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Carrick RT, Gasperetti A, Protonotarios A, Murray B, Laredo M, van der Schaaf I, Dooijes D, Syrris P, Cannie D, Tichnell C, Gilotra NA, Cappelletto C, Medo K, Saguner AM, Duru F, Hylind RJ, Abrams DJ, Lakdawala NK, Cadrin-Tourigny J, Targetti M, Olivotto I, Graziosi M, Cox M, Biagini E, Charron P, Compagnucci P, Casella M, Conte G, Tondo C, Yazdani M, Ware JS, Prasad SK, Calò L, Smith ED, Helms AS, Hespe S, Ingles J, Tandri H, Ader F, Peretto G, Peters S, Horton A, Yao J, Schulze-Bahr E, Dittman S, Carruth ED, Young K, Qureshi M, Haggerty C, Parikh VN, Taylor M, Mestroni L, Wilde A, Sinagra G, Merlo M, Gandjbakhch E, van Tintelen JP, te Riele ASJM, Elliott P, Calkins H, Wu KC, James CA. A novel tool for arrhythmic risk stratification in desmoplakin gene variant carriers. Eur Heart J 2024; 45:2968-2979. [PMID: 39011630 PMCID: PMC11335372 DOI: 10.1093/eurheartj/ehae409] [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: 09/27/2023] [Revised: 01/16/2024] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND AND AIMS Pathogenic desmoplakin (DSP) gene variants are associated with the development of a distinct form of arrhythmogenic cardiomyopathy known as DSP cardiomyopathy. Patients harbouring these variants are at high risk for sustained ventricular arrhythmia (VA), but existing tools for individualized arrhythmic risk assessment have proven unreliable in this population. METHODS Patients from the multi-national DSP-ERADOS (Desmoplakin SPecific Effort for a RAre Disease Outcome Study) Network patient registry who had pathogenic or likely pathogenic DSP variants and no sustained VA prior to enrolment were followed longitudinally for the development of first sustained VA event. Clinically guided, step-wise Cox regression analysis was used to develop a novel clinical tool predicting the development of incident VA. Model performance was assessed by c-statistic in both the model development cohort (n = 385) and in an external validation cohort (n = 86). RESULTS In total, 471 DSP patients [mean age 37.8 years, 65.6% women, 38.6% probands, 26% with left ventricular ejection fraction (LVEF) < 50%] were followed for a median of 4.0 (interquartile range: 1.6-7.3) years; 71 experienced first sustained VA events {2.6% [95% confidence interval (CI): 2.0, 3.5] events/year}. Within the development cohort, five readily available clinical parameters were identified as independent predictors of VA and included in a novel DSP risk score: female sex [hazard ratio (HR) 1.9 (95% CI: 1.1-3.4)], history of non-sustained ventricular tachycardia [HR 1.7 (95% CI: 1.1-2.8)], natural logarithm of 24-h premature ventricular contraction burden [HR 1.3 (95% CI: 1.1-1.4)], LVEF < 50% [HR 1.5 (95% CI: .95-2.5)], and presence of moderate to severe right ventricular systolic dysfunction [HR 6.0 (95% CI: 2.9-12.5)]. The model demonstrated good risk discrimination within both the development [c-statistic .782 (95% CI: .77-.80)] and external validation [c-statistic .791 (95% CI: .75-.83)] cohorts. The negative predictive value for DSP patients in the external validation cohort deemed to be at low risk for VA (<5% at 5 years; n = 26) was 100%. CONCLUSIONS The DSP risk score is a novel model that leverages readily available clinical parameters to provide individualized VA risk assessment for DSP patients. This tool may help guide decision-making for primary prevention implantable cardioverter-defibrillator placement in this high-risk population and supports a gene-first risk stratification approach.
