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Mansfield LK, Reichman JR, Crowley DI, Flyer JN, Freeman K, Gauvreau KK, Mackie SA, Marino BS, Newburger JW, Ziniel SI, Brown DW. Living with Congenital Aortic Stenosis: Exercise Restriction, Patterns of Adherence, and Quality of Life. Pediatr Cardiol 2024; 45:1430-1439. [PMID: 37344559 DOI: 10.1007/s00246-023-03165-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/16/2023] [Indexed: 06/23/2023]
Abstract
Modern consensus panel guidelines recommend restriction from most organized sports for patients with moderate or severe aortic stenosis (AS). However, there is little published data on how frequently physicians deviate from guidelines, how well patients adhere to exercise restrictions, or the effect of restriction on patient-reported quality of life. In this study, we surveyed 93 subjects with AS and their cardiologists regarding participation in organized sports, physical activity, weightlifting, and exercise restriction. Subjects completed the pediatric quality of life inventory (PedsQL) and the pediatric cardiac quality of life inventory (PCQLI). We found that subjects with severe AS (n = 3) were commonly, but not universally, restricted from organized sports (n = 2, 66%). Subjects with moderate AS (n = 40) were rarely restricted from organized sports (n = 6, 17%). No physician-specific characteristics were associated with increased likelihood of recommending exercise restriction. Subjects were more likely to be restricted if they were older (16 years vs. 13 years, p 0.02) and had moderate versus mild AS (p 0.013). PCQLI scores for teens and young adults with AS (age 13-25) were lower than a comparison group of patients with mild congenital heart disease. For all age groups, the PedsQL social functioning score was lower for subjects with exercise restriction (p 0.052). In summary, cardiologists apply consensus guidelines leniently when restricting patients with moderate/severe AS from organized sports and weightlifting. Patients with AS routinely adhere to exercise restriction recommendations. Children and young adults with AS and exercise restriction have lower QOL scores in the social functioning domain.
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Affiliation(s)
- Laura K Mansfield
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
| | - Jeffrey R Reichman
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - David I Crowley
- Department of Pediatrics, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Jonathan N Flyer
- Division of Pediatric Cardiology, Department of Pediatrics, The Robert Larner, M.D. College of Medicine, The University of Vermont, Burlington, VT, USA
| | - Kaitlyn Freeman
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Kimberlee K Gauvreau
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Stewart A Mackie
- Division of Pediatric Cardiology Department of Pediatrics and Medical Social Sciences Department of PediatricsBaystate Medical Center, University of Massachusetts Medical School, Springfield, MA, USA
| | - Bradley S Marino
- Divisions of Cardiology and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jane W Newburger
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Sonja I Ziniel
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - David W Brown
- Department of Cardiology, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
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Lampert R, Chung EH, Ackerman MJ, Arroyo AR, Darden D, Deo R, Dolan J, Etheridge SP, Gray BR, Harmon KG, James CA, Kim JH, Krahn AD, La Gerche A, Link MS, MacIntyre C, Mont L, Salerno JC, Shah MJ. 2024 HRS expert consensus statement on arrhythmias in the athlete: Evaluation, treatment, and return to play. Heart Rhythm 2024; 21:e151-e252. [PMID: 38763377 DOI: 10.1016/j.hrthm.2024.05.018] [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: 05/09/2024] [Accepted: 05/09/2024] [Indexed: 05/21/2024]
Abstract
Youth and adult participation in sports continues to increase, and athletes may be diagnosed with potentially arrhythmogenic cardiac conditions. This international multidisciplinary document is intended to guide electrophysiologists, sports cardiologists, and associated health care team members in the diagnosis, treatment, and management of arrhythmic conditions in the athlete with the goal of facilitating return to sport and avoiding the harm caused by restriction. Expert, disease-specific risk assessment in the context of athlete symptoms and diagnoses is emphasized throughout the document. After appropriate risk assessment, management of arrhythmias geared toward return to play when possible is addressed. Other topics include shared decision-making and emergency action planning. The goal of this document is to provide evidence-based recommendations impacting all areas in the care of athletes with arrhythmic conditions. Areas in need of further study are also discussed.
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Affiliation(s)
- Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut
| | - Eugene H Chung
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Rajat Deo
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Joe Dolan
- University of Utah, Salt Lake City, Utah
| | | | - Belinda R Gray
- University of Sydney, Camperdown, New South Wales, Australia
| | | | | | | | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Victoria, Australia
| | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | | | - Lluis Mont
- Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Jack C Salerno
- University of Washington School of Medicine, Seattle, Washington
| | - Maully J Shah
- Childrens Hospital of Philadelphia, Philadelphia, Pennsylvania
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3
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Krishnan S, Guseh JS, Chukumerije M, Grant AJ, Dean PN, Hsu JJ, Husaini M, Phelan DM, Shah AB, Stewart K, Wasfy MM, Capers Q, Essien UR, Johnson AE, Levine BD, Kim JH. Racial Disparities in Sports Cardiology: A Review. JAMA Cardiol 2024; 9:935-943. [PMID: 39018059 DOI: 10.1001/jamacardio.2024.1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Importance Racial disparities in cardiovascular health, including sudden cardiac death (SCD), exist among both the general and athlete populations. Among competitive athletes, disparities in health outcomes potentially influenced by social determinants of health (SDOH) and structural racism remain inadequately understood. This narrative review centers on race in sports cardiology, addressing racial disparities in SCD risk, false-positive cardiac screening rates among athletes, and the prevalence of left ventricular hypertrophy, and encourages a reexamination of race-based practices in sports cardiology, such as the interpretation of screening 12-lead electrocardiogram findings. Observations Drawing from an array of sources, including epidemiological data and broader medical literature, this narrative review discusses racial disparities in sports cardiology and calls for a paradigm shift in approach that encompasses 3 key principles: race-conscious awareness, clinical inclusivity, and research-driven refinement of clinical practice. These proposed principles call for a shift away from race-based assumptions towards individualized, health-focused care in sports cardiology. This shift would include fostering awareness of sociopolitical constructs, diversifying the medical team workforce, and conducting diverse, evidence-based research to better understand disparities and address inequities in sports cardiology care. Conclusions and Relevance In sports cardiology, inadequate consideration of the impact of structural racism and SDOH on racial disparities in health outcomes among athletes has resulted in potential biases in current normative standards and in the clinical approach to the cardiovascular care of athletes. An evidence-based approach to successfully address disparities requires pivoting from outdated race-based practices to a race-conscious framework to better understand and improve health care outcomes for diverse athletic populations.
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Affiliation(s)
- Sheela Krishnan
- Cardiovascular Services, Division of Cardiology, Maine Medical Center, Portland
| | - James Sawalla Guseh
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Merije Chukumerije
- Sports and Exercise Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Cedars-Sinai Medical Group, Los Angeles, California
| | | | - Peter N Dean
- Division of Pediatric Cardiology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jeffrey J Hsu
- Department of Medicine (Cardiology), David Geffen School of Medicine, University of California, Los Angeles
| | - Mustafa Husaini
- Division of Cardiovascular Medicine, Department of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Dermot M Phelan
- The Gragg Center for Cardiovascular Performance, Atrium Health Sanger Heart & Vascular Institute, Charlotte, North Carolina
| | - Ankit B Shah
- Sports & Performance Cardiology, Georgetown University School of Medicine, Chevy Chase, Maryland
| | - Katie Stewart
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston
| | - Quinn Capers
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas
| | - Utibe R Essien
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Amber E Johnson
- Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian, Dallas
- Department of Medicine and Cardiology, The University of Texas Southwestern Medical Center, Dallas
| | - Jonathan H Kim
- Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia
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Gray B, Ackerman MJ, Link MS, Lampert R. VIGOROUS EXERCISE AND SPORTS PARTICIPATION IN INDIVIDUALS WITH HYPERTROPHIC CARDIOMYOPATHY. Trends Cardiovasc Med 2024:S1050-1738(24)00091-4. [PMID: 39357663 DOI: 10.1016/j.tcm.2024.09.004] [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: 08/09/2024] [Revised: 09/18/2024] [Accepted: 09/26/2024] [Indexed: 10/04/2024]
Abstract
Historically, individuals with HCM have been restricted from vigorous competitive sports due to concerns for risk of sudden death. More recently, prospective data are emerging that individuals with HCM who participate in vigorous sports do not have increased arrhythmic risk compared to the less active, and series of athletes with HCM continuing to compete, while small, have not shown high risk. Guidelines are evolving, and while differences exist, all now recommend an individualized approach and shared decision-making for athletes with HCM wishing to return to play.
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Affiliation(s)
- Belinda Gray
- Department of Cardiology, Royal Prince Alfred Hospital; Faculty of Medicine and Health University of Sydney; Centre for Cardiovascular Research, Centenary Institute, Sydney, NSW, Australia
| | - Michael J Ackerman
- Mayo Clinic, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Genetic Heart Rhythm Clinic, Rochester, MN
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Wang N, Huang J, Fang Y, Du H, Chen Y, Zhao S. Molecular biomarkers of blunt cardiac injury: recent advances and future perspectives. Expert Rev Mol Diagn 2024:1-9. [PMID: 39285529 DOI: 10.1080/14737159.2024.2405919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 09/14/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Blunt cardiac injury (BCI), associated with high morbidity and mortality, involves multiple injuries. With no widely accepted gold standard diagnostic test and molecular biomarkers still in debate and far from application in clinical practice, exploring specific molecular biomarkers of BCI is of great significance. The clarification of molecular biomarkers can improve the diagnosis of BCI, leading to more precise care for victims in various situations. AREAS COVERED Using the search term 'Biomarker AND Blunt cardiac injury,' we carefully reviewed related papers from June 2004 to June 2024 in PubMed and CNKI. After reviewing, we included 20 papers, summarizing the biomarkers reported in previous studies, and then reviewed molecular biomarkers such as troponins, Nterminal proBtype natriuretic peptide (NT proBNP), hearttype fatty acid binding protein (hFABP), and lactate for BCI diagnosis. Finally, valuable views on future research directions for diagnostic biomarkers of BCI were presented. EXPERT OPINION Several advanced technologies have been introduced into clinical medicine, which have ultimately changed the research on cardiac diseases in recent years. Some biomarkers have been identified and utilized for BCI diagnosis. Herein, we summarize the latest relevant information as a reference for clinical practice and future studies.
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Affiliation(s)
- Ning Wang
- Department of Forensic Pathology, Zhongshan School of Medicine Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiliang Huang
- Department of Gastroenterology, Huizhou Central People's Hospital, Huizhou, Guangdong, China
| | - Ying Fang
- Department of Forensic Pathology, Zhongshan School of Medicine Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Honglin Du
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yanlin Chen
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Shuquan Zhao
- Department of Forensic Pathology, Zhongshan School of Medicine Sun Yat-sen University, Guangzhou, Guangdong, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-sen University, Guangzhou, Guangdong, China
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Finocchiaro G, Radaelli D, D'Errico S, Bhatia R, Papadakis M, Behr ER, Westaby J, Sharma S, Sheppard MN. Ethnicity and sudden cardiac death in athletes: insights from a large United Kingdom registry. Eur J Prev Cardiol 2024; 31:1518-1525. [PMID: 38636095 DOI: 10.1093/eurjpc/zwae146] [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: 12/15/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/20/2024]
Abstract
AIMS The relationship between ethnicity and causes of sudden cardiac death (SCD) in athletes is poorly understood. OBJECTIVES To investigate aetiology of SCD among different ethnicities in a large cohort of athletes. METHODS AND RESULTS Between 1994 and November 2022, 7880 cases of SCD were consecutively referred from all over the United Kingdom to our national cardiac pathology centre; 848 (11%) were athletes. All cases underwent detailed autopsy evaluation by expert cardiac pathologists. Clinical information was obtained from referring coroners. Most of athletes were white (n = 758; 89%). Black and Asian athletes were in number of 51 (6%) and 39 (5%), respectively. A structurally normal heart, indicative of sudden arrhythmic death syndrome (SADS) was the most common autopsy finding (n = 385; 45%), followed by myocardial diseases (n = 275; 32%), atherosclerotic coronary artery disease (CAD) (n = 58; 7%), and coronary artery anomalies (n = 29; 3%). In most of cases, death occurred during exercise (n = 737; 87%). Arrhythmogenic cardiomyopathy (ACM) was more common in black (n = 13; 25%) than in white (n = 109; 14%) and Asian (n = 3; 8%) athletes (P = 0.03 between black and white athletes; P = 0.04 between black and Asian athletes); in contrast, CAD was more common in Asians (n = 6; 15% vs. n = 51; 7% in whites vs. n = 1; 2%; in blacks, P = 0.02 between Asian and black athletes). Among white athletes, ACM was more common in individuals who died during exercise than in the ones who died at rest (P = 0.005). Such a difference was not observed in Asian and black athletes. In Asian athletes, CAD was the diagnosis at autopsy in 18% of individuals who died during exercise and in none of individuals who died at rest. CONCLUSION A structurally normal heart at autopsy and myocardial diseases are the most common findings in athletes who died suddenly. While ACM is more common in black athletes, atherosclerotic CAD is more common in Asian athletes, with a strong association with exercise-induced SCD. ACM appears to be a driver of exercise-induced SCD in white athletes, however this is not the case in black and Asian athletes.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Davide Radaelli
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Stefano D'Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Raghav Bhatia
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Elijah R Behr
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Joseph Westaby
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Mary N Sheppard
- Cardiovascular Sciences Research Centre, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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Hametner G, Widmer F. Blunt Chest Wall Trauma Leading to Sudden Cardiac Arrest. JACC Case Rep 2024; 29:102504. [PMID: 39359512 PMCID: PMC11442348 DOI: 10.1016/j.jaccas.2024.102504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 07/08/2024] [Accepted: 07/17/2024] [Indexed: 10/04/2024]
Abstract
A 54-year-old hockey player survived sudden cardiac arrest after a chest slapshot, receiving immediate resuscitation and defibrillation of ventricular fibrillation. Examinations revealed chest trauma and subclinical single-vessel disease; a coronary dissection could not be ruled out. The patient recovered without complications, underscoring the importance of rescue equipment in sports facilities.
