1
|
Svensson A, Jensen HK, Boonstra MJ, Tétreault-Langlois M, Dahlberg P, Bundgaard H, Christensen AH, Rylance RT, Svendsen JH, Cadrin-Tourigny J, Te Riele ASJM, Platonov PG. Natural Course of Electrocardiographic Features in Arrhythmogenic Right Ventricular Cardiomyopathy and Their Relation to Ventricular Arrhythmic Events. J Am Heart Assoc 2024; 13:e031893. [PMID: 39158567 DOI: 10.1161/jaha.123.031893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/02/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Electrocardiographic abnormalities are common in arrhythmogenic right ventricular cardiomyopathy and are included in the 2010 Task Force Criteria. Their time course, however, remains uncertain. In this retrospective observational study, we aimed to assess the long-term evolution of electrocardiographic characteristics and their relation to ventricular arrhythmias. METHODS AND RESULTS Three hundred fifty-three patients with arrhythmogenic right ventricular cardiomyopathy as per the 2010 Task Force Criteria with 6871 automatically processed 12-lead digital ECGs were included. The relationship between the electrocardiographic parameters and the risk of ventricular arrhythmias was assessed at 10 years from the first ECG. Electrocardiographic parameters were compared between the first contact ECG, the ECG at diagnosis, and the most recent ECG. Median time between the first and the latest ECG was 6 [interquartile range, 1-14] years. Reductions of QRS voltage, R- and T-wave amplitudes between the first, diagnostic, and the latest ECGs were observed across precordial and extremity leads. Mean QRS duration increased from 96 to 102 ms (P<0.001), terminal activation duration (V1) from 47 to 52 ms (P<0.001), and QTc from 419 to 432 ms (P<0.001). T-wave inversions in leads V3 to V6 and aVF at first ECG were associated with ventricular arrhythmias (adjusted hazard ratio [HRadj][V3], 2.03 [95% CI, 1.23-3.34] and HRadj[aVF], 1.87 [95% CI, 1.13-3.08]). CONCLUSIONS Depolarization and repolarization parameters evolved over time in patients with arrhythmogenic right ventricular cardiomyopathy, supporting the progressive nature of arrhythmogenic right ventricular cardiomyopathy. Electrocardiographic abnormalities may be detected before diagnosis and might, although not fulfilling the 2010 Task Force Criteria, be markers of early disease. T-wave inversion in leads V3 or aVF before diagnosis was associated with ventricular arrhythmias during follow-up.
Collapse
Affiliation(s)
- Anneli Svensson
- Department of Cardiology Linköping University Hospital Linköping Sweden
- Department of Health, Medicine and Caring Sciences Linköping University Linköping Sweden
| | - Henrik Kjaerulf Jensen
- Department of Cardiology Aarhus University Hospital Aarhus Denmark
- Department of Clinical Medicine Aarhus University Aarhus Denmark
| | - Machteld J Boonstra
- Division of Heart and Lungs, Department of Cardiology University Medical Center Utrecht, Utrecht University, Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' (ERN GUARDHEART; Utrecht the Netherlands
| | | | - Pia Dahlberg
- Department of Cardiology, Department of Molecular and Clinical Medicine Institute of Medicine, Sahlgrenska Academy Gothenburg Sweden
| | - Henning Bundgaard
- Unit for Inherited Cardiac Diseases, the Heart Center The National University Hospital, Rigshospitalet Copenhagen Denmark
| | - Alex Hørby Christensen
- Department of Cardiology Copenhagen University Hospital Herlev-Gentofte Herlev Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Science University of Copenhagen Denmark
| | - Rebecca T Rylance
- Department of Cardiology, Clinical Sciences Lund University Lund Sweden
| | - Jesper H Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Science University of Copenhagen Denmark
- Department of Cardiology, the Heart Centre Copenhagen University Hospital, Rigshospitalet Copenhagen Denmark
| | | | - Anneline S J M Te Riele
- Division of Heart and Lungs, Department of Cardiology University Medical Center Utrecht, Utrecht University, Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' (ERN GUARDHEART; Utrecht the Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences Lund University Lund Sweden
| |
Collapse
|
2
|
Tonet E, Vitali F, Amantea V, Azzolini G, Balla C, Micillo M, Lapolla D, Canovi L, Bertini M. Prognostic Electrocardiographic Signs in Arrhythmogenic Cardiomyopathy. BIOLOGY 2024; 13:265. [PMID: 38666877 PMCID: PMC11048689 DOI: 10.3390/biology13040265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/28/2024]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare cardiac disease, characterized by the progressive replacement of myocardial tissue with fibrous and fatty deposits. It can involve both the right and left ventricles. It is associated with the development of life-threatening arrhythmias and culminates in sudden cardiac death. Electrocardiography (ECG) has emerged as a pivotal tool, offering diagnostic insights and prognostic information. The specific ECG abnormalities observed in ACM not only contribute to early detection but also hold the key to the prediction of the likelihood of severe complications. The recognition of these nuanced ECG manifestations has become imperative for clinicians as it guides them in the formulation of tailored therapeutic strategies that address both the present symptoms and the potential future risks.
