Elise Balse
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Anselme
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Stéphane N Hatem
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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19
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Affiliation(s)
- Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center Washington University in St. Louis MO
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20
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Bear LR, Cluitmans M, Abell E, Rogier J, Labrousse L, Cheng LK, LeGrice I, Lever N, Sands GB, Smaill B, Haïssaguerre M, Bernus O, Coronel R, Dubois R. Electrocardiographic Imaging of Repolarization Abnormalities. J Am Heart Assoc 2021; 10:e020153. [PMID: 33880931 PMCID: PMC8200734 DOI: 10.1161/jaha.120.020153] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background Dispersion and gradients in repolarization have been associated with life‐threatening arrhythmias, but are difficult to quantify precisely from surface electrocardiography. The objective of this study was to evaluate electrocardiographic imaging (ECGI) to noninvasively detect repolarization‐based abnormalities. Methods and Results Ex vivo data were obtained from Langendorff‐perfused pig hearts (n=8) and a human donor heart. Unipolar electrograms were recorded simultaneously during sinus rhythm from an epicardial sock and the torso‐shaped tank within which the heart was suspended. Regional repolarization heterogeneities were introduced through perfusion of dofetilide and pinacidil into separate perfusion beds. In vivo data included torso and epicardial potentials recorded simultaneously in anesthetized, closed‐chest pigs (n=5), during sinus rhythm, and ventricular pacing. For both data sets, ECGI accurately reconstructed T‐wave electrogram morphologies when compared with those recorded by the sock (ex vivo: correlation coefficient, 0.85 [0.52–0.96], in vivo: correlation coefficient, 0.86 [0.52–0.96]) and repolarization time maps (ex‐vivo: correlation coefficient, 0.73 [0.63–0.83], in vivo: correlation coefficient, 0.76 [0.67–0.82]). ECGI‐reconstructed repolarization time distributions were strongly correlated to those measured by the sock (both data sets, R2 ≥0.92). Although the position of the gradient was slightly shifted by 8.3 (0–13.9) mm, the mean, max, and SD between ECGI and recorded gradient values were highly correlated (R2=0.87, 0.75, and 0.86 respectively). There was no significant difference in ECGI accuracy between ex vivo and in vivo data. Conclusions ECGI reliably and accurately maps potentially critical repolarization abnormalities. This noninvasive approach allows imaging and quantifying individual parameters of abnormal repolarization‐based substrates in patients with arrhythmogenesis, to improve diagnosis and risk stratification.
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Affiliation(s)
- Laura R Bear
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Matthijs Cluitmans
- CARIM School for Cardiovascular Diseases Maastricht UMC Maastricht Netherlands
| | - Emma Abell
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | | | - Louis Labrousse
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Cardiac Surgery CHU Pessac France
| | - Leo K Cheng
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Ian LeGrice
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Nigel Lever
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Gregory B Sands
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Bruce Smaill
- Auckland Bioengineering Institute University of Auckland Auckland New Zealand
| | - Michel Haïssaguerre
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France.,Department of Cardiac Electrophysiology and Stimulation Bordeaux University Hospital (CHU) Pessac France
| | - Olivier Bernus
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
| | - Ruben Coronel
- IHU-LIRYCFondation Bordeaux Université Pessac France.,Department of Experimental Cardiology Academic Medical Center Amsterdam the Netherlands
| | - Rémi Dubois
- IHU-LIRYCFondation Bordeaux Université Pessac France.,CRCTB U1045 Université de Bordeaux Bordeaux France.,Inserm U1045 CRCTB Pessac France
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21
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Pretorius D, Serpooshan V, Zhang J. Nano-Medicine in the Cardiovascular System. Front Pharmacol 2021; 12:640182. [PMID: 33746761 PMCID: PMC7969876 DOI: 10.3389/fphar.2021.640182] [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] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/19/2021] [Indexed: 01/19/2023] Open
Abstract
Nano-medicines that include nanoparticles, nanocomposites, small molecules, and exosomes represent new viable sources for future therapies for the dysfunction of cardiovascular system, as well as the other important organ systems. Nanomaterials possess special properties ranging from their intrinsic physicochemical properties, surface energy and surface topographies which can illicit advantageous cellular responses within the cardiovascular system, making them exceptionally valuable in future clinical translation applications. The success of nano-medicines as future cardiovascular theranostic agents requires a comprehensive understanding of the intersection between nanomaterial and the biomedical fields. In this review, we highlight some of the major types of nano-medicine systems that are currently being explored in the cardiac field. This review focusses on the major differences between the systems, and how these differences affect the specific therapeutic or diagnostic applications. The important concerns relevant to cardiac nano-medicines, including cellular responses, toxicity of the different nanomaterials, as well as cardio-protective and regenerative capabilities are discussed. In this review an overview of the current development of nano-medicines specific to the cardiac field is provided, discussing the diverse nature and applications of nanomaterials as therapeutic and diagnostic agents.