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Affiliation(s)
- Richard T Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alexandros Protonotarios
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, UCL Institute of Cardiovascular Science, London, UK
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Mikael Laredo
- Institut de Cardiologie, Sorbonne Université, AP-HP, IHU-ICAN, Groupe Hospitalier Pitié-Salpêtrière, Institut de Cardiologie, Paris, France
| | - Iris van der Schaaf
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dennis Dooijes
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petros Syrris
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, UCL Institute of Cardiovascular Science, London, UK
| | - Douglas Cannie
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, UCL Institute of Cardiovascular Science, London, UK
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Chiara Cappelletto
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Kristen Medo
- Department of Medicine, Division of Cardiology, University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ardan M Saguner
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Robyn J Hylind
- Center for Cardiovascular Genetics, Boston Children’s Hospital, Boston, MA, USA
| | - Dominic J Abrams
- Center for Cardiovascular Genetics, Boston Children’s Hospital, Boston, MA, USA
| | - Neal K Lakdawala
- Center for Advanced Heart Disease, Brigham and Women's Hospital Cardiovascular Medicine, Boston, MA, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Mattia Targetti
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital, Careggi University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Department of Experimental and Clinical Medicine, University of Florence, Meyer Children Hospital, Careggi University Hospital, Florence, Italy
| | - Maddalena Graziosi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Moniek Cox
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Elena Biagini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Philippe Charron
- Institut de Cardiologie, Sorbonne Université, AP-HP, IHU-ICAN, Groupe Hospitalier Pitié-Salpêtrière, Institut de Cardiologie, Paris, France
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital ‘Ospedali Riuniti’, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Giulio Conte
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, Cen, IRCCS, University of Milan, Milan, Italy
- Department of Biochemical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Momina Yazdani
- Department of Cardiology, National Heart and Lung Institute and and MRC London Institute of Medical Sciences, London, United Kingdom
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - James S Ware
- Department of Cardiology, National Heart and Lung Institute and and MRC London Institute of Medical Sciences, London, United Kingdom
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Sanjay K Prasad
- Department of Cardiology, National Heart and Lung Institute and and MRC London Institute of Medical Sciences, London, United Kingdom
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Eric D Smith
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, USA
| | - Adam S Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, USA
| | - Sophie Hespe
- Centre for Population Genomics, Garvan Institute of Medical Research, UNSW Sydney, Sydney, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, UNSW Sydney, Sydney, Australia
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Flavie Ader
- UF de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, APHP Sorbonne Université, DMU BioGem, 75013 Paris, France
- Université Paris Cité, UFR de Pharmacie, UP Biochimie, 75006 Paris, France
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Stacey Peters
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Ari Horton
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Jessica Yao
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Eric Schulze-Bahr
- Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - Sven Dittman
- Department of Cardiovascular Medicine, Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - Eric D Carruth
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Katelyn Young
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Maria Qureshi
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
| | - Chris Haggerty
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, USA
- The Heart Institute, Geisinger, Danville, PA, USA
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Taylor
- Department of Medicine, Division of Cardiology, University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luisa Mestroni
- Department of Medicine, Division of Cardiology, University of Colorado Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Arthur Wilde
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Gianfranco Sinagra
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, University of Trieste, Trieste, Italy
| | - Estelle Gandjbakhch
- Institut de Cardiologie, Sorbonne Université, AP-HP, IHU-ICAN, Groupe Hospitalier Pitié-Salpêtrière, Institut de Cardiologie, Paris, France
| | - J Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anneline S J M te Riele
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Perry Elliott
- Inherited Cardiovascular Diseases Unit, St Bartholomew's Hospital, UCL Institute of Cardiovascular Science, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Katherine C Wu
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, 601 North Caroline St., Baltimore, MD 21287, USA
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Carrick RT, Carruth ED, Gasperetti A, Murray B, Tichnell C, Gaine S, Sampognaro J, Muller SA, Asatryan B, Haggerty C, Thiemann D, Calkins H, James CA, Wu KC. Improved diagnosis of arrhythmogenic right ventricular cardiomyopathy using electrocardiographic deep-learning. Heart Rhythm 2024:S1547-5271(24)03149-7. [PMID: 39168295 DOI: 10.1016/j.hrthm.2024.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/11/2024] [Accepted: 08/10/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic heart disease associated with life-threatening ventricular arrhythmias. Diagnosis of ARVC is based on the 2010 Task Force Criteria (TFC), application of which often requires clinical expertise at specialized centers. OBJECTIVE To develop and validate an electrocardiogram (ECG) deep-learning (DL) tool for ARVC diagnosis. METHODS ECGs of patients referred for ARVC evaluation were used to develop (n=551, 80.1%) and test (n=137, 19.9%) an ECG-DL model for prediction of TFC-defined ARVC diagnosis. The ARVC ECG-DL model was externally validated in a cohort of patients with pathogenic or likely pathogenic (P/LP) ARVC gene variants identified through the Geisinger MyCode Community Health Initiative (N=167). RESULTS Of 688 patients evaluated at JHH (57.3% male, mean age 40.2 years), 329 (47.8%) were diagnosed with ARVC. While ARVC diagnosis made by referring cardiologist ECG interpretation was unreliable (c-statistic 0.53 [CI: 0.52, 0.53]), ECG-DL discrimination in the hold-out testing cohort was excellent (0.87 [0.86, 0.89]) and compared favorably to that of ECG interpretation by an ARVC expert (0.85 [0.84, 0.86]). In the Geisinger cohort, prevalence of ARVC was lower (n=17, 10.2%), but ECG-DL based identification of ARVC phenotype remained reliable (0.80 [0.77, 0.83]). Discrimination was further increased when ECG-DL predictions were combined with non-ECG-derived TFC in the JHH testing (c-statistic 0.940 [95%CI: 0.933; 0.948]) and Geisinger validation (0.897 [95%CI: 0.883; 0.912]) cohorts. CONCLUSION ECG-DL augments diagnosis of ARVC to the level of an ARVC expert and can differentiate true ARVC diagnosis from phenotype-mimics and at-risk family members/genotype-positive individuals.