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Affiliation(s)
- Greta Hametner
- Rehabilitation Centre, Hochgebirgsklinik, Davos, Switzerland
| | - Fritz Widmer
- Department of Internal Medicine, Cardiology, Kantonsspital Muensterlingen, Muensterlingen, Switzerland
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Wang W, Jia H, Hua X, Song J. New insights gained from cellular landscape changes in myocarditis and inflammatory cardiomyopathy. Heart Fail Rev 2024; 29:883-907. [PMID: 38896377 DOI: 10.1007/s10741-024-10406-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2024] [Indexed: 06/21/2024]
Abstract
Advances in the etiological classification of myocarditis and inflammatory cardiomyopathy (ICM) have reached a consensus. However, the mechanism of myocarditis/ICM remains unclear, which affects the development of treatment and the improvement of outcome. Cellular transcription and metabolic reprogramming, and the interactions between cardiomyocytes and non-cardiomyocytes, such as the immune cells, contribute to the process of myocarditis/ICM. Recent efforts have been made by multi-omics techniques, particularly in single-cell RNA sequencing, to gain a better understanding of the cellular landscape alteration occurring in disease during the progression. This article aims to provide a comprehensive overview of the latest studies in myocarditis/ICM, particularly as revealed by single-cell sequencing.
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Affiliation(s)
- Weiteng Wang
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Hao Jia
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Xiumeng Hua
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China
| | - Jiangping Song
- Beijing Key Laboratory of Preclinical Research and Evaluation for Cardiovascular Implant Materials, Animal Experimental Centre, Fuwai Hospital, National Centre for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Science and Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
- Shenzhen Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, 518057, China.
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10037, China.
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Movahed MR, Bahrami A, Bates S. Reported Physical Symptoms During Screening Echocardiography Are Not Associated With Presence of Suspected Hypertrophic Cardiomyopathy. Crit Pathw Cardiol 2024; 23:137-140. [PMID: 38598543 DOI: 10.1097/hpc.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND The prevalence of hypertrophic cardiomyopathy (HCM) can be silent and can present with sudden death as the first manifestation of this disease. The goal of this study was to evaluate any association between reported physical symptoms with the presence of suspected HCM. METHOD The Anthony Bates Foundation has been performing screening echocardiography across the United States for prevention of sudden death since 2001. A total of 4120 subjects between the ages of 4 and 79 underwent echocardiographic screening. We evaluated any association between various symptoms and suspected HCM defined as any left ventricular wall thickness³ ≥15 mm. RESULTS The total prevalence of suspected HCM in the entire study population was 1.1%. The presence of physical symptoms was not associated with HCM (chest pain in 4.3% of participants with HCM vs. 9.9% of the control, P = 0.19, palpitation in 4.3% of participants with HCM vs. 7.3% of the control, P = 0.41, shortness of breath in 6.4% of participant with HCM vs. 11.7% of the control, P = 0.26, lightheadedness in 4.3% of participant with HCM vs. 13.1% of the control, P = 0.07, ankle swelling in 2.1% of participant with HCM vs. 4.0% of the control, P = 0.52, dizziness in 8.5% of participant with HCM vs. 12.2% of the control, P = 0.44). CONCLUSIONS Echocardiographic presence of suspected HCM is not associated with a higher prevalence of physical symptoms in the participants undergoing screening echocardiography.
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Affiliation(s)
- Mohammad Reza Movahed
- From the Department of Medicine, University of Arizona Sarver Heart Center, Tucson, AZ
| | - Ashkan Bahrami
- Department of Medicine, University of Arizona College of Medicine, Phoenix, AZ
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10
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Henning RJ. The differentiation of the competitive athlete with physiologic cardiac remodeling from the athlete with cardiomyopathy. Curr Probl Cardiol 2024; 49:102473. [PMID: 38447749 DOI: 10.1016/j.cpcardiol.2024.102473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 03/08/2024]
Abstract
There are currently 5 million active high school, collegiate, professional, and master athletes in the United States. Regular intense exercise by these athletes can promote structural, electrical and functional remodeling of the heart, which is termed the "athlete's heart." In addition, regular intense exercise can lead to pathological adaptions that promote or worsen cardiac disease. Many of the athletes in the United States seek medical care. Consequently, physicians must be aware of the normal cardiac anatomy and physiology of the athlete, the differentiation of the normal athlete heart from the athlete with cardiomyopathy, and the contemporary care of the athlete with a cardiomyopathy. In athletes with persistent cardiovascular symptoms, investigations should include a detailed history and physical examination, an ECG, a transthoracic echocardiogram, and in athletes in whom the diagnosis is uncertain, a maximal exercise stress test or a continuous ECG recording, and cardiac magnetic resonance imaging or cardiac computed tomography angiography when definition of the coronary anatomy or characterization of the aorta and the aortic great vessels is indicated. This article discusses the differentiation of the normal athlete with physiologic cardiac remodeling from the athlete with hypertrophic, dilated or arrhythmogenic ventricular cardiomyopathy (ACM). The ECG changes in trained athletes that are considered normal, borderline, or abnormal are listed. In addition, the normal echocardiographic measurements for athletes who consistently participate in endurance, power, combined or heterogeneous sports are enumerated and discussed. Algorithms are listed that are useful in the diagnosis of trained athletes with borderline or abnormal echocardiographic measurements suggestive of cardiomyopathies along with the major and minor criteria for the diagnosis of ACM in athletes. Thereafter, the treatment of athletes with hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies are reviewed. The distinction between physiologic changes and pathologic changes in the hearts of athletes has important therapeutic and prognostic implications. Failure by the physician to correctly diagnose an athlete with hypertrophic cardiomyopathy, dilated cardiomyopathy, or ACM, can lead to the sudden cardiac arrest and death of the athlete during training or sports competition. Conversely, an incorrect diagnosis by a physician of cardiac pathology in a normal athlete can lead to an unnecessary restriction of athlete training and competition with resultant significant emotional, psychological, financial, and long-term health consequences in the athlete.
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11
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Schauer JS, Hong B. A Review of Pediatric Cardiomyopathy. Semin Cardiothorac Vasc Anesth 2024; 28:165-176. [PMID: 38708810 DOI: 10.1177/10892532241250241] [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: 05/07/2024]
Abstract
Though pediatric cardiomyopathy is rare in children, there is significant associated morbidity and mortality. Etiology varies from inborn errors of metabolism to familial genetic mutations and myocyte injury. Major classes include dilated, hypertrophic, restrictive, and non-compaction. Diagnosis generally involves a combination of clinical history and echocardiography. The use of cross-sectional imaging is gaining popularity. Management varies between subtype and may involve a combination of medical and surgical interventions depending on clinical status.
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Affiliation(s)
- Jenna S Schauer
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Borah Hong
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
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12
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Venkataraman A, Hong IZ, Ho LC, Teo TL, Ang SHC. Public Perceptions on the Use of the Physical Activity Readiness Questionnaire. Healthcare (Basel) 2024; 12:1686. [PMID: 39273711 PMCID: PMC11395539 DOI: 10.3390/healthcare12171686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/06/2024] [Accepted: 08/22/2024] [Indexed: 09/15/2024] Open
Abstract
Self-administered pre-participation screening for physical activity (PA) requires an instrument that should be easily used and identify individuals at high risk. The Physical Activity Readiness Questionnaire (PAR-Q+) has been used for many years. Its ease of use and ability to identify those not fit to undergo PA has not been assessed. This study was to determine the rates of the PAR-Q+ in identifying adults who may not be fit for moderate or intense PA and obtain feedback on the use of this tool. A randomized, cross-sectional study involving a wide spectrum of members of the public was carried out. Participants were asked to provide their bio-characteristics, complete the PARQ+, and provide feedback on the questionnaire. With 1019 participants, about 33.1% of the participants using the PARQ+ would have required further medical evaluation. Except for those patients with respiratory illness, there was no difference in levels of PA in those who answered yes or no to the seven PARQ+ questions. Only 4 of the 7 main PAR-Q+ questions were perceived by the public as easily understood. Difficulties were encountered with 21 of the 45 follow-up questions, especially amongst those with co-morbidities. The wordiness of the questions and the large number of technical terms were also sources of concern. Suggestions were provided by participants on areas where improvements may be made to the wording of the questions. The study suggests that the PAR-Q+ probably over-identified those who require further medical evaluation. In addition, the wordiness of the questions and frequent use of medical jargon made the PARQ+ challenging to understand and use. The suggestions provide opportunities to review areas for possible improvements.
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Affiliation(s)
- Anantharaman Venkataraman
- Department of Emergency Medicine, Singapore General Hospital, Emergency Medicine Academic Clinical Program, Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
| | - Ian Zhirui Hong
- Department of Emergency Medicine, Singapore General Hospital, Emergency Medicine Academic Clinical Program, Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
| | - Lisa Cuiying Ho
- Department of Orthopaedic Surgery, Sengkang General Hospital, 110 Sengkang East Way, Singapore 544886, Singapore
| | - Tess Lin Teo
- Department of Emergency Medicine, Singapore General Hospital, Emergency Medicine Academic Clinical Program, Duke-NUS Academic Medical Centre, Outram Road, Singapore 169608, Singapore
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Harris KM, Mackey-Bojack S, Fisher G, Nwaudo D, Maron BJ. Arrhythmogenic Mitral Valve Prolapse Revisited: A Not Uncommon Cause of Youthful Sudden Death in Athletes and Women. Am J Med 2024:S0002-9343(24)00494-7. [PMID: 39147083 DOI: 10.1016/j.amjmed.2024.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Revised: 08/03/2024] [Accepted: 08/05/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND Sudden deaths (SD) in young people including competitive athletes, albeit uncommon, are usually attributable to genetic, congenital or acquired cardiovascular conditions. However, it is under-appreciated that mitral valve prolapse (MVP), a relatively common valvular heart disease, is associated with SD in this youthful population. METHODS Forty-three MVP-related SDs are identified from 2 large cardiovascular registries with pathologic, clinical, and demographic findings reported. RESULTS Events occurred in both genders, but females were unexpectedly common (49%); median age was 22 ± 8 years, and 29 (67%) were engaged in competitive sports, including 17 with preparticipation examination. Of the 43 MVP cases, 21 died suddenly during or just after vigorous exercise including 6 during organized sports. Sixteen (37%) had been evaluated by a cardiologist resulting in confirmed MVP diagnosis in 11.. Pathologic findings characteristic of MVP included: bileaflet myxomatous involvement in all cases; and areas of interstitial or replacement myocardial fibrosis in 79%, most evident in posterolateral left ventricular wall. CONCLUSIONS Arrhythmogenic myxomatous degeneration (MVP) is an under-recognized cause of SD in young people including competitive athletes, disproportionally affecting females and requiring requires a high index of clinical suspicion. Frequency of left ventricular fibrosis in these young people with MVP suggests a mechanism for ventricular tachyarrhythmias and SD, relevant to future risk stratification.
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Affiliation(s)
- Kevin M Harris
- Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN.
| | | | - Giselle Fisher
- Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN
| | - Darlington Nwaudo
- Minneapolis Heart Institute Foundation at Abbott-Northwestern Hospital, Minneapolis, MN
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Smyła-Gruca W, Szczurek-Wasilewicz W, Skrzypek M, Romuk E, Karmański A, Jurkiewicz M, Gąsior M, Osadnik T, Banach M, Jóźwiak JJ, Szyguła-Jurkiewicz B. Ceruloplasmin and Lipofuscin Serum Concentrations Are Associated with Presence of Hypertrophic Cardiomyopathy. Biomedicines 2024; 12:1767. [PMID: 39200231 PMCID: PMC11352126 DOI: 10.3390/biomedicines12081767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 07/28/2024] [Accepted: 08/03/2024] [Indexed: 09/02/2024] Open
Abstract
Oxidative stress reflects an imbalance between the systemic manifestation of reactive oxygen species and cells' ability to neutralize them by antioxidant systems. The role of oxidative stress in hypertrophic cardiomyopathy (HCM) is not fully understood. The aim of the study was to examine selected parameters of oxidative stress in patients with HCM compared to the control group. We enrolled 85 consecutive HCM patients and 97 controls without HCM. The groups were matched for sex, the body mass index, and age. Oxidative stress markers included superoxide dismutase (SOD), ceruloplasmin (CER), and lipofuscin (LPS). The median age of the HCM patients was 53 (40-63) years, and 41.2% of them were male. HCM patients, compared to the control ones, had significantly increased levels of CER and LPS. The areas under the receiver operating characteristics curves (AUC) indicated a good discriminatory power of CER (AUC 0.924, sensitivity 84%, and specificity 88%), an acceptable discriminatory power of LPS (AUC 0.740, sensitivity 66%, and specificity 72%), and poor discriminatory power of SOD (AUC 0.556, sensitivity 34%, and specificity 94%) for HCM detection. CER with good predictive strength, as well as LPS with acceptable predictive power, allows for HCM detection. The utility of SOD for HCM detection is limited.
