1
|
Cohen MI, Atkins MB, Jordan CP. Mitral annular disjunction and mitral valve prolapse extrapolating adult data to an adolescent cohort? Curr Opin Cardiol 2024; 39:340-347. [PMID: 38606680 DOI: 10.1097/hco.0000000000001141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW The aim of this study is to provide an update on mitral valve prolapse (MVP) and mitral annular disjunction (MAD) and who may be at risk for ventricular arrhythmias and sudden cardiac death. RECENT FINDINGS MVP is generally considered a benign condition. However, a small subset of patients may be at risk for life-threatening ventricular arrhythmias. Among the risk factors identified in adults include patients with bileaflet mitral valves, myxomatous changes, myocardial fibrosis, and the presence of MAD. Advances in multimodal imaging have allowed for improved identification of fibrosis, anatomical valve derangements, and the amount of MAD. Recent guidelines have suggested that patients with MVP with or without MAD may be at risk for life-threatening arrhythmias if they have had prior ventricular arrhythmias, ventricular dysfunction, or unexplained syncope. Yet, extrapolation of adult data to a pediatric cohort with similar MVP and MAD at this juncture is challenging. There is, however, early evidence that some pediatric patients with significant myocardial fibrosis or abnormal tissue Doppler may be at risk for ventricular tachycardia. SUMMARY Mitral valve prolapse and mitral annular disjunction at times coexist and at other times can be seen as isolated entities. While the incidence of arrhythmic MVP is quite rare, there is increasing evidence that certain select adults with MVP may be at risk for ventricular tachycardia and sudden cardiac death. Future multicenter studies are needed to better understand the natural history of arrhythmic mitral valve disease and how early disease manifestation in children may impact findings now being reported in young adults.
Collapse
Affiliation(s)
- Mitchell I Cohen
- Chief, Pediatric Cardiology, Director of Arrhythmia Services, Inova Children's Cardiology, Inova L.J. Murphy Children's Hospital, Professor of Pediatrics, UVA School of Medicine, 8260 Willow Oaks Corporate Drive, Suite 400 Fairfax, VA
| | | | | |
Collapse
|
2
|
Westaby J, Bicalho L, Zullo E, Sheppard MN. Insights into malignant mitral valve degenerative disease from a sudden cardiac death cohort highlighting significant measurement differences from normal. Histopathology 2024; 84:960-966. [PMID: 38233105 DOI: 10.1111/his.15142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/08/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024]
Abstract
AIMS Mitral valve prolapse (MVP) is an accepted cause of sudden cardiac death (SCD) in most autopsy series. Diagnosis at autopsy relies upon subjective assessment with no established objective pathological criteria. This study set out to establish objective measurements to help pathologists dealing with SCD. METHODS We diagnosed 120 (1.5%) cases of MVP in 8108 cases of SCD. We measured the mitral annulus, anterior and posterior leaflets, rough zone and mitral annular disjunction (MAD) in 27 MVP cases and compared them to 54 age- and sex-matched normal mitral valves. RESULTS Age of death was 39 ± 16 years, with 59 females and 61 males. History of mild MV disease was present in 19 (16%). Eleven (9%) died associated with exertion. Left ventricular hypertrophy was present in nine (15%) females and 10 (16%) males. Both MV leaflets showed thickening and ballooning in all individuals. MVP showed highly significantly increased annular circumference, elongation and thickening of both leaflets as well as increased MAD (all P < 0.001). Left ventricular fibrosis was present in 108 (90%), with interstitial fibrosis in the posterolateral wall and papillary muscle in 88 (81%) and coexisting replacement fibrosis in 40 (37%). CONCLUSION This is the largest MVP associated with SCD series highlighting a young cohort with equal representation of males and females. There is involvement of both leaflets with significant annular dilatation, elongation and thickening of both leaflets with MAD. Left ventricular fibrosis explains arrhythmia. Our quantitative measurements should serve as a reference for pathologists assessing post-mortem hearts for MVP.