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Affiliation(s)
- Richard T Carrick
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland.
| | - Eric D Carruth
- Department of Genomic Health, Geisinger Medical Center. Danville, Pennsylvania
| | - Alessio Gasperetti
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Brittney Murray
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Crystal Tichnell
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Sean Gaine
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - James Sampognaro
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Steven A Muller
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Babken Asatryan
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Chris Haggerty
- Department of Biomedical Informatics, Columbia University, New York City, New York
| | - David Thiemann
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Cynthia A James
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
| | - Katherine C Wu
- Heart and Vascular Institute, Johns Hopkins Hospital. Baltimore, Maryland
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3
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van der Heide MYC, Verstraelen TE, van Lint FHM, Bosman LP, de Brouwer R, Proost VM, van Drie E, Taha K, Zwinderman AH, Dickhoff C, Schoonderwoerd BA, Germans T, Houweling AC, Gimeno-Blanes JR, van der Zwaag PA, de Boer RA, Cox MGPJ, van Tintelen JP, Wilde AAM. Long-term reliability of the phospholamban (PLN) p.(Arg14del) risk model in predicting major ventricular arrhythmia: a landmark study. Europace 2024; 26:euae069. [PMID: 38558121 PMCID: PMC10983074 DOI: 10.1093/europace/euae069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS Recently, a genetic variant-specific prediction model for phospholamban (PLN) p.(Arg14del)-positive individuals was developed to predict individual major ventricular arrhythmia (VA) risk to support decision-making for primary prevention implantable cardioverter defibrillator (ICD) implantation. This model predicts major VA risk from baseline data, but iterative evaluation of major VA risk may be warranted considering that the risk factors for major VA are progressive. Our aim is to evaluate the diagnostic performance of the PLN p.(Arg14del) risk model at 3-year follow-up. METHODS AND RESULTS We performed a landmark analysis 3 years after presentation and selected only patients with no prior major VA. Data were collected of 268 PLN p.(Arg14del)-positive subjects, aged 43.5 ± 16.3 years, 38.9% male. After the 3 years landmark, subjects had a mean follow-up of 4.0 years (± 3.5 years) and 28 (10%) subjects experienced major VA with an annual event rate of 2.6% [95% confidence interval (CI) 1.6-3.6], defined as sustained VA, appropriate ICD intervention, or (aborted) sudden cardiac death. The PLN p.(Arg14del) risk score yielded good discrimination in the 3 years landmark cohort with a C-statistic of 0.83 (95% CI 0.79-0.87) and calibration slope of 0.97. CONCLUSION The PLN p.(Arg14del) risk model has sustained good model performance up to 3 years follow-up in PLN p.(Arg14del)-positive subjects with no history of major VA. It may therefore be used to support decision-making for primary prevention ICD implantation not merely at presentation but also up to at least 3 years of follow-up.
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Affiliation(s)
- Myrthe Y C van der Heide
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Tom E Verstraelen
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Freyja H M van Lint
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Laurens P Bosman
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Remco de Brouwer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Virginnio M Proost
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Esmée van Drie
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Karim Taha
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology and Biostatistics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Cathelijne Dickhoff
- Department of Cardiology, Dijklander Ziekenhuis Hoorn, Maelsonstraat 3, 1624 NP Hoorn, Netherlands
| | - Bas A Schoonderwoerd
- Department of Cardiology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Noordwest Ziekenhuisgroep, Wilhelminalaan 12, 1815 JD Alkmaar, Netherlands
| | - Arjan C Houweling
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Juan R Gimeno-Blanes
- Department of Cardiology, Virgen de Arrixaca Hospital, Ctra, Murcia-Cartagena, s/n, El Palmar, 30120 Murcia, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Paul A van der Zwaag
- Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, Erasmus Medical Center, University of Erasmus Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, Netherlands
| | - Moniek G P J Cox
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, Netherlands
| | - J Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Arthur A M Wilde
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
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4
