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Perry J, Brody JA, Fong C, Sunshine JE, O'Reilly-Shah VN, Sayre MR, Rea TD, Simon N, Shojaie A, Sotoodehnia N, Chatterjee NA. Predicting Out-of-Hospital Cardiac Arrest in the General Population Using Electronic Health Records. Circulation 2024; 150:102-110. [PMID: 38860364 DOI: 10.1161/circulationaha.124.069105] [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: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The majority of out-of-hospital cardiac arrests (OHCAs) occur among individuals in the general population, for whom there is no established strategy to identify risk. In this study, we assess the use of electronic health record (EHR) data to identify OHCA in the general population and define salient factors contributing to OHCA risk. METHODS The analytical cohort included 2366 individuals with OHCA and 23 660 age- and sex-matched controls receiving health care at the University of Washington. Comorbidities, electrocardiographic measures, vital signs, and medication prescription were abstracted from the EHR. The primary outcome was OHCA. Secondary outcomes included shockable and nonshockable OHCA. Model performance including area under the receiver operating characteristic curve and positive predictive value were assessed and adjusted for observed rate of OHCA across the health system. RESULTS There were significant differences in demographic characteristics, vital signs, electrocardiographic measures, comorbidities, and medication distribution between individuals with OHCA and controls. In external validation, discrimination in machine learning models (area under the receiver operating characteristic curve 0.80-0.85) was superior to a baseline model with conventional cardiovascular risk factors (area under the receiver operating characteristic curve 0.66). At a specificity threshold of 99%, correcting for baseline OHCA incidence across the health system, positive predictive value was 2.5% to 3.1% in machine learning models compared with 0.8% for the baseline model. Longer corrected QT interval, substance abuse disorder, fluid and electrolyte disorder, alcohol abuse, and higher heart rate were identified as salient predictors of OHCA risk across all machine learning models. Established cardiovascular risk factors retained predictive importance for shockable OHCA, but demographic characteristics (minority race, single marital status) and noncardiovascular comorbidities (substance abuse disorder) also contributed to risk prediction. For nonshockable OHCA, a range of salient predictors, including comorbidities, habits, vital signs, demographic characteristics, and electrocardiographic measures, were identified. CONCLUSIONS In a population-based case-control study, machine learning models incorporating readily available EHR data showed reasonable discrimination and risk enrichment for OHCA in the general population. Salient factors associated with OCHA risk were myriad across the cardiovascular and noncardiovascular spectrum. Public health and tailored strategies for OHCA prediction and prevention will require incorporation of this complexity.
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Affiliation(s)
- Jessica Perry
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Jennifer A Brody
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Christine Fong
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Jacob E Sunshine
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Vikas N O'Reilly-Shah
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Michael R Sayre
- Department of Emergency Medicine (M.R.S.), University of Washington, Seattle
- Seattle Fire Department (M.R.S.), WA
| | - Thomas D Rea
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Noah Simon
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
- King County Emergency Medical Services (T.D.R.), Seattle, WA
| | - Ali Shojaie
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Nona Sotoodehnia
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
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Esposito A, Gatti M, Trivieri MG, Agricola E, Peretto G, Gallone G, Catapano F, Pradella S, Devesa A, Bruno E, Fiore G, Francone M, Palmisano A. Imaging for the assessment of the arrhythmogenic potential of mitral valve prolapse. Eur Radiol 2024; 34:4243-4260. [PMID: 38078997 PMCID: PMC11164824 DOI: 10.1007/s00330-023-10413-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 05/18/2024]
Abstract
Mitral valve prolapse (MVP) is the most common valve disease in the western world and recently emerged as a possible substrate for sudden cardiac death (SCD). It is estimated an annual risk of sudden cardiac death of 0.2 to 1.9% mostly caused by complex ventricular arrhythmias (VA). Several mechanisms have been recognized as potentially responsible for arrhythmia onset in MVP, resulting from the combination of morpho-functional abnormality of the mitral valve, structural substrates (regional myocardial hypertrophy, fibrosis, Purkinje fibers activity, inflammation), and mechanical stretch. Echocardiography plays a central role in MVP diagnosis and assessment of severity of regurgitation. Several abnormalities detectable by echocardiography can be prognostic for the occurrence of VA, from morphological alteration including leaflet redundancy and thickness, mitral annular dilatation, and mitral annulus disjunction (MAD), to motion abnormalities detectable with "Pickelhaube" sign. Additionally, speckle-tracking echocardiography may identify MVP patients at higher risk for VA by detection of increased mechanical dispersion. On the other hand, cardiac magnetic resonance (CMR) has the capability to provide a comprehensive risk stratification combining the identification of morphological and motion alteration with the detection of myocardial replacement and interstitial fibrosis, making CMR an ideal method for arrhythmia risk stratification in patients with MVP. Finally, recent studies have suggested a potential role in risk stratification of new techniques such as hybrid PET-MR and late contrast enhancement CT. The purpose of this review is to provide an overview of the mitral valve prolapse syndrome with a focus on the role of imaging in arrhythmic risk stratification. CLINICAL RELEVANCE STATEMENT: Mitral valve prolapse is the most frequent valve condition potentially associated with arrhythmias. Imaging has a central role in the identification of anatomical, functional, mechanical, and structural alterations potentially associated with a higher risk of developing complex ventricular arrhythmia and sudden cardiac death. KEY POINTS: • Mitral valve prolapse is a common valve disease potentially associated with complex ventricular arrhythmia and sudden cardiac death. • The mechanism of arrhythmogenesis in mitral valve prolapse is complex and multifactorial, due to the interplay among multiple conditions including valve morphological alteration, mechanical stretch, myocardial structure remodeling with fibrosis, and inflammation. • Cardiac imaging, especially echocardiography and cardiac magnetic resonance, is crucial in the identification of several features associated with the potential risk of serious cardiac events. In particular, cardiac magnetic resonance has the advantage of being able to detect myocardial fibrosis which is currently the strongest prognosticator.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy.
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy
| | - Maria Giovanna Trivieri
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Eustachio Agricola
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
- Cardiovascular Imaging Unit, Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Peretto
- Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Città Della Salute E Della Scienza, University of Turin, Turin, Italy
| | - Federica Catapano
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Silvia Pradella
- Department of Emergency Radiology, University Hospital Careggi, Florence, Italy
| | - Ana Devesa
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elisa Bruno
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Imaging Unit, Cardiothoracic Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Francone
- IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
- School of Medicine, Università Vita-Salute San Raffaele, Milan, Italy
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Lynge TH, Albert CM, Basso C, Garcia R, Krahn AD, Semsarian C, Sheppard MN, Behr ER, Tfelt-Hansen J. Autopsy of all young sudden death cases is important to increase survival in family members left behind. Europace 2024; 26:euae128. [PMID: 38715537 PMCID: PMC11164113 DOI: 10.1093/europace/euae128] [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: 12/05/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Sudden cardiac death (SCD) is an important public health problem worldwide, accounting for an estimated 6-20% of total mortality. A significant proportion of SCD is caused by inherited heart disease, especially among the young. An autopsy is crucial to establish a diagnosis of inherited heart disease, allowing for subsequent identification of family members who require cardiac evaluation. Autopsy of cases of unexplained sudden death in the young is recommended by both the European Society of Cardiology and the American Heart Association. Overall autopsy rates, however, have been declining in many countries across the globe, and there is a lack of skilled trained pathologists able to carry out full autopsies. Recent studies show that not all cases of sudden death in the young are autopsied, likely due to financial, administrative, and organizational limitations as well as awareness among police, legal authorities, and physicians. Consequently, diagnoses of inherited heart disease are likely missed, along with the opportunity for treatment and prevention among surviving relatives. This article reviews the evidence for the role of autopsy in sudden death, how the cardiologist should interpret the autopsy-record, and how this can be integrated and implemented in clinical practice. Finally, we identify areas for future research along with potential for healthcare reform aimed at increasing autopsy awareness and ultimately reducing mortality from SCD.
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Affiliation(s)
- Thomas H Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cristina Basso
- The Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Via Aristide Gabelli, 61, 35121 Padova PD, Italy
| | - Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, Poitiers, France
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Pathology Unit, Cardiovascular and Genetics Research Institute, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Cardiovascular and Genetics Research Institute, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Durstenfeld MS, Thakkar A, Jeon D, Short R, Ma Y, Tseng ZH, Hsue PY. HIV-Associated Heart Failure: Phenotypes and Clinical Outcomes in a Safety-Net Setting. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.08.24307095. [PMID: 38766063 PMCID: PMC11100928 DOI: 10.1101/2024.05.08.24307095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Human immunodeficiency virus (HIV) is associated with increased risk of heart failure (HF) but data regarding phenotypes of heart failure and outcomes after HF diagnosis, especially within the safety-net which is where half of people with HIV in the United States receive care, are less clear. Methods Using an electronic health record cohort of all individuals with HF within a municipal safety-net system from 2001-2019 linked to the National Death Index Plus, we compared HF phenotypes, all-cause mortality, HF hospitalization, and cause of death for individuals with and without HIV. Results Among people with HF (n=14,829), 697 individuals had HIV (4.7%). Persons with HIV (PWH) were diagnosed with HF ten years younger on average. A higher proportion of PWH had a reduced ejection fraction at diagnosis (37.9% vs 32.7%). Adjusted for age, sex, and risk factors, coronary artery disease on angiography was similar by HIV status. HIV was associated with 55% higher risk of all-cause mortality (HR 1.55; 95% CI 1.37-1.76; P<0.001) and lower odds of HF hospitalization (OR 0.51; 95% CI 0.39-0.66; P<0.001). Among PWH with HF, cause of death was less often attributed to cardiovascular disease (22.5% vs 54.6% uninfected; P<0.001) and more to substance use (17.9% vs 9.3%; P<0.001), consistent with autopsy findings in a subset (n=81). Conclusions Among people with HF who receive care within a municipal safety-net system, HIV infection is associated with higher mortality, despite lower odds of HF hospitalization, attributable to non-cardiovascular causes including substance-related and HIV-related mortality.
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Affiliation(s)
- Matthew S. Durstenfeld
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
| | - Anjali Thakkar
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Diane Jeon
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Robert Short
- Department of Medicine, University of California, San Francisco
| | - Yifei Ma
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
| | - Zian H. Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Priscilla Y Hsue
- Division of Cardiology at ZSFG and Department of Medicine, University of California, San Francisco (UCSF), USA
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Shaeri S, Considine J, Dainty KN, Olasveengen TM, Morrison LJ. Accuracy of etiological classification of out-of-hospital cardiac arrest: A scoping review. Resuscitation 2024; 198:110199. [PMID: 38582438 DOI: 10.1016/j.resuscitation.2024.110199] [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: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION The Utstein reporting template classifies the etiology of OHCA into "presumed cardiac" and "obvious non-cardiac" or "medical" and "non-medical" categories; however, the accuracy of these classifications is unclear. Ascertaining more accurately the etiology of OHCA is important to tailor advanced life support and identify etiologically consistent patient cohorts for reporting incidence and outcome and enrollment in clinical trials. This scoping review was proposed to identify the state of agreement on etiological classification based on emergency medical service (EMS) data using the Utstein format against other sources. METHOD We searched Medline, EBM-Cochrane, and Embase databases from 1946-2023 to identify studies that reported initial and confirmed etiologies of OHCA. A descriptive review of the included studies was conducted. RESULT The search yielded 22,994 citations. After excluding duplicates, 16,932 citations were reviewed for titles and abstracts. Twelve studies met the inclusion criteria of this review. The frequency of presumed cardiac etiologies based on EMS data was higher than confirmed cardiac etiologies (88% vs 33%) with 83-94% sensitivity and 73-76% specificity. In contrast, the frequency of presumed non-cardiac etiologies was lower than confirmed non-cardiac etiologies (3% vs 27%) with 52-74% sensitivity and 90-97.7% specificity estimated for respiratory disease. CONCLUSION Major disparities exist between current etiological classifications based on the Utstein reporting template and robust sources such as autopsy and medical records. Data linkage and validation are necessary to confirm the etiology of OHCA. Further research is needed on how this misclassification affects reported incidence and outcomes, and how contributing factors may improve etiological classifications.
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Affiliation(s)
- Sedigheh Shaeri
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
| | - Julie Considine
- School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia; Centre for Quality and Patient Safety Research - Eastern Health, Eastern Health, Box Hill, Australia
| | - Katie N Dainty
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Office of Research & Innovation, North York General Hospital, Toronto, Canada
| | - Theresa Mariero Olasveengen
- Department of Anesthesia and Intensive Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Laurie J Morrison
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Department of Emergency Services, Sunnybrook Health Sciences Centre, Toronto, Canada; The Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Canada.