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Affiliation(s)
- Wiktoria Smyła-Gruca
- Student’s Scientific Society, 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (W.S.-G.); (M.J.)
| | | | - Michał Skrzypek
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Ewa Romuk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Andrzej Karmański
- Department of Descriptive and Topographic Anatomy, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Michał Jurkiewicz
- Student’s Scientific Society, 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (W.S.-G.); (M.J.)
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
| | - Tadeusz Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland;
- Cardiology and Lipid Disorders Clinic, Independent Public Health Care Institution “REPTY” Upper Silesian Rehabilitation Centre, 42-600 Tarnowskie Góry, Poland
| | - Maciej Banach
- Polish Mothers Memorial Hospital Research Institute, 90-419 Łódź, Poland;
- Department of Hypertension, Medical University of Lodz, 90-419 Łódź, Poland
- Cardiovascular Research Centre, University of Zielona Gora, 65-046 Zielona Gora, Poland
| | - Jacek J. Jóźwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, 45-040 Opole, Poland;
| | - Bożena Szyguła-Jurkiewicz
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland; (M.G.); (B.S.-J.)
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15
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Schütze J, Stark AW, Bigler MR, Räber L, Gräni C. Misconception of 'malignant' and 'scissor-like compression' of interarterial course in anomalous aortic origin of a coronary artery: a case series. Eur Heart J Case Rep 2024; 8:ytae380. [PMID: 39132298 PMCID: PMC11310694 DOI: 10.1093/ehjcr/ytae380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 07/22/2024] [Indexed: 08/13/2024]
Abstract
Background The notion that the 'interarterial' segment of anomalous aortic origin of a coronary artery (AAOCA) is 'malignant' and 'scissor-like' compressed between the aorta and pulmonary artery (PA) is debated, owing to the lower pressure in the pulmonary system compared with that in the coronary system. However, data supporting or refuting this belief under stress conditions are lacking. Case summary Three cases of right AAOCA with interarterial/intramural courses (52, 66, and 51 years old) were assessed. Invasively measured fractional flow reserve (FFR) under dobutamine was 0.85, 0.82, and 0.81, respectively. Intravascular ultrasound illustrated lateral vessel compression of the intramural course with a decrease of minimal lumen area (MLA) (i.e. 5.71-3.47 mm2, 5.88-4.00 mm2, and 5.85-4.06 mm2) under stress conditions with heart rates of 130, 140, and 150 b.p.m., respectively. Pulmonary artery pressure (PAP) increased from rest {s/d (m) [systolic/diastolic (mean)] 22/11 (15), 15/2 (5), and 24/6 (14) mmHg} to stress [s/d (m) 47/24 (36), 30/3 (11), and 36/22 (24) mmHg] and remained below aortic peak pressure (blood pressure, BP) rest [s/d (m) 116/64 (91), 94/48 (71), 99/53 and (62) mmHg]; BP stress [s/d (m) 142/63 (80), 123/63 (88), and 86/46 (62) mmHg]; coronary pressure (CoP) rest [s/d (m) 100/59 (80), 80/45 (62), and 83/47 (63) mmHg]; and CoP stress [s/d (m) 95/60 (69),101/54 (72), and 70/32 (50) mmHg]. Conclusion This case series challenges the assumption that the interarterial segment of AAOCA is scissor-like compressed by both the aorta and PA. The decrease in MLA and FFR under stress is due to the aorta's unidirectional lateral compression on the intramural segment. Additionally, the term 'malignant' should not be universally applied to all AAOCA cases with an interarterial course, as not all result in haemodynamic significance.
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Affiliation(s)
- Jonathan Schütze
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH - 3010 Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH - 3010 Bern, Switzerland
| | - Marius R Bigler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH - 3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH - 3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse, CH - 3010 Bern, Switzerland
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16
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Gil BM, Chang S, Beck KS, Lee W, Lee HJ, Choo KS, Chung MH, Kim TH, Jung JI. Evaluating the Association between Anomalous Aortic Origin of the Right Coronary Artery from the Left Sinus with Interarterial Course at Coronary CT Angiography and Sudden Cardiac Death. Radiol Cardiothorac Imaging 2024; 6:e230407. [PMID: 39023372 PMCID: PMC11369655 DOI: 10.1148/ryct.230407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 05/17/2024] [Accepted: 06/21/2024] [Indexed: 07/20/2024]
Abstract
Purpose To investigate the association between the anomalous aortic origin of the right coronary artery (R-AAOCA) from the left coronary sinus with interarterial course (IAC) found at coronary CT angiography and sudden cardiac death using a large data set from five university hospitals. Materials and Methods From a total of 89 314 CCTA scans (January 2009 to December 2016) that were retrospectively collected, 316 patients with R-AAOCA from the left sinus with IAC were retrospectively collected. After excluding patients with less than 2 years of follow-up, patients who had already undergone cardiovascular surgery or intervention, and patients with arrhythmia or heart failure before undergoing coronary CT angiography, 224 patients were analyzed. Follow-up was terminated upon the occurrence of major adverse cardiovascular events (MACE). Logistic regression was used to identify clinical and radiologic information as independent predictors of MACE. Results The period prevalence of R-AAOCA from the left sinus with IAC was 0.354%. The mean age was 62.03 years, with a male-to-female ratio of 182:134. During follow-up, 19 of 224 patients (8.5%) experienced MACE, but none had sudden cardiac death. Of these cases, only seven (3.13%) were suspected of being due to R-AAOCA from the left sinus with IAC and all of them had unstable angina. Coronary artery disease was significantly associated with MACE (P < .001), while no significant correlation was observed with radiologic features. Conclusion Sudden cardiac death was not associated with R-AAOCA from the left sinus with IAC found at coronary CT angiography. The occurrence of MACE was low, with coronary artery disease being the sole significant predictor of a patient's prognosis. Keywords: Anomalous Aortic Origin of the Right Coronary Artery, Left Coronary Sinus with Interarterial Course, Coronary CT Angiography, Sudden Cardiac Death Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Bo Mi Gil
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Suyon Chang
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Kyongmin Sarah Beck
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Whal Lee
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Hye-Jeong Lee
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Ki Seok Choo
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Myung Hee Chung
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Tae Hoon Kim
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
| | - Jung Im Jung
- From the Department of Radiology, Bucheon St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
(B.M.G., M.H.C.); Department of Radiology, Seoul St. Mary’s Hospital,
College of Medicine, The Catholic University of Korea, 222 Banpo-daero,
Seocho-gu, Seoul 06591, Republic of Korea (S.C., K.S.B., J.I.J.); Department of
Radiology, Seoul National University Hospital, Seoul National College of
Medicine, Seoul, Republic of Korea (W.L.); Department of Radiology, Research
Institute of Radiological Science, Severance Hospital, Yonsei University College
of Medicine, Seoul, Republic of Korea (H.J.L.); Department of Radiology, Pusan
National University Hospital, Pusan National University School of Medicine,
Busan, Republic of Korea (K.S.C.); and Department of Radiology, Gangnam
Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
(T.H.K.)
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Fernandez-Cisneros A, Feins E, Newburger J, Sekhavat S, Quinn B, Quinonez L. Repeat Repair After Translocation of an Anomalous Left Coronary Artery. Ann Thorac Surg 2024; 118:506-509. [PMID: 38621655 DOI: 10.1016/j.athoracsur.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/17/2024]
Abstract
We repaired a left anomalous aortic origin of coronary artery using coronary ostium translocation/reimplantation. Repeat repair was required due to suboptimal flow pattern in postoperative transesophageal echocardiography, which was confirmed with coronary angiography. We emphasize the importance of early recognition, diagnosis, and intervention to deal with a problem with the coronary repair.
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Affiliation(s)
| | - Eric Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jane Newburger
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sepehr Sekhavat
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Brian Quinn
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Luis Quinonez
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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18
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Shore E, Moseley GA, DeLong R, Register-Mihalik J, Drezner JA, Dickey GJ, Mao H, Cantu RC, Kucera KL. Incidents and patterns of commotio cordis among athletes in the USA from 1982 to 2023. Inj Prev 2024:ip-2024-045374. [PMID: 39084698 DOI: 10.1136/ip-2024-045374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 06/22/2024] [Indexed: 08/02/2024]
Abstract
INTRODUCTION Commotio cordis is a rare event that occurs following blunt, non-penetrating trauma to the chest, precipitating a ventricular arrhythmia. Commotio cordis requires immediate medical attention through cardiopulmonary resuscitation and defibrillation, often resulting in death. Commotio cordis is most common condition among young male athletes. The purpose of this study was to describe the incidents and patterns of commotio cordis among young athletes participating in organised sports in the USA from academic years 1982-1983 through 2022-2023. METHODS This was a retrospective, descriptive epidemiology study using surveillance data from the National Center for Catastrophic Sport Injury Research. The study included all commotio cordis incidents captured in the database. We calculated descriptive statistics (counts and proportions) overall and stratified by outcome and athlete sport. RESULTS Over the study period, 64 incidents of commotio cordis were captured. The majority occurred among males (n=60) and were caused by contact with an object/apparatus (n=39) or contact with another player (n=20). The most common sports were baseball (n=20), lacrosse (n=17) and football (n=13). Over half of these incidents resulted in death (n=34), although survival from commotio cordis increased over the study period. A higher proportion of fatal incidents occurred among football athletes and were caused by contact with another player. CONCLUSIONS Commotio cordis remains most common among young male athletes who participate in organised baseball, lacrosse and football. Although survival has improved over time, greater awareness and emergency preparedness for commotio cordis in an organised sport are needed to facilitate prompt recognition and intervention.
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Affiliation(s)
- Erin Shore
- Department of Epidemiology, The University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Garrett A Moseley
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Randi DeLong
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Johna Register-Mihalik
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Matthew Gfeller Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jonathan A Drezner
- Center for Sports Cardiology, Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Grant James Dickey
- School of Biomedical Engineering, Western University, London, Ontario, Canada
| | - Haojie Mao
- School of Biomedical Engineering, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Faculty of Engineering, Western University, London, Ontario, Canada
| | - Robert C Cantu
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Cantu Concussion Center, Emerson Hospital, Concord, Massachusetts, USA
| | - Kristen L Kucera
- National Center for Catastrophic Sport Injury Research, Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Exercise and Sport Science, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Kapusniak A, Nath L, Hebart M, Franklin S. Heritability of sudden cardiac death in Thoroughbred racehorses. Equine Vet J 2024. [PMID: 38984817 DOI: 10.1111/evj.14130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 06/05/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND Sudden cardiac death (SCD) is an important cause of exercise-associated fatalities in Thoroughbred racehorses. Equine deaths share similarities with fatalities in human athletes that result from inherited cardiac disease. Whilst genetic causes have been postulated in horses, these have not been confirmed and heritability of SCD has not previously been estimated in Thoroughbred racehorses. OBJECTIVES To determine the heritability of SCD in a sample population of Thoroughbred racehorses. STUDY DESIGN Retrospective case-control study. METHODS Steward and post-mortem reports of Thoroughbred racehorses in Australia between 2007 and 2020 were reviewed to identify horses with SCD. Control horses were randomly selected from races in which SCD occurred or from races on the date of the case fatality. A five-generation integrated pedigree chart was collected for each horse. Estimates of heritability were obtained using an animal model in the ASReml-R program with variance components estimated assuming SCD was normally distributed, and on the logit transformed scale. Inbreeding coefficients were calculated and the risk of producing SCD-affected progeny was calculated for stallions that sired ≥5 individuals in the case-control population. RESULTS Ninety-three horses with SCD and 465 control horses were identified. Heritability on the underlying scale was 0.15 ± 0.09 (logit animal) and 0.24 ± 0.12 (normal animal). Inbreeding coefficients were not significantly different between groups. Of the 16 first generation sires that appeared ≥5 times in the case-control data set, two sires more frequently produced affected progeny (OR 7.95-10.41). MAIN LIMITATIONS Challenges in definitively confirming SCD may lead to misclassification of some cases. Some control horses may have not been exposed to environmental influences of SCD. Case numbers are low and the studied population may not represent the entire Thoroughbred genetic pool. CONCLUSION The heritability of SCD in this population was relatively low. However, individual stallions appear more likely to produce affected progeny. Further studies are required to understand the genetic and environmental influences that contribute to disease expression.