Collapse
Affiliation(s)
- Joseph Westaby
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Luciana Bicalho
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Emelia Zullo
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - Mary N Sheppard
- CRY Cardiovascular Pathology Unit, Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| |
Collapse
|
3
|
Van der Bijl P, Stassen J, Haugaa KH, Essayagh B, Basso C, Thiene G, Faletra FF, Edvardsen T, Enriquez-Sarano M, Nihoyannopoulos P, Ajmone Marsan N, Chandrashekhar YS, Bax JJ. Mitral Annular Disjunction in the Context of Mitral Valve Prolapse: Identifying the At-Risk Patient. JACC Cardiovasc Imaging 2024:S1936-878X(24)00119-0. [PMID: 38703174 DOI: 10.1016/j.jcmg.2024.03.006] [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: 05/07/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 05/06/2024]
Abstract
Mitral annular disjunction (MAD), a separation between the left atrium/mitral valve annulus and the left ventricular myocardium, is frequently seen in patients with arrhythmic mitral valve prolapse. Although an association exists between MAD and ventricular arrhythmias, little is known regarding the identification of individuals at high risk. Multimodality imaging including echocardiography, computed tomography, cardiac magnetic resonance, and positron emission tomography can play an important role in both the diagnosis and risk stratification of MAD. Due to a paucity of data, clinical decision making in a patient with MAD is challenging and remains largely empirical. Although MAD itself can be corrected surgically, the prevention and treatment of associated arrhythmias may require medical therapy, catheter ablation, and an implantable cardioverter-defibrillator. Prospective data are required to define the role of implantable cardioverter-defibrillators, targeted catheter ablation, and surgical correction in selected, at-risk patients.
Collapse
Affiliation(s)
- Pieter Van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Huddinge, Karolinska Institute and Cardiovascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin Essayagh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA; Department of Echocardiography, CardioXClinic, Cannes, France
| | - Cristina Basso
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Gaetano Thiene
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | | | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | | | | | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| |
Collapse
|
4
|
Beyazal M, Ozgur S, Sayici IU, Celebi SK. Assessment of Heart Rate Variability in Children with Mitral Valve Prolapse. Pediatr Cardiol 2024:10.1007/s00246-024-03481-1. [PMID: 38619610 DOI: 10.1007/s00246-024-03481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/24/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Mitral valve prolapse (MVP) is a heart valve anomaly with specific electrocardiographic findings and arrhythmia. A predominant sympathetic tone and diminished vagal activity have been reported especially in symptomatic MVP patients. OBJECTIVES In the current study, we aim to review heart rate variability (HRV) parameters of MVP children in order to determine if there is an impaired autonomic regulation. METHODS The data of children with MVP were retrospectively analyzed. Demographic characteristics, body mass index, symptomatology, MVP type and mitral regurgitation, MVP-related electrocardiographic changes, arrhythmia, and HRV parameters in 24-h Holter monitoring were recorded. HRV parameters of the control group were obtained from children applying for sport participation. Statistical significance limit was accepted as p < 0.05. RESULTS 154 of the patients (74.8%) were girls, the median age was 13.58 ± 2.99 years. While MVP patients had shorter PR intervals, those who had syncope had longer PR intervals. Short PR distance may be a feature of MVP, long PR distance may be a condition associated with syncope with the underlying paroxysmal atrioventricular block. Moreover, the minimum heart rate was significantly lower in the MVP group compared to the control and there were no significant differences in terms of remaining parameters. The number of low LF values was higher in MVP patients than the control. Comparing HRV values of groups by gender, we found that overall HRV parameters were lower in girls with MVP while minimum, maximum, and average heart rate were lower in boys with MVP. CONCLUSION Impaired HRV associated with MVP could be age, gender, and symptom related. In addition, low LF may indicate impaired baroreflex sensitivity in MVP patients.