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Mäntyniemi L, Pakanen L, Tikkanen J, Holmström L, Hämaläinen J, Ruuska L, Vähätalo J, Haukilahti A, Perkiömäki J, Huikuri H, Junttila J. Incidence and autopsy rates for sudden cardiac death in Northern Finland. Heart Rhythm 2024; 21:682-683. [PMID: 38184057 DOI: 10.1016/j.hrthm.2023.12.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 12/14/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Lassi Mäntyniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland; Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu, Finland
| | - Jani Tikkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Lauri Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center for Cardiac Arrest Prevention, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jessica Hämaläinen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Laura Ruuska
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Vähätalo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Anette Haukilahti
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Paludan-Müller C, Hassager C, Kjærgaard J, Tfelt-Hansen J, Winkel BG. Toxicological profile using mass spectrometry in sudden cardiac arrest survivors admitted to a tertiary centre. Resuscitation 2024; 198:110197. [PMID: 38582441 DOI: 10.1016/j.resuscitation.2024.110197] [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: 02/01/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND There has been no previous thorough toxicological examination of a cohort of patients with resuscitated sudden cardiac arrest. We aimed to determine the qualitative and quantitative drug composition in a resuscitated sudden cardiac arrest population, using forensic toxicology, with focus on prescribed, non-prescribed, and commonly abused drugs. METHODS Individuals aged 18-90 years with resuscitated sudden cardiac arrest of presumed cardiac causes were prospectively included from a single tertiary center. Data from the sudden cardiac arrest hospitalization was collected from medical reports. Drugs used during resuscitation or before the blood sampling were identified and excluded in each patient. Mass spectrometry-based toxicology was performed to determine the absence or presence of most drugs and to quantify the findings. RESULTS Among 186 consecutively enrolled resuscitated sudden cardiac arrest patients (median age 62 years, 83% male), 90% had a shockable rhythm, and were primarily caused by ischemic heart disease (66%). In total, 90 different drugs (excluding metabolites) were identified, and 82% of patients had at least one drug detected (median of 2 detected drugs (IQR:1-4)) (polypharmacy). Commonly abused drugs were present in 16%, and QT-prolonging drugs were present in 12%. Polypharmacy (≥5drugs) were found in 19% of patients. Importantly, none had potentially lethal concentrations of any drugs. CONCLUSION In resuscitated sudden cardiac arrest patients with cardiac arrest of presumed cardiac cause, routine toxicological screening provides limited extra information. However, the role of polypharmacy in sudden cardiac arrest requires further investigation. No occult overdose-related cardiac arrests were identified.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Paludan-Müller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Marimpouy N, Guilbeau-Frugier C, Ferrières J, Balen F, Ramirez A, Delmas C, Biendel C, Beneyto M, Cherbi M, Foltran D, Mondoly P, Bongard V, Minville V, Delasnerie H, Rollin A, Maury P. The real incidence of sudden death: Fair estimations or futile speculations? Arch Cardiovasc Dis 2024; 117:244-248. [PMID: 38490843 DOI: 10.1016/j.acvd.2024.01.003] [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: 10/21/2023] [Revised: 12/31/2023] [Accepted: 01/03/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The true incidence of sudden death remains undetermined, with controversial results from various publications over time and countries. AIM To investigate if different estimations would reach the values usually reported for France. METHODS Three different kinds of estimations were used. First, the number of resuscitated sudden deaths and necropsies for sudden death in the Haute-Garonne French administrative department (i.e. county) over the last 10years was expanded to the national level. Second, sudden death coding of death certificates was collected at the national level. Third, the total number of out-of-hospital cardiac arrests leading to any emergency call (with/without intervention) in Haute-Garonne over the last 10years was expanded to the national level. RESULTS There was a mean of 26 resuscitated sudden deaths and 145 necropsies for sudden death each year in Haute-Garonne, i.e. 12 to 14 sudden deaths for 100,000 inhabitants, and 7700 to 9400 sudden deaths yearly when related to the whole French population, according to the year of inclusion. Based on death certificates, a mean of 6584 sudden deaths was registered each year in France. Finally, there were about 600 yearly calls/interventions for out-of-hospital cardiac arrests in Haute-Garonne, i.e. 40 to 50 sudden deaths for 100,000 inhabitants, and 16,000 to 27,000 sudden deaths yearly for the whole French territory, according to the year of inclusion. CONCLUSIONS The incidence of sudden death ranges from 6500 to 27,000 in France according to the calculation methods. This huge difference raises the question of the true current incidence of sudden death, which may have been overestimated previously or may be underestimated in France. More straight prospective surveys are needed to solve this question, because of relevant implications for priorities that should be given to sudden death.
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Affiliation(s)
- Nathan Marimpouy
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | | | - Jean Ferrières
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France; Department of Epidemiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Frederic Balen
- Department of Emergency Medicine, University Hospital Rangueil, 31059 Toulouse, France
| | - Anthony Ramirez
- Department of médecine légale, University Hospital Rangueil, 31059 Toulouse, France
| | - Clement Delmas
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Caroline Biendel
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Maxime Beneyto
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Miloud Cherbi
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Deborah Foltran
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Pierre Mondoly
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Vanina Bongard
- Department of Epidemiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Vincent Minville
- Department of Emergency Medicine, University Hospital Rangueil, 31059 Toulouse, France
| | - Hubert Delasnerie
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Anne Rollin
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, 31059 Toulouse, France; I2MC, Inserm UMR 1297, 31432 Toulouse, France.
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9
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Tastet L, Ramakrishna S, Lim LJ, Bibby D, Olgin JE, Connolly AJ, Moffatt E, Tseng ZH, Delling FN. Mechanical Dispersion Discriminates Between Arrhythmic and Nonarrhythmic Sudden Death: From the POST SCD Study. JACC Clin Electrophysiol 2024; 10:771-773. [PMID: 38363275 DOI: 10.1016/j.jacep.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/26/2023] [Accepted: 01/01/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Lionel Tastet
- University of California, San Francisco, California, USA
| | | | - Lisa J Lim
- University of California, San Francisco, California, USA
| | - Dwight Bibby
- University of California, San Francisco, California, USA
| | | | | | - Ellen Moffatt
- City and County of San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- University of California, San Francisco, California, USA
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10
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Li Y, Liu Z, Liu T, Li J, Mei Z, Fan H, Cao C. Risk Prediction for Sudden Cardiac Death in the General Population: A Systematic Review and Meta-Analysis. Int J Public Health 2024; 69:1606913. [PMID: 38572495 PMCID: PMC10988292 DOI: 10.3389/ijph.2024.1606913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Objective: Identification of SCD risk is important in the general population from a public health perspective. The objective is to summarize and appraise the available prediction models for the risk of SCD among the general population. Methods: Data were obtained searching six electronic databases and reporting prediction models of SCD risk in the general population. Studies with duplicate cohorts and missing information were excluded from the meta-analysis. Results: Out of 8,407 studies identified, fifteen studies were included in the systematic review, while five studies were included in the meta-analysis. The Cox proportional hazards model was used in thirteen studies (96.67%). Study locations were limited to Europe and the United States. Our pooled meta-analyses included four predictors: diabetes mellitus (ES = 2.69, 95%CI: 1.93, 3.76), QRS duration (ES = 1.16, 95%CI: 1.06, 1.26), spatial QRS-T angle (ES = 1.46, 95%CI: 1.27, 1.69) and factional shortening (ES = 1.37, 95%CI: 1.15, 1.64). Conclusion: Risk prediction model may be useful as an adjunct for risk stratification strategies for SCD in the general population. Further studies among people except for white participants and more accessible factors are necessary to explore.
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Affiliation(s)
- Yue Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Zhengkun Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Zihan Mei
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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11
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Somani S, Rogers AJ. Just in time: detecting cardiac arrest with smartwatch technology. Lancet Digit Health 2024; 6:e148-e149. [PMID: 38395532 DOI: 10.1016/s2589-7500(24)00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Sulaiman Somani
- Department of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Albert J Rogers
- Department of Medicine and Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA 94305, USA.
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12
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Pham HN, Ibrahim R, Sainbayar E, Aiti D, Mouhaffel R, Shahid M, Ozturk NB, Olson A, Ferreira JP, Lee K. Ischemic heart disease mortality in individuals with inflammatory bowel disease: A nationwide analysis of disparities in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00072-1. [PMID: 38431496 DOI: 10.1016/j.carrev.2024.02.018] [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: 02/01/2024] [Revised: 02/20/2024] [Accepted: 02/22/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Inflammatory bowel disease (IBD) is linked to immune-mediated pathogenesis and a pro-inflammatory state, leading to accelerated atherosclerosis. This earlier onset of clinical cardiovascular disease poses significant morbidity and mortality. We sought to identify IHD mortality trends in individuals with IBD in the United States (US). METHODS Mortality due to ischemic heart diseases (IHD) as the underlying cause of death with the IBD as a contributor of death were queried from death certificates using the CDC database from 1999 to 2020. Yearly crude mortality rates (CMR) were estimated by dividing the death count by the respective population size, reported per 100,000 persons. Mortality rates were adjusted for age using the Direct method and compared by demographic subpopulations. Log-linear regression models were utilized to assess temporal variation (annual percentage change [APC]) in mortality. RESULTS Age-adjusted mortality rates (AAMR) decreased from 0.11 in 1999 to 0.07 in 2020, primarily between 1999 and 2018 (APC -4.41, p < 0.001). AAMR was higher among male (AAMR 0.08) and White (AAMR 0.08) populations compared to female populations (AAMR 0.06) and Black (AAMR 0.04) populations, respectively. No significant differences were seen when comparing mortality between urban (AAMR 0.07) and rural (AAMR 0.08) regions. Southern US regions (AAMR 0.06) had the lowest mortality rates when compared to the other US census regions: Northeastern (AAMR 0.08), Midwestern (AAMR 0.08), and Western (AAMR 0.08). CONCLUSION Disparities in IHD mortality exist among individuals with IBD in the US based on demographic factors, with an overall decline in mortality during the 22-year period. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.
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Affiliation(s)
- Hoang Nhat Pham
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Ramzi Ibrahim
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America. https://twitter.com/ramziw_
| | - Enkhtsogt Sainbayar
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Danny Aiti
- Department of Medicine, Canton Medical Education Foundation-Northeast Ohio Medical University, Canton, OH, United States of America
| | - Rama Mouhaffel
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Mahek Shahid
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Nazli Begum Ozturk
- Department of Medicine, Beaumont Hospital, Royal Oak, MI, United States of America
| | - April Olson
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - João Paulo Ferreira
- Department of Medicine, University of Arizona-Tucson, Tucson, AZ, United States of America
| | - Kwan Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, United States of America
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13
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [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] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Rav-Acha M, Wube O, Brodie OT, Michowitz Y, Ilan M, Ovdat T, Klempfner R, Suleiman M, Goldenberg I, Glikson M. Evaluation of MADIT-II Risk Stratification Score Among Nationwide Registry of Heart Failure Patients With Primary Prevention Implantable Cardiac Defibrillators or Resynchronization Therapy Devices. Am J Cardiol 2024; 211:17-28. [PMID: 37879381 DOI: 10.1016/j.amjcard.2023.10.044] [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: 08/15/2023] [Revised: 10/05/2023] [Accepted: 10/15/2023] [Indexed: 10/27/2023]
Abstract
The current guidelines advocate prophylactic implantable cardioverter-defibrillator (ICD) for all patients with symptomatic heart failure (HF) with low left ventricular ejection fraction. Because many patients will never use their device, a score delineating subgroups with differential ICD benefit is crucial. We aimed to evaluate the MADIT-II-based Risk Stratification Score (MRSS) feasibility to delineate the ICD survival benefit in a nationwide registry of patients with HF with prophylactic ICDs. Accordingly, all Israeli patients with HF with prophylactic ICD/cardiac resynchronization therapy defibrillators were categorized into MRSS-based risk subgroups. The study end points included overall mortality, sustained ventricular arrhythmia (VA), and a competing risk of VA (potential preventable arrhythmic death, where ICD could benefit survival) versus nonarrhythmic death. Potential ICD survival benefit was estimated by the area between these cumulative incidence curves. In 2,177 patients with HF implanted prophylactic device, 189 patients (8.7%) had VA and 316 (14.5%) died during a median follow-up of 2.9 years. The MRSS risk subgroups were significantly associated with overall mortality (p <0.001) and weakly with VA (p = 0.3). The competing risk analysis of VA versus nonarrhythmic death revealed a significantly shorter duration (p <0.001) and smaller magnitude of ICD survival benefit with increased risk subgroups, yielding an estimated 76, 60, 38, and 0 life days gained from prophylactic ICD implant during a 5-year follow-up for the MRSS low-, intermediate-, high-, and very high-risk subgroups, respectively (p for trend <0.05). In conclusion, MRSS use in a nationwide registry of patients with ischemic and nonischemic cardiomyopathy, revealed subgroups with differing ICD survival benefit, suggesting it could help evaluate prophylactic ICD survival benefit.