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Affiliation(s)
- Danielle Pretorius
- Department of Biomedical Engineering, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Vahid Serpooshan
- Emory Children's Center, Emory University School of Medicine, Atlanta, GA, United States
| | - Jianyi Zhang
- Department of Biomedical Engineering, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Biomedical Engineering, School of Engineering, University of Alabama at Birmingham, Birmingham, AL, United States
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22
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Pereira H, Niederer S, Rinaldi CA. Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy. Europace 2020; 22:euaa165. [PMID: 32754737 PMCID: PMC7544539 DOI: 10.1093/europace/euaa165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Use of the 12-lead electrocardiogram (ECG) is fundamental for the assessment of heart disease, including arrhythmias, but cannot always reveal the underlying mechanism or the location of the arrhythmia origin. Electrocardiographic imaging (ECGi) is a non-invasive multi-lead ECG-type imaging tool that enhances conventional 12-lead ECG. Although it is an established technology, its continuous development has been shown to assist in arrhythmic activation mapping and provide insights into the mechanism of cardiac resynchronization therapy (CRT). This review addresses the validity, reliability, and overall feasibility of ECGi for use in a diverse range of arrhythmias. A systematic search limited to full-text human studies published in peer-reviewed journals was performed through Medline via PubMed, using various combinations of three key concepts: ECGi, arrhythmia, and CRT. A total of 456 studies were screened through titles and abstracts. Ultimately, 42 studies were included for literature review. Evidence to date suggests that ECGi can be used to provide diagnostic insights regarding the mechanistic basis of arrhythmias and the location of arrhythmia origin. Furthermore, ECGi can yield valuable information to guide therapeutic decision-making, including during CRT. Several studies have used ECGi as a diagnostic tool for atrial and ventricular arrhythmias. More recently, studies have tested the value of this technique in predicting outcomes of CRT. As a non-invasive method for assessing cardiovascular disease, particularly arrhythmias, ECGi represents a significant advancement over standard procedures in contemporary cardiology. Its full potential has yet to be fully explored.
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Affiliation(s)
- Helder Pereira
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
- Cardiac Physiology Services—Clinical Investigation Centre, Bupa Cromwell Hospital, London, UK
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
- Cardiovascular Department, Guys and St Thomas NHS Foundation Trust, London, UK
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23
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Caulier-Cisterna R, Sanromán-Junquera M, Muñoz-Romero S, Blanco-Velasco M, Goya-Esteban R, García-Alberola A, Rojo-Álvarez JL. Spatial-Temporal Signals and Clinical Indices in Electrocardiographic Imaging (I): Preprocessing and Bipolar Potentials. SENSORS (BASEL, SWITZERLAND) 2020; 20:E3131. [PMID: 32492938 PMCID: PMC7309141 DOI: 10.3390/s20113131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 12/19/2022]
Abstract
During the last years, Electrocardiographic Imaging (ECGI) has emerged as a powerful and promising clinical tool to support cardiologists. Starting from a plurality of potential measurements on the torso, ECGI yields a noninvasive estimation of their causing potentials on the epicardium. This unprecedented amount of measured cardiac signals needs to be conditioned and adapted to current knowledge and methods in cardiac electrophysiology in order to maximize its support to the clinical practice. In this setting, many cardiac indices are defined in terms of the so-called bipolar electrograms, which correspond with differential potentials between two spatially close potential measurements. Our aim was to contribute to the usefulness of ECGI recordings in the current knowledge and methods of cardiac electrophysiology. For this purpose, we first analyzed the basic stages of conventional cardiac signal processing and scrutinized the implications of the spatial-temporal nature of signals in ECGI scenarios. Specifically, the stages of baseline wander removal, low-pass filtering, and beat segmentation and synchronization were considered. We also aimed to establish a mathematical operator to provide suitable bipolar electrograms from the ECGI-estimated epicardium potentials. Results were obtained on data from an infarction patient and from a healthy subject. First, the low-frequency and high-frequency