Collapse
Affiliation(s)
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria of Ferrara, 44124 Cona, Italy; (E.T.); (V.A.); (G.A.); (C.B.); (M.M.); (D.L.); (L.C.); (M.B.)
| | | | | | | | | | | | | | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Aljehani A, Baig S, Kew T, Kalla M, Sommerfeld LC, Murukutla VA, Fabritz L, Steeds RP. Structural Progression in Patients with Definite and Non-Definite Arrhythmogenic Right Ventricular Cardiomyopathy and Risk of Major Adverse Cardiac Events. Biomedicines 2024; 12:328. [PMID: 38397930 PMCID: PMC10886648 DOI: 10.3390/biomedicines12020328] [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: 10/25/2023] [Revised: 12/17/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited disease characterised by early arrhythmias and structural changes. Still, there are limited echocardiography data on its structural progression. We studied structural progression and its impact on the occurrence of major adverse cardiovascular events (MACE). In this single-centre observational cohort study, structural progression was defined as the development of new major or minor imaging 2010 Task Force Criteria during follow-up. Of 101 patients, a definite diagnosis of ARVC was made in 51 patients, while non-definite 'early' disease was diagnosed in 50 patients. During 4 years of follow-up (IQR: 2-6), 23 (45%) patients with a definite diagnosis developed structural progression while only 1 patient in the non-definite (early) group gained minor imaging Task Force Criteria. Male gender was strongly associated with structural progression (62% of males progressed structurally, while 88% of females remained stable). Patients with structural progression were at higher risk of MACE (64% of patients with MACE had structural progression). Therefore, the rate of structural progression is an essential factor to be considered in ARVC studies.
Collapse
Affiliation(s)
- Areej Aljehani
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
- Echocardiography Cardiovascular Technology (ECVT) Program, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
| | - Shanat Baig
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Tania Kew
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Manish Kalla
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| | - Laura C. Sommerfeld
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Vaishnavi Ameya Murukutla
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center and University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Hamburg/Kiel/Luebeck, 20246 Hamburg, Germany
| | - Richard P. Steeds
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth, Birmingham B15 2GW, UK
| |
Collapse
|
5
|
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.