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Affiliation(s)
- Amie Kapusniak
- School of Animal & Veterinary Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Laura Nath
- School of Animal & Veterinary Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michelle Hebart
- School of Animal & Veterinary Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Samantha Franklin
- School of Animal & Veterinary Sciences, University of Adelaide, Adelaide, South Australia, Australia
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20
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Moccia E, Dhutia H, Malhotra A, Papatheodorou E, Behr E, Sharma R, Papadakis M, Sharma S, Finocchiaro G. Left ventricular morphology and geometry in élite athletes characterised by extreme anthropometry. Hellenic J Cardiol 2024:S1109-9666(24)00131-3. [PMID: 38972547 DOI: 10.1016/j.hjc.2024.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 06/09/2024] [Accepted: 06/17/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE The aim of the study was to explore the individual impact of BMI and height on LV size and geometry in a cohort of healthy athletes. METHODS From a total cohort of 1857 healthy élite athletes (21 ± 5 years, males 70%) investigated with ECG and echocardiogram, we considered three groups: Group 1 n = 50: BMI ≥ 30 and height < 1.90 m; Group 2 n = 87: height ≥ 1.95 m and BMI < 30; control Group 3 n = 243: height < 1.90 m and BMI = 20-29. RESULTS BSA was ≤2.3 m2 in 52% of athletes in group 1 and 47% of athletes in group 2. Athletes in group 1 and in group 2 showed an enlarged LV end-diastolic diameter (LVEDD) (57 ± 6 vs 57 ± 4 vs 53 ± 4 mm in Group 3); 50% of athletes in group 1 and 38% of athletes in group 2 exhibited a LVEDD > 57 mm (p = 0.23). LV wall thickness was higher in group 1 (11 ± 1 vs 10 ± 2 mm in Group 2, p = 0.001). Concentric hypertrophy or concentric remodelling was found in 20% of athletes in group 1 vs 7% of athletes in group 2 (p = 0.04). Athletes of group 1 with BSA ≤ 2.3 m2 showed lower LVEDD (53 ± 5 vs 60 ± 5 mm, p < 0.001), similar LV wall thickness (10 ± 1 vs 11 ± 1 mm, p = 0.128) and higher prevalence of concentric hypertrophy or concentric remodelling (31% vs 8%, p = 0.04) compared to those with BSA > 2.3 m2. CONCLUSION Athletes with high BMI have similar LV dimensions but greater wall thickness and higher prevalence of concentric remodelling compared to very tall athletes. Athletes with high BMI and large BSA have the widest LV dimensions.
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Affiliation(s)
- Eleonora Moccia
- Cardiology Unit, San Francesco Hospital, Nuoro, Italy; Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK.
| | - Harshil Dhutia
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Aneil Malhotra
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Efstathios Papatheodorou
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Elijah Behr
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Rajan Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Michael Papadakis
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, Cardiology Clinical Academic Group, St George's University of London, London, UK
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21
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Yamaguchi H, Mori T, Hanano H, Oishi K, Ikeue K, Yamamoto Y, Ishii K. Using wet-bulb globe temperature meters to examine the effect of heat on various tennis court surfaces. Sci Rep 2024; 14:15548. [PMID: 38969696 PMCID: PMC11226421 DOI: 10.1038/s41598-024-66518-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/02/2024] [Indexed: 07/07/2024] Open
Abstract
In this study, we evaluated the thermal environments of different tennis courts using wet-bulb globe temperature (WBGT) meters. WBGT meters were installed in an outdoor hard court, sand-filled artificial grass court, and clay court (a softball field), and measurements were taken hourly from 9:00 to 17:00 on weekdays from June 1 to September 21, 2022. The results were compared with data from different courts and the nearest Japan Meteorological Agency station (JMA WBGT) based on the Japan Sports Association's guidelines for exercise to prevent heat stroke. The median WBGT on each court was significantly higher for hard courts at the "Warning" (25 ≤ JMA WBGT < 28) level or above, sand-filled artificial grass courts at the "Severe Warning" (28 ≤ JMA WBGT < 31) level or above, and clay courts at the "Danger" (31 ≤ JMA WBGT) level than the JMA WBGT. Compared with the JMA WBGT, hard and sand-filled artificial grass courts are played on under particularly hot conditions. The results of this study could indicate to tournament organizers and coaches the importance of measuring the WBGT on each court surface from an early stage to prevent heat-related incidents.
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Affiliation(s)
- Hiroki Yamaguchi
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Takaaki Mori
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Hiromi Hanano
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Kan Oishi
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
- Japan Society for the Promotion of Sciences, Chiyoda-ku, Tokyo, Japan
- Department of Physical Activity Research, National Institutes of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka, Japan
| | - Kentaro Ikeue
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
- Department of Endocrinology, Clinical Research Institute, Metabolism, and Hypertension Research, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Yuiko Yamamoto
- Graduate School of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan
| | - Kojiro Ishii
- Faculty of Health and Sports Science, Doshisha University, Kyotanabe, Kyoto, Japan.
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22
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Andreini D, Conte E, Monizzi G, Prestini B, Ratti A, Belmonte M, Melotti E, Doldi M, Marchetti D, Schillaci M, Nicoli F, Mastrangelo A, Paolisso P, Gigante C, Novembre ML, Baggiano A, Mancini ME, Annoni A, Formenti A, Pizzamiglio F, Pontone G, Zeppilli P, Bartorelli AL, Mushtaq S. Predictors of adverse cardiac events of coronary myocardial bridging diagnosed with computed tomography angiography. Int J Cardiol 2024; 406:131997. [PMID: 38556216 DOI: 10.1016/j.ijcard.2024.131997] [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: 01/12/2024] [Revised: 03/06/2024] [Accepted: 03/27/2024] [Indexed: 04/02/2024]
Abstract
AIMS Myocardial bridging (MB) is a frequent congenital anomaly of the epicardial coronary arteries commonly considered a benign condition. However, in some cases a complex interplay between anatomical, clinical and physiology factors may lead to adverse events, including sudden cardiac death. Coronary CT angiography (CCTA) emerged as the gold standard noninvasive imaging technique for the evaluation of MB. Aim of the study was to evaluate MB prevalence and anatomical features in a large population of patients who underwent CCTA for suspected CAD and to identify potential anatomical and clinical predictors of adverse cardiac events at long-term follow-up. METHODS AND RESULTS Two-hundred and six patients (mean age 60.3 ± 11.8 years, 128 male) with MB diagnosed at CCTA were considered. A long MB was defined as ≥25 mm of overlying myocardium, whereas a deep MB as ≥2 mm of overlying myocardium. The study endpoint was the sum of the following adverse events: cardiac death, bridge-related acute coronary syndrome, hospitalization for angina or bridge-related ventricular arrhythmias and MB surgical treatment. Of the 206 patients enrolled in the study, 9 were lost to follow-up, whereas 197 (95.6%) had complete follow-up (mean 7.01 ± 3.0 years) and formed the analytic population. Nineteen bridge-related events occurred in 18 patients (acute coronary syndrome in 7, MB surgical treatment in 2 and hospitalization for bridge-related events in 10). Typical angina at the time of diagnosis and long MB resulted as significant independent predictors of adverse outcome. CONCLUSIONS Typical angina and MB length ≥ 25 mm were independent predictors of cardiac events.
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Affiliation(s)
- Daniele Andreini
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
| | - Edoardo Conte
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Giovanni Monizzi
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Blanca Prestini
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Angelo Ratti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Marta Belmonte
- Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Eleonora Melotti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Marco Doldi
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Davide Marchetti
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Matteo Schillaci
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Flavia Nicoli
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Angelo Mastrangelo
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Pasquale Paolisso
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Carlo Gigante
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | - Maria Laura Novembre
- Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
| | | | | | | | | | | | | | - Paolo Zeppilli
- Sports Medicine Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio L Bartorelli
- Centro Cardiologico Monzino, IRCCS, Milan, Italy; Division of University Cardiology, IRCCS Ospedale Galeazzi-Sant'Ambrogio, Milan, Italy
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23
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Conte E, Marchetti D, Melotti E, Schillaci M, Mushtaq S, Maffi V, Pontone G, Bartorelli A, Andreini D. Clinical and cardiac CT characteristics of congenital coronary abnormalities occasionally detected in a middle-aged population: A long-term follow-up study. J Cardiovasc Comput Tomogr 2024; 18:375-382. [PMID: 38641453 DOI: 10.1016/j.jcct.2024.04.002] [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: 01/02/2024] [Revised: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION Congenital coronary artery anomalies (CCAA) represent one of the most challenging conditions as their clinical presentation may range from sudden cardiac death to a complete subclinical form. The aim of the present study was to evaluate the diagnostic and prognostic role of cardiac CT (CCT) evaluation in patients with CCAA, focusing on anomalies of origin. MATERIAL AND METHODS The present is a retrospective analysis of a prospective clinical registry including a consecutive cohort of patients who underwent clinically indicated CCT from January 2007 to October 2015 for suspected but unknown coronary artery disease (CAD) and were diagnosed for having a congenital coronary abnormality compared to a control group matched for age, sex and segment stenosis score (SSS). Dedicated analysis of all CCT was performed for the present study and only coronary anomalies of origin were considered and included in the study. Two different composite end-points were identified for the present analysis: major cardiovascular events (MACE) and all-cause of death. RESULTS Among the 81 patients with CCAAs enrolled the most frequent anomaly was left main artery absence, which was identified in 41 individuals (50.6%). Forty-five subjects (55.5%) have an anomalous origin of the coronary artery from a different sinus of Valsalva and 45 subjects had also an anomalous course with the retro-aortic being the most common (32%). Eleven participants (13.6%) displayed also an intramural segment, while 10 (10.3%) had a slit-like ostial morphology. At multivariate analysis CT identification of ARCA, anomalous inter-arterial course and abnormal ostial morphology were significantly associated with MACE even when adjusted for age and SSS, without any differences in all-cause mortality between the two groups (6.2% vs 2.4% p = 0.2478). CONCLUSION The result of the present study is that CCT can be successfully used to define the anatomy and features of CAA. It suggested that in middle-aged patients, the identification of high risk characteristics at CT may have a prognostic value in term of cardiovascular events occurrence at follow-up even if the rate of events strictly linked to CCAA is low.
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Affiliation(s)
- Edoardo Conte
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical Science for Health, University of Milan, Milan, Italy.
| | | | | | | | | | - Vanessa Maffi
- Department of Biomedical Science for Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | | | - Daniele Andreini
- Centro Cardiologico Monzino IRCCS, Milan, Italy; Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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24
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Festa P, Lovato L, Bianco F, Alaimo A, Angeli E, Baccano G, Barbi E, Bennati E, Bonhoeffer P, Bucciarelli V, Curione D, Ciliberti P, Clemente A, Di Salvo G, Esposito A, Ferroni F, Gaeta A, Giovagnoni A, Inserra MC, Leonardi B, Marcora S, Marrone C, Peritore G, Pergola V, Pluchinotta F, Puppini G, Stagnaro N, Raimondi F, Sandrini C, Spaziani G, Tchana B, Trocchio G, Ait-Ali L, Secinaro A. Recommendations for cardiovascular magnetic resonance and computed tomography in congenital heart disease: a consensus paper from the CMR/CCT Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology endorsed by the Italian Society of Medical and Interventional Radiology (Part II). J Cardiovasc Med (Hagerstown) 2024; 25:473-487. [PMID: 38829936 DOI: 10.2459/jcm.0000000000001628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Cardiovascular magnetic resonance (CMR) and computed tomography (CCT) are advanced imaging modalities that recently revolutionized the conventional diagnostic approach to congenital heart diseases (CHD), supporting echocardiography and often replacing cardiac catheterization. This is the second of two complementary documents, endorsed by experts from the Working Group of the Italian Society of Pediatric Cardiology and the Italian College of Cardiac Radiology of the Italian Society of Medical and Interventional Radiology, aimed at giving updated indications on the appropriate use of CMR and CCT in different clinical CHD settings, in both pediatrics and adults. In this article, support is also given to radiologists, pediatricians, cardiologists, and cardiac surgeons for indications and appropriateness criteria for CMR and CCT in the most referred CHD, following the proposed new criteria presented and discussed in the first document. This second document also examines the impact of devices and prostheses for CMR and CCT in CHD and additionally presents some indications for CMR and CCT exams when sedation or narcosis is needed.