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Carrick RT, De Marco C, Gasperetti A, Bosman LP, Gourraud JB, Trancuccio A, Mazzanti A, Murray B, Pendleton C, Tichnell C, Tandri H, Zeppenfeld K, Wilde AAM, Davies B, Seifer C, Roberts JD, Healey JS, MacIntyre C, Alqarawi W, Tadros R, Cutler MJ, Targetti M, Calò L, Vitali F, Bertini M, Compagnucci P, Casella M, Dello Russo A, Cappelletto C, De Luca A, Stolfo D, Duru F, Jensen HK, Svensson A, Dahlberg P, Hasselberg NE, Di Marco A, Jordà P, Arbelo E, Moreno Weidmann Z, Borowiec K, Delinière A, Biernacka EK, van Tintelen JP, Platonov PG, Olivotto I, Saguner AM, Haugaa KH, Cox M, Tondo C, Merlo M, Krahn AD, te Riele ASJM, Wu KC, Calkins H, James CA, Cadrin-Tourigny J. Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe. Eur Heart J 2024; 45:538-548. [PMID: 38195003 PMCID: PMC11024811 DOI: 10.1093/eurheartj/ehad799] [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: 04/03/2023] [Revised: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. METHODS This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (<10%/5 years), intermediate- (10%-25%/5 years), and high-risk (>25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. RESULTS One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. CONCLUSIONS North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/epidemiology
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Retrospective Studies
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Risk Factors
- North America/epidemiology
- Europe/epidemiology
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Affiliation(s)
- Richard T Carrick
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Corrado De Marco
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Alessio Gasperetti
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | | | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri (IRCCS), Pavia, Italy
| | - Brittney Murray
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Crystal Tichnell
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Harikrishna Tandri
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Amsterdam UMC, Heart Center Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Brianna Davies
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colette Seifer
- St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Michael J Cutler
- Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Chiara Cappelletto
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antonio De Luca
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Henrik K Jensen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Anneli Svensson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nina E Hasselberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Andrea Di Marco
- Arrhythmia Unit, Department ofCardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BioHeartCardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Karolina Borowiec
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Antoine Delinière
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Claude Bernard Lyon 1 University, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, Lyon, France
| | - Elżbieta K Biernacka
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - J Peter van Tintelen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Moniek Cox
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Merlo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Andrew D Krahn
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Katherine C Wu
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
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5
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van Opbergen CJ, Narayanan B, Sacramento CB, Stiles KM, Mishra V, Frenk E, Ricks D, Chen G, Zhang M, Yarabe P, Schwartz J, Delmar M, Herzog CD, Cerrone M. AAV-Mediated Delivery of Plakophilin-2a Arrests Progression of Arrhythmogenic Right Ventricular Cardiomyopathy in Murine Hearts: Preclinical Evidence Supporting Gene Therapy in Humans. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004305. [PMID: 38288614 PMCID: PMC10923105 DOI: 10.1161/circgen.123.004305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 11/30/2023] [Indexed: 02/22/2024]
Abstract
BACKGROUND Pathogenic variants in PKP2 (plakophilin-2) cause arrhythmogenic right ventricular cardiomyopathy, a disease characterized by life-threatening arrhythmias and progressive cardiomyopathy leading to heart failure. No effective medical therapy is available to prevent or arrest the disease. We tested the hypothesis that adeno-associated virus vector-mediated delivery of the human PKP2 gene to an adult mammalian heart deficient in PKP2 can arrest disease progression and significantly prolong survival. METHODS Experiments were performed using a PKP2-cKO (cardiac-specific, tamoxifen-activated PKP2 knockout murine model). The potential therapeutic, adeno-associated virus vector of serotype rh.74 (AAVrh.74)-PKP2a (PKP2 variant A; RP-A601) is a recombinant AAVrh.74 gene therapy viral vector encoding the human PKP2 variant A. AAVrh.74-PKP2a was delivered to adult mice by a single tail vein injection either before or after tamoxifen-activated PKP2-cKO. PKP2 expression was confirmed by molecular and histopathologic analyses. Cardiac function and disease progression were monitored by survival analyses, echocardiography, and electrocardiography. RESULTS Consistent with prior findings, loss of PKP2 expression caused 100% mortality within 50 days after tamoxifen injection. In contrast, AAVrh.74-PKP2a-mediated PKP2a expression resulted in 100% survival for >5 months (at study termination). Echocardiographic analysis revealed that AAVrh.74-PKP2a prevented right ventricle dilation, arrested left ventricle functional decline, and mitigated arrhythmia burden. Molecular and histological analyses showed AAVrh.74-PKP2a-mediated transgene mRNA and protein expression and appropriate PKP2 localization at the cardiomyocyte intercalated disc. Importantly, the therapeutic benefit was shown in mice receiving AAVrh.74-PKP2a after disease onset. CONCLUSIONS These preclinical data demonstrate the potential for AAVrh.74-PKP2a (RP-A601) as a therapeutic for PKP2-related arrhythmogenic right ventricular cardiomyopathy in both early and more advanced stages of the disease.