Collapse
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
Collapse
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
| |
Collapse
|
6
|
Reisqs JB, Moreau A, Sleiman Y, Boutjdir M, Richard S, Chevalier P. Arrhythmogenic cardiomyopathy as a myogenic disease: highlights from cardiomyocytes derived from human induced pluripotent stem cells. Front Physiol 2023; 14:1191965. [PMID: 37250123 PMCID: PMC10210147 DOI: 10.3389/fphys.2023.1191965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/02/2023] [Indexed: 05/31/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiomyopathy characterized by the replacement of myocardium by fibro-fatty infiltration and cardiomyocyte loss. ACM predisposes to a high risk for ventricular arrhythmias. ACM has initially been defined as a desmosomal disease because most of the known variants causing the disease concern genes encoding desmosomal proteins. Studying this pathology is complex, in particular because human samples are rare and, when available, reflect the most advanced stages of the disease. Usual cellular and animal models cannot reproduce all the hallmarks of human pathology. In the last decade, human-induced pluripotent stem cells (hiPSC) have been proposed as an innovative human cellular model. The differentiation of hiPSCs into cardiomyocytes (hiPSC-CM) is now well-controlled and widely used in many laboratories. This hiPSC-CM model recapitulates critical features of the pathology and enables a cardiomyocyte-centered comprehensive approach to the disease and the screening of anti-arrhythmic drugs (AAD) prescribed sometimes empirically to the patient. In this regard, this model provides unique opportunities to explore and develop new therapeutic approaches. The use of hiPSC-CMs will undoubtedly help the development of precision medicine to better cure patients suffering from ACM. This review aims to summarize the recent advances allowing the use of hiPSCs in the ACM context.
Collapse
Affiliation(s)
- J. B. Reisqs
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - A. Moreau
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - Y. Sleiman
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
| | - M. Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, NY, United States
- Department of Medicine, Cell Biology and Pharmacology, State University of New York Downstate Health Sciences University, NY, United States
- Department of Medicine, New York University School of Medicine, NY, United States
| | - S. Richard
- Université de Montpellier, Institut National de la Santé et de la Recherche Médicale, Centre National de la Recherche Scientifique, PhyMedExp, Montpellier, France
| | - P. Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Villeurbanne, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
| |
Collapse
|
7
|
Carrick RT, Te Riele ASJM, Gasperetti A, Bosman L, Muller SA, Pendleton C, Tichnell C, Murray B, Yap SC, van den Berg MP, Wilde A, Zeppenfeld K, Hays A, Zimmerman SL, Tandri H, Cadrin-Tourigny J, van Tintelen P, Calkins H, James CA, Wu KC. Longitudinal Prediction of Ventricular Arrhythmic Risk in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Arrhythm Electrophysiol 2022; 15:e011207. [PMID: 36315818 PMCID: PMC9669260 DOI: 10.1161/circep.122.011207] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The arrhythmogenic right ventricular cardiomyopathy (ARVC) risk calculator stratifies risk for incident sustained ventricular arrhythmias (VA) at the time of ARVC diagnosis. However, included risk factors change over time, and how well the ARVC risk calculator performs at follow-up is unknown. METHODS This was a retrospective analysis of patients with definite ARVC and without prior sustained VA. Risk factors for VA including age, nonsustained ventricular tachycardia, premature ventricular complex burden, T-wave inversions on electrocardiogram, cardiac syncope, right ventricular function, therapeutic medication use, and exercise intensity were assessed at the time of 2010 Task Force Criteria based ARVC diagnosis and upon repeat evaluations. Changes in these risk factors were analyzed over 5-year follow-up. The 5-year risk of VA was predicted longitudinally using (1) the baseline ARVC risk calculator prediction, (2) the ARVC risk prediction calculated using updated risk factors, and (3) time-varying Cox regression. Discrimination and calibration were assessed in comparison to observed VA event rates. RESULTS Four hundred eight patients with ARVC experiencing 132 primary VA events were included. Matched comparison of risk factors at baseline versus at 5 years of follow-up revealed decreased burdens of premature ventricular complexes (-1200/day) and nonsustained ventricular tachycardia (-14%). Presence of significant right ventricular dysfunction and number of T-wave inversions on electrocardiogram were unchanged. Observed risk for VA decreased by 13% by 5 years follow-up. The baseline ARVC risk calculator's ability to predict 5-year VA risk worsened during follow-up (C statistics, 0.83 at diagnosis versus 0.68 at 5 years). Both the updated ARVC risk calculator (C statistics of 0.77) and time-varying Cox regression model (C statistics, 0.77) had strong discrimination. The updated ARVC risk calculator overestimated 5-year VA risk by an average of +6%. CONCLUSIONS Risk factors for VA in ARVC are dynamic, and overall risk for incident sustained VA decreases during follow-up. Up-to-date risk factor assessment improves VA risk stratification.