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Affiliation(s)
- Moshe Rav-Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - Orli Wube
- Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Oholi Tovia Brodie
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Ben-Gurion University, Beer Sheva, Israel
| | - Yoav Michowitz
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Ilan
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Tal Ovdat
- Israeli Center for Cardiovascular Research, Sheba Medical Center, Israel
| | - Robert Klempfner
- Israeli Center for Cardiovascular Research, Sheba Medical Center, Israel
| | | | - Ilan Goldenberg
- Department of Medicine, University of Rochester Medical Center, New York, New York
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
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15
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Tastet L, Dixit S, Nguyen T, Lim LJ, Al-Akchar M, Bibby D, Arya F, Cristin L, Anwar S, Higuchi S, Hsia H, Lee YJ, Delling FN. Interstitial Fibrosis and Arrhythmic Mitral Valve Prolapse: Unravelling Sex-Based Differences. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.01.12.24301217. [PMID: 38260659 PMCID: PMC10802759 DOI: 10.1101/2024.01.12.24301217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Background Interstitial fibrosis as quantified by cardiac magnetic resonance (CMR) has been demonstrated in arrhythmic mitral valve prolapse (MVP), a condition with known female predominance. However, prior studies included only MVP cases with significant mitral regurgitation (MR) or mitral annular disjunction (MAD). We sought to evaluate the association between interstitial fibrosis and complex ventricular ectopy (ComVE) in MVPs unselected for MAD or severe MR, and to investigate the contribution of sex to this association. Methods We performed contrast CMR in consecutive individuals with MVP between 2020 and 2022. Extracellular volume fraction (ECV%), a surrogate marker for interstitial fibrosis, was quantified using T 1 mapping. Replacement fibrosis was assessed using late gadolinium enhancement (LGE). ComVE, defined as frequent premature ventricular contractions and/or non-sustained/sustained ventricular tachycardia (VT), was detected using ambulatory ECG monitoring. Results We identified 59 MVP cases without severe MR (49% women, 80% with mild or less MR) and available ECV% measurement. Among these, 23 (39%) had ComVE, including a case of aborted ventricular fibrillation (VF) and one with sudden arrhythmic death, both females. Global ECV% was significantly greater in ComVE versus non-ComVE (31%[27-33] vs 27%[23-30], p=0.002). In MVP-ComVE, higher segmental ECV% was not limited to the inferolateral/inferior LV wall, but was also demonstrated in atypical segments including the anterior/anterolateral wall (p<0.05). The association between ComVE and ECV% was driven by female sex (32%[30-33] vs 28%[26-30], p=0.003 in females; 31%[25-33] vs 26%[23-30], p=0.22 in males). ECV% remained independently associated with an increased risk of ComVE, including VT/VF, after adjustment for cardiovascular risk factors, MAD, and LGE (p<0.01). Conclusion In MVP without significant MR, interstitial fibrosis by CMR is associated with an increased risk of ComVE, suggesting a primary myopathic process. The stronger association between interstitial fibrosis and ComVE in females may explain why severe arrhythmic complications are more prevalent among women. Abstract Figure
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16
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Ling X, Hou Y, Jia X, Lan Y, Wu X, Wu J, Jie W, Liu H, Huang S, Wan Z, Li T, Guo J, Liang T. Characterization of cardiac involvement in patients with LMNA splice-site mutation-related dilated cardiomyopathy and sudden cardiac death. Front Genet 2024; 14:1291411. [PMID: 38259623 PMCID: PMC10800368 DOI: 10.3389/fgene.2023.1291411] [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: 09/09/2023] [Accepted: 12/18/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction: LMNA splicing mutations occur in 9.1% of cases with cardiac involvement cases, but the phenotype and severity of disease they cause have not yet been systematically studied. The aim of this study was to understand the clinical and pathogenic characteristics of the LMNA splice-site mutation phenotype in patients with LMNA-related dilated cardiomyopathy (DCM) and sudden cardiac death (SCD). Methods and Results: First, we reported a novel family with LMNA-related DCM and SCD, and the clinical characteristics of all current patients with LMNA splicing mutations were further summarized through the ClinVar database. Seventeen families with a total of 134 individuals, containing a total of 15 LMNA splicing mutation sites, were enrolled. A total of 42 subjects (31.3%) had SCD. Compared without with the non-DCM group (n = 56), the patients within the DCM group (n = 78) presented a lower incidence of atrioventricular block (AVB) (p = 0.015) and a higher incidence rates of non-sustained ventricular tachycardia (p = 0.004),) and implantable cardioverter defibrillator (ICD) implantation (p = 0.005). Kaplan‒Meier survival analysis showed that the patients with pacemaker (PM) implantation had a significantly reduced the occurrence of SCD compared to patientswith those without PM implantation (log-rank p < 0.001), while there was no significant difference in ICD implantation between the two groups (log-rank p = 0.73). Second, we identified the family that we reported with a mutation in an LMNA c.513+1 G>A mutation in the reported family, and pathogenic prediction analysis showed that the mutation site was extremely harmful. Next, we conducted gene expression levels and cardiac pathological biopsy studies on the proband of this family. We found that the expression of normal LMNA mRNA from the proband was significantly downregulated in peripheral blood mononuclear cells than incompared with healthy individuals. Finally, we comprehensively summarized the pathological characteristics of LMNA-related DCM, including hypertrophy, atrophy, fibrosis, white blood cell infiltration, intercalated disc remodeling, and downregulation of desmin and connexin 43 (Cx43) expression. Discussion: Above all, Cardiaccardiac involvement in patients with LMNA splice-site mutation presented with a high rate of SCD. Implanting a pacemaker significantly reduced the SCD rate in non-DCM patients with AVB. The pathogenic characterization was not only haveinvolved suppressed the expression of the healthy LMNA allele, but was also associated with abnormal expression and distribution of desmin and Cx43.
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Affiliation(s)
- Xuebin Ling
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Yanjun Hou
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xingyu Jia
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Youling Lan
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Xiaoping Wu
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Julan Wu
- Department of Pathology, Hainan Women and Children Medical Center, Hainan Medical University, Haikou, China
| | - Wei Jie
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Hui Liu
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Shan Huang
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Zhenling Wan
- Department of Pathology, Hainan Women and Children Medical Center, Hainan Medical University, Haikou, China
| | - Tianfa Li
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Junli Guo
- Department of Cardiovascular Medicine and Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research and Hainan Engineering Research Center for Biological Sample Resources of Major Diseases, The First Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Tiebiao Liang
- Department of Cardiovascular Medicine, People’s Hospital of Wanning, Wanning, China
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17
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Jansen M, Schmidt AF, Jans JJM, Christiaans I, van der Crabben SN, Hoedemaekers YM, Dooijes D, Jongbloed JDH, Boven LG, Lekanne Deprez RH, Wilde AAM, van der Velden J, de Boer RA, van Tintelen JP, Asselbergs FW, Baas AF. Circulating Acylcarnitines Associated with Hypertrophic Cardiomyopathy Severity: an Exploratory Cross-Sectional Study in MYBPC3 Founder Variant Carriers. J Cardiovasc Transl Res 2023; 16:1267-1275. [PMID: 37278928 PMCID: PMC10721678 DOI: 10.1007/s12265-023-10398-2] [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: 11/30/2022] [Accepted: 05/10/2023] [Indexed: 06/07/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a relatively common genetic heart disease characterised by myocardial hypertrophy. HCM can cause outflow tract obstruction, sudden cardiac death and heart failure, but severity is highly variable. In this exploratory cross-sectional study, circulating acylcarnitines were assessed as potential biomarkers in 124 MYBPC3 founder variant carriers (59 with severe HCM, 26 with mild HCM and 39 phenotype-negative [G + P-]). Elastic net logistic regression identified eight acylcarnitines associated with HCM severity. C3, C4, C6-DC, C8:1, C16, C18 and C18:2 were significantly increased in severe HCM compared to G + P-, and C3, C6-DC, C8:1 and C18 in mild HCM compared to G + P-. In multivariable linear regression, C6-DC and C8:1 correlated to log-transformed maximum wall thickness (coefficient 5.01, p = 0.005 and coefficient 0.803, p = 0.007, respectively), and C6-DC to log-transformed ejection fraction (coefficient -2.50, p = 0.004). Acylcarnitines seem promising biomarkers for HCM severity, however prospective studies are required to determine their prognostic value.
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Affiliation(s)
- Mark Jansen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal Mail No HTx Secr. (E03.511), Postbus 85500, 3508 GA, Utrecht, the Netherlands.
- Netherlands Heart Institute, Utrecht, the Netherlands.
- , .
| | - A F Schmidt
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal Mail No HTx Secr. (E03.511), Postbus 85500, 3508 GA, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - J J M Jans
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - I Christiaans
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S N van der Crabben
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Y M Hoedemaekers
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Department of Clinical Genetics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - D Dooijes
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J D H Jongbloed
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L G Boven
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R H Lekanne Deprez
- Department of Human Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - A A M Wilde
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - J van der Velden
- Department of Physiology, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - J P van Tintelen
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - F W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Internal Mail No HTx Secr. (E03.511), Postbus 85500, 3508 GA, Utrecht, the Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - A F Baas
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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Haghighat L, Ramakrishna S, Salazar JW, Feng J, Chiang J, Moffatt E, Tseng ZH. Homelessness and Incidence and Causes of Sudden Death: Data From the POST SCD Study. JAMA Intern Med 2023; 183:1306-1314. [PMID: 37870865 PMCID: PMC10594172 DOI: 10.1001/jamainternmed.2023.5475] [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: 05/29/2023] [Accepted: 08/26/2023] [Indexed: 10/24/2023]
Abstract
Importance Over 580 000 people in the US experience homelessness, with one of the largest concentrations residing in San Francisco, California. Unhoused individuals have a life expectancy of approximately 50 years, yet how sudden death contributes to this early mortality is unknown. Objective To compare incidence and causes of sudden death by autopsy among housed and unhoused individuals in San Francisco County. Design, Setting, and Participants This cohort study used data from the Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) study, a prospective cohort of consecutive out-of-hospital cardiac arrest deaths countywide among individuals aged 18 to 90 years. Cases meeting World Health Organization criteria for presumed SCD underwent autopsy, toxicologic analysis, and medical record review. For rate calculations, all 525 incident SCDs in the initial cohort were used (February 1, 2011, to March 1, 2014). For analysis of causes, 343 SCDs (incident cases approximately every third day) were added from the extended cohort (March 1, 2014, to December 16, 2018). Data analysis was performed from July 1, 2022, to July 1, 2023. Main Outcomes and Measures The main outcomes were incidence and causes of presumed SCD by housing status. Causes of sudden death were adjudicated as arrhythmic (potentially rescuable with implantable cardioverter-defibrillator), cardiac nonarrhythmic (eg, tamponade), or noncardiac (eg, overdose). Results A total of 868 presumed SCDs over 8 years were identified: 151 unhoused individuals (17.4%) and 717 housed individuals (82.6%). Unhoused individuals compared with housed individuals were younger (mean [SD] age, 56.7 [0.8] vs 61.0 [0.5] years, respectively) and more often male (132 [87.4%] vs 499 [69.6%]), with statistically significant racial differences. Paramedic response times were similar (mean [SD] time to arrival, unhoused individuals: 5.6 [0.4] minutes; housed individuals: 5.6 [0.2] minutes; P = .99), while proportion of witnessed sudden deaths was lower among unhoused individuals compared with housed individuals (27 [18.0%] vs 184 [25.7%], respectively, P = .04). Unhoused individuals had higher rates of sudden death (incidence rate ratio [IRR], 16.2; 95% CI, 5.1-51.2; P < .001) and arrhythmic death (IRR, 7.2; 95% CI, 1.3-40.1; P = .02). These associations remained statistically significant after adjustment for differences in age and sex. Noncardiac causes (96 [63.6%] vs 270 [37.7%], P < .001), including occult overdose (48 [31.8%] vs 90 [12.6%], P < .001), gastrointestinal causes (8 [5.3%] vs 15 [2.1%], P = .03), and infection (11 [7.3%] vs 20 [2.8%], P = .01), were more common among sudden deaths in unhoused individuals. A lower proportion of sudden deaths in unhoused individuals were due to arrhythmic causes (48 of 151 [31.8%] vs 420 of 717 [58.6%], P < .001), including acute and chronic coronary disease. Conclusions and Relevance In this cohort study among individuals who experienced sudden death in San Francisco County, homelessness was associated with greater risk of sudden death from both noncardiac causes and arrhythmic causes potentially preventable with a defibrillator.