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Affiliation(s)
| | | | | | | | | | | | | | - Grace Chen
- The Leon Charney Division of Cardiology, New York Univ Grossmann School of Medicine, New York, NY
| | - Mingliang Zhang
- The Leon Charney Division of Cardiology, New York Univ Grossmann School of Medicine, New York, NY
| | | | | | - Mario Delmar
- The Leon Charney Division of Cardiology, New York Univ Grossmann School of Medicine, New York, NY
| | | | - Marina Cerrone
- The Leon Charney Division of Cardiology, New York Univ Grossmann School of Medicine, New York, NY
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6
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Iqbal M, Kamarullah W, Achmad C, Karwiky G, Akbar MR. The pivotal role of compelling high-risk electrocardiographic markers in prediction of ventricular arrhythmic risk in arrhythmogenic right ventricular cardiomyopathy: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102241. [PMID: 38040211 DOI: 10.1016/j.cpcardiol.2023.102241] [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: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Several investigations have shown that existing risk stratification processes remain insufficient for stratifying sudden cardiac death risk in arrhythmogenic right ventricular cardiomyopathy (ARVC). Multiple auxiliary parameters are investigated to offer a more precise prognostic model. Our aim was to assess the association between several ECG markers (epsilon waves, prolonged terminal activation duration (TAD) of QRS, fragmented QRS (fQRS), late potentials on signal-averaged electrocardiogram (SA-ECG), T-wave inversion (TWI) in right precordial leads, and extension of TWI in inferior leads) with the risk of developing poor outcomes in ARVC. METHODS A systematic literature search from several databases was conducted until September 9th, 2023. Studies were eligible if it investigated the relationship between the ECG markers with the risk of developing ventricular arrhythmic events. RESULTS This meta-analysis encompassed 25 studies with a total of 3767 participants. Our study disclosed that epsilon waves, prolonged TAD of QRS, fQRS, late potentials on SA-ECG, TWI in right precordial leads, and extension of TWI in inferior leads were associated with the incremental risk of ventricular arrhythmias, implantable cardioverter-defibrillator shock, and sudden cardiac death, with the risk ratios ranging from 1.46 to 2.11. In addition, diagnostic test accuracy meta-analysis stipulated that the extension of TWI in inferior leads had the uppermost overall area under curve (AUC) value amidst other ECG markers apropos of our outcomes of interest. CONCLUSION A multivariable risk assessment strategy based on the previously stated ECG markers potentially enhances the current risk stratification models in ARVC patients, especially extension of TWI in inferior leads.
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Affiliation(s)
- Mohammad Iqbal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia.
| | - William Kamarullah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Chaerul Achmad
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Giky Karwiky
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
| | - Mohammad Rizki Akbar
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Padjadjaran University, Jl. Pasteur No.38, Pasteur, Kec. Sukajadi, Bandung, Jawa Barat, Indonesia
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7
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Kolk MZH, Ruipérez-Campillo S, Alvarez-Florez L, Deb B, Bekkers EJ, Allaart CP, Van Der Lingen ALCJ, Clopton P, Išgum I, Wilde AAM, Knops RE, Narayan SM, Tjong FVY. Dynamic prediction of malignant ventricular arrhythmias using neural networks in patients with an implantable cardioverter-defibrillator. EBioMedicine 2024; 99:104937. [PMID: 38118401 PMCID: PMC10772563 DOI: 10.1016/j.ebiom.2023.104937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/20/2023] [Accepted: 12/12/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Risk stratification for ventricular arrhythmias currently relies on static measurements that fail to adequately capture dynamic interactions between arrhythmic substrate and triggers over time. We trained and internally validated a dynamic machine learning (ML) model and neural network that extracted features from longitudinally collected electrocardiograms (ECG), and used these to predict the risk of malignant ventricular arrhythmias. METHODS A multicentre study in patients implanted with an implantable cardioverter-defibrillator (ICD) between 2007 and 2021 in two academic hospitals was performed. Variational autoencoders (VAEs), which combine neural networks with variational inference principles, and can learn patterns and structure in data without explicit labelling, were trained to encode the mean ECG waveforms from the limb leads into 16 variables. Supervised dynamic ML models using these latent ECG representations and clinical baseline information were trained to predict malignant ventricular arrhythmias treated by the ICD. Model performance was evaluated on a hold-out set, using time-dependent receiver operating characteristic (ROC) and calibration curves. FINDINGS 2942 patients (61.7 ± 13.9 years, 25.5% female) were included, with a total of 32,129 ECG recordings during a mean follow-up of 43.9 ± 35.9 months. The mean time-varying area under the ROC curve for the dynamic model was 0.738 ± 0.07, compared to 0.639 ± 0.03 for a static (i.e. baseline-only model). Feature analyses indicated dynamic changes in latent ECG representations, particularly those affecting the T-wave morphology, were of highest importance for model predictions. INTERPRETATION Dynamic ML models and neural networks effectively leverage routinely collected longitudinal ECG recordings for personalised and updated predictions of malignant ventricular arrhythmias, outperforming static models. FUNDING This publication is part of the project DEEP RISK ICD (with project number 452019308) of the research programme Rubicon which is (partly) financed by the Dutch Research Council (NWO). This research is partly funded by the Amsterdam Cardiovascular Sciences (personal grant F.V.Y.T).