Collapse
Affiliation(s)
- Meryem Beyazal
- Pediatric Cardiology Department, Dr. Sami Ulus Gynecology, Obstetrics, and Child Health and Diseases Training and Research Hospital, Yenimahalle, 06560, Ankara, Turkey.
| | - Senem Ozgur
- Pediatric Cardiology Department, Dr. Sami Ulus Gynecology, Obstetrics, and Child Health and Diseases Training and Research Hospital, Yenimahalle, 06560, Ankara, Turkey
| | - Ilker Ufuk Sayici
- Pediatric Cardiology Department, Dr. Sami Ulus Gynecology, Obstetrics, and Child Health and Diseases Training and Research Hospital, Yenimahalle, 06560, Ankara, Turkey
| | - Serpil Kaya Celebi
- Pediatric Cardiology Department, Dr. Sami Ulus Gynecology, Obstetrics, and Child Health and Diseases Training and Research Hospital, Yenimahalle, 06560, Ankara, Turkey
| |
Collapse
|
5
|
Markman TM, Marchlinski FE, Callans DJ, Frankel DS. Programmed Ventricular Stimulation: Risk Stratification and Guiding Antiarrhythmic Therapies. JACC Clin Electrophysiol 2024:S2405-500X(24)00182-8. [PMID: 38661601 DOI: 10.1016/j.jacep.2024.02.034] [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: 01/16/2024] [Accepted: 02/13/2024] [Indexed: 04/26/2024]
Abstract
Electrophysiologic testing with programmed ventricular stimulation (PVS) has been utilized to induce ventricular tachycardia (VT), thereby improving risk stratification for patients with ischemic and nonischemic cardiomyopathies and determining the effectiveness of antiarrhythmic therapies, especially catheter ablation. A variety of procedural aspects can be modified during PVS in order to alter the sensitivity and specificity of the test including the addition of multiple baseline pacing cycle lengths, extrastimuli, and pacing locations. The definition of a positive result is also critically important, which has varied from exclusively sustained monomorphic VT (>30 seconds) to any ventricular arrhythmia regardless of morphology. In this review, we discuss the history of PVS and evaluate its role in sudden cardiac death risk stratification in a variety of patient populations. We propose an approach to future investigations that will capitalize on the unique ability to vary the sensitivity and specificity of this test. We then discuss the application of PVS during and following catheter ablation. The strategies that have been utilized to improve the efficacy of intraprocedural PVS are highlighted during a discussion of the limitations of this probabilistic strategy. The role of noninvasive programmed stimulation is also reviewed in predicting recurrent VT and informing management decisions including repeat ablations, modifications in antiarrhythmic drugs, and implantable cardioverter-defibrillator programming. Based on the available evidence and guidelines, we propose an approach to future investigations that will allow clinicians to optimize the use of PVS for risk stratification and assessment of therapeutic efficacy.
Collapse
Affiliation(s)
- Timothy M Markman
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Cardiovascular Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| |
Collapse
|
6
|
Miller MA, Edens M, Malyshev Y. Ventricular Arrhythmias in Mitral Valve Prolapse: Disjunction, Curling and Fibrosis: A Whodunit Mystery. JACC Clin Electrophysiol 2024; 10:682-684. [PMID: 38658059 DOI: 10.1016/j.jacep.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 02/05/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Marc A Miller
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Madison Edens
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yury Malyshev
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
7
|
Park MH, van Kampen A, Zhu Y, Melnitchouk S, Levine RA, Borger MA, Woo YJ. Neochordal Goldilocks: Analyzing the biomechanics of neochord length on papillary muscle forces suggests higher tolerance to shorter neochordae. J Thorac Cardiovasc Surg 2024; 167:e78-e89. [PMID: 37160219 DOI: 10.1016/j.jtcvs.2023.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Estimating neochord lengths during mitral valve repair is challenging, because approximation must be performed largely based on intuition and surgical experience. Little data exist on quantifying the effects of neochord length misestimation. We aimed to evaluate the impact of neochord length on papillary muscle forces and mitral valve hemodynamics, which is especially pertinent because increased forces have been linked to aberrant mitral valve biomechanics. METHODS Porcine mitral valves (n = 8) were mounted in an ex vivo heart simulator, and papillary muscles were fixed to high-resolution strain gauges while hemodynamic data were recorded. We used an adjustable system to modulate neochord lengths. Optimal length was qualitatively verified by a single experienced operator, and neochordae were randomly lengthened or shortened in 1-mm increments up to ±5 mm from the optimal length. RESULTS Optimal length neochordae resulted in the lowest peak composite papillary muscle forces (6.94 ± 0.29 N), significantly different from all lengths greater than ±1 mm. Both longer and shorter neochordae increased forces linearly according to difference from optimal length. Both peak papillary muscle forces and mitral regurgitation scaled more aggressively for longer versus shorter neochordae by factors of 1.6 and 6.9, respectively. CONCLUSIONS Leveraging precision ex vivo heart simulation, we found that millimeter-level neochord length differences can result in significant differences in papillary muscle forces and mitral regurgitation, thereby altering valvular biomechanics. Differences in lengthened versus shortened neochordae scaling of forces and mitral regurgitation may indicate different levels of biomechanical tolerance toward longer and shorter neochordae. Our findings highlight the need for more thorough biomechanical understanding of neochordal mitral valve repair.