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Affiliation(s)
- Leila Haghighat
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Satvik Ramakrishna
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - James W. Salazar
- Division of Cardiology, Department of Medicine, University of California, San Francisco
| | - Jean Feng
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Joey Chiang
- Department of Internal Medicine, University of Washington, Seattle
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, San Francisco, California
- Department of Pathology and Laboratory Medicine, University of California, San Francisco
| | - Zian H. Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco
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19
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Somma V, Pflaumer A, Connell V, Rowe S, Fahy L, Zentner D, James P, Ingles J, Semsarian C, Stub D, Nehme Z, La Gerche A, Paratz ED. Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults. Heart Rhythm 2023; 20:1525-1531. [PMID: 37331677 DOI: 10.1016/j.hrthm.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with ∼90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. OBJECTIVE The purpose of this study was to outline the characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death Registry. METHODS A prospective statewide multisource registry identified all pOHCAs cases in patients aged 1-18 years in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital, and forensic records; clinic assessments; and interviews of survivors and family members. RESULTS The analysis included 106 cases after adjudication (62, 58.5% male), 45 (42.5%) of which were due to cardiac causes of OHCA, with unascertained (n = 33 [31.1%]) being the most common cardiac cause reported. Respiratory events (n = 28 [26.4%]) were the most common noncardiac cause of pOHCA. Noncardiac causes were more likely to present with asystole or pulseless electrical activity (P = .007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest, and initial ventricular arrhythmias (P < .05). CONCLUSION The incidence of pOHCA in the study population was 3.69 per 100,000 child-years. In contrast to young adults with OHCA, the most common etiology was noncardiac in pediatric patients. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest, and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were suboptimal.
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Affiliation(s)
- Vincenzo Somma
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia
| | | | - Stephanie Rowe
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Louise Fahy
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Dominica Zentner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Paul James
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, St Darlinghurst, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Elizabeth D Paratz
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia.
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20
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Junttila MJ, Holmström LTA, Huikuri HV. Sudden cardiac death-Progress in epidemiology limited by time. Heart Rhythm 2023; 20:1510-1511. [PMID: 37607655 DOI: 10.1016/j.hrthm.2023.08.024] [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: 08/17/2023] [Accepted: 08/17/2023] [Indexed: 08/24/2023]
Affiliation(s)
- M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland.
| | - Lauri T A Holmström
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu, Oulu University Hospital, Oulu, Finland
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21
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Desai R, Mohammed AS, Gurram P, Srikanth S, Vyas A, Katukuri N, Sanku K, Paul TK, Kumar G, Sachdeva R. Predicting Risk of Cardiac Arrest in Young Asian Americans: Insights from an Artificial Neural Network Analysis of the Nationwide Cohort. Curr Probl Cardiol 2023; 48:101939. [PMID: 37423314 DOI: 10.1016/j.cpcardiol.2023.101939] [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: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/11/2023]
Abstract
We used the Artificial Neural Network (ANN) model to identify predictors of Sudden Cardiac Arrest (SCA) in a national cohort of young Asian patients in the United States. The National Inpatient Sample (2019) was used to identify young Asians (18-44-year-old) who were hospitalized with SCA. The neural network's predicted criteria for SCA were selected. After eliminating missing data, young Asians (n = 65,413) were randomly divided into training (n = 45,094) and testing (n = 19347) groups. Training data (70%) was used to calibrate ANN while testing data (30%) was utilized to assess the algorithm's accuracy. To determine ANN's performance in predicting SCA, we compared the frequency of incorrect prediction between training and testing data and measured the area under the Receiver Operating Curve (AUC). The 2019 young Asian cohort had 327,065 admissions (median age 32 years; 84.2% female), with SCA accounting for 0.21%. The exact rate of error in predictions vs. tests was shown by training data (0.2% vs 0.2%). In descending order, the normalized importance of predictors to accurately predict SCA in young adults included prior history of cardiac arrest, sex, age, diabetes, anxiety disorders, prior coronary artery bypass grafting, hypertension, congenital heart disease, income, peripheral vascular disease, and cancer. The AUC was 0.821, indicating an excellent ANN model for SCA prediction. Our ANN models performed excellently in revealing the order of important predictors of SCA in young Asian American patients. These findings could have a considerable impact on clinical practice to develop risk prediction models to improve the survival outcome in high-risk patients.
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Affiliation(s)
- Rupak Desai
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA.
| | - Adil Sarvar Mohammed
- Department of Internal Medicine, Central Michigan University College of Medicine, Saginaw, MI
| | - Priyatham Gurram
- Internal Medicine, Mamata Medical College, Khammam, Telangana, India
| | - Sashwath Srikanth
- Department of Internal Medicine, East Carolina University, Brody School of Medicine, Greenville, NC
| | - Ankit Vyas
- Department of Internal Medicine, Baptist Hospitals of Southeast Texas, Beaumont, TX
| | | | - Koushik Sanku
- Department of Internal Medicine, East Tennessee State University, Johnson City, TN
| | - Timir K Paul
- University of Tennessee Health Sciences Center at Nashville, Saint Thomas Heart Institute, Nashville, TN
| | - Gautam Kumar
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA; Division of Cardiology, Emory University School of Medicine, Atlanta, GA
| | - Rajesh Sachdeva
- Division of Cardiology, Atlanta VA Medical Center, Decatur, GA
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22
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Salazar JW, Minter DJ, Tseng ZH, Santhosh L. Exercises in Clinical Reasoning: Beyond the Surface. J Gen Intern Med 2023; 38:3257-3261. [PMID: 37592120 PMCID: PMC10651606 DOI: 10.1007/s11606-023-08365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/03/2023] [Indexed: 08/19/2023]
Affiliation(s)
- James W Salazar
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | - Daniel J Minter
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Lekshmi Santhosh
- Department of Medicine, Pulmonary/Critical Care Medicine and Hospital Medicine, University of California, San Francisco, San Francisco, CA, USA
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23
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Hansen CJ, Svane J, Lynge TH, Stampe NK, Bhardwaj P, Torp-Pedersen C, Banner J, Tfelt-Hansen J, Winkel BG. Differences among young unwitnessed sudden cardiac death, according to time from last seen alive: Insights from a 15-year nationwide study. Heart Rhythm 2023; 20:1504-1509. [PMID: 37453604 DOI: 10.1016/j.hrthm.2023.07.005] [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: 04/03/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND More than half of all sudden cardiac deaths (SCDs) are unwitnessed, but the composition of the unwitnessed SCD population is poorly described. OBJECTIVE The purpose of this study was to compare clinical and autopsy characteristics of young unwitnessed SCD subjects, based on the time from last contact to being found dead. METHODS All unwitnessed SCD subjects aged 1-35 years in Denmark from 2000-2014 identified through a multisource approach were included. Time from last seen alive to being found dead was dichotomized to <1 hour or 1-24 hours. Clinical characteristics and autopsy results were compared, and predictors of autopsy were assessed by logistic regression. RESULTS Of 440 unwitnessed SCD subjects, 366 (83%) had not been seen alive within 1 hour of being found dead. Comorbidities differed between the groups, with more epilepsy (17% vs 5%) and psychiatric diseases (13% vs 7%) in the 24-hour group. Patients in the 24-hour group died more frequently during sleep (64% vs 23%), the autopsy rate was higher (75% vs 61%), and deaths were more often unexplained after autopsy (69% vs 53%). Having been seen within 1 hour of death independently decreased the chance of being autopsied (odds ratio 0.51; 95% confidence interval 0.27-1.00; P = .0497). CONCLUSION The majority of unwitnessed SCD subjects had not been seen alive within 1 hour of being found dead. Clinical- and autopsy-related characteristics differed between the 2 groups. Differences were mainly attributable to death-related circumstances and comorbidities. Excluding SCD cases not seen alive within 1 hour of being found dead would severely underestimate the burden of SCD.
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Affiliation(s)
- Carl Johann Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Jesper Svane
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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24
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Pham HN, Sainbayar E, Ibrahim R, Lee JZ. Intracerebral hemorrhage mortality in individuals with atrial fibrillation: a nationwide analysis of mortality trends in the United States. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01674-x. [PMID: 37861964 DOI: 10.1007/s10840-023-01674-x] [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: 08/04/2023] [Accepted: 10/13/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is a risk factor for intracerebral hemorrhage (ICH), both with and without use of anticoagulation. Limited data exists on mortality trends and disparities related to this phenomenon. We aimed to assess ICH mortality trends and disparities based on demographic factors in individuals with atrial fibrillation in the United States (US). METHODS Our cross-sectional analysis utilized mortality data from the CDC database through death certificate queries from the years 1999 to 2020 in the US. We queried for all deaths with ICH as the underlying cause of death and atrial fibrillation as the multiple causes of death. Mortality data was obtained for overall population and demographic subpopulations based on sex, race and ethnicity, and geographic region. Trend analysis and average annual-mortality percentage change (AAPC) were completed using log-linear regression models. RESULTS ICH age-adjusted mortality rate (AAMR) in patients with AF increased from 0.27 (95% CI 0.25-0.29) in 1999 to 0.30 (95% CI 0.29-0.32) in 2020. A higher mortality rate was observed in males (AAMR 0.33) than in females (AAMR 0.26). The highest mortality was found in Asian/Pacific Islander (AAMR: 0.32) populations, followed by White (AAMR: 0.30), Black (AAMR: 0.15), and American Indian/Alaska Native (AAMR: 0.11) populations. Southern (AAPC: 1.3%) and non-metropolitan US regions (AAPC: + 1.9%) had the highest increase in annual mortality change. CONCLUSION Our findings highlight the disparities in ICH mortality in patients with AF. Further investigation is warranted to confirm these findings and evaluate for contributors to the observed disparities.
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Affiliation(s)
- Hoang Nhat Pham
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | | | - Ramzi Ibrahim
- Department of Medicine, University of Arizona Tucson, Tucson, Arizona, USA
| | - Justin Z Lee
- Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue J2-2, Cleveland, Ohio, USA.
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25
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Branch KR, Nguyen ML, Kudenchuk PJ, Johnson NJ. Head-to-pelvis CT imaging after sudden cardiac arrest: Current status and future directions. Resuscitation 2023; 191:109916. [PMID: 37506817 DOI: 10.1016/j.resuscitation.2023.109916] [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: 05/04/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023]
Abstract
Causes for sudden circulatory arrest (SCA) can vary widely making early treatment and triage decisions challenging. Additionally, cardiopulmonary resuscitation (CPR), while a life-saving link in the chain of survival, can be associated with traumatic injuries. Computed tomography (CT) can identify many causes of SCA as well as its sequelae. However, the diagnostic and therapeutic impact of CT in survivors of SCA has not been reviewed to date. This general review outlines the rationale and potential applications of focused head, chest, and abdomen/pelvis CT as well as comprehensive head-to-pelvis CT imaging after SCA. CT has a diagnostic yield approaching 30% to identify causes of SCA while the addition of ECG-gated chest CT provides further information about coronary anatomy and cardiac function. Risks of CT include radiation exposure, contrast-induced kidney injury, and incidental findings. This review's findings suggest that routine head-to-pelvis CT can yield clinically actional findings with the potential to improve clinical outcome after SCA that merits further investigation.
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Affiliation(s)
- Kelley R Branch
- Division of Cardiology, University of Washington, Seattle, WA, USA.
| | - My-Linh Nguyen
- Department of Internal Medicine, University of Washington, Seattle, WA, USA
| | | | - Nicholas J Johnson
- Department of Emergency Medicine, University of Washington, Seattle, WA, USA; Divsion of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, WA, USA
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26
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Chiu YW, Su MH, Lin YF, Chen CY, Chen TT, Wang SH. Causal influence of sleeping phenotypes on the risk of coronary artery disease and sudden cardiac arrest: A Mendelian randomization analysis. Sleep Health 2023; 9:726-732. [PMID: 37429813 DOI: 10.1016/j.sleh.2023.05.009] [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: 05/14/2022] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 07/12/2023]
Abstract
OBJECTIVES To assess the causal influence of sleep and circadian traits on coronary artery disease and sudden cardiac arrest with adjustment for obesity through a two-sample Mendelian randomization study. METHODS We used summary statistics of 5 sleep and circadian traits for genome-wide association studies, including chronotype, sleep duration, long sleep (≥9 h a day), short sleep (<7 h a day), and insomnia (sample size range: 237,622-651,295). Coronary artery disease genome-wide association studies with 60,801 cases and 123,504 controls, sudden cardiac arrest genome-wide association studies with 3939 cases and 25,989 controls, and obesity genome-wide association studies with 806,834 individuals were also used. Multivariable Mendelian randomization was performed to estimate the causality. RESULTS After adjusting for obesity, genetically predicted short sleep (odds ratio = 1.87 and p = .02), and genetically predicted insomnia (odds ratio = 1.17 and p = .001) were causally associated with increased odds of coronary artery disease. Genetically predicted long sleep (odds ratio = 0.06 and p = .02) and genetically predicted longer sleep duration (odds ratio = 0.36 for per-hour increase in sleep duration and p = .0006) were causally associated with decreased odds of sudden cardiac arrest. CONCLUSIONS The findings of this Mendelian randomization study indicate that insomnia and short sleep contribute to the development of coronary artery disease, whereas a longer sleep duration protects from sudden cardiac arrest, independent of the influence of obesity. The mechanisms underlying these associations warrant further investigation.