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Affiliation(s)
- Maarten Z H Kolk
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Samuel Ruipérez-Campillo
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA; Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology Zurich (ETHz), Gloriastrasse 35, Zurich, Switzerland; ITACA Institute, Universtitat Politècnica de València, Camino de Vera S/n, Valencia, Spain
| | - Laura Alvarez-Florez
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Brototo Deb
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Erik J Bekkers
- Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Location VU Medical Center, De Boelelaan 1118, Amsterdam, the Netherlands
| | | | - Paul Clopton
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Ivana Išgum
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Center Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Faculty of Science, University of Amsterdam, Science Park 904, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Reinoud E Knops
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Sanjiv M Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Fleur V Y Tjong
- Department of Clinical and Experimental Cardiology, Amsterdam UMC Location University of Amsterdam, Heart Center, Meibergdreef 9, Amsterdam, the Netherlands; Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA; Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands.
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Kirkels FP, Rootwelt-Norberg C, Bosman LP, Aabel EW, Muller SA, Castrini AI, Taha K, van Osta N, Lie ØH, Asselbergs FW, Lumens J, te Riele ASJM, Hasselberg NE, Cramer MJ, Haugaa KH, Teske AJ. The added value of abnormal regional myocardial function for risk prediction in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:1710-1718. [PMID: 37474315 PMCID: PMC10667035 DOI: 10.1093/ehjci/jead174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS A risk calculator for individualized prediction of first-time sustained ventricular arrhythmia (VA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients has recently been developed and validated (www.ARVCrisk.com). This study aimed to investigate whether regional functional abnormalities, measured by echocardiographic deformation imaging, can provide additional prognostic value. METHODS AND RESULTS From two referral centres, 150 consecutive patients with a definite ARVC diagnosis, no prior sustained VA, and an echocardiogram suitable for deformation analysis were included (aged 41 ± 17 years, 50% female). During a median follow-up of 6.3 (interquartile range 3.1-9.8) years, 37 (25%) experienced a first-time sustained VA. All tested left and right ventricular (LV and RV) deformation parameters were univariate predictors for first-time VA. While LV function did not add predictive value in multivariate analysis, two RV deformation parameters did; RV free wall longitudinal strain and regional RV deformation patterns remained independent predictors after adjusting for the calculator-predicted risk [hazard ratio 1.07 (95% CI 1.02-1.11); P = 0.004 and 4.45 (95% CI 1.07-18.57); P = 0.040, respectively] and improved its discriminative value (from C-statistic 0.78 to 0.82 in both; Akaike information criterion change > 2). Importantly, all patients who experienced VA within 5 years from the echocardiographic assessment had abnormal regional RV deformation patterns at baseline. CONCLUSIONS This study showed that regional functional abnormalities measured by echocardiographic deformation imaging can further refine personalized arrhythmic risk prediction when added to the ARVC risk calculator. The excellent negative predictive value of normal RV deformation could support clinicians considering the timing of implantable cardioverter defibrillator implantation in patients with intermediate arrhythmic risk.
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Affiliation(s)
- Feddo P Kirkels
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christine Rootwelt-Norberg
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Eivind W Aabel
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steven A Muller
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anna I Castrini
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karim Taha
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Nick van Osta
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Øyvind H Lie
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Nina E Hasselberg
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maarten J Cramer
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Kristina H Haugaa
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arco J Teske
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
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Gasperetti A, James CA, Carrick RT, Protonotarios A, te Riele ASJM, Cadrin-Tourigny J, Compagnucci P, Duru F, van Tintelen P, Elliot PM, Calkins H. Arrhythmic risk stratification in arrhythmogenic right ventricular cardiomyopathy. Europace 2023; 25:euad312. [PMID: 37935403 PMCID: PMC10674106 DOI: 10.1093/europace/euad312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable cardiomyopathy characterized by a predominantly arrhythmic presentation. It represents the leading cause of sudden cardiac death (SCD) among athletes and poses a significant morbidity threat in the general population. As a causative treatment for ARVC is still not available, the placement of an implantable cardioverter defibrillator represents the current cornerstone for SCD prevention in this setting. Thanks to international ARVC-dedicated efforts, significant steps have been achieved in recent years towards an individualized, patient-centred risk stratification approach. A novel risk calculator algorithm estimating the 5-year risk of arrhythmias of patients with ARVC has been introduced in clinical practice and subsequently validated. The purpose of this article is to summarize the body of evidence that has allowed the development of this tool and to discuss the best way to implement its use in the care of an individual patient.