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Affiliation(s)
- Pierluigi Festa
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Luigi Lovato
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Pediatric and Adult CardioThoracic and Vascular, Oncohematologic and Emergency Radiology Unit, Bologna
| | - Francesco Bianco
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Annalisa Alaimo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- U.O.C. di Cardiologia Pediatrica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Emanuela Angeli
- Pediatric & Grown-up Congenital Cardiac Surgery Unit, Cardiothoracic-Vascular Department, University Hospital S. Orsola-Malpighi, Bologna
| | - Giovanna Baccano
- Department of Pediatric Cardiology - Centro Cardiologico Pediatrico Mediterraneo, Taormina
| | - Egidio Barbi
- Institute for Maternal and Child Health, IRCCS 'Burlo Garofolo'
- Department of Pediatrics, University of Trieste, Trieste
| | - Elena Bennati
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | | | - Valentina Bucciarelli
- Department of Paediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
| | - Davide Curione
- Advanced Cardiovascular Imaging Unit - Department of Imaging, Bambino Gesù Children's Hospital
| | - Paolo Ciliberti
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Alberto Clemente
- UOC Imaging Multimodale Cardiovascolare e Neuroradiologico - Dipartimento Immagini, Fondazione Toscana 'Gabriele Monasterio'/CNR - Pisa
| | - Giovanni Di Salvo
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Department of Women's and Children's Health, University of Padua, Padua
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center IRCCS Ospedale San Raffaele, Milan
| | | | - Alberto Gaeta
- Radiology Unit, Pediatric Hospital Giovanni XXIII, Bari
| | - Andrea Giovagnoni
- Radiology department, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona 'Umberto I, G. M. Lancisi, G. Salesi', Ancona
| | - Maria Cristina Inserra
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Radiologia 2 - Centro Alta Specialità e Trapianti (C.A.S.T.), Azienda Ospedaliero Universitaria Policlinico San Marco. Catania
| | - Benedetta Leonardi
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- Cardiology Unit, Bambino Gesù Children's Hospital, IRCCS, Rome
| | - Simona Marcora
- Congenital Heart Diseases Working Group of the Italian Society of Cardiology, Rome
- USSD Cardiologia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda, Milan
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Massa-Pisa
| | - Giuseppe Peritore
- U.O.C. di Radiodiagnostica, ARNAS Civico-Di Cristina-Benfratelli, Palermo
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Padua
| | - Francesca Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, IRCCS Policlinico San Donato, Milan
| | | | | | - Francesca Raimondi
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, Verona
| | - Gaia Spaziani
- Department of Pediatric Cardiology, IRCCS Meyer Children's Hospital, Florence
| | - Bertrand Tchana
- Department of Pediatrics, Ospedale dei Bambini Barilla, University of Parma, Parma
| | | | - Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, Pisa, Italy
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25
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Ahmad A, Roplekar S, Podlasek A. A Pictorial Essay of Coronary Artery Anomalies on Coronary CT Angiography: A Single-Centre Observational Study. Cureus 2024; 16:e64398. [PMID: 39130895 PMCID: PMC11317033 DOI: 10.7759/cureus.64398] [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] [Accepted: 07/12/2024] [Indexed: 08/13/2024] Open
Abstract
Background Congenital anomalies of the coronary artery anatomy (CAAs) encompass a spectrum of disorders, often asymptomatic but potentially carrying severe clinical implications such as arrhythmia, chest pain, myocardial infarction, or sudden death. The estimated prevalence of CAAs in the general population ranges from 0.3% to 1.3%, with underdiagnosis in asymptomatic individuals. Multidetector computed tomography angiography (CTA) has emerged as a vital non-invasive tool for diagnosing and characterising CAAs, offering improved visualisation and aiding in appropriate management decisions. This study aims to analyse the spectrum of CAAs in a tertiary care setting, focusing on imaging features, prevalence, and potential clinical significance, utilising data from patients who underwent multidetector CTA. Methodology A single-centre, retrospective analysis of consecutive coronary angiograms over a five-year period identified patients with CAAs, with imaging conducted using a 128-slice, single-source CT scanner. Detailed imaging evaluation was performed by experienced radiologists, with anomalies classified according to established criteria. Results Among 756 coronary CTA examinations analysed, 37 instances of anomalous coronary vessels were identified. The study revealed a diverse range of anomalies, including myocardial bridging, anomalous origin of coronary arteries, and extracardiac abnormalities. Conclusions This study contributes valuable insights into the prevalence and imaging features of CAAs, enhancing our understanding of these anomalies and guiding improved patient outcomes in cardiovascular care. Future research should focus on elucidating pathophysiological mechanisms and establishing multicenter registries to address the challenges associated with studying these infrequent but clinically significant anomalies.
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Affiliation(s)
| | | | - Anna Podlasek
- Radiological Sciences, University of Nottingham, Nottingham, GBR
- Radiology and Imaging Technology, University of Dundee, Dundee, GBR
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26
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Edenfield KM, Clugston JR, Martinez MW. Shared decision making for participation in elite athletes with cardiovascular conditions. Where are we now? AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 43:100401. [PMID: 38798912 PMCID: PMC11126763 DOI: 10.1016/j.ahjo.2024.100401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/26/2024] [Accepted: 04/28/2024] [Indexed: 05/29/2024]
Abstract
Sudden Cardiac Death is a leading medical cause of death in athletes of all ages. Recently there has been a shift from an authoritarian approach to that of using a Shared Decision Making (SDM) model in eligibility decisions of athletes with cardiovascular decisions. SDM in elite athletics can be complex and collaboration amongst the athlete, family, physicians, athletic trainers, and institutional stakeholders is critical. SDM acknowledges the complexities of a collaboration between sports cardiologists bringing disease and sport-specific expertise, and team physicians, in complementary fashion to integrate medical knowledge, clinical uncertainty, athlete and family values, and institutional philosophies and risk tolerance.
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Affiliation(s)
- Katherine M. Edenfield
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - James R. Clugston
- Department of Community Health and Family Medicine, University of Florida, Gainesville, FL, USA
| | - Matthew W. Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA
- Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
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27
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Fox N, Fox N, Jacobsen AP, Blumenthal RS, Barouch LA. Vigorous Exercise in Patients with Hypertrophic Cardiomyopathy. Curr Sports Med Rep 2024; 23:270-274. [PMID: 38941549 DOI: 10.1249/jsr.0000000000001182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
ABSTRACT Hypertrophic cardiomyopathy is a genetic heart condition occurring in up to 1 in 200 patients in the United States, many of whom are young and otherwise healthy. This condition puts those affected at increased risk for adverse cardiac outcomes, including sudden cardiac arrest and death, with particular concern for this to occur during exercise and other forms of exertion. Recent studies aimed at evaluating the risk of exercise in hypertrophic cardiomyopathy patients have suggested that moderate and even vigorous exercise may be safe for certain patients. Clinical guidelines are changing to reflect this recent information and to encourage a shared decision-making approach, which can allow more hypertrophic cardiomyopathy patients to participate in health-promoting exercise activities.
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Affiliation(s)
- Nolan Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Nicholas Fox
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Lili A Barouch
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD
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Moliterno E, Rovere G, Giarletta L, Brancasi A, Larici AR, Savino G, Bianco M, Meduri A, Palmieri V, Natale L, Marano R. The role of coronary CT angiography in athletes. LA RADIOLOGIA MEDICA 2024; 129:1008-1024. [PMID: 38971947 DOI: 10.1007/s11547-024-01837-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 06/19/2024] [Indexed: 07/08/2024]
Abstract
The sudden death of a young or high-level athlete or adolescent during recreational sports is one of the events with the greatest impact on public opinion in modern society. Sudden cardiac death (SCD) is the principal medical cause of death in athletes and can be the first and last clinical presentation of underlying disease. To prevent such episodes, pre-participation screening has been introduced in many countries to guarantee cardiovascular safety during sports and has become a common target among medical sports/governing organizations. Different cardiac conditions may cause SCD, with incidence depending on definition, evaluation methods, and studied populations, and a prevalence and etiology changing according to the age of athletes, with CAD most frequent in master athletes, while coronary anomalies and non-ischemic causes prevalent in young. To detect silent underlying causes early would be of considerable clinical value. This review summarizes the pre-participation screening in athletes, the specialist agonistic suitability visit performed in Italy, the anatomical characteristics of malignant coronary anomalies, and finally, the role of coronary CT angiography in such arena. In particular, the anatomical conditions suggesting potential disqualification from sport, the post-treatment follow-up to reintegrate young athletes, the diagnostic workflow to rule-out CAD in master athletes, and their clinical management are analyzed.
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Affiliation(s)
- Eleonora Moliterno
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Rovere
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Lorenzo Giarletta
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Brancasi
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Larici
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Giancarlo Savino
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Agostino Meduri
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi Natale
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy
| | - Riccardo Marano
- Department of Radiological and Haematological Sciences - Section of Radiology, Università Cattolica del Sacro Cuore, Rome, Italy.
- Department of Diagnostic Imaging, Oncological Radiotherapy and Hematology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168, Rome, Italy.
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Aden GW, Blank ZJ, Wehrmann MA, Sorensen MW, Robinson JA. American Academy of Pediatrics Recommended Cardiac Screening Questions in Preparticipation Physical Evaluation Forms. J Pediatr 2024; 274:114168. [PMID: 38944190 DOI: 10.1016/j.jpeds.2024.114168] [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: 04/22/2024] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024]
Abstract
To evaluate the utilization of the American Academy of Pediatrics' (AAP) cardiovascular screening questions within preparticipation physical evaluation forms from the 50 state high school athletic associations. We found that fewer than one-half of state forms incorporated all 10 AAP questions; moreover, a subset failed to adhere to criteria recommended by either the AAP or American Heart Association.
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Affiliation(s)
- Grant W Aden
- School of Medicine, Creighton University, Omaha, NE
| | - Zane J Blank
- Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE
| | - Melissa A Wehrmann
- Division of Cardiology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE; The Criss Heart Center, Children's Nebraska, Omaha, NE
| | - Matthew W Sorensen
- Division of Cardiology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE; The Criss Heart Center, Children's Nebraska, Omaha, NE
| | - Jeffrey A Robinson
- Division of Cardiology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE; The Criss Heart Center, Children's Nebraska, Omaha, NE.
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Wagner MJ, Jeewa A, Pidborochynski T, Lemaire‐Paquette S, Khoury M, Cunningham C, Dhillon S, Laroussi NA, Vaujois L, Dallaire F, Schantz D, Armstrong K, Mawad W, Bradley TJ, Conway J. Exploring Health-Related Quality of Life in Children With Hypertrophic Cardiomyopathy and Relationship to Physical Activity. J Am Heart Assoc 2024; 13:e033968. [PMID: 38879453 PMCID: PMC11255765 DOI: 10.1161/jaha.123.033968] [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: 02/12/2024] [Accepted: 05/15/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Hypertrophic cardiomyopathy is a burdensome condition that inflicts both physical and psychological impairment on those with the disease, negatively impacting health-related quality of life (HRQoL). Given the abundance of evidence suggesting a role of physical activity (PA) in modulating HRQoL in healthy populations of children, we sought to determine the relationship between HRQoL and PA in children diagnosed with hypertrophic cardiomyopathy. METHODS AND RESULTS A multicenter prospective observational cohort study was conducted, with patients with hypertrophic cardiomyopathy aged 10 to 19 years being provided a wrist-worn activity tracker (Fitbit Charge HR) to wear for 14 days. Patients self-reported on Pediatric Quality of Life 4.0 quality of life inventory items, which were associated with PA metrics following covariate adjustment using linear regression. A total of 56 participants were recruited to the study. The median age at enrollment was 15.5 years (interquartile range, 13.8-16.8), and 16 out of 56 (29%) of the cohort were girls. The cohort reported decreased metrics of physical, psychosocial, and total summary scores compared with health reference populations, with scores comparable with that of published populations with chronic disease. Increased physical HRQoL scores were significantly associated with increased daily steps taken, distance traveled, and flights of stairs climbed. CONCLUSIONS These results show that impaired PA correlates with reduced HRQoL in children with hypertrophic cardiomyopathy, suggesting PA may partially mediate HRQoL in this population.
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Affiliation(s)
| | - Aamir Jeewa
- Department of Pediatrics, Division of CardiologyThe Hospital for Sick ChildrenTorontoONCanada
| | | | | | - Michael Khoury
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
| | - Chentel Cunningham
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
| | - Santokh Dhillon
- Department of Pediatrics, Division of CardiologyIWK Health CentreHalifaxNSCanada
| | - Nassiba Alami Laroussi
- Division of Pediatric CardiologySainte‐Justine University Hospital Center, University of MontrealMontrealQCCanada
| | - Laurence Vaujois
- Department of Pediatric CardiologyCentre Hospitalier Universitaire Quebec‐LavalQuebec CityQCCanada
| | - Frederic Dallaire
- Division of Pediatric CardiologyUniversité de SherbrookeSherbrookeQCCanada
| | - Daryl Schantz
- Department of PediatricsVariety Children’s Heart CentreWinnipegMBCanada
| | - Kathryn Armstrong
- Department of PediatricsBritish Columbia Children’s HospitalVancouverBCCanada
| | - Wadi Mawad
- Department of PediatricsMontreal Children’s HospitalMontrealQCCanada
| | - Timothy J. Bradley
- Division of Pediatric CardiologyJim Pattison Children’s HospitalSaskatoonSKCanada
| | - Jennifer Conway
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
- Division of Pediatric CardiologyStollery Children’s HospitalEdmontonABCanada
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2024; 83:2324-2405. [PMID: 38727647 DOI: 10.1016/j.jacc.2024.02.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Sachdeva S, Molossi S, Reaves-O’Neal D, Masand P, Doan TT. Wall motion assessment by feature tracking in pediatric patients with coronary anomalies undergoing dobutamine stress CMR. Front Cardiovasc Med 2024; 11:1380630. [PMID: 38919544 PMCID: PMC11196760 DOI: 10.3389/fcvm.2024.1380630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/27/2024] [Indexed: 06/27/2024] Open
Abstract
Background Left ventricular (LV) wall motion assessment is an important adjunct in addition to perfusion defects in assessing ischemic changes. This study aims to investigate the feasibility and utility of performing feature tracking (FT) in pediatric patients with coronary anomalies undergoing dobutamine stress CMR to assess wall motion abnormalities (WMA) and perfusion defects. Method This is a retrospective study where 10 patients with an inducible first-pass perfusion (FPP) defect and 10 without were selected. Global LV circumferential strain/strain rate (GCS/GCSR) was measured at rest and at peak stress (systole and diastole) using a commercially available feature tracking software. Peak GCS and GCSR were compared to indexed wall motion score (WMSI) between groups with and without FPP defect and in subjects with and without WMA. Results The median age of patients was 13.5 years (Q1, 11 years; Q3, 15 years). Five subjects had qualitatively WMA at peak stress. A moderate correlation of GCS with WMSI at peak stress (0.48, p = 0.026) and a significant difference between GCS at rest and stress in patients with no inducible WMA (p = 0.007) were seen. No significant difference was noted in GCS between rest and stress in patients with WMA (p = 0.13). There was a larger absolute GCS/GCSR at peak stress in subjects with no inducible FPP defect or WMA. Conclusion Smaller absolute GCS and a lack of significant change in GCS at peak stress in those with inducible WMA or perfusion defect are suggestive of compromised LV deformation in subjects with inducible WMA. Given these findings, GCS derived from CMR-FT may be used to objectively assess WMA in pediatric patients undergoing stress CMR.