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Affiliation(s)
- Yen-Wei Chiu
- Department of Emergency Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Mei-Hsin Su
- College of Public Health, China Medical University, Taichung, Taiwan
| | - Yen-Feng Lin
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Chia-Yen Chen
- Biogen, Cambridge, MA, USA; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Tzu-Ting Chen
- Center for Neuropsychiatric Research, National Health Research Institutes, Miaoli, Taiwan
| | - Shi-Heng Wang
- College of Public Health, China Medical University, Taichung, Taiwan; National Center for Geriatrics and Welfare Research, National Health Research Institutes, Zhunan, Taiwan.
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27
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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28
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Barcella CA, Christensen DM, Idorn L, Mudalige N, Malmborg M, Folke F, Torp-Pedersen C, Gislason G, El-Chouli M. Outcomes of out-of-hospital cardiac arrest in adult congenital heart disease: a Danish nationwide study. Eur Heart J 2023; 44:3264-3274. [PMID: 37409410 DOI: 10.1093/eurheartj/ehad358] [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: 11/20/2022] [Revised: 03/20/2023] [Accepted: 04/18/2023] [Indexed: 07/07/2023] Open
Abstract
AIMS The risk, characteristics, and outcome of out-of-hospital cardiac arrest (OHCA) in patients with congenital heart disease (CHD) remain scarcely investigated. METHODS AND RESULTS An epidemiological registry-based study was conducted. Using time-dependent Cox regression models fitted with a nested case-control design, hazard ratios (HRs) with 95% confidence intervals of OHCA of presumed cardiac cause (2001-19) associated with simple, moderate, and severe CHD were calculated. Moreover, using multiple logistic regression, we investigated the association between pre-hospital OHCA characteristics and 30-day survival and compared 30-day survival in OHCA patients with and without CHD. Overall, 43 967 cases (105 with simple, 144 with moderate, and 53 with severe CHD) and 219 772 controls (median age 72 years, 68.2% male) were identified. Any type of CHD was found to be associated with higher rates of OHCA compared with the background population [simple CHD: HR 1.37 (1.08-1.70); moderate CHD: HR 1.64 (1.36-1.99); and severe CHD: HR 4.36 (3.01-6.30)]. Pre-hospital cardiopulmonary resuscitation and defibrillation were both associated with improved 30-day survival in patients with CHD, regardless of CHD severity. Among patients with OHCA, simple, moderate, and severe CHD had a similar likelihood of 30-day survival compared with no CHD [odds ratio 0.95 (0.53-1.69), 0.70 (0.43-1.14), and 0.68 (0.33-1.57), respectively]. CONCLUSION A higher risk of OHCA was found throughout the spectrum of CHD. Patients with and without CHD showed the same 30-day survival, which relies on the pre-hospital chain of survival, namely cardiopulmonary resuscitation and defibrillation.
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Affiliation(s)
- Carlo Alberto Barcella
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Department of Internal Medicine, Nykøbing Falster Hospital, Fjordvej 15, 4800 Nykøbing Falster, Denmark
| | | | - Lars Idorn
- Department of Pediatric Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Nishan Mudalige
- Health Systems Intelligence Unit, Data Analytics, Reporting and Evaluation, Provincial Health Services Authority, British Columbia, Canada
| | - Morten Malmborg
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Frederik Folke
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- Emergency Medical Services: The Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
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29
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Stanasiuk C, Milting H, Homm S, Persson J, Holtz L, Wittmer A, Fox H, Laser T, Knöll R, Pohl GM, Paluszkiewicz L, Jakob T, Bachmann-Mennenga B, Henzler D, Grautoff S, Veit G, Klingel K, Hori E, Kellner U, Karger B, Schlepper S, Pfeiffer H, Gummert J, Gärtner A, Tiesmeier J. Blood taken immediately after fatal resuscitation attempts yields higher quality DNA for genetic studies as compared to autopsy samples. Int J Legal Med 2023; 137:1569-1581. [PMID: 36773088 PMCID: PMC10421769 DOI: 10.1007/s00414-023-02966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND The out-of-hospital cardiac arrest (OHCA) in the young may be associated with a genetic predisposition which is relevant even for genetic counseling of relatives. The identification of genetic variants depends on the availability of intact genomic DNA. DNA from autopsy may be not available due to low autopsy frequencies or not suitable for high-throughput DNA sequencing (NGS). The emergency medical service (EMS) plays an important role to save biomaterial for subsequent molecular autopsy. It is not known whether the DNA integrity of samples collected by the EMS is better suited for NGS than autopsy specimens. MATERIAL AND METHODS DNA integrity was analyzed by standardized protocols. Fourteen blood samples collected by the EMS and biomaterials from autopsy were compared. We collected 172 autopsy samples from different tissues and blood with postmortem intervals of 14-168 h. For comparison, DNA integrity derived from blood stored under experimental conditions was checked against autopsy blood after different time intervals. RESULTS DNA integrity and extraction yield were higher in EMS blood compared to any autopsy tissue. DNA stability in autopsy specimens was highly variable and had unpredictable quality. In contrast, collecting blood samples by the EMS is feasible and delivered comparably the highest DNA integrity. CONCLUSIONS Isolation yield and DNA integrity from blood samples collected by the EMS is superior in comparison to autopsy specimens. DNA from blood samples collected by the EMS on scene is stable at room temperature or even for days at 4 °C. We conclude that the EMS personnel should always save a blood sample of young fatal OHCA cases died on scene to enable subsequent genetic analysis.
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Affiliation(s)
- Caroline Stanasiuk
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany.
| | - Sören Homm
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Jan Persson
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Lars Holtz
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Axel Wittmer
- Institute for Pathology, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Fox
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thorsten Laser
- Center for Congenital Heart Diseases, Heart and Diabetes Center NRW, 32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Ralph Knöll
- Karolinska Institute, University Hospital, Myocardial Genetic, 14157, Huddinge, Sweden
| | - Greta Marie Pohl
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Lech Paluszkiewicz
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Thomas Jakob
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
- Present address: Clinic for Anesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Medicine, Bielefeld Hospital, University Hospital Eastern Westphalia-Lippe, Bielefeld University, Bielefeld, Germany
| | - Bernd Bachmann-Mennenga
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Henzler
- Intensive Care and Emergency Medicine, Herford Hospital, Campus OWL, Ruhr-University Bochum, University Clinic for Anesthesiology, Bochum, Germany
| | - Steffen Grautoff
- Emergency Department, Herford Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Gunter Veit
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Johannes Wesling Hospital Minden, MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Karin Klingel
- Institute for Pathology and Neuropathology, University Hospital Tuebingen, D-72076, Tuebingen, Germany
| | - Erika Hori
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Udo Kellner
- Institute for Pathology, Johannes Wesling Hospital Minden, MKK-Hospital, D-32429 Minden, Campus OWL, Ruhr-University Bochum, Bochum, Germany
| | - Bernd Karger
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Stefanie Schlepper
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Heidi Pfeiffer
- Institute for Forensic Medicine, University Hospital, Wilhelms-University Muenster, Muenster, Germany
| | - Jan Gummert
- Clinic for Thoracic and Cardiovascular Surgery, Heart- and Diabetes Center NRW, D-32545 Bad Oeynhausen, University Hospital of the Ruhr-University Bochum, Bochum, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
| | - Jens Tiesmeier
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development, Heart- and Diabetes Center NRW, University Hospital of the Ruhr-University Bochum, Georgstr. 11, D-32545, Bad Oeynhausen, Germany
- Institute for Anesthesiology, Intensive Care- and Emergency Medicine, Luebbecke MKK-Hospital, Campus OWL, Ruhr-University Bochum, Bochum, Germany
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30
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Leslie F, Avis SR, Bagnall RD, Bendall J, Briffa T, Brouwer I, Butters A, Figtree GA, La Gerche A, Gray B, Nedkoff L, Page G, Paratz E, Semsarian C, Sy RW, du Toit-Prinsloo L, Yeates L, Sweeting J, Ingles J. The New South Wales Sudden Cardiac Arrest Registry: A Data Linkage Cohort Study. Heart Lung Circ 2023; 32:1069-1075. [PMID: 37419791 DOI: 10.1016/j.hlc.2023.06.573] [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: 12/23/2022] [Revised: 05/04/2023] [Accepted: 06/18/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Sudden cardiac arrest (SCA) in young people aged 1 to 50 years often occurs with no presenting symptoms or risk factors prompting screening for cardiovascular disease prior to their cardiac arrest. Approximately 3,000 young Australians suffer from sudden cardiac death (SCD) each year, making this a major public health issue. However, there is significant variation in the way incidence is estimated resulting in discrepancy across reporting which impacts our ability to understand and prevent these devastating events. We describe the New South Wales (NSW) Sudden Cardiac Arrest Registry: a retrospective, data linkage study which will identify all SCAs in the young in NSW from 2009 through to June 2022. OBJECTIVE To determine the incidence, demographic characteristics and causes of SCA in young people. We will develop an NSW-based registry that will contribute to a greater understanding of SCA including risk factors and outcomes. METHODS The cohort will include all people who experience a SCA in the NSW community aged between 1 to 50 years. Cases will be identified using the following three datasets: the Out of Hospital Cardiac Arrest Register housed at NSW Ambulance, the NSW Emergency Department Data Collection, and the National Coronial Information System. Data from eight datasets will be collected, anonymised and linked for the entire cohort. Analysis will be undertaken and reported using descriptive statistics. CONCLUSIONS The NSW SCA registry will be an important resource for the improved understanding of SCA and inform the widespread impacts it has on individuals, their families and society.
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Affiliation(s)
- Felicity Leslie
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Suzanne R Avis
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia; Tasmanian School of Medicine, University of Tasmania, Hobart, Tas, Australia
| | - Richard D Bagnall
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
| | - Jason Bendall
- Clinical Systems, NSW Ambulance, Sydney, NSW, Australia; Department of Rural Health, The University of Newcastle, Newcastle, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Isabel Brouwer
- Forensic Medicine, Forensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia
| | - Alexandra Butters
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Gemma A Figtree
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Cardiovascular Discovery Group, Kolling Institute of Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, Melbourne, Vic, Australia
| | - Belinda Gray
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lee Nedkoff
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
| | | | | | - Christopher Semsarian
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Lorraine du Toit-Prinsloo
- Forensic Medicine, Forensic and Analytical Science Service, NSW Health Pathology, Sydney, NSW, Australia
| | - Laura Yeates
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joanna Sweeting
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia; Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, Vic, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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31
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Zaveri S, Qu YS, Chahine M, Boutjdir M. Ethnic and racial differences in Asian populations with ion channelopathies associated with sudden cardiac death. Front Cardiovasc Med 2023; 10:1253479. [PMID: 37600027 PMCID: PMC10436680 DOI: 10.3389/fcvm.2023.1253479] [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: 07/05/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
Cardiovascular diseases are associated with several morbidities and are the most common cause of worldwide disease-related fatalities. Studies show that treatment and outcome-related differences for cardiovascular diseases disproportionately affect minorities in the United States. The emergence of ethnic and racial differences in sudden cardiac death (SCD) and related ion channelopathies complicates cardiovascular disease prevention, diagnosis, management, prognosis, and treatment objectives for patients and physicians alike. This review compiles and synthesizes current research in cardiac ion channelopathies and genetic disorders in Asian populations, an underrepresented population in cardiovascular literature. We first present a brief introduction to SCD, noting relevant observations and statistics from around the world, including Asian populations. We then examined existing differences between Asian and White populations in research, treatment, and outcomes related to cardiac ion channelopathies and SCD, showing progression in thought and research over time for each ion channelopathy. The review also identifies research that explored phenotypic abnormalities, device usage, and risk of death in Asian patients. We touch upon the unique genetic risk factors in Asian populations that lead to cardiac ion channelopathies and SCD while comparing them to White and Western populations, particularly in the United States, where Asians comprise approximately 7% of the total population. We also propose potential solutions such as improving early genetic screening, addressing barriers affecting access to medical care and device utilization, physician training, and patient education on risks.