Collapse
Affiliation(s)
- Matthew H Park
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Mechanical Engineering, Stanford University, Stanford, Calif
| | - Antonia van Kampen
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass; University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| | - Yuanjia Zhu
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif
| | - Serguei Melnitchouk
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Michael A Borger
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Mass
| | - Y Joseph Woo
- Department of Cardiothoracic Surgery, Stanford University, Stanford, Calif; Department of Bioengineering, Stanford University, Stanford, Calif.
| |
Collapse
|
8
|
Papadopoulos K, Ikonomidis I, Vannan MA. The added value of three-dimensional transthoracic echocardiography in mitral annular disjunction: a case report. Front Cardiovasc Med 2024; 11:1366444. [PMID: 38601046 PMCID: PMC11004239 DOI: 10.3389/fcvm.2024.1366444] [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: 01/06/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Background Mitral annular disjunction (MAD) refers to the arrhythmic mitral valve prolapse (MVP) syndrome associated with ventricular arrhythmias and sudden cardiac death. Although the pathophysiology of this disease is still under investigation, specific imaging criteria that establish the diagnosis have been recognized. In this article, we demonstrate most of these criteria using three-dimensional transthoracic echocardiography (3D-TTE) and provide added value in the management of MAD syndrome. Case presentation A 50-year-old male patient with recent syncope and a history of mitral regurgitation (MR) and MAD was admitted to our clinic for further investigation. According to our protocol, the patient underwent a complete 3D-TTE, laboratory blood exams, and 24 h ambulatory electrocardiogram (ECG). Our investigation confirmed the presence of MAD syndrome with bileaflet prolapse, severe MR, and non-sustained ventricular tachycardia, necessitating an implantable cardioverter defibrillator (ICD) and surgical mitral valve repair. The 3D-TTE analysis of the mitral valve demonstrated mitral annular systolic expansion and systolic flattening of the saddle-shaped annulus and quantified the extent of the disjunction arc. Additionally, four-dimensional (4D) strain analysis of the left ventricle revealed the presence of fibrosis of the posteromedial papillary muscle and basal inferolateral wall, which are variables that are required for the diagnosis and therapeutic management of MAD syndrome. Conclusions 3D-TTE and 4D strain offer valuable insights for diagnosing and managing patients with MAD syndrome. This method seems to correlate well with the other imaging modalities and could be included in the management protocol of MAD syndrome.