noises are shown to be non-independently distributed in the ECGI-estimated recordings due to their spatial dimension. Second, bipolar electrograms are better estimated when using the criterion of the maximum-amplitude difference between spatial neighbors, but also a temporal delay in discrete time of about 40 samples has to be included to obtain the usual morphology in clinical bipolar electrograms from catheters. We conclude that spatial-temporal digital signal processing and bipolar electrograms can pave the way towards the usefulness of ECGI recordings in the cardiological clinical practice. The companion paper is devoted to analyzing clinical indices obtained from ECGI epicardial electrograms measuring waveform variability and repolarization tissue properties.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, Boadilla, 28223 Madrid, Spain
| | - Manuel Blanco-Velasco
- Department of Signal Theory and Communications, Universidad de Alcalá, Alcalá de Henares, 28805 Madrid, Spain;
| | - Rebeca Goya-Esteban
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, El Palmar, 30120 Murcia, Spain;
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (R.C.-C.); (M.S.-J.); (S.M.-R.); (R.G.-E.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, Boadilla, 28223 Madrid, Spain
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24
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Caulier-Cisterna R, Blanco-Velasco M, Goya-Esteban R, Muñoz-Romero S, Sanromán-Junquera M, García-Alberola A, Rojo-Álvarez JL. Spatial-Temporal Signals and Clinical Indices in Electrocardiographic Imaging (II): Electrogram Clustering and T-wave Alternans. SENSORS (BASEL, SWITZERLAND) 2020; 20:s20113070. [PMID: 32485879 PMCID: PMC7309062 DOI: 10.3390/s20113070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/17/2020] [Accepted: 04/27/2020] [Indexed: 06/11/2023]
Abstract
During the last years, attention and controversy have been present for the first commercially available equipment being used in Electrocardiographic Imaging (ECGI), a new cardiac diagnostic tool which opens up a new field of diagnostic possibilities. Previous knowledge and criteria of cardiologists using intracardiac Electrograms (EGM) should be revisited from the newly available spatial-temporal potentials, and digital signal processing should be readapted to this new data structure. Aiming to contribute to the usefulness of ECGI recordings in the current knowledge and methods of cardiac electrophysiology, we previously presented two results: First, spatial consistency can be observed even for very basic cardiac signal processing stages (such as baseline wander and low-pass filtering); second, useful bipolar EGMs can be obtained by a digital processing operator searching for the maximum amplitude and including a time delay. In addition, this work aims to demonstrate the functionality of ECGI for cardiac electrophysiology from a twofold view, namely, through the analysis of the EGM waveforms, and by studying the ventricular repolarization properties. The former is scrutinized in terms of the clustering properties of the unipolar an bipolar EGM waveforms, in control and myocardial infarction subjects, and the latter is analyzed using the properties of T-wave alternans (TWA) in control and in Long-QT syndrome (LQTS) example subjects. Clustered regions of the EGMs were spatially consistent and congruent with the presence of infarcted tissue in unipolar EGMs, and bipolar EGMs with adequate signal processing operators hold this consistency and yielded a larger, yet moderate, number of spatial-temporal regions. TWA was not present in control compared with an LQTS subject in terms of the estimated alternans amplitude from the unipolar EGMs, however, higher spatial-temporal variation was present in LQTS torso and epicardium measurements, which was consistent through three different methods of alternans estimation. We conclude that spatial-temporal analysis of EGMs in ECGI will pave the way towards enhanced usefulness in the clinical practice, so that atomic signal processing approach should be conveniently revisited to be able to deal with the great amount of information that ECGI conveys for the clinician.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Manuel Blanco-Velasco
- Department of Signal Theory and Communications, Universidad de Alcalá, 28805 Alcalá de Henares, Madrid, Spain;
| | - Rebeca Goya-Esteban
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28223 Boadilla, Madrid, Spain
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital Clínico Universitario Virgen de la Arrixaca de Murcia, El Palmar, 30120 Murcia, Spain;
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications, Telematics and Computing Systems, Rey Juan Carlos University, 28943 Fuenlabrada, Madrid, Spain; (R.C.-C.); (R.G.-E.); (S.M.-R.); (M.S.-J.)