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Affiliation(s)
- Shagun Sachdeva
- Pediatric Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Silvana Molossi
- Pediatric Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Dana Reaves-O’Neal
- Pediatric Cardiology, Baylor College of Medicine, Houston, TX, United States
| | - Prakash Masand
- Pediatric Radiology, Baylor College of Medicine, Houston, TX, United States
| | - Tam T. Doan
- Pediatric Cardiology, Baylor College of Medicine, Houston, TX, United States
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33
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Ommen SR, Ho CY, Asif IM, Balaji S, Burke MA, Day SM, Dearani JA, Epps KC, Evanovich L, Ferrari VA, Joglar JA, Khan SS, Kim JJ, Kittleson MM, Krittanawong C, Martinez MW, Mital S, Naidu SS, Saberi S, Semsarian C, Times S, Waldman CB. 2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2024; 149:e1239-e1311. [PMID: 38718139 DOI: 10.1161/cir.0000000000001250] [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] [Indexed: 06/05/2024]
Abstract
AIM The "2024 AHA/ACC/AMSSM/HRS/PACES/SCMR Guideline for the Management of Hypertrophic Cardiomyopathy" provides recommendations to guide clinicians in the management of patients with hypertrophic cardiomyopathy. METHODS A comprehensive literature search was conducted from September 14, 2022, to November 22, 2022, encompassing studies, reviews, and other evidence on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through May 23, 2023, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Hypertrophic cardiomyopathy remains a common genetic heart disease reported in populations globally. Recommendations from the "2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy" have been updated with new evidence to guide clinicians.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Victor A Ferrari
- AHA/ACC Joint Committee on Clinical Practice Guidelines liaison
- SCMR representative
| | | | - Sadiya S Khan
- ACC/AHA Joint Committee on Performance Measures representative
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34
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Edwards JJ, Compton C, Chatrath N, Petek BJ, Baggish A, Börjesson M, Chung E, Corrado D, Drezner JA, Gati S, Gray B, Kim J, La Gerche A, Malhotra A, Marijon E, Papadakis M, Pelliccia A, Phelan D, Semsarian C, Sharma S, Sharma R, O'Driscoll JM, Harmon KG. International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death Tool. J Am Heart Assoc 2024; 13:e033723. [PMID: 38780180 PMCID: PMC11255648 DOI: 10.1161/jaha.123.033723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Studies reporting on the incidence of sudden cardiac arrest and/or death (SCA/D) in athletes commonly lack methodological and reporting rigor, which has implications for screening and preventative policy in sport. To date, there are no tools designed for assessing study quality in studies investigating the incidence of SCA/D in athletes. METHODS AND RESULTS The International Criteria for Reporting Study Quality for Sudden Cardiac Arrest/Death tool (IQ-SCA/D) was developed following a Delphi process. Sixteen international experts in sports cardiology were identified and invited. Experts voted on each domain with subsequent moderated discussion for successive rounds until consensus was reached for a final tool. Interobserver agreement between a novice, intermediate, and expert observer was then assessed from the scoring of 22 relevant studies using weighted and unweighted κ analyses. The final IQ-SCA/D tool comprises 8 domains with a summated score of a possible 22. Studies are categorized as low, intermediate, and high quality with summated IQ-SCA/D scores of ≤11, 12 to 16, and ≥17, respectively. Interrater agreement was "substantial" between all 3 observers for summated IQ-SCA/D scores and study categorization. CONCLUSIONS The IQ-SCA/D is an expert consensus tool for assessing the study quality of research reporting the incidence of SCA/D in athletes. This tool may be used to assist researchers, reviewers, journal editors, and readers in contextualizing the methodological quality of different studies with varying athlete SCA/D incidence estimates. Importantly, the IQ-SCA/D also provides an expert-informed framework to support and guide appropriate design and reporting practices in future SCA/D incidence trials.
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Affiliation(s)
- Jamie J. Edwards
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
| | - Claire Compton
- Department of CardiologySouth Tees Hospitals National Health Service Foundation Trust, The James Cook University HospitalMiddlesbroughUK
| | - Nikhil Chatrath
- Cardiology Clinical Academic Group, St George’sUniversity of LondonLondonUK
| | | | - Aaron Baggish
- Cardiovascular Performance ProgramMassachusetts General HospitalBostonMA
| | - Mats Börjesson
- Center for Lifestyle Intervention, Medicine, Geriatrics and Emergency DepartmentSahlgrenska University HospitalGöteborgSweden
- Department of Molecular and Clinical MedicineInstitute of Medicine, Sahlgrenska Academy, University of GothenburgGöteborgSweden
| | - Eugene Chung
- University of Michigan, West Michigan Program, Cardiac Electrophysiology Service, Sports Cardiology Clinic, Michigan MedicineAnn ArborMI
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public HealthUniversity of PadovaPadovaItaly
| | - Jonathan A. Drezner
- Department of Family Medicine, Center for Sports CardiologyUniversity of WashingtonSeattleWA
| | - Sabiha Gati
- National Heart and Lung Institute, Imperial College LondonLondonUK
- Department of CardiologyRoyal Brompton Hospital LondonLondonUK
| | - Belinda Gray
- Agnes Ginges Centre for Molecular CardiologyCentenary InstituteNew South WalesAustralia
- Faculty of Health and Medical SciencesUniversity of SydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalNew South WalesAustralia
| | - Jonathan Kim
- Emory School of MedicineEmory Clinical Cardiovascular Research InstituteAtlantaGA
| | - Andre La Gerche
- Clinical Research DomainBaker Heart and Diabetes Institute, Alfred CentreMelbourneVictoriaAustralia
- National Centre for Sports CardiologyFitzroyVictoriaAustralia
- Cardiology DepartmentSt Vincent’s Hospital MelbourneFitzroyVictoriaAustralia
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, St George’sUniversity of LondonLondonUK
- Institute of SportManchester Metropolitan University and Manchester University NHS Foundation TrustManchesterUK
| | - Eloi Marijon
- Paris Cardiovascular Research CenterINSERM U970, Hôpital Européen Georges PompidouParisFrance
| | - Michael Papadakis
- Cardiology Clinical Academic Group, St George’sUniversity of LondonLondonUK
| | | | - Dermot Phelan
- Sports Cardiology Center, Sanger Heart and Vascular Institute, Atrium HealthCharlotteNC
| | - Chris Semsarian
- Agnes Ginges Centre for Molecular CardiologyCentenary InstituteNew South WalesAustralia
- Faculty of Health and Medical SciencesUniversity of SydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalNew South WalesAustralia
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St George’sUniversity of LondonLondonUK
| | - Rajan Sharma
- Department of CardiologySt George’s University Hospitals NHS Foundation TrustTooting, LondonUK
| | - Jamie M. O'Driscoll
- School of Psychology and Life SciencesCanterbury Christ Church UniversityKentUK
- Department of CardiologySt George’s University Hospitals NHS Foundation TrustTooting, LondonUK
| | - Kimberly G. Harmon
- Department of Family Medicine, Center for Sports CardiologyUniversity of WashingtonSeattleWA
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Zafeiri M, Knott K, Lampejo T. Acute myocarditis: an overview of pathogenesis, diagnosis and management. Panminerva Med 2024; 66:174-187. [PMID: 38536007 DOI: 10.23736/s0031-0808.24.05042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Acute myocarditis encompasses a diverse presentation of inflammatory cardiomyopathies with infectious and non-infectious triggers. The clinical presentation is heterogeneous, from subtle symptoms like mild chest pain to life-threatening fulminant heart failure requiring urgent advanced hemodynamic support. This review provides a comprehensive overview of the current state of knowledge regarding the pathogenesis, diagnostic approach, management strategies, and directions for future research in acute myocarditis. The pathogenesis of myocarditis involves interplay between the inciting factors and the subsequent host immune response. Infectious causes, especially cardiotropic viruses, are the most frequently identified precipitants. However, autoimmune processes independent of microbial triggers, as well as toxic myocardial injury from drugs, chemicals or metabolic derangements also contribute to the development of myocarditis through diverse mechanisms. Furthermore, medications like immune checkpoint inhibitor therapies are increasingly recognized as causes of myocarditis. Elucidating the nuances of viral, autoimmune, hypersensitivity, and toxic subtypes of myocarditis is key to guiding appropriate therapy. The heterogeneous clinical presentation coupled with non-specific symptoms creates diagnostic challenges. A multifaceted approach is required, incorporating clinical evaluation, electrocardiography, biomarkers, imaging studies, and endomyocardial biopsy. Cardiovascular magnetic resonance imaging has become pivotal for non-invasive assessment of myocardial inflammation and fibrosis. However, biopsy remains the gold standard for histological classification and definitively establishing the underlying etiology. Management relies on supportive care, while disease-specific therapies are limited. Although some patients recover well with conservative measures, severe or fulminant myocarditis necessitates aggressive interventions such as mechanical circulatory support devices and transplantation. While immunosuppression is beneficial in certain histological subtypes, clear evidence supporting antiviral or immunomodulatory therapies for the majority of acute viral myocarditis cases remains insufficient. Substantial knowledge gaps persist regarding validated diagnostic biomarkers, optimal imaging surveillance strategies, evidence-based medical therapies, and risk stratification schema. A deeper understanding of the immunopathological mechanisms, rigorous clinical trials of targeted therapies, and longitudinal outcome studies are imperative to advance management and improve the prognosis across the myocarditis spectrum.
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Affiliation(s)
- Marina Zafeiri
- King's College Hospital NHS Foundation Trust, London, UK
- University Hospitals Dorset NHS Foundation Trust, London, UK
| | | | - Temi Lampejo
- King's College Hospital NHS Foundation Trust, London, UK -
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Mendez-Marti SR, Zik C, Alan S, Wang H, Ershler WB. Sickle Cell Screening in Adults: A Current Review of Point-of-Care Testing. J Hematol 2024; 13:53-60. [PMID: 38993742 PMCID: PMC11236353 DOI: 10.14740/jh1272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/10/2024] [Indexed: 07/13/2024] Open
Abstract
In adults, the sickle cell solubility test (SCST) is the most common screening test to determine the presence of hemoglobin S (HbS) within a blood sample. The assay is inexpensive, rapid, highly sensitive and specific. However, the SCST cannot accurately quantify the level of HbS in a test sample and requires confirmatory testing to distinguish between sickle trait and sickle cell disease. Despite these limitations, it remains the standard screening tool for HbS in a variety of settings such as screening in the US military or by the National Collegiate Athletic Association. With an increased awareness of the importance of screening for sickle cell in adults, we herein describe the current sensitivity, specificity, positive predictive value, and negative predictive value of this test. We also review overall clinical utility of this laboratory measure and briefly discuss new point-of-care techniques designed to overcome the SCST's shortcomings.
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Affiliation(s)
- Sebastian R. Mendez-Marti
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Chad Zik
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Sheinei Alan
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Hongkun Wang
- Biostatics, Bioinformatics and Biomathematics Department, Georgetown University, Washington, DC, USA
| | - William B. Ershler
- Adult Sickle Cell Center, Inova Schar Cancer Institute, Inova Fairfax Medical Campus, Fairfax, VA, USA
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Stephens EH, Jegatheeswaran A, Brothers JA, Ghobrial J, Karamlou T, Francois CJ, Krishnamurthy R, Dearani JA, Binsalamah Z, Molossi S, Mery CM. Anomalous Aortic Origin of a Coronary Artery. Ann Thorac Surg 2024; 117:1074-1086. [PMID: 38302054 DOI: 10.1016/j.athoracsur.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/09/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Although anomalous aortic origin of a coronary artery (AAOCA) is associated with risk of sudden cardiac arrest (SCA), there is a spectrum of disease, with the appropriate management for many remaining unclear. Increasing data warrant review for an updated perspective on management. METHODS A panel of congenital cardiac surgeons, cardiologists, and imaging practitioners reviewed the current literature related to AAOCA and its management. Survey of relevant publications from 2010 to the present in PubMed was performed. RESULTS The prevalence of AAOCA is 0.4% to 0.8%. Anomalous left coronary artery is 3 to 8 times less common than anomalous right coronary, but carries a much higher risk of SCA. Nevertheless, anomalous right coronary is not completely benign; 10% demonstrate ischemia, and it remains an important cause of SCA. Decision-making regarding which patients should be recommended for surgical intervention includes determining anatomic features associated with ischemia, evidence of ischemia on provocative testing, and concerning cardiovascular symptoms. Ischemia testing continues to prove challenging with low sensitivity and specificity, but the utility of new modalities is an active area of research. Surgical interventions focus on creating an unobstructed path for blood flow and choosing the appropriate surgical technique given the anatomy to accomplish this. Nontrivial morbidity has been reported with surgery, including new-onset ischemia. CONCLUSIONS A proportion of patients with AAOCA demonstrate features and ischemia that warrant surgical intervention. Continued work remains to improve the ability to detect inducible ischemia, to risk stratify these patients, and to provide guidance in terms of which patients warrant surgical intervention.