Collapse
Affiliation(s)
| | - Ignatios Ikonomidis
- Echocardiography Laboratory, 2nd Cardiology Department, Medical School, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mani A. Vannan
- Structural and Valvular Center of Excellence, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, United States
| |
Collapse
|
9
|
Compagnucci P, Selimi A, Cipolletta L, Volpato G, Gasperetti A, Valeri Y, Parisi Q, Curcio A, Natale A, Dello Russo A, Casella M. Arrhythmic Mitral Valve Prolapse and Sports Activity: Pathophysiology, Risk Stratification, and Sports Eligibility Assessment. J Clin Med 2024; 13:1350. [PMID: 38592178 PMCID: PMC10932446 DOI: 10.3390/jcm13051350] [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: 01/09/2024] [Revised: 02/16/2024] [Accepted: 02/20/2024] [Indexed: 04/10/2024] Open
Abstract
Although mitral valve prolapse (MVP) is the most prevalent valvular abnormality in Western countries and generally carries a good prognosis, a small subset of patients is exposed to a significant risk of malignant ventricular arrhythmias (VAs) and sudden cardiac death (SCD), the so-called arrhythmic MVP (AMVP) syndrome. Recent work has emphasized phenotypical risk features of severe AMVP and clarified its pathophysiology. However, the appropriate assessment and risk stratification of patients with suspected AMVP remains a clinical conundrum, with the possibility of both overestimating and underestimating the risk of malignant VAs, with the inappropriate use of advanced imaging and invasive electrophysiology study on one hand, and the catastrophic occurrence of SCD on the other. Furthermore, the sports eligibility assessment of athletes with AMVP remains ill defined, especially in the grey zone of intermediate arrhythmic risk. The definition, epidemiology, pathophysiology, risk stratification, and treatment of AMVP are covered in the present review. Considering recent guidelines and expert consensus statements, we propose a comprehensive pathway to facilitate appropriate counseling concerning the practice of competitive/leisure-time sports, envisioning shared decision making and the multidisciplinary "sports heart team" evaluation of borderline cases. Our final aim is to encourage an active lifestyle without compromising patients' safety.
Collapse
Affiliation(s)
- Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Adelina Selimi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Laura Cipolletta
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Giovanni Volpato
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Alessio Gasperetti
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
- Department of Cardiology, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Quintino Parisi
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
| | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, 87036 Rende, Italy
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St David’s Medical Center, Austin, TX 78705, USA;
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA 92037, USA
- Department of Internal Medicine, Metro Health Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44195, USA
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60121 Ancona, Italy;
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, Marche University Hospital, 60126 Ancona, Italy; (A.S.); (L.C.); (G.V.); (Y.V.); (Q.P.); (A.D.R.)
- Department of Medical, Special and Dental Sciences, Marche Polytechnic University, 60121 Ancona, Italy
| |
Collapse
|
10
|
Cecere A, Cipriani A, De Lazzari M, Graziano F, Brunetti G, De Conti G, Motta R, Ravagnin A, Lorenzoni G, Gregori D, Basso C, Tona F, Lee YJ, Delling FN, Iliceto S, Marra MP. Left ventricular fibrosis in arrhythmic mitral valve prolapse: quantification and comparison of semi-automated techniques assessed by cardiac magnetic resonance. Int J Cardiovasc Imaging 2024; 40:275-285. [PMID: 38141098 PMCID: PMC10884156 DOI: 10.1007/s10554-023-03006-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/03/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE Left ventricular (LV) fibrosis has a key role in arrhythmogenesis in patients with mitral valve prolapse (MVP). Cardiac magnetic resonance identifies LV fibrosis by using late gadolinium enhancement (LGE) technique. LGE assessment and quantification in patients with MVP lacks of standardization protocols. METHODS 66 MVP patients with normal systolic function and without significant regurgitation were enrolled. Semi-automated gray-scale thresholding techniques using full width at half maximum (FWHM) and 2, 3 and 5 standard deviation (SD) above the remote myocardium were used and compared with the visual assessment, considered as the gold standard. RESULTS LGE was identified in 41 MVP patients (62%) and quantified. The mean quantity of LGE visually assessed was 2.40 ± 1.07% or 1.40 ± 0.82 g. With FWHM, LGE resulted 3.56 ± 1.23% or 1.99 ± 1.13 g. Using thresholding, the mean LGE quantity was 9.2 ± 3.1% or 4.82 ± 2.28 g for 2-SD, 5.72 ± 1.75% or 3.06 ± 1.47 g for 3-SD and 2.36 ± 0.99% or 1.29 ± 0.79 g for 5-SD. The 5-SD measurement in percentage demonstrated a good correlation with LGE quantification visually assessed (2.40 ± 1.07 vs. 2.363 ± 0.9909, p = 0.543). When compared with the gold standard, the 5-SD threshold quantification, both in percentage and in grams, revealed the least intra-observer (respectively, ICC: 0.976 and 0.966) and inter-observer variability (respectively ICC: 0.948 and 0.935). CONCLUSION The 5-SD gray-scale threshold technique in percentage revealed the best correlation with the visual assessment and an optimal reproducibility in MVP patient.