- Center for Computational Simulation, Universidad Politécnica de Madrid, 28223 Boadilla, Madrid, Spain
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25
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Abstract
The term phenotype is so commonly used that we often assume that we each mean the same thing. The general definition, the set of observable characteristics of an individual resulting from the interaction of their genotype with the environment, is often left to the eye of the beholder. Whether applied to the multiple levels of biological phenomena or the intact human being, our ability to characterize, classify, and analyze phenotype has been limited by measurement deficits, computing limitations, and a culture that avoids the generalizable. With the advent of modern technology, there is the potential for a revolution in phenotyping, which incorporates old and new in structured ways to dramatically advance basic understanding of biology and behavior and to lead to major improvements in clinical care and public health. This revolution in how we think about phenotypes will require a radical change in the scale at which biomedicine operates with significant changes in the unit of action, which will have far-reaching implications for how care, translation, and discovery are implemented.
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Affiliation(s)
- Calum A MacRae
- From the One Brave Idea (C.A.M., R.M.C.).,Cardiovascular Medicine Division and Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA (C.A.M.)
| | - Robert M Califf
- From the One Brave Idea (C.A.M., R.M.C.).,Verily Life Sciences (R.M.C.).,Google Health, South San Francisco and Mountain View, CA (R.M.C.)
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26
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Arteyeva NV, Azarov JE. ECG markers of local but not global increase in dispersion of ventricular repolarization (simulation study). J Electrocardiol 2020; 60:54-59. [PMID: 32268231 DOI: 10.1016/j.jelectrocard.2020.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND An increase in local dispersion of repolarization (DOR) may contribute more to arrhythmogenesis as compared to changes of global DOR. The aim of this simulation study was to find ECG markers of local increase in DOR in conditions where global DOR remains normal. METHODS In the framework of van Oosterom and Oostendorp ECGSIM model, the local DOR was increased in 10 different ventricular locations by (1) action potential duration (APD) shortening/lengthening both on epi- and endocardium, (2) epicardial APD shortening, and (3) endocardial APD shortening. The simulation cases where the increase in local DOR was accompanied by increase in global DOR were excluded from consideration. T-wave parameters were analyzed in the simulated precordial and anatomically ordered limb leads. RESULTS The increase in local DOR resulted in increased lead-to‑lead differences in Tpeak and Tend instants in 28 out of 32 simulated scenarios, and in an increased dispersion of Tpeak-Tend interval throughout 12 standard leads in 8 out of 32 simulated scenarios. In all simulations, the global DOR measured as a difference between earliest and latest repolarization times and standard APD deviation was the same. CONCLUSIONS The local increase in DOR was expressed in increased lead-to‑lead differences in Tpeak and Tend instants between adjacent anatomically ordered standard leads (aVL, I, aVR(-), II, aVF, III, and V1-V6), even if global DOR, Tpeak-Tend interval and Tpeak-Tend dispersion were within a normal range.
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Affiliation(s)
- Natalia V Arteyeva
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya st., Syktyvkar 167982, Russia.
| | - Jan E Azarov
- Department of Cardiac Physiology, Institute of Physiology, Komi Science Center, Ural Branch, Russian Academy of Sciences, 50, Pervomayskaya st., Syktyvkar 167982, Russia; Department of Physiology, Medical Institute of Pitirim Sorokin, Syktyvkar State University, 11, Babushkin st., Syktyvkar 167000, Russia
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27
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Jurlander R, Mills HL, Espersen KI, Raja AA, Svendsen JH, Theilade J, Iversen K, Vejlstrup N, Bundgaard H, Christensen AH. Screening relatives in arrhythmogenic right ventricular cardiomyopathy: yield of imaging and electrical investigations. Eur Heart J Cardiovasc Imaging 2020; 21:175-182. [PMID: 31435658 DOI: 10.1093/ehjci/jez204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 07/19/2019] [Indexed: 11/12/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease and presymptomatic screening of relatives is recommended. In 2010, the Task Force Criteria (TFC2010) introduced specific diagnostic imaging parameters. The aim of the study was to evaluate the diagnostic yield of family screening and the value of different diagnostic modalities. METHODS AND RESULTS Family evaluation, including cardiac magnetic resonance (CMR), is routinely offered to ARVC relatives at our institution. We retrospectively registered baseline characteristics, symptomatology, and results of non-invasive examinations from 2010 to 2016 and assessed the findings according to TFC2010. A total of 286 relatives (150 females; age 12-76 years; 251 first-degree) were included. A total of 103 (36%) individuals reported cardiovascular symptoms. The non-invasive workup showed that 101 (35%) relatives had ≥1 positive parameter on signal-averaged electrocardiogram (ECG), 40 (14%) had abnormal findings on Holter monitoring, 36 (13%) fulfilled an ECG criterion, six (2%) fulfilled CMR criteria, and echocardiographic abnormalities was seen in one (0.3%) relative. In total, 21 (7% overall; 13% among gene-positive subgroup) relatives were diagnosed with ARVC and 78 (27% overall; 49% among gene-positive subgroup) with borderline ARVC based on the combined non-invasive evaluations. Family history and electrical investigations alone diagnosed 20 out of 21 (95%) ARVC cases and 73 out of 78 (94%) borderline cases. CONCLUSION Consecutive evaluation of ARVC relatives diagnosed 7% with definite and 27% with borderline ARVC according to the TFC2010. Screening relatives for electrical abnormalities with 12 lead ECG, signal-averaged ECG, and Holter monitoring was more sensitive than imaging modalities.