Collapse
Affiliation(s)
- Richard T Carrick
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Anneline S J M Te Riele
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
- Member of the European Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' Academic Medical Center' Amsterdam' the Netherlands (A.S.J.M.t.R., S.-C.Y.)
| | - Alessio Gasperetti
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Laurens Bosman
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Steven A Muller
- Division of Cardiology, Department of Heart & Lungs (A.G., A.S.J.M.t.R., L.B., S.A.M.), University Medical Center Utrecht, the Netherlands
| | - Catherine Pendleton
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Crystal Tichnell
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Brittney Murray
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Sing-Chien Yap
- Member of the European Network for Rare, Low Prevalence and Complex Diseases of the Heart: ERN GUARD-Heart' Academic Medical Center' Amsterdam' the Netherlands (A.S.J.M.t.R., S.-C.Y.)
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, the Netherlands (M.P.v.d.B.)
| | - Arthur Wilde
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
- Amsterdam University Medical Center, Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, the Netherlands (A.W.)
| | | | - Allison Hays
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Stefan L Zimmerman
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Harikrishna Tandri
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | | | - Peter van Tintelen
- Department of Clinical Genetics (P.v.T.), University Medical Center Utrecht, the Netherlands
- Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.C.Y., A.W., P.v.T.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Cynthia A James
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| | - Katherine C Wu
- Division of Cardiology, Johns Hopkins Medical Institute, Baltimore, MD (R.T.C., A.G., C.P., C.T., B.M., A.H., S.L.Z., H.T., H.C., C.A.J., K.C.W.)
| |
Collapse
|
8
|
Castrichini M, Eldemire R, Groves DW, Taylor MR, Miyamoto S, Mestroni L. Clinical and genetic features of arrhythmogenic cardiomyopathy: diagnosis, management and the heart failure perspective. PROGRESS IN PEDIATRIC CARDIOLOGY 2022; 63. [PMID: 34970070 DOI: 10.1016/j.ppedcard.2021.101459] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Arrhythmogenic cardiomyopathy (ACM) is an emerging new concept of a life-threatening heart muscle disorder due not only to desmosome gene mutations, but also to non-desmosome genes, such as filamin C, lamin A/C, phospholamban, transmembrane protein 43, titin, SCN5A and RNA binding motif protein 20.Multi-modality imaging along with genetic testing are important tools for risk stratification to tailor treatment to a single patient. Cardiac magnetic resonance imaging (CMR) with late gadolinium enhancement (LGE) is the gold standard for evaluating left and right ventricular structure and function, edema, and fibrosis. The identification of regional fibrosis with LGE has prognostic value. The management of ACM involves several aspects: treatment of arrhythmias and heart failure, risk stratification, implantable cardioverter-defibrillator (ICD) placement, exercise restrictions, and life-style changes. The decision for ICD placement in ACM patients is not well established and should be made weighing risks and benefits. However, the presence of specific genotypes can allow a precision medicine approach. In ACM patients with only mild left ventricular dysfunction but phospholamban, filamin C or lamin A/C mutations, an ICD is now considered a reasonable approach. Aim of Review We sought to provide an overview of clinical and genetic feature of arrhythmogenic cardiomyopathy providing epidemiology, imaging, diagnostic and treatment information, using a systematic genetic approach.
Collapse
Affiliation(s)
- Matteo Castrichini
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiology, Cardiothoracovascular Department, Azienda Ospedaliera Universitaria Integrata Giuliano Isontina (ASUGI), Trieste, Italy
| | - Ramone Eldemire
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Daniel W Groves
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus Aurora, CO
| | - Matthew Rg Taylor
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Shelley Miyamoto
- Division of Cardiology, Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Luisa Mestroni
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|