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MESH Headings
- Humans
- Risk Factors
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/complications
- Defibrillators, Implantable/adverse effects
- Risk Assessment
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Richard T Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | | | - Anneline S J M te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Firat Duru
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Perry M Elliot
- Department of Cardiology, UCL Institute of Cardiovascular Science, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
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10
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Trancuccio A, Kukavica D, Sugamiele A, Mazzanti A, Priori SG. Prevention of Sudden Death and Management of Ventricular Arrhythmias in Arrhythmogenic Cardiomyopathy. Card Electrophysiol Clin 2023; 15:349-365. [PMID: 37558305 DOI: 10.1016/j.ccep.2023.04.004] [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] [Indexed: 08/11/2023]
Abstract
Arrhythmogenic cardiomyopathy is an umbrella term for a group of inherited diseases of the cardiac muscle characterized by progressive fibro-fatty replacement of the myocardium. As suggested by the name, the disease confers electrical instability to the heart and increases the risk of the development of life-threatening arrhythmias, representing one of the leading causes of sudden cardiac death (SCD), especially in young athletes. In this review, the authors review the current knowledge of the disease, highlighting the state-of-the-art approaches to the prevention of the occurrence of SCD.
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Affiliation(s)
- Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Andrea Sugamiele
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy
| | - Silvia G Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy; Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.
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Muller SA, Te Riele ASJM. Implantable cardioverter-defibrillator shocks during long-term follow-up in arrhythmogenic right ventricular cardiomyopathy. Heart 2023:heartjnl-2022-322138. [PMID: 36977546 DOI: 10.1136/heartjnl-2022-322138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Steven A Muller
- Cardiology, UMC Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anneline S J M Te Riele
- Cardiology, UMC Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Molitor N, Hofer D, Çimen T, Gasperetti A, Akdis D, Costa S, Jenni R, Breitenstein A, Wolber T, Winnik S, Fokstuen S, Fu G, Medeiros-Domingo A, Ruschitzka F, Brunckhorst C, Duru F, Saguner AM. Evolution and triggers of defibrillator shocks in patients with arrhythmogenic right ventricular cardiomyopathy. Heart 2023:heartjnl-2022-321739. [PMID: 36889907 DOI: 10.1136/heartjnl-2022-321739] [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: 08/13/2022] [Accepted: 02/13/2023] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION Implantable cardioverter-defibrillators (ICDs) can prevent sudden cardiac death due to ventricular arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). The aim of our study was to assess the cumulative burden, evolution and potential triggers of appropriate ICD shocks during long-term follow-up, which may help to reduce and further refine individual arrhythmic risk in this challenging disease. METHODS This retrospective cohort study included 53 patients with definite ARVC according to the 2010 Task Force Criteria from the multicentre Swiss ARVC Registry with an implanted ICD for primary or secondary prevention. Follow-up was conducted by assessing all available patient records from patient visits, hospitalisations, blood samples, genetic analysis, as well as device interrogation and tracings. RESULTS Fifty-three patients (male 71.7%, mean age 43±2.2 years, genotype positive 58.5%) were analysed during a median follow-up of 7.9 (IQR 10) years. In 29 (54.7%) patients, 177 appropriate ICD shocks associated with 71 shock episodes occurred. Median time to first appropriate ICD shock was 2.8 (IQR 3.6) years. Long-term risk of shocks remained high throughout long-term follow-up. Shock episodes occurred mainly during daytime (91.5%, n=65) and without seasonal preference. We identified potentially reversible triggers in 56 of 71 (78.9%) appropriate shock episodes, the main triggers representing physical activity, inflammation and hypokalaemia. CONCLUSION The long-term risk of appropriate ICD shocks in patients with ARVC remains high during long-term follow-up. Ventricular arrhythmias occur more often during daytime, without seasonal preference. Reversible triggers are frequent with the most common triggers for appropriate ICD shocks being physical activity, inflammation and hypokalaemia in this patient population.