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Affiliation(s)
- Rebecca Jurlander
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Helen L Mills
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Kiri I Espersen
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Anna Axelsson Raja
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Jesper Hastrup Svendsen
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Juliane Theilade
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
| | - Niels Vejlstrup
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Henning Bundgaard
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark
| | - Alex Hørby Christensen
- The Capital Regions Unit for Inherited Cardiac Diseases, Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK-2100 Copenhagen OE, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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28
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Andrews C, Cupps BP, Pasque MK, Rudy Y. Electromechanics of the Normal Human Heart In Situ. Circ Arrhythm Electrophysiol 2019; 12:e007484. [PMID: 31698936 DOI: 10.1161/circep.119.007484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Christopher Andrews
- Department of Biomedical Engineering, Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO (C.A., Y.R.)
| | - Brian P Cupps
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (B.P.C., M.K.P.)
| | - Michael K Pasque
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO (B.P.C., M.K.P.)
| | - Yoram Rudy
- Department of Biomedical Engineering, Cardiac Bioelectricity and Arrhythmia Center, Washington University, St. Louis, MO (C.A., Y.R.)
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29
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Orini M, Graham AJ, Martinez-Naharro A, Andrews CM, de Marvao A, Statton B, Cook SA, O'Regan DP, Hawkins PN, Rudy Y, Fontana M, Lambiase PD. Noninvasive Mapping of the Electrophysiological Substrate in Cardiac Amyloidosis and Its Relationship to Structural Abnormalities. J Am Heart Assoc 2019; 8:e012097. [PMID: 31496332 PMCID: PMC6818012 DOI: 10.1161/jaha.119.012097] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background The relationship between structural pathology and electrophysiological substrate in cardiac amyloidosis is unclear. Differences between light‐chain (AL) and transthyretin (ATTR) cardiac amyloidosis may have prognostic implications. Methods and Results ECG imaging and cardiac magnetic resonance studies were conducted in 21 cardiac amyloidosis patients (11 AL and 10 ATTR). Healthy volunteers were included as controls. With respect to ATTR, AL patients had lower amyloid volume (51.0/37.7 versus 73.7/16.4 mL, P=0.04), lower myocardial cell volume (42.6/19.1 versus 58.5/17.2 mL, P=0.021), and higher T1 (1172/64 versus 1109/80 ms, P=0.022) and T2 (53.4/2.9 versus 50.0/3.1 ms, P=0.003). ECG imaging revealed differences between cardiac amyloidosis and control patients in virtually all conduction‐repolarization parameters. With respect to ATTR, AL patients had lower epicardial signal amplitude (1.07/0.46 versus 1.83/1.26 mV, P=0.026), greater epicardial signal fractionation (P=0.019), and slightly higher dispersion of repolarization (187.6/65 versus 158.3/40 ms, P=0.062). No significant difference between AL and ATTR patients was found using the standard 12‐lead ECG. T1 correlated with epicardial signal amplitude (cc=−0.78), and extracellular volume with epicardial signal fractionation (cc=0.48) and repolarization time (cc=0.43). Univariate models based on single features from both cardiac magnetic resonance and ECG imaging classified AL and ATTR patients with an accuracy of 70% to 80%. Conclusions In this exploratory study cardiac amyloidosis was associated with ventricular conduction and repolarization abnormalities, which were more pronounced in AL than in ATTR. Combined ECG imaging–cardiac magnetic resonance analysis supports the hypothesis that additional mechanisms beyond infiltration may contribute to myocardial damage in AL amyloidosis. Further studies are needed to assess the clinical impact of this approach.