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Affiliation(s)
- Sahil Zaveri
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
| | - Yongxia Sarah Qu
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Department of Cardiology, New York Presbyterian Brooklyn Methodist Hospital, New York, NY, United States
| | - Mohamed Chahine
- CERVO Brain Research Center, Institut Universitaire en Santé Mentale de Québec, Québec, QC, Canada
- Department of Medicine, Faculté de Médecine, Université Laval, Quebec, QC, Canada
| | - Mohamed Boutjdir
- Department of Medicine, Cell Biology, and Pharmacology, State University of New York Downstate Health Sciences University, Brooklyn, NY, United States
- Cardiovascular Research Program, VA New York Harbor Healthcare System, New York, NY, United States
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, NY, United States
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32
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Wojcik MH, Poduri AH, Holm IA, MacRae CA, Goldstein RD. The fundamental need for unifying phenotypes in sudden unexpected pediatric deaths. Front Med (Lausanne) 2023; 10:1166188. [PMID: 37332751 PMCID: PMC10273404 DOI: 10.3389/fmed.2023.1166188] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/03/2023] [Indexed: 06/20/2023] Open
Abstract
A definitive, authoritative approach to evaluate the causes of unexpected, and ultimately unexplained, pediatric deaths remains elusive, relegating final conclusions to diagnoses of exclusion in the vast majority of cases. Research into unexplained pediatric deaths has focused primarily on sudden infant deaths (under 1 year of age) and led to the identification of several potential, albeit incompletely understood, contributory factors: nonspecific pathology findings, associations with sleep position and environment that may not be uniformly relevant, and the elucidation of a role for serotonin that is practically difficult to estimate in any individual case. Any assessment of progress in this field must also acknowledge the failure of current approaches to substantially decrease mortality rates in decades. Furthermore, potential commonalities with pediatric deaths across a broader age spectrum have not been widely considered. Recent epilepsy-related observations and genetic findings, identified post-mortem in both infants and children who died suddenly and unexpectedly, suggest a role for more intense and specific phenotyping efforts as well as an expanded role for genetic and genomic evaluation. We therefore present a new approach to reframe the phenotype in sudden unexplained deaths in the pediatric age range, collapsing many distinctions based on arbitrary factors (such as age) that have previously guided research in this area, and discuss its implications for the future of postmortem investigation.
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Affiliation(s)
- Monica H. Wojcik
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Annapurna H. Poduri
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- F.M. Kirby Neurobiology Center, Boston Children's Hospital, Boston, MA, United States
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, MA, United States
| | - Ingrid A. Holm
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Division of Genetics and Genomics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Calum A. MacRae
- Harvard Medical School, Boston, MA, United States
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, United States
| | - Richard D. Goldstein
- Robert’s Program for Sudden Unexpected Death in Pediatrics, Boston Children’s Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, Boston, MA, United States
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33
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Younis A, Wilkoff BL. Implantable Cardioverter-Defibrillator for Primary Prevention in Asia. JACC. ASIA 2023; 3:321-334. [PMID: 37323870 PMCID: PMC10261897 DOI: 10.1016/j.jacasi.2022.11.014] [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: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
In a contemporary setting, where the risk of sudden cardiac death (SCD) is low, heart failure management is improved, and technology is advanced, identifying the patients who would benefit the most from an implantable cardioverter-defibrillator (ICD) treatment for primary prevention remains a challenge. The prevalence of SCD is lower in Asia when compared with the United States/Europe (35-45 per 100,000 person-years vs 55-100 per 100,000 person-years, respectively). Nevertheless, this should not explain the enormous gap in ICD's utilization among eligible candidates (∼12% in Asia vs ∼45% in the United States/Europe). The disparity between Asia and Western countries, together with significant variation among the Asian population and the previously mentioned challenges, requires an individualized approach and specific regional recommendation, especially in countries with limited resources where ICDs are being extremely underutilized This review focuses on the current knowledge of ICD therapy for SCD prevention and how to improve patient and device selection.
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Affiliation(s)
| | - Bruce L. Wilkoff
- Address for correspondence: Dr Bruce L. Wilkoff, Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Desk J2-2, Cleveland, Ohio 44195, USA. @BruceWilkoff
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34
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Ueda N, Noda T, Kusano K, Yasuda S, Kurita T, Shimizu W. Use of Implantable Cardioverter-Defibrillators for Primary Prevention of Sudden Cardiac Death in Asia. JACC. ASIA 2023; 3:335-345. [PMID: 37323866 PMCID: PMC10261895 DOI: 10.1016/j.jacasi.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/13/2023] [Indexed: 06/17/2023]
Abstract
The effectiveness of primary prevention implantable cardioverter-defibrillators (ICDs) is well established. However, there are several unsolved problems related to ICD use for primary prevention in Asia, including ICD underuse, population differences in underlying heart disease, and the rate of appropriate ICD therapy compared with Western countries. Although the prevalence of ischemic cardiomyopathy in Asia is lower than in Europe and the United States, the mortality rate of Asian patients with ischemic heart disease has been increasing recently. As for the use of ICDs for primary prevention, there have been no randomized clinical trials, and limited data are available in Asia. This review focuses on the unmet needs related to ICD use for primary prevention in Asia.
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Affiliation(s)
- Nobuhiko Ueda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kurita
- Department of Internal Medicine, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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35
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Holmström L, Zhang FZ, Ouyang D, Dey D, Slomka PJ, Chugh SS. Artificial Intelligence in Ventricular Arrhythmias and Sudden Death. Arrhythm Electrophysiol Rev 2023; 12:e17. [PMID: 37457439 PMCID: PMC10345967 DOI: 10.15420/aer.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 03/16/2023] [Indexed: 07/18/2023] Open
Abstract
Sudden cardiac arrest due to lethal ventricular arrhythmias is a major cause of mortality worldwide and results in more years of potential life lost than any individual cancer. Most of these sudden cardiac arrest events occur unexpectedly in individuals who have not been identified as high-risk due to the inadequacy of current risk stratification tools. Artificial intelligence tools are increasingly being used to solve complex problems and are poised to help with this major unmet need in the field of clinical electrophysiology. By leveraging large and detailed datasets, artificial intelligence-based prediction models have the potential to enhance the risk stratification of lethal ventricular arrhythmias. This review presents a synthesis of the published literature and a discussion of future directions in this field.
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Affiliation(s)
- Lauri Holmström
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Frank Zijun Zhang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - David Ouyang
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Damini Dey
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Piotr J Slomka
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
| | - Sumeet S Chugh
- Division of Artificial Intelligence in Medicine, Department of Medicine, Cedars-Sinai Health System, Los Angeles, CA, US
- Center for Cardiac Arrest Prevention, Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, US
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Tastet L, Ramakrishna S, Lim LJ, Bibby D, Olgin JE, Connolly AJ, Moffatt E, Tseng ZH, Delling FN. Mechanical Dispersion Discriminates between Arrhythmic and Non-Arrhythmic Sudden Death: From the POST SCD Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.05.22.23290353. [PMID: 37293041 PMCID: PMC10246127 DOI: 10.1101/2023.05.22.23290353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Global longitudinal strain (GLS) and mechanical dispersion (MD) by speckle-tracking echocardiography can predict sudden cardiac death (SCD) beyond left ventricular ejection fraction (LVEF) alone. However, prior studies have presumed cardiac cause from EMS records or death certificates rather than gold-standard autopsies. Objectives We sought to investigate whether abnormal GLS and MD, reflective of underlying myocardial fibrosis, are associated with autopsy-defined sudden arrhythmic death (SAD) in a comprehensive postmortem study. Methods We identified and autopsied all World Health Organization-defined (presumed) SCDs ages 18-90 via active surveillance of out of hospital deaths in the ongoing San Francisco POstmortem Systematic InvesTigation of Sudden Cardiac Death (POST SCD) Study to refine presumed SCDs to true cardiac causes. We retrieved all available pre-mortem echocardiograms and assessed LVEF, LV-GLS, and MD. The extent of LV myocardial fibrosis was assessed and quantified histologically. Results Of 652 autopsied subjects, 65 (10%) had echocardiograms available for primary review, obtained at a mean 1.5 years before SCD. Of these, 37 (56%) were SADs and 29 (44%) were non-SADs; fibrosis was quantified in 38 (58%). SADs were predominantly male, but had similar age, race, baseline comorbidities, and LVEF compared to non-SADs (all p>0.05). SADs had significantly reduced LV-GLS (median: -11.4% versus -18.5%, p=0.008) and increased MD (median: 14.8 ms versus 9.4 ms, p=0.006) compared to non-SADs. MD was associated with total LV fibrosis by linear regression in SADs (r=0.58, p=0.002). Conclusion In this countywide postmortem study of all sudden deaths, autopsy-confirmed arrhythmic deaths had significantly lower LV-GLS and increased MD than non-arrhythmic sudden deaths. Increased MD correlated with higher histologic levels of LV fibrosis in SADs. These findings suggest that increased MD, which is a surrogate for the extent of myocardial fibrosis, may improve risk stratification and specification for SAD beyond LVEF. PERSPECTIVES Competency in medical knowledge: Mechanical dispersion derived from speckle tracking echocardiography provides better discrimination between autopsy-defined arrhythmic vs non-arrhythmic sudden death than LVEF or LV-GLS. Histological ventricular fibrosis correlates with increased mechanical dispersion in SAD.Translational outlook: Speckle tracking echocardiography parameters, in particular mechanical dispersion, may be considered as a non-invasive surrogate marker for myocardial fibrosis and risk stratification in SCD.
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Goldsmith ES, Krebs EE, Ramirez MR, MacLehose RF. Opioid-related Mortality in United States Death Certificate Data: A Quantitative Bias Analysis With Expert Elicitation of Bias Parameters. Epidemiology 2023; 34:421-429. [PMID: 36735892 DOI: 10.1097/ede.0000000000001600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Opioid-related mortality is an important public health problem in the United States. Incidence estimates rely on death certificate data generated by health care providers and medical examiners. Opioid overdoses may be underreported when other causes of death appear plausible. We applied physician-elicited death certificate bias parameters to quantitative bias analyses assessing potential age-related differential misclassification in US opioid-related mortality estimates. METHODS We obtained cause-of-death data (US, 2017) from the National Center for Health Statistics and calculated crude opioid-related outpatient death counts by age category (25-54, 55-64, 65+). We elicited beliefs from 10 primary care physicians on sensitivity of opioid-related death classification from death certificates. We summarized elicited sensitivity estimates, calculated plausible specificity values, and applied resulting parameters in a probabilistic bias analysis. RESULTS Physicians estimated wide sensitivity ranges for classification of opioid-related mortality by death certificates, with lower estimated sensitivities among older age groups. Probabilistic bias analyses adjusting for physician-estimated misclassification indicated 3.1 times more (95% uncertainty interval: 1.2-23.5) opioid-related deaths than the observed death count in the 65+ age group. All age groups had substantial increases in bias-adjusted death counts. CONCLUSIONS We developed and implemented a feasible method of eliciting physician expert opinion on bias parameters for sensitivity of a medical record-based death indicator and applied findings in quantitative bias analyses adjusting for differential misclassification. Our findings are consistent with the hypothesis that opioid-related mortality rates may be substantially underestimated, particularly among older adults, due to misclassification in cause-of-death data from death certificates.
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Affiliation(s)
- Elizabeth S Goldsmith
- Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis Veterans Affairs Health Care System
- Department of Medicine, University of Minnesota Medical School
| | - Erin E Krebs
- Center for Care Delivery and Outcomes Research (CCDOR), Minneapolis Veterans Affairs Health Care System
- Department of Medicine, University of Minnesota Medical School
| | - Marizen R Ramirez
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota
| | - Richard F MacLehose
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota
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R. H. Branch K, Gatewood MO, Kudenchuk PJ, Maynard C, Sayre MR, Carlbom DJ, Edwards RM, Counts CR, Probstfield JL, Brusen R, Johnson N, Gunn ML. Diagnostic Yield, Safety, and Outcomes of Head-to-Pelvis Sudden Death CT Imaging in Post Arrest Care: The CT FIRST Cohort Study. Resuscitation 2023:109785. [PMID: 37019352 DOI: 10.1016/j.resuscitation.2023.109785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/08/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023]
Abstract
AIM Our aim was to test whether a head-to-pelvis CT scan improves diagnostic yield and speed to identify causes for out of hospital circulatory arrest (OHCA). METHODS CT FIRST was a prospective observational pre-/post-cohort study of patients successfully resuscitated from OHCA. Inclusion criteria included unknown cause for arrest, age>18 years, stability to undergo CT, and no known cardiomyopathy or obstructive coronary artery disease. A head-to-pelvis sudden death CT (SDCT) scan within 6 hours of hospital arrival was added to the standard of care for patients resuscitated from OHCA (post-cohort) and compared to standard of care (SOC) alone (pre-cohort). The primary outcome was SDCT diagnostic yield. Secondary outcomes included time to identifying OHCA cause and time-critical diagnoses, SDCT safety, and survival to hospital discharge. RESULTS Baseline characteristics between the SDCT (N=104) and the SOC (N=143) cohorts were similar. CT scans (either head, chest, and/or abdomen) were ordered in 74 (52%) of SOC patients. Adding SDCT scanning identified 92% of causes for arrest compared to 75% (SOC-cohort; p value <0.001) and reduced the time to diagnosis by 78% (SDCT 3.1 hours, SOC alone 14.1 hours, p <0.0001). Identification of critical diagnoses was similar between cohorts, but SDCT reduced delayed (>6 hours) identification of critical diagnoses by 81% (p<0.001). SDCT safety endpoints were similar including acute kidney injury. Patient survival to discharge was similar between cohorts. DISCUSSION SDCT scanning early after OHCA resuscitation safely improved the efficiency and diagnostic yield for causes of arrest compared to the standard of care alone. CLINICAL TRIALS NUMBER NCT03111043.