Collapse
Affiliation(s)
- Annagrazia Cecere
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Alberto Cipriani
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Manuel De Lazzari
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Francesca Graziano
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giulia Brunetti
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giorgio De Conti
- Radiology Unit, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Raffaella Motta
- Department of Medicine, University of Padua-Azienda Ospedaliera, Padua, Italy
| | - Alberto Ravagnin
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Giulia Lorenzoni
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Dario Gregori
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Cristina Basso
- Cardiovascular Pathology Unit, University Hospital of Padua, Padua, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Yoo Jin Lee
- Clinical Radiology, Cardiac and Pulmonary Imaging, University of California, San Francisco, CA, USA
| | - Francesca Nesta Delling
- Department of Medicine (Cardiovascular Division), University of California San Francisco, San Francisco, CA, USA
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua-Azienda Ospedaliera, Via Giustiniani, 2, 35128, Padua, Italy.
| |
Collapse
|
11
|
Spampinato RA, Marin-Cuartas M, van Kampen A, Fahr F, Sieg F, Strotdrees E, Jahnke C, Klaeske K, Wiesner K, Morningstar JE, Nagata Y, Izquierdo-Garcia D, Dieterlen MT, Norris RA, Levine RA, Paetsch I, Borger MA. Left ventricular fibrosis and CMR tissue characterization of papillary muscles in mitral valve prolapse patients. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:213-224. [PMID: 37891450 DOI: 10.1007/s10554-023-02985-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
PURPOSE Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies. METHODS MVP patients with indication for surgery due to severe mitral regurgitation (n = 19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings. RESULTS MVP patients (54 ± 10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096 ± 78ms vs. 994 ± 54ms and 33.9 ± 5.6% vs. 25.9 ± 3.1%, respectively, p < 0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE + in LV and PM was identified in 5 (26.3%) patients, while DB-LGE + was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE + in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs. 36.8%, p = 0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p = 0.029). CONCLUSIONS CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.
Collapse
Affiliation(s)
- Ricardo A Spampinato
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany.
| | - Mateo Marin-Cuartas
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Antonia van Kampen
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
- Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Florian Fahr
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Franz Sieg
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Elfriede Strotdrees
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Cosima Jahnke
- Department of Cardiology and Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Kristin Klaeske
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Karoline Wiesner
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Jordan E Morningstar
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Yasufumi Nagata
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David Izquierdo-Garcia
- The Institute for Innovation in Imaging, Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maja-Theresa Dieterlen
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ingo Paetsch
- Department of Cardiology and Electrophysiology, Leipzig Heart Center, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, University, Leipzig Heart Center, Struempellstrasse 39, 04289, Leipzig, Germany
| |
Collapse
|
12
|
Zhou N, Zhao Q, Li R, Cheng R, Wu Q, Cheng J, Chen Y. Mutation in mitral valve prolapse susceptible gene DCHS1 causes familial mitral annular disjunction. J Med Genet 2024; 61:125-131. [PMID: 37399314 DOI: 10.1136/jmg-2023-109278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/18/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Mitral annular disjunction (MAD) is an under-recognised phenotype associated with severe ventricular arrhythmias. Limited knowledge has been gained on its molecular genesis. METHODS A total of 150 unrelated deceased Chinese were collected for whole-exome sequencing, with analysis focusing on a panel of 118 genes associated with 'abnormal mitral valve morphology'. Cases were prespecified as 'longitudinally extensive MAD (LE-MAD)' or 'longitudinally less-extensive MAD (LLE-MAD)' according to the gross disjunctional length with a cut-off of 4.0 mm. The pedigree investigation was conducted on a case carrying an ultra-rare (minor allele frequency <0.1%) deleterious variant in DCHS1. RESULTS Seventy-seven ultra-rare deleterious variants were finally identified. Exclusively, 12 ultra-rare deleterious variants distributed in nine genes occurred in LE-MAD, which were ANK1, COL3A1, DCHS1, FBN2, GNPTAB, LZTR1, PLD1, RYR1 and VPS13B. Ultra-rare deleterious variants in those nine genes were predominantly distributed in LE-MAD compared with LLE-MAD (28% vs 5%, OR 7.30, 95% CI 2.33 to 23.38; p<0.001), and the only gene related to LE-MAD with borderline significance was DCHS1. LE-MAD was consistently observed in a sizeable Chinese family, in which LE-MAD independently co-segregated with an ultra-rare deleterious variant in DCHS1, rs145429962. CONCLUSION This study initially proposed that isolated LE-MAD might be a particular phenotype of MAD with a complex genetic predisposition. Deleterious variants in DCHS1 might be associated with the morphogenesis of LE-MAD.