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Affiliation(s)
- Michele Orini
- Barts Heart Centre Barts Health NHS Trust London United Kingdom.,Institute of Cardiovascular Science University College London London United Kingdom
| | - Adam J Graham
- Barts Heart Centre Barts Health NHS Trust London United Kingdom
| | | | - Christopher M Andrews
- Cardiac Bioelectricity and Arrhythmia Center Washington University in St Louis St. Louis MO
| | - Antonio de Marvao
- MRC London Institute of Medical Sciences Imperial College London London United Kingdom
| | - Ben Statton
- MRC London Institute of Medical Sciences Imperial College London London United Kingdom
| | - Stuart A Cook
- MRC London Institute of Medical Sciences Imperial College London London United Kingdom
| | - Declan P O'Regan
- MRC London Institute of Medical Sciences Imperial College London London United Kingdom
| | - Philip N Hawkins
- The Royal Free Hospital UCL Hospitals Trust London United Kingdom
| | - Yoram Rudy
- Cardiac Bioelectricity and Arrhythmia Center Washington University in St Louis St. Louis MO
| | - Marianna Fontana
- The Royal Free Hospital UCL Hospitals Trust London United Kingdom
| | - Pier D Lambiase
- Barts Heart Centre Barts Health NHS Trust London United Kingdom.,Institute of Cardiovascular Science University College London London United Kingdom
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30
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Zghaib T, Ghasabeh MA, Assis FR, Chrispin J, Keramati A, Misra S, Berger R, Calkins H, Kamel I, Nazarian S, Zimmerman S, Tandri H. Regional Strain by Cardiac Magnetic Resonance Imaging Improves Detection of Right Ventricular Scar Compared With Late Gadolinium Enhancement on a Multimodality Scar Evaluation in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Cardiovasc Imaging 2019; 11:e007546. [PMID: 30354675 DOI: 10.1161/circimaging.118.007546] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy characterized by fibrofatty replacement of right ventricular myocardium resulting in reentrant ventricular tachycardia (VT). Cardiac magnetic resonance imaging (CMR) can noninvasively measure regional abnormalities using tissue-tracking strain as well as late gadolinium enhancement (LGE). In this study, we examine arrhythmogenic substrate using regional CMR strain, LGE, and electroanatomic mapping (EAM) in arrhythmogenic right ventricular cardiomyopathy patients presenting for VT ablation. METHODS AND RESULTS Twenty-one patients underwent right ventricular endocardial EAM, whereas 17 underwent epicardial EAM, to detect dense scar (<0.5 mV) as well as CMR study within 12 months. Quantitative regional strain analysis was performed in all 21 patients, although the presence of LGE was visually examined in 17 patients. Strain was lower in segments with dense scar on endocardial and epicardial EAM (-9.7±4.1 versus -7.3±4.0, and -9.8±2.8 versus -7.6±3.8; P<0.05), in segments with LGE scar (-9.9±4.4 versus -6.0±3.6; P=0.001), and at VT culprit sites (-7.4±3.7 versus -10.1±4.1; P<0.001), compared with the rest of right ventricular. On patient-clustered analysis, a unit increase in strain was associated with 21% and 18% decreased odds of scar on endocardial and epicardial EAM, respectively, 17% decreased odds of colocalizing VT culprit site, and 43% decreased odds of scar on LGE-CMR ( P<0.05 for all). LGE and EAM demonstrated poor agreement with κ=0.18 (endocardial, n=17) and κ=0.06 (epicardial, n=13). Only 8 (15%) VT termination sites exhibited LGE. CONCLUSIONS Regional myocardial strain on cine CMR improves detection of arrhythmogenic VT substrate compared with LGE. This may enhance diagnostic accuracy of CMR in arrhythmogenic right ventricular cardiomyopathy without the need for invasive procedures and facilitate the planning of VT ablation procedures.