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Parthiban N, Sani H. Sudden cardiac arrest in a patient with malignant mitral valve prolapse with CACNB2 gene mutation: a simple coincidence or coexistence?-a case report. Eur Heart J Case Rep 2023; 7:ytad196. [PMID: 37123658 PMCID: PMC10141575 DOI: 10.1093/ehjcr/ytad196] [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: 09/21/2022] [Revised: 10/26/2022] [Accepted: 04/14/2023] [Indexed: 05/02/2023]
Abstract
Background Despite recent advances in cardiology, sudden cardiac death remains to be a significant challenge, and the precise cause for a large proportion of sudden cardiac arrests remains unclear. Case summary A 48-year-old fit and healthy medical personnel with no previous medical illness suffered from ventricular fibrillation at his workplace and was successfully resuscitated. Although the basal electrocardiogram did not show a Brugada pattern, we identified mutations in the CACNB2 genes (Chr10: 18150879 and Chr10: 18539538 variants), which are pathogenic variants linked to the Brugada syndrome. A transthoracic echocardiogram and cardiac magnetic resonance revealed mitral valve prolapse (MVP) with characteristics of Barlow's disease, as well as malignant MVP features such as the presence of bileaflet prolapse, mitral annular disjunction, and inferior and inferolateral left ventricular wall fibrosis. Discussion To the best of our knowledge, this is the first case report on sudden cardiac arrest in a patient with malignant MVP with a CACNB2 gene mutation. This study highlights the merit for further research to establish standardized criteria for the diagnosis of malignant MVP, for the primary prevention of sudden cardiac death. Cardiac MR should also be part of the diagnostic evaluation of MVP to allow for the early detection of arrhythmogenic features, especially left ventricular fibrosis. We also suggest that the utility of genetic testing should be complementary to the current diagnostic tools for unexplained cardiac arrest and patients with MVP. This would help to better understand the genetic basis between these two conditions for better risk stratification and early cardiac intervention.
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Yoshimura S, Kiguchi T, Irisawa T, Yamada T, Yoshiya K, Park C, Nishimura T, Ishibe T, Kobata H, Kishimoto M, Kim SH, Ito Y, Sogabe T, Morooka T, Sakamoto H, Suzuki K, Onoe A, Matsuyama T, Matsui S, Nishioka N, Okada Y, Makino Y, Kimata S, Kawai S, Zha L, Kiyohara K, Kitamura T, Iwami T. Diagnostic test accuracy of life-threatening electrocardiographic findings (ST-elevation myocardial infarction equivalents) for acute coronary syndrome after out-of-hospital cardiac arrest without ST-segment elevation. Resuscitation 2023; 184:109700. [PMID: 36702338 DOI: 10.1016/j.resuscitation.2023.109700] [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: 10/28/2022] [Revised: 01/04/2023] [Accepted: 01/15/2023] [Indexed: 01/25/2023]
Abstract
AIM Life-threatening electrocardiographic (ECG) findings aid in the diagnosis of acute coronary syndrome (ACS), which has not been well-evaluated in patients with out-of-hospital cardiac arrest (OHCA). This study aimed to evaluate the diagnostic test accuracy (DTA) of ST-elevation myocardial infarction (STEMI) equivalents following the return of spontaneous circulation (ROSC) in patients with OHCA to identify patients with ACS. METHODS Using the database of the Comprehensive Registry of In-Hospital Intensive Care for OHCA Survival study from 2012 to 2017, patients aged ≥18 years with non-traumatic OHCA and ventricular fibrillation or pulseless ventricular tachycardia on the arrival of emergency medical service personnel or arrival at the emergency department, who achieved ROSC, were included. Patients without ST-segment elevation or complete left bundle branch block on ECG and those who did not undergo ECG or coronary angiography, were excluded from the study. We evaluated the DTA of STEMI equivalents for the diagnosis of ACS: isolated T-wave inversion, ST-segment depression, Wellens' signs, and ST-segment elevation in lead aVR. RESULTS Isolated T-wave inversion and Wellens' signs had high specificity for ACS with 0.95 (95% confidence interval [CI], 0.87-0.99) and 0.92 (95% CI, 0.82-0.97), respectively, but their positive likelihood ratios were low, with a wide range of 95% CI: 1.89 (95% CI, 0.51-7.02) and 0.81 (95% CI, 0.25-2.68), respectively. CONCLUSION The DTA of STEMI equivalents for the diagnosis of ACS was low among patients with OHCA. Further investigation considering the measurement timing of the ECG after ROSC is required.
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Affiliation(s)
- Satoshi Yoshimura
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeyuki Kiguchi
- Critical Care and Trauma Centre, Osaka General Medical Centre, Osaka, Japan
| | - Taro Irisawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoki Yamada
- Emergency and Critical Care Medical Centre, Osaka Police Hospital, Osaka, Japan
| | - Kazuhisa Yoshiya
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Takii Hospital, Moriguchi, Japan
| | - Changhwi Park
- Department of Emergency Medicine, Tane General Hospital, Osaka, Japan
| | - Tetsuro Nishimura
- Department of Critical Care Medicine, Osaka City University, Osaka, Japan
| | - Takuya Ishibe
- Department of Emergency and Critical Care Medicine, Kindai University School of Medicine, Osaka-Sayama, Japan
| | - Hitoshi Kobata
- Osaka Mishima Emergency Critical Care Centre, Takatsuki, Japan
| | - Masafumi Kishimoto
- Osaka Prefectural Nakakawachi Medical Centre of Acute Medicine, Higashi-Osaka, Japan
| | - Sung-Ho Kim
- Senshu Trauma and Critical Care Centre, Osaka, Japan
| | - Yusuke Ito
- Senri Critical Care Medical Centre, Saiseikai Senri Hospital, Suita, Japan
| | - Taku Sogabe
- Traumatology and Critical Care Medical Centre, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takaya Morooka
- Emergency and Critical Care Medical Centre, Osaka City General Hospital, Osaka, Japan
| | - Haruko Sakamoto
- Department of Pediatrics, Osaka Red Cross Hospital, Osaka, Japan
| | - Keitaro Suzuki
- Emergency and Critical Care Medical Centre, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Atsunori Onoe
- Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Norihiro Nishioka
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Yohei Okada
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan; Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Yuto Makino
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kimata
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Shunsuke Kawai
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, Tokyo, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taku Iwami
- Department of Preventive Services, Kyoto University School of Public Health, Kyoto, Japan.
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Kolk MZH, Deb B, Ruipérez-Campillo S, Bhatia NK, Clopton P, Wilde AAM, Narayan SM, Knops RE, Tjong FVY. Machine learning of electrophysiological signals for the prediction of ventricular arrhythmias: systematic review and examination of heterogeneity between studies. EBioMedicine 2023; 89:104462. [PMID: 36773349 PMCID: PMC9945642 DOI: 10.1016/j.ebiom.2023.104462] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/19/2023] [Accepted: 01/19/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Ventricular arrhythmia (VA) precipitating sudden cardiac arrest (SCD) is among the most frequent causes of death and pose a high burden on public health systems worldwide. The increasing availability of electrophysiological signals collected through conventional methods (e.g. electrocardiography (ECG)) and digital health technologies (e.g. wearable devices) in combination with novel predictive analytics using machine learning (ML) and deep learning (DL) hold potential for personalised predictions of arrhythmic events. METHODS This systematic review and exploratory meta-analysis assesses the state-of-the-art of ML/DL models of electrophysiological signals for personalised prediction of malignant VA or SCD, and studies potential causes of bias (PROSPERO, reference: CRD42021283464). Five electronic databases were searched to identify eligible studies. Pooled estimates of the diagnostic odds ratio (DOR) and summary area under the curve (AUROC) were calculated. Meta-analyses were performed separately for studies using publicly available, ad-hoc datasets, versus targeted clinical data acquisition. Studies were scored on risk of bias by the PROBAST tool. FINDINGS 2194 studies were identified of which 46 were included in the systematic review and 32 in the meta-analysis. Pooling of individual models demonstrated a summary AUROC of 0.856 (95% CI 0.755-0.909) for short-term (time-to-event up to 72 h) prediction and AUROC of 0.876 (95% CI 0.642-0.980) for long-term prediction (time-to-event up to years). While models developed on ad-hoc sets had higher pooled performance (AUROC 0.919, 95% CI 0.867-0.952), they had a high risk of bias related to the re-use and overlap of small ad-hoc datasets, choices of ML tool and a lack of external model validation. INTERPRETATION ML and DL models appear to accurately predict malignant VA and SCD. However, wide heterogeneity between studies, in part due to small ad-hoc datasets and choice of ML model, may reduce the ability to generalise and should be addressed in future studies. FUNDING This publication is part of the project DEEP RISK ICD (with project number 452019308) of the research programme Rubicon which is (partly) financed by the Dutch Research Council (NWO). This research is partly funded by the Amsterdam Cardiovascular Sciences (personal grant F.V.Y.T).
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Affiliation(s)
- Maarten Z H Kolk
- Amsterdam UMC Location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Brototo Deb
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | | | - Neil K Bhatia
- Department of Cardiology, Emory University, Atlanta, GA, USA
| | - Paul Clopton
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Arthur A M Wilde
- Amsterdam UMC Location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Sanjiv M Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, USA
| | - Reinoud E Knops
- Amsterdam UMC Location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Fleur V Y Tjong
- Amsterdam UMC Location University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
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Tsao CW, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Beaton AZ, Boehme AK, Buxton AE, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Fugar S, Generoso G, Heard DG, Hiremath S, Ho JE, Kalani R, Kazi DS, Ko D, Levine DA, Liu J, Ma J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Virani SS, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2023 Update: A Report From the American Heart Association. Circulation 2023; 147:e93-e621. [PMID: 36695182 DOI: 10.1161/cir.0000000000001123] [Citation(s) in RCA: 1169] [Impact Index Per Article: 1169.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2023 Statistical Update is the product of a full year's worth of effort in 2022 by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. The American Heart Association strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional COVID-19 (coronavirus disease 2019) publications, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Tie J, Takanari H, Ota K, Okuda T. Role of miR-143 and miR-146 in Risk Evaluation of Coronary Artery Diseases in Autopsied Samples. Genes (Basel) 2023; 14:471. [PMID: 36833398 PMCID: PMC9956587 DOI: 10.3390/genes14020471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/05/2023] [Accepted: 02/10/2023] [Indexed: 02/15/2023] Open
Abstract
Coronary artery disease (CAD) is a common and fatal cardiovascular disease. Among known CAD risk factors, miRNA polymorphisms, such as Has-miR-143 (rs41291957 C>G) and Has-miR-146a (rs2910164 G>A), have emerged as important genetic markers of CAD. Despite many genetic association studies in multiple populations, no study assessing the association between CAD risk and SNPs of miR-143 and miR-146 was documented in the Japanese people. Therefore, using the TaqMan SNP assay, we investigated two SNP genotypes in 151 subjects with forensic autopsy-proven CAD. After pathological observation, we used ImageJ software to assess the degree of coronary artery atresia. Moreover, the genotypes and miRNA content of the two groups of samples with atresia <10% and >10% were analyzed. The results showed that the CC genotype of rs2910164 was more frequent in patients with CAD than in controls, which was associated with the risk of CAD in the study population. However, Has-miR-143 rs41291957 genotype did not show a clear correlation with the risk of CAD.