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Affiliation(s)
| | - Anusha Jegatheeswaran
- Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, United Kingdom; Department of Children's Cardiovascular Disease, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Julie A Brothers
- Division of Cardiology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Tara Karamlou
- Division of Pediatric and Congenital Cardiac Surgery, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Rajesh Krishnamurthy
- Division of Cardiovascular Imaging, Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Ziyad Binsalamah
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Silvana Molossi
- Division of Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, Dell Medical School at The University of Texas at Austin, Dell Children's Medical Center, Austin, Texas
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Lander BS, Hoit BD. Is It Finally Time to Untangle Elite Athletes From the Controversial Web of Left Ventricular Trabeculations? J Am Soc Echocardiogr 2024; 37:587-590. [PMID: 38548117 DOI: 10.1016/j.echo.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/23/2024]
Affiliation(s)
- Bradley S Lander
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, Case Western Reserve University, Cleveland, Ohio.
| | - Brian D Hoit
- Harrington Heart and Vascular Institute, Case Western Reserve University, Cleveland, Ohio; University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Medicine, Case Western Reserve University, Cleveland, Ohio
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Gaddameedi SR, Thapa M, Arty F, Atreya S, Ravilla J, Panchal P, Du D. Case Report and Literature Review of an Anomalous Course of the Left Main Coronary Artery (LMCA) Arising From the Right Sinus of Valsalva (RSV) Presenting as Takotsubo Cardiomyopathy. Cureus 2024; 16:e63028. [PMID: 38919862 PMCID: PMC11197674 DOI: 10.7759/cureus.63028] [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] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Takotsubo cardiomyopathy (TC) mimics myocardial infarction with symptoms like chest pain, electrocardiogram (EKG) changes, and elevated troponin levels, although it typically features normal coronary arteries upon angiography. While often asymptomatic, coronary artery anomalies (CAAs) can cause intermittent vasospasm and endothelial dysfunction, potentially inducing TC. We report the case of a 74-year-old female with a history of hypertension, hyperlipidemia, and peripheral artery disease, who presented with sudden onset chest pain. Initial EKG and elevated troponin suggested myocardial infarction. However, coronary angiography revealed an anomalous left main coronary artery (LMCA) originating from the right coronary artery (RCA), with no significant stenosis. Subsequent transthoracic echocardiography indicated TC, with the left ventricular ejection fraction improving from 35-40% to 60-65% within days. Cardiac computed tomography angiography (CCTA) revealed that the anomalous LMCA originated from the common trunk at the right sinus of Valsalva (RSV), which further continued as a large, dominant RCA. The LMCA branched into a small to moderate left anterior descending artery (LAD) and a non-dominant left circumflex artery (LCx). The LMCA followed a prepulmonic/anterior course, while the LCx took an interarterial course between the aorta and pulmonary artery. The patient was referred for further surgical evaluation. We conclude that the CAA was an incidental finding and was not related to underlying TC. Although rare, this case suggests a possible correlation between CAAs and a predisposition to stress-induced cardiomyopathy, warranting further investigation.
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Affiliation(s)
| | - Milan Thapa
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Fnu Arty
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Suryansh Atreya
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Jayasree Ravilla
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Pratik Panchal
- Cardiology, Rutgers Health/Monmouth Medical Center, Long Branch, USA
| | - Doantrang Du
- Internal Medicine, Rutgers Health/Monmouth Medical Center, Long Branch, USA
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Landi I, Alkhabaz A, Abou Shaar B, Galzerano D, Albert-Brotons D, Tahir M, Eltayeb A, Alenazy A, Arshi F, Limongelli G, Bossone E, Vriz O. Non-atherosclerotic coronary artery disease: an overview of a heterogeneous disease. Coron Artery Dis 2024; 35:333-347. [PMID: 38206797 DOI: 10.1097/mca.0000000000001317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
- Irene Landi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Anas Alkhabaz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Bader Abou Shaar
- Heart Centre, King Faisal Specialist Hospital & Research Centre
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | | | - Mohammed Tahir
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Abdulla Eltayeb
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Ali Alenazy
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Fatima Arshi
- Heart Centre, King Faisal Specialist Hospital & Research Centre
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Disease Unit, Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', AORN dei Colli, Monaldi Hospital
| | - Eduardo Bossone
- Department of Cardiology, Azienda Ospedaliera di Rilevanza Nazionale 'A. Cardarelli' Hospital, Naples, Italy
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital & Research Centre
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Akita K, Hasegawa K, Fifer MA, Tower-Rader A, Jung J, Maurer MS, Reilly MP, Shimada YJ. Prediction of cardiac death in patients with hypertrophic cardiomyopathy using plasma adipokine levels. Nutr Metab Cardiovasc Dis 2024; 34:1352-1360. [PMID: 38403486 PMCID: PMC11116053 DOI: 10.1016/j.numecd.2024.01.017] [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: 05/30/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUNDS AND AIMS Hypertrophic cardiomyopathy (HCM) causes cardiac death through both sudden cardiac death (SCD) and death due to heart failure (HF). Although adipokines lead to adverse cardiac remodeling in HCM, the prognostic value of plasma adipokines in HCM remains unknown. We aimed to predict cardiac death in patients with HCM using plasma adipokines. METHODS AND RESULTS We performed a multicenter prospective cohort study of patients with HCM. The outcome was cardiac death including heart transplant, death due to HF, and SCD. With data from 1 institution (training set), a prediction model was developed using random forest classification algorithm based on 10 plasma adipokines. The performance of the prediction model adjusted for 8 clinical parameters was examined in samples from another institution (test set). Time-to-event analysis was performed in the test set to compare the rate of outcome events between the low-risk and high-risk groups determined by the prediction model. In total, 389 (267 in the training set; 122 in the test set) patients with HCM were included. During the median follow-up of 2.7 years, 21 patients experienced the outcome event. The area under the covariates-adjusted receiver-operating characteristics curve was 0.89 (95 % confidence interval [CI] 0.71-0.99) in the test set. revealed the high-risk group had a significantly higher risk of cardiac death (hazard ratio 17.8, 95 % CI 2.1-148.3, P = 0.008). CONCLUSION The present multicenter prospective study demonstrated that a panel of plasma adipokines predicts cardiac death in patients with HCM.
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Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael A Fifer
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Albree Tower-Rader
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jeeyoun Jung
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Mathew S Maurer
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Muredach P Reilly
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA.
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42
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Barry M, Sylla IS, Balde MD, Bangoura M, Camara I. [Place of the electrocardiogram in the visit of non-contra-indication to the practice of competitive sports between the ages of 12 and 35 : Survey of physicians who are members of the Guinean Association of Sports Physicians]. Ann Cardiol Angeiol (Paris) 2024; 73:101762. [PMID: 38733860 DOI: 10.1016/j.ancard.2024.101762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/13/2024] [Accepted: 03/29/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION An electrocardiogram (ECG), combined with a well-conducted clinical examination, is more effective than the clinical examination alone in detecting underlying cardiac pathologies in athletes. The aim of this study was to evaluate the use of ECGs by physicians who are members of the Guinean Association of Sports Physicians, during the non-contraindication visit for competitive sports between the ages of 12 and 35. METHODOLOGY We conducted a web-survey from July 15 to August 15, 2023. A survey form was created on "Google Docs" and pre-tested. It was then broadcast on all the communication networks used by these doctors. The data were secured using "Google Drive" software. Analyses were performed using SPSS version 20 software. RESULTS Of the 51 included, 74.51% said they had received at least one training session on ECG interpretation for athletes. All of them either requested or performed an ECG at least once in a while, as part of the check-up for non-contraindication to competitive sport. The ECG was systematic, according to 72.55% of doctors. Three quarters referred to a sports cardiologist in the event of an abnormal ECG, 66.67% to a cardiology resident and 58.82% to a cardiologist. In the absence of an ECG, the presence of functional signs on exertion, the notion of a family history of cardiovascular disease and the presence of at least two cardiovascular risk factors were the main reasons for seeking an opinion. CONCLUSION A resting ECG is carried out almost systematically by doctors who are members of the Guinean Association of Sports Doctors, as part of the check-up for non-contraindication to practising sport.
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Affiliation(s)
- Mamadou Barry
- Service de cardiologie hôpital National Ignace DEEN, Conakry, Guinée.
| | | | | | - Mohamed Bangoura
- Service de cardiologie hôpital National Ignace DEEN, Conakry, Guinée
| | - Ibrahima Camara
- Service de médecine général B Rhumatologie hôpital National Ignace DEEN, Conakry, Guinée
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43
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Ito Y, Sakaguchi H, Tsuda E, Kurosaki K. Effect of beta-blockers and exercise restriction on the prevention of sudden cardiac death in pediatric hypertrophic cardiomyopathy. J Cardiol 2024; 83:407-414. [PMID: 38043708 DOI: 10.1016/j.jjcc.2023.11.009] [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: 09/19/2023] [Revised: 11/11/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Risk assessment tools and effective prevention strategies for sudden cardiac death (SCD) in pediatric patients with hypertrophic cardiomyopathy (HCM) have not been established. This study aimed to evaluate the efficacy of beta-blockers and exercise restriction for SCD prevention in this population. METHODS We retrospectively reviewed the medical records of patients aged <18 years who were diagnosed with HCM at our center between January 1996 and December 2021. SCD and aborted SCD were defined as SCD equivalents. We divided patients based on whether they were prescribed beta-blockers or exercise restriction and compared the outcomes among the groups. The primary outcome was the overall survival (OS), and the secondary outcome was the cumulative SCD equivalent rate. Outcomes were analyzed using Kaplan-Meier curves and Cox proportional hazard analysis. We also compared patients according to the occurrence of SCD equivalents to identify SCD risk predictors. RESULTS Among the 43 included patients [mean age, 7.7 (1.6-12.1) years; 23 male individuals], SCD equivalents occurred in 13 patients over 11.2 (4.5-15.6) years of follow-up, among whom 12 were resuscitated and 1 died. The OS rate was significantly higher in the beta-blocker and exercise restriction groups than in the non-beta-blocker and non-exercise restriction groups (81.3 % vs. 19.1 %, p < 0.01 and 57.4 % vs. 12.7 %, p < 0.01, respectively). Among the 13 patients with SCD equivalents, 5 had 9 recurrent SCD equivalents. A significant difference was observed between the SCD equivalent and non-SCD equivalent groups in the history of suspected arrhythmogenic syncope (p < 0.01) in the univariable but not in the multivariable analysis. CONCLUSIONS Beta-blockers and exercise restriction may decrease the risk of SCD in pediatric patients with HCM and should be considered for SCD prevention in this population, particularly because predicting SCD in these patients remains challenging.
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Affiliation(s)
- Yuki Ito
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenichi Kurosaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
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Weizman O, Marijon E. [Physical activity to reduce cardiovascular risk -Why deprive yourself ?]. Ann Cardiol Angeiol (Paris) 2024; 73:101764. [PMID: 38723317 DOI: 10.1016/j.ancard.2024.101764] [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: 03/22/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 06/05/2024]
Abstract
Sports-related sudden death is an uncommon event, affecting mainly middle-aged men who practice leisure sports, and is related to unknown coronary artery disease. In athletes, cardiac causes are also predominant, with a greater proportion of structural and electrical heart disease. If first-aid resuscitation measures are initiated, survival easily exceeds 50%, and this is an excellent educational illustration of how to improve the prognosis of non-sport-related cardiac arrest. Prevention of a sport-related cardiovascular event remains difficult, and relies on clinical examination, questioning (including family history) and resting ECG in participants >35 years old. The non-contraindication visit is also an opportunity to pass on to the patient the rules of good sports "hygiene" and life-saving gestures in the event of sudden death during sport in one of the partners (and the importance of regularly educating oneself in life-saving gestures...).
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Affiliation(s)
| | - Eloi Marijon
- European Georges Pompidou Hospital, Paris, France.