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Affiliation(s)
- Nadine Molitor
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Daniel Hofer
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Tolga Çimen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alessio Gasperetti
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, US
| | - Deniz Akdis
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Division of Cardiology, GZO - Regional Health Center, Wetzikon, Switzerland
| | - Sarah Costa
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Jenni
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Alexander Breitenstein
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Wolber
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Stephan Winnik
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Siv Fokstuen
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Genetic Medicine division, Diagnostic Department, Hôpitaux Universitaires de Genève, Genève, Switzerland
| | - Guan Fu
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Frank Ruschitzka
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Corinna Brunckhorst
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Firat Duru
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland.,Center for Integrative Human Physiology (ZIHP), University of Zurich, Zurich, Switzerland
| | - Ardan M Saguner
- Cardiology, Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Gerodias FR, Tan MK, De Guzman A, Bernan A, Locnen SA, Apostol-Alday A, Ybanez EJ, Magno JD, Lim A, Junia A, Mambulao R, Cosare-San Pedro J, Lucero J, Quijano Z, Apurillo J, Uson AJ, Lim JL, Inso CA, Agoncillo-Infante A, Bongcawil RY, Fernando GY, Ramos-Manalaysay AM, Arellano-Simon FA, Ilagan-Cargullo EM, Bago-Azares MJ, Baterna J, Tapispisan JA, Masadao-Rodriguez NM, Tarranza JL, Lista LS, Gumapon JK. Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients: A Five-Year Retrospective Study in 10 Centers. Cardiol Res 2022; 13:380-392. [PMID: 36660064 PMCID: PMC9822673 DOI: 10.14740/cr1442] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Background Cardiotoxicity as a result of anthracycline chemotherapy has been linked to increased morbidity and mortality in breast cancer patients. There is a need for early detection through risk factor identification. To date, no large multicenter study has been conducted to describe the incidence, risk factors and clinical and demographic profiles of breast cancer patients with anthracycline-induced cardiotoxicity (AIC) in the Philippines. Methods This was a nationwide multicenter retrospective cohort study among adult breast cancer patients who underwent anthracycline chemotherapy from 2015 to 2020 in 10 sites in the Philippines. Baseline characteristics and possible risk factors for AIC were retrieved from medical records and cancer registries. AIC was defined as a reduction of left ventricular ejection fraction (LVEF) by > 10% from baseline to a value of < 53% or the development of overt left ventricular systolic dysfunction or heart failure (HF). Odds ratios from logistic regression were computed to determine risk factors associated with AIC using STATA-15.0 software. Results Out of 341 patients included, 33 had AIC, accounting for an incidence of 9.68%. Nine patients (2.6%) had clinical HF. AIC patients had a mean age of 53.91 ± 10.84 years. Breast cancer AIC patients were significantly older and had lower body mass index (BMI) than those without AIC. AIC patients had significantly more comorbidities, especially hypertension and atrial fibrillation. Multivariate analysis showed that patients with any preexisting comorbidity are approximately 12.37 times as likely to have AIC, while those with concurrent chemotherapy are 0.07 times or 93% less likely to have AIC. Conclusion Among adult breast cancer patients undergoing anthracycline chemotherapy, we determined a high incidence of cardiotoxicity at 9.68%. Having preexisting comorbidities gave patients 12 times increased odds of developing anthracycline cardiotoxicity. The presence of concurrent non-anthracycline chemotherapy showed an inverse association with the development of AIC which we attribute largely to patient selection in a retrospective study. The significantly higher propensity for AIC development in patients with preexisting comorbidities may warrant closer monitoring and control of patient comorbidities such as hypertension among patients undergoing anthracycline chemotherapy.
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Affiliation(s)
- Ferdinand R. Gerodias
- St. Luke’s Medical Center-QC, Quezon City, Philippines,Department of Medicine, St. Luke’s Medical Center College of Medicine, William H. Quasha Memorial, Quezon City, Philippines,Corresponding Author: Ferdinand R. Gerodias, Jr., Department of Medicine, St. Luke’s Medical Center College of Medicine, William H. Quasha Memorial, Quezon City, Philippines.
| | - Maria Katrina Tan
- St. Luke’s Medical Center-QC, Quezon City, Philippines,St. Luke’s Medical Center-GC, Bonifacio Global City, Philippines
| | - Arnold De Guzman
- Angeles University Foundation Medical Center, Angeles City, Pampanga, Philippines
| | - Alisa Bernan
- Davao Doctors Hospital, Davao City, Davao del Sur, Philippines
| | - Sue Ann Locnen
- St. Luke’s Medical Center-QC, Quezon City, Philippines,St. Luke’s Medical Center-GC, Bonifacio Global City, Philippines,University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | - Erwin Janino Ybanez
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
| | | | - Alvin Lim
- University of Santo Tomas (UST) Hospital, Manila, Philippines
| | - Alex Junia
- Perpetual Succour Hospital, Cebu City, Cebu, Philippines
| | - Ryan Mambulao
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | | | - Jonald Lucero
- Vicente Sotto Memorial Medical Center, Cebu City, Cebu, Philippines
| | - Zaldy Quijano
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | - Josephine Apurillo
- Dona Remedios Trinidad Romualdez Hospital, Tacloban City, Leyte, Philippines
| | | | | | | | | | | | | | | | | | | | | | - Jamil Baterna
- St. Luke’s Medical Center-QC, Quezon City, Philippines
| | | | | | | | - Lorenz Sagayaga Lista
- University of the East Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines
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