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Affiliation(s)
- Jian Tie
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Hiroki Takanari
- Department of Interdisciplinary Research for Medicine and Photonics, Institute of Post-LED, Tokushima 7700814, Japan
| | - Koya Ota
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
| | - Takahisa Okuda
- Department of Legal Medicine, Nihon University School of Medicine, Tokyo 1738610, Japan
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Braund S, Leviel J, Morau E, Deneux-Tharaux C, Verspyck E. Maternal sudden death: A nationwide retrospective study. BJOG 2023; 130:257-263. [PMID: 36156354 PMCID: PMC10092016 DOI: 10.1111/1471-0528.17294] [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: 06/07/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the prevalence of maternal sudden death (MSD) and to compare the characteristics of death between women with explained and unexplained sudden death. DESIGN A national retrospective study in France. POPULATION Maternal deaths related to an unexpected sudden cardiac arrest were extracted from the French National Confidential Enquiry into Maternal Deaths database for 2007-2012. METHODS Maternal, pregnancy, sudden death characteristics and maternal investigations were compared between women with explained and unexplained cause of death. RESULTS A total of 83 maternal sudden deaths and 4 949 890 live births occurred over the period studied, thus accounting for 16% of all maternal deaths (n = 510). Death was explained in 51 (61%) women and unexplained in 32 women (39%). Compared with women with unexplained death, women with explained death were more often found to have in-hospital cardiac arrest (47% versus 12%, P < 0.01), witnessed cardiac arrest (86% versus 62%, P = 0.03) and in-hospital death (82% versus 47%, P < 0.01). Postmortem investigations such as autopsy and/or CT scan (65% versus 31%, P < 0.01) were also more often carried out in women with explained death. The proportion of deaths for which the preventability factors could not be assessed was 58% among unexplained MSD and 7% among explained MSD. CONCLUSION Maternal sudden death is a rare event but accounts for a high proportion of all maternal deaths. This highlights the importance of providing training in diagnostic and management strategy for care providers. Systematic postmortem investigations are required to help understand causes and improve practices.
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Affiliation(s)
- Sophia Braund
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
| | - Juliette Leviel
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France.,Department of Gynaecology and Obstetrics, Hospital center Eure Seine, Evreux, France
| | - Estelle Morau
- Department of Anaesthetics, Nîmes University Hospital, Nîmes, France
| | - Catherine Deneux-Tharaux
- Centre for Research in Epidemiology and Statistics (CRESS), Université Paris Cité, INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology (EPOPé) Research Team, Paris, France
| | - Eric Verspyck
- Department of Gynaecology and Obstetrics, Rouen University Hospital, Rouen, France
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Wong CX, Tu SJ, Marcus GM. Alcohol and Arrhythmias. JACC Clin Electrophysiol 2023; 9:266-279. [PMID: 36858701 DOI: 10.1016/j.jacep.2022.10.023] [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: 09/08/2022] [Accepted: 10/12/2022] [Indexed: 03/03/2023]
Abstract
The association between alcohol consumption and abnormalities of heart rate and rhythm has long been recognized. Significant attention has focused on the risk of atrial fibrillation (AF) and sudden cardiac death (SCD) with excessive alcohol intake. Recent studies have advanced our understanding of these relationships and provided additional insights into potentially arrhythmogenic mechanisms. However, considerable uncertainty remains, such as the level of consumption at which harm begins and whether alcohol plays a role in other arrhythmias. This review characterizes the spectrum of conduction abnormalities and heart rhythm disorders in relation to alcohol consumption. In addition, it discusses the latest epidemiologic and experimental evidence, the potential importance of beverage type and constituent ingredients, and conflicting information on drink definitions, thresholds, and recommendations.
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Affiliation(s)
- Christopher X Wong
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA; Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Samuel J Tu
- Centre for Heart Rhythm Disorders (CHRD), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Gregory M Marcus
- Department of Electrophysiology, Division of Cardiology, University of California-San Francisco, San Francisco, California, USA.
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Paratz ED, Rowe SJ, Stub D, Pflaumer A, La Gerche A. A systematic review of global autopsy rates in all-cause mortality and young sudden death. Heart Rhythm 2023; 20:607-613. [PMID: 36640854 DOI: 10.1016/j.hrthm.2023.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/03/2023] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Autopsy is the gold standard method for determining cause of death. Young sudden death (SD) is a prototype condition in which autopsy is universally recommended. The aim of this review was to quantify real-world global rates of autopsy in either all-cause death or young SD. A systematic review was conducted. Rates of autopsy in all-cause death and in young SD were determined in each country using scientific and commercial search engines. In total, 59 of 195 countries (30.3%) reported autopsy rates in all-cause death, with rates varying from 0.01%-83.9%. Almost all of these figures derived from academic publications rather than governmental statistics. Only 16 of 195 countries (8.2%) reported autopsy rates in the context of young SD, with reported rates ranging from 5%-100%. The definition of "young" was heterogeneous. No governmental statistics reported autopsy rates in young SD. Risks of bias included inability to verify reported figures, heterogeneity in reporting of clinical vs medicolegal autopsies, and the small number of studies identified overall, resulting in the consistent exclusion of low- and middle-income countries. In conclusion, most countries globally do not report autopsy rates in either all-cause death (69.7%) or in SD (92.8%). Without transparent reporting of autopsy rates, global burdens of disease and rates of sudden cardiac death cannot be reliably calculated.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia.
| | - Stephanie J Rowe
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia
| | - Dion Stub
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, Melbourne University, Parkville, Australia; Murdoch Children's Research Institute, Parkville, Australia
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Prahran, Australia; Alfred Hospital, Prahran, Australia; St. Vincent's Hospital, Fitzroy, Australia
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De A, Bansal M. Clinical profile and the extent of residual myocardial dysfunction among patients with previous coronavirus disease 2019. Int J Cardiovasc Imaging 2023; 39:887-894. [PMID: 36607468 PMCID: PMC9816519 DOI: 10.1007/s10554-022-02787-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/24/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Many patients who have recovered from their coronavirus disease 2019 (COVID-19) episode continue to remain symptomatic and seek medical opinion. The clinical characteristics and echocardiography findings of such subjects have not been adequately studied. METHODS The study included 472 subjects (age 54.0 ± 13.4 years, 57% men) with previous COVID-19 (median duration since COVID-19 12.0 weeks, interquartile range 9.0-26.0 weeks) and 100 controls (age 53.9 ± 13.6 years, 53% men). All subjects underwent detailed clinical assessment and echocardiography, including measurement of left ventricular (LV) ejection fraction (EF) and global longitudinal strain (GLS). RESULTS Less than third (29.2%) of the post-COVID subjects had needed hospitalization for their initial infection. Exertional dyspnea or breathing difficulty at rest were the commonest reasons for post-COVID presentation. As compared to controls, the post-COVID subjects had impaired LV systolic (LVEF 63.2 ± 2.2 vs. 61.9 ± 4.6, P = 0.007; GLS - 19.9 ± 2.6% vs. -17.6 ± 3.4%, P < 0.001) and diastolic function. Majority of those with reduced LV GLS had preserved LVEF. The patients presenting before 12 weeks were more likely to be symptomatic, but LV GLS did not differ. The patients needing hospitalization had higher burden of co-morbidities and significantly reduced LV GLS as compared to those who had received domiciliary treatment. The patients in the lowest GLS tertile were older, had higher burden of co-morbidities, and had had more severe initial infection with greater need for hospitalization, oxygen therapy and steroids. The need for hospitalization was independently associated with lower GLS at the time of current presentation. CONCLUSION This study shows that impairment of LV systolic and diastolic function is common among subjects recovering from previous COVID-19 episode. The patients with more severe initial infection have more marked impairment of LV function and this impairment persists even after several months of recovery from the initial infection. Routine measurement of GLS may be helpful since LV systolic dysfunction in these patients is mostly subclinical.
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Affiliation(s)
- Aniruddha De
- Suraksha Diagnostics Private Limited, Kolkata, India ,Dept. of Non-invasive Cardiology, Apollo Multispecialty Hospitals, Kolkata, India
| | - Manish Bansal
- Clinical and Preventive Cardiology, Medanta Heart Institute, Medanta- The Medicity, 122001 Gurgaon, Haryana India
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Lynge TH, Nielsen JL, Risgaard B, van der Werf C, Winkel BG, Tfelt-Hansen J. Causes of sudden cardiac death according to age and sex in persons aged 1-49 years. Heart Rhythm 2023; 20:61-68. [PMID: 36075534 DOI: 10.1016/j.hrthm.2022.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Knowledge of causes of sudden cardiac death (SCD) according to age is important in clinical decision making and to lower the risk of SCD in family members of the deceased. OBJECTIVE The purpose of this study was to report overall and sex-stratified causes of SCD according to age in persons aged 1-49 years. METHODS The study population consisted of all persons in Denmark aged 1-35 years in 2000-2009 and 36-49 years in 2007-2009, which equals 27.1 million person-years. Danish death certificates, discharge summaries, autopsy reports, and data from nationwide registries were used to identify all SCD cases. The SCD cases were divided into 5-year age groups. RESULTS In the 10-year study period, there were 14,294 deaths, of which 1362 (10%) were classified as SCD. Potentially inherited cardiac disease accounted for a high proportion (43%-78%) of autopsied SCD in all age groups. A significant proportion (19%-54%) of SCD was caused by sudden arrhythmic death syndrome in all age groups. Autopsy rates in both sudden unexpected death cases and SCD cases declined significantly with increasing age (74% in the youngest age group vs 35% in the oldest). CONCLUSION The proportion of SCD cases that were identified with a potentially inherited cardiac disease postmortem was high in all studied age groups, while autopsy rates in sudden and unexpected death cases declined markedly with increasing age. Our findings indicate that diagnoses of inherited heart disease are likely missed in some SCD cases, along with the opportunity for treatment and prevention in surviving relatives.
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Affiliation(s)
- Thomas Hadberg Lynge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lund Nielsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bjarke Risgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian van der Werf
- Department of Clinical and Experimental Cardiology, Heart Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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49
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, Gerche AL. Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry. Europace 2022; 24:1933-1941. [PMID: 36037012 DOI: 10.1093/europace/euac141] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
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50
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Ramakrishna S, Salazar JW, Olgin JE, Moffatt E, Tseng ZH. Heart Failure Burden by Autopsy, Guideline-Directed Medical Therapy, and ICD Utilization Among Sudden Deaths. JACC Clin Electrophysiol 2022; 9:403-413. [PMID: 36752450 DOI: 10.1016/j.jacep.2022.10.018] [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: 06/13/2022] [Revised: 09/14/2022] [Accepted: 10/09/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Studies of heart failure with reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF) report high sudden cardiac death (SCD) rates but presume cardiac cause. Underlying causes, guideline-directed medical therapy (GDMT), and implantable cardioverter-defibrillator (ICD) use in community sudden deaths with heart failure (HF) are unknown. OBJECTIVES This study aims to assess the burden of HF, GDMT, and ICD use among autopsied sudden deaths in the POST SCD (Postmortem Systematic Investigation of Sudden Cardiac Death) study, a countywide postmortem study of all presumed SCDs. METHODS Incident WHO-defined (presumed) SCDs for individuals of ages 18 to 90 years were autopsied via prospective surveillance of consecutive out-of-hospital deaths in San Francisco County from February 1, 2011, to March 1, 2014. Sudden arrhythmic deaths (SADs) had no identifiable nonarrhythmic cause (eg, pulmonary embolism), and are thus considered potentially rescuable with ICD. RESULTS Of 525 presumed SCDs, 100 (19%) had HF. There were 85 patients with known HF (31 HFpEF, 54 HFrEF) and 15 with subclinical HF (postmortem evidence of cardiomyopathy and pulmonary edema without HF diagnosis). SADs comprised 56% (293 of 525) of all presumed SCDs, and 69% (69 of 100) of HF SCDs. The rates were similar in HFrEF (40 of 54 [74%]) and HFpEF (19 of 31 [61%], P = 0.45). Four SAD patients (4%) had ICDs, 3 of which experienced device failure. Twenty-eight SCDs had ejection fraction ≤35%: 22 (79%) with arrhythmic and 6 (21%) with noncardiac causes. Of the 22 SAD patients, 8 (36%) had no identifiable barrier to ICD referral. Complete use of GDMT in HFrEF was 6%. CONCLUSIONS One in 5 community sudden deaths had HF; two-thirds had autopsy-confirmed arrhythmic causes. ICD prevention criteria captured only 8% (22 of 293) of all SAD cases countywide; GDMT and ICD use remain important targets for HF sudden death prevention.
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Affiliation(s)
- Satvik Ramakrishna
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - James W Salazar
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Jeffrey E Olgin
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA
| | - Ellen Moffatt
- Office of the Chief Medical Examiner, City and County of San Francisco, San Francisco, California, USA
| | - Zian H Tseng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Internal Medicine, University of California-San Francisco, San Francisco, California, USA.
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