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45
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Callon D, Joanne P, Andreoletti L, Agbulut O, Chevalier P, Fornès P. Viral myocarditis in combination with genetic cardiomyopathy as a cause of sudden death. An autopsy series. BMC Cardiovasc Disord 2024; 24:282. [PMID: 38811883 PMCID: PMC11134698 DOI: 10.1186/s12872-024-03913-z] [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: 01/17/2024] [Accepted: 05/02/2024] [Indexed: 05/31/2024] Open
Abstract
Sudden cardiac death (SCD) is a major public health issue worldwide. In the young (< 40 years of age), genetic cardiomyopathies and viral myocarditis, sometimes in combination, are the most frequent, but underestimated, causes of SCD. Molecular autopsy is essential for prevention. Several studies have shown an association between genetic cardiomyopathies and viral myocarditis, which is probably underestimated due to insufficient post-mortem investigations. We report on four autopsy cases illustrating the pathogenesis of these combined pathologies. In two cases, a genetic hypertrophic cardiomyopathy was diagnosed in combination with Herpes Virus Type 6 (HHV6) and/or Parvovirus-B19 (PVB19) in the heart. In the third case, autopsy revealed a dilated cardiomyopathy and virological analyses revealed acute myocarditis caused by three viruses: PVB19, HHV6 and Epstein-Barr virus. Genetic analyses revealed a mutation in the gene coding for desmin. The fourth case illustrated a channelopathy and a PVB19/HHV6 coinfection. Our four cases illustrate the highly probable deleterious role of cardiotropic viruses in the occurrence of SCD in subjects with genetic cardiomyopathies. We discuss the pathogenetic link between viral myocarditis and genetic cardiomyopathy. Molecular autopsy is essential in prevention of these SCD, and a close collaboration between cardiologists, pathologists, microbiologists and geneticians is mandatory.
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MESH Headings
- Adult
- Female
- Humans
- Male
- Middle Aged
- Young Adult
- Autopsy
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/virology
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/pathology
- Cause of Death
- Coinfection
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/pathology
- Death, Sudden, Cardiac/prevention & control
- Epstein-Barr Virus Infections/complications
- Fatal Outcome
- Genetic Predisposition to Disease
- Herpesvirus 4, Human/genetics
- Herpesvirus 6, Human/genetics
- Herpesvirus 6, Human/isolation & purification
- Mutation
- Myocarditis/virology
- Myocarditis/pathology
- Myocarditis/genetics
- Parvoviridae Infections/complications
- Parvovirus B19, Human/genetics
- Roseolovirus Infections/complications
- Roseolovirus Infections/virology
- Roseolovirus Infections/diagnosis
- Roseolovirus Infections/pathology
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Affiliation(s)
- Domitille Callon
- University of Reims Champagne Ardennes, INSERM, UMR-S1320 Cardiovir, Reims, France.
- Biology Institute of Paris-Seine (IBPS), Biological Adaptation and Ageing, Sorbonne University, UMR CNRS 8256, INSERM U1164, Paris, France.
- Forensic and Pathology Departments, Academic Hospital of Reims, Reims, France.
| | - Pierre Joanne
- Biology Institute of Paris-Seine (IBPS), Biological Adaptation and Ageing, Sorbonne University, UMR CNRS 8256, INSERM U1164, Paris, France
| | - Laurent Andreoletti
- University of Reims Champagne Ardennes, INSERM, UMR-S1320 Cardiovir, Reims, France
- Virology Department, Academic Hospital of Reims, Reims, France
| | - Onnik Agbulut
- Biology Institute of Paris-Seine (IBPS), Biological Adaptation and Ageing, Sorbonne University, UMR CNRS 8256, INSERM U1164, Paris, France
| | | | - Paul Fornès
- University of Reims Champagne Ardennes, INSERM, UMR-S1320 Cardiovir, Reims, France
- Forensic and Pathology Departments, Academic Hospital of Reims, Reims, France
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Rafiee P, Rasaei N, Amini MR, Rabiee R, Kalantar Z, Sheikhhossein F, Gholizadeh M, Hekmatdoost A. The effects of ursolic acid on cardiometabolic risk factors: a systematic review and meta-analysis. Future Cardiol 2024; 20:151-161. [PMID: 38923885 PMCID: PMC11216268 DOI: 10.1080/14796678.2024.2349476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 04/26/2024] [Indexed: 06/28/2024] Open
Abstract
Aim: Ursolic acid (UA) has an important biological role in the fight against fat accumulation, insulin resistance, obesity and inflammation. Therefore, in the current review and meta-analysis work, we investigate the effects of UA (dosage range is 50.94 to 450 mg/day) on cardiometabolic risk factors. Materials & methods: After searching the studies up to February 2023, six articles were included in the study. Results: The pooled effect size showed that UA supplementation didn't significantly change body weight, body mass index, waist circumference, body fat percentage, lean body mass, systolic blood pressure, diastolic blood pressure, fasting blood glucose, insulin, triglyceride and high-density lipoprotein compared with control groups. Conclusion: UA supplementation had no significant effect on the cardiometabolic risk factors in adults.
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Affiliation(s)
- Pegah Rafiee
- Student Research Committee, Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences & Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, 1981619573, Iran
| | - Niloufar Rasaei
- Department of Community Nutrition, School of Nutritional Sciences & Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, 14155-6117, Iran
- Network of Interdisciplinarity in Neonates & Infants (NINI), Universal Scientific Education & Research Network (USERN), Tehran, 14155-6117, Iran
| | - Mohammad Reza Amini
- Student Research Committee, Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences & Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, 1981619573, Iran
- Nutrition & Food Security Research Center & Department of Community Nutrition, School of Nutrition & Food Science, Isfahan University of Medical Sciences, Isfahan, 1981619573, Iran
| | - Reyhaneh Rabiee
- Student Research Committee, Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, 8915173160, Iran
| | - Zahra Kalantar
- Department of Clinical Nutrition, School of Nutritional Sciences & Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Fatemeh Sheikhhossein
- Department of Clinical Nutrition, School of Nutritional Sciences & Dietetics, Tehran University of Medical Sciences, Tehran, 14155-6117, Iran
| | - Mohammad Gholizadeh
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences & Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 1981619573, Tehran,Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition & Dietetics, Faculty of Nutrition Sciences & Food Technology, National Nutrition & Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, 1981619573, Tehran,Iran
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47
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Yao Z, Liang M, Zhu S. Infectious factors in myocarditis: a comprehensive review of common and rare pathogens. Egypt Heart J 2024; 76:64. [PMID: 38789885 PMCID: PMC11126555 DOI: 10.1186/s43044-024-00493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Myocarditis is a significant health threat today, with infectious agents being the most common cause. Accurate diagnosis of the etiology of infectious myocarditis is crucial for effective treatment. MAIN BODY Infectious myocarditis can be caused by viruses, prokaryotes, parasites, and fungi. Viral infections are typically the primary cause. However, some rare opportunistic pathogens can also damage heart muscle cells in patients with immunodeficiencies, neoplasms and those who have undergone heart surgery. CONCLUSIONS This article reviews research on common and rare pathogens of infectious myocarditis, emphasizing the complexity of its etiology, with the aim of helping clinicians make an accurate diagnosis of infectious myocarditis.
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Affiliation(s)
- Zongjie Yao
- School of Health and Life Sciences, University of Health and Rehabilitation Sciences, Qindao, China.
| | - Mingjun Liang
- Department of Intensive Care Medicine, Shanghai Six People's Hospital Affilicated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Zhu
- Wuhan Third Hospital-Tongren Hospital of Wuhan University, Wuhan, China
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48
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Gräni C, Stark AW, Lo Rito M, Frigiola A, Siepe M, Tchana B, Cipriani A, Zorzi A, Pergola V, Crea D, Sarris G, Protopapas E, Sirico D, Di Salvo G, Pegoraro C, Sarto P, Francois K, Frigiola A, Cristofaletti A, Accord RE, Gonzalez Rocafort A, Debeco G, Padalino M. First report from the European registry for anomalous aortic origin of coronary artery (EURO-AAOCA). INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae074. [PMID: 38648747 PMCID: PMC11101283 DOI: 10.1093/icvts/ivae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/21/2024] [Accepted: 04/18/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES Anomalous aortic origin of a coronary artery (AAOCA) is a group of rare congenital heart defects with various clinical presentations. The lifetime-risk of an individual living with AAOCA is unknown, and data from multicentre registries are urgently needed to adapt current recommendations and guide optimal patient management. The European AAOCA Registry (EURO-AAOCA) aims to assess differences with regard to AAOCA management between centres. METHODS EURO-AAOCA is a prospective, multicentre registry including 13 European centres. Herein, we evaluated differences in clinical presentations and management, treatment decisions and surgical outcomes across centres from January 2019 to June 2023. RESULTS A total of 262 AAOCA patients were included, with a median age of 33 years (12-53) with a bimodal distribution. One hundred thirty-nine (53.1%) were symptomatic, whereas chest pain (n = 74, 53.2%) was the most common complaint, followed by syncope (n = 21, 15.1%). Seven (5%) patients presented with a myocardial infarction, 2 (1.4%) with aborted sudden cardiac death. Right-AAOCA was most frequent (150, 57.5%), followed by left-AAOCA in 51 (19.5%), and circumflex AAOCA in 20 (7.7%). There were significant differences regarding diagnostics between age groups and across centres. Seventy-four (28.2%) patients underwent surgery with no operative deaths; minor postoperative complications occurred in 10 (3.8%) cases. CONCLUSIONS Currently, no uniform agreement exists among European centres with regard to diagnostic protocols and clinical management for AAOCA variants. Although surgery is a safe procedure in AAOCA, future longitudinal outcome data will hopefully shed light on how to best decide towards optimal selection of patients undergoing revascularization versus conservative treatment.
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Affiliation(s)
- Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anselm W Stark
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Matthias Siepe
- Department of Cardiac Surgery, Cardiovascular Center, Inselspital Universitatsspital Bern, Bern, Switzerland
| | - Bertrand Tchana
- Struttura Semplice Dipartimentale di Cardiologia Pediatrica, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Alberto Cipriani
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiology Clinic, University of Padova, Padova, Italy
| | - Domenico Crea
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - George Sarris
- 2nd Department of Pediatric and Congenital Cardiac Surgery, Mitera Children’s Hospital, Athens Heart Surgery Institute, Athens, Greece
| | - Elephterios Protopapas
- 2nd Department of Pediatric and Congenital Cardiac Surgery, Mitera Children’s Hospital, Athens Heart Surgery Institute, Athens, Greece
| | - Domenico Sirico
- Pediatric Cardiology, Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Giovanni Di Salvo
- Pediatric Cardiology, Department of Woman and Child’s Health, University of Padova, Padova, Italy
| | - Cinzia Pegoraro
- UOC Medicina dello Sport, Ospedale Ca’ Foncello, Treviso, Italy
| | - Patrizio Sarto
- UOC Medicina dello Sport, Ospedale Ca’ Foncello, Treviso, Italy
| | - Katrien Francois
- Department of Cardiac Surgery, University Hospital Ghent, Ghent, Belgium
| | - Alessandra Frigiola
- Guy and St Thomas Hospital, NHS foundation Trust and King’s College, London, UK
| | | | - Ryan E Accord
- Pediatric and Congenital Cardiothoracic Surgery, Thoraxcenter/Center for Pediatric and Congenital Heart Disease, Groningen, Netherlands
| | | | | | - Massimo Padalino
- Pediatric and Congenital Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, Bari, Italy
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49
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McKinney J, Isserow M, Wong J, Isserow S, Moulson N. New Insights and Recommendations for Athletes With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:921-933. [PMID: 38369259 DOI: 10.1016/j.cjca.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has long been considered to be a high-risk cardiac condition for which exercise was thought to increase the risk of sudden cardiac death (SCD). This was founded in part by initial autopsy studies reporting HCM to be a leading medical cause of SCD among young athletes. Most forms of competitive sport and exercise were therefore thought to increase the risk of SCD to a prohibitive level. Resultant expert consensus guideline recommendations universally restricted athletes with HCM from participation in moderate- to vigourous-intensity sport and exercise in a binary "yes" or "no" clinical decision making process with the goal of reducing the risk of sports-related SCD. HCM is, however, a heterogeneous genetic condition with variable penetrance and risk. The degree to which sports and exercise increases the risk of SCD at an individual patient level continues to be an area of clinical uncertainty. Emerging data and clinical experience from the past several decades have provided important new insights into exercise-related risks and have brought into question the appropriateness of overly restrictive binary clinical decision making for exercise recommendations in HCM. This includes an improved understanding of the overall prevalence of HCM in the general population, improved observational estimates of the risk of SCD related to continued sport and exercise participation, and a general shift toward improved patient-centred approaches to care through shared decision making processes. The rules by which the game is played may be changing for athletes with HCM.
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Affiliation(s)
- James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Megan Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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50
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Serafini L, Piazzani M, Madureri A, Giacomarra G, Elia S, Chizzola G, Metra M, Adamo M. Anomalous origin of the coronary arteries: a brief summary for clinical practice. J Cardiovasc Med (Hagerstown) 2024; 25:364-369. [PMID: 38555582 DOI: 10.2459/jcm.0000000000001607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Affiliation(s)
- Lisa Serafini
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | | | | | | | - Stefano Elia
- Radiology Unit, ASST Valcamonica, Esine, Brescia, Italy
| | - Giuliano Chizzola
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marco Metra
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical specialties, Radiological sciences and Public Health, University of Brescia
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