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Affiliation(s)
- Tarek Zghaib
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Mounes Aliyari Ghasabeh
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (M.A.G., I.K., S.Z.)
| | - Fabrizio R Assis
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Jonathan Chrispin
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Ali Keramati
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Satish Misra
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Ronald Berger
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Hugh Calkins
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
| | - Ihab Kamel
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (M.A.G., I.K., S.Z.)
| | - Saman Nazarian
- Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD (M.A.G., I.K., S.Z.)
| | - Stefan Zimmerman
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia (S.N.)
| | - Harikrishna Tandri
- Precision Medicine Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Johns Hopkins University School of Medicine, Baltimore, MD (T.Z., F.R.A., J.C., A.K., S.M., R.B., H.C., H.T.)
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31
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Reply to the Editor—Performance and limitations of noninvasive cardiac activation mapping. Heart Rhythm 2019; 16:e51. [DOI: 10.1016/j.hrthm.2019.02.003] [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: 01/16/2019] [Indexed: 11/21/2022]
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32
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Porter B, Bishop MJ, Claridge S, Child N, Van Duijvenboden S, Bostock J, Sieniewicz BJ, Gould J, Sidhu B, Hanson B, Chen Z, Rinaldi CA, Taggart P, Gill JS. Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in patients with heart failure. Heart Rhythm 2019; 16:702-709. [DOI: 10.1016/j.hrthm.2018.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Indexed: 01/01/2023]
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Duchateau J, Sacher F, Pambrun T, Derval N, Chamorro-Servent J, Denis A, Ploux S, Hocini M, Jaïs P, Bernus O, Haïssaguerre M, Dubois R. Performance and limitations of noninvasive cardiac activation mapping. Heart Rhythm 2019; 16:435-442. [DOI: 10.1016/j.hrthm.2018.10.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 11/24/2022]
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Cluitmans M, Brooks DH, MacLeod R, Dössel O, Guillem MS, van Dam PM, Svehlikova J, He B, Sapp J, Wang L, Bear L. Validation and Opportunities of Electrocardiographic Imaging: From Technical Achievements to Clinical Applications. Front Physiol 2018; 9:1305. [PMID: 30294281 PMCID: PMC6158556 DOI: 10.3389/fphys.2018.01305] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/29/2018] [Indexed: 11/23/2022] Open
Abstract
Electrocardiographic imaging (ECGI) reconstructs the electrical activity of the heart from a dense array of body-surface electrocardiograms and a patient-specific heart-torso geometry. Depending on how it is formulated, ECGI allows the reconstruction of the activation and recovery sequence of the heart, the origin of premature beats or tachycardia, the anchors/hotspots of re-entrant arrhythmias and other electrophysiological quantities of interest. Importantly, these quantities are directly and non-invasively reconstructed in a digitized model of the patient's three-dimensional heart, which has led to clinical interest in ECGI's ability to personalize diagnosis and guide therapy. Despite considerable development over the last decades, validation of ECGI is challenging. Firstly, results depend considerably on implementation choices, which are necessary to deal with ECGI's ill-posed character. Secondly, it is challenging to obtain (invasive) ground truth data of high quality. In this review, we discuss the current status of ECGI validation as well as the major challenges remaining for complete adoption of ECGI in clinical practice. Specifically, showing clinical benefit is essential for the adoption of ECGI. Such benefit may lie in patient outcome improvement, workflow improvement, or cost reduction. Future studies should focus on these aspects to achieve broad adoption of ECGI, but only after the technical challenges have been solved for that specific application/pathology. We propose 'best' practices for technical validation and highlight collaborative efforts recently organized in this field. Continued interaction between engineers, basic scientists, and physicians remains essential to find a hybrid between technical achievements, pathological mechanisms insights, and clinical benefit, to evolve this powerful technique toward a useful role in clinical practice.
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Affiliation(s)
- Matthijs Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht Maastricht University, Maastricht, Netherlands
| | - Dana H. Brooks
- Department of Electrical and Computer Engineering, Northeastern University, Boston, MA, United States
| | - Rob MacLeod
- Biomedical Engineering Department, Scientific Computing and Imaging Institute (SCI), and Cardiovascular Research and Training Institute (CVRTI), The University of Utah, Salt Lake City, UT, United States
| | - Olaf Dössel
- Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Peter M. van Dam
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| | - Jana Svehlikova
- Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Bin He
- Department of Biomedical Engineering Carnegie Mellon University, Pittsburgh, PA, United States
| | - John Sapp
- QEII Health Sciences Centre and Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Linwei Wang
- Rochester Institute of Technology, Rochester, NY, United States
| | - Laura Bear
- IHU LIRYC, Fondation Bordeaux Université, Inserm U1045 and Université de Bordeaux, Bordeaux, France
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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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Vazquez Alvarez MDC, Grosse-Wortmann L. Form Follows Function? Circ Cardiovasc Imaging 2018; 11:e008271. [DOI: 10.1161/circimaging.118.008271] [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: 11/16/2022]
Affiliation(s)
- Maria del Carmen Vazquez Alvarez
- The Labatt Family Heart Centre, Department of Paediatrics (M.d.C.V.A., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
| | - Lars Grosse-Wortmann
- The Labatt Family Heart Centre, Department of Paediatrics (M.d.C.V.A., L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
- Department of Diagnostic Imaging (L.G.-W.), The Hospital for Sick Children, University of Toronto, Ontario, Canada
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Caulier-Cisterna R, Muñoz-Romero S, Sanromán-Junquera M, García-Alberola A, Rojo-Álvarez JL. A new approach to the intracardiac inverse problem using Laplacian distance kernel. Biomed Eng Online 2018; 17:86. [PMID: 29925384 PMCID: PMC6011421 DOI: 10.1186/s12938-018-0519-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Accepted: 06/13/2018] [Indexed: 11/30/2022] Open
Abstract
Background The inverse problem in electrophysiology consists of the accurate estimation of the intracardiac electrical sources from a reduced set of electrodes at short distances and from outside the heart. This estimation can provide an image with relevant knowledge on arrhythmia mechanisms for the clinical practice. Methods based on truncated singular value decomposition (TSVD) and regularized least squares require a matrix inversion, which limits their resolution due to the unavoidable low-pass filter effect of the Tikhonov regularization techniques. Methods We propose to use, for the first time, a Mercer’s kernel given by the Laplacian of the distance in the quasielectrostatic field equations, hence providing a Support Vector Regression (SVR) formulation by following the principles of the Dual Signal Model (DSM) principles for creating kernel algorithms. Results Simulations in one- and two-dimensional models show the performance of our Laplacian distance kernel technique versus several conventional methods. Firstly, the one-dimensional model is adjusted for yielding recorded electrograms, similar to the ones that are usually observed in electrophysiological studies, and suitable strategy is designed for the free-parameter search. Secondly, simulations both in one- and two-dimensional models show larger noise sensitivity in the estimated transfer matrix than in the observation measurements, and DSM−SVR is shown to be more robust to noisy transfer matrix than TSVD. Conclusion These results suggest that our proposed DSM−SVR with Laplacian distance kernel can be an efficient alternative to improve the resolution in current and emerging intracardiac imaging systems.
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Affiliation(s)
- Raúl Caulier-Cisterna
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain
| | - Sergio Muñoz-Romero
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain.,Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain
| | - Margarita Sanromán-Junquera
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain
| | - Arcadi García-Alberola
- Arrhythmia Unit, Hospital General Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - José Luis Rojo-Álvarez
- Department of Signal Theory and Communications and Telematics and Computation, Rey Juan Carlos University, Camino del Molino s/n, 28943, Fuenlabrada, Madrid, Spain. .,Center for Computational Simulation, Universidad Politécnica de Madrid, Madrid, Spain.
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Di Marco A, Anguera I, Dallaglio P. Letter by Di Marco et al Regarding Article, “Electrical and Structural Substrate of Arrhythmogenic Right Ventricular Cardiomyopathy Determined Using Noninvasive Electrocardiographic Imaging and Late Gadolinium Magnetic Resonance Imaging”. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005687. [DOI: 10.1161/circep.117.005687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Di Marco
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Ignasi Anguera
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Paolo Dallaglio
- From the Department of Cardiology, Arrhythmia Unit, Bellvitge University Hospital, Barcelona, Spain
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Chrispin J, Assis F, Tandri H. Mapping the Electrical Substrate in Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005524. [DOI: 10.1161/circep.117.005524] [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: 11/16/2022]
Affiliation(s)
- Jonathan Chrispin
- From the Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Fabrizio Assis
- From the Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Harikrishna Tandri
- From the Center of Excellence for ARVC and Complex Ventricular Arrhythmias, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
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