Collapse
Affiliation(s)
- Nan Zhou
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
- Guangzhou Key Laboratory of Molecular Mechanisms and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qianhao Zhao
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Rui Li
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Ruofei Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Qiuping Wu
- Department of Pathology, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jianding Cheng
- Department of Forensic Pathology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- Guangdong Province Translational Forensic Medicine Engineering Technology Research Center, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yangxin Chen
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
- Guangdong Province Key Laboratory of Arrhythmia and Electrophysiology, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong, China
- Guangzhou Key Laboratory of Molecular Mechanisms and Translation in Major Cardiovascular Disease, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
13
|
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
Collapse
|
14
|
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 2023:10.1007/s00330-023-10413-9. [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] [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.
Collapse
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
| |
Collapse
|
15
|
Delgado V, Ajmone Marsan N, Bonow RO, Hahn RT, Norris RA, Zühlke L, Borger MA. Degenerative mitral regurgitation. Nat Rev Dis Primers 2023; 9:70. [PMID: 38062018 DOI: 10.1038/s41572-023-00478-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/18/2023]
Abstract
Degenerative mitral regurgitation is a major threat to public health and affects at least 24 million people worldwide, with an estimated 0.88 million disability-adjusted life years and 34,000 deaths in 2019. Improving access to diagnostic testing and to timely curative therapies such as surgical mitral valve repair will improve the outcomes of many individuals. Imaging such as echocardiography and cardiac magnetic resonance allow accurate diagnosis and have provided new insights for a better definition of the most appropriate timing for intervention. Advances in surgical techniques allow minimally invasive treatment with durable results that last for ≥20 years. Transcatheter therapies can provide good results in select patients who are considered high risk for surgery and have a suitable anatomy; the durability of such repairs is up to 5 years. Translational science has provided new knowledge on the pathophysiology of degenerative mitral regurgitation and may pave the road to the development of medical therapies that could be used to halt the progression of the disease.
Collapse
Affiliation(s)
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert O Bonow
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rebecca T Hahn
- Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | - Russell A Norris
- Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC, USA
| | - Liesl Zühlke
- South African Medical Research Council, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics, Institute of Child Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Michael A Borger
- University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany
| |
Collapse
|
16
|
Gupte T, Liang JJ, Latchamsetty R, Crawford T, Jongnarangsin K, Bogun F, Ghannam M. Long-term outcomes of patients with ventricular arrhythmias and negative programmed ventricular stimulation followed with implantable loop recorders: Impact of delayed-enhancement cardiac magnetic resonance imaging. J Cardiovasc Electrophysiol 2023; 34:2581-2589. [PMID: 37921260 DOI: 10.1111/jce.16109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/03/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Programed ventricular stimulation (PVS) is a risk stratification tool in patients at risk for adverse arrhythmia outcomes. Patients with negative PVS may yet be at risk for adverse arrhythmia-related events, particularly in the presence of symptomatic ventricular arrhythmias (VA). OBJECTIVE To investigate the long-term outcomes of real-world patients with symptomatic VA without indication for device therapy and negative PVS, and to examine the role of cardiac scaring on arrhythmia recurrence. METHODS Patients with symptomatic VA, and late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR), and negative PVS testing were included. All patients underwent placement of implantable cardiac monitors (ICM). Survival analysis was performed to investigate the impact of LGE-CMR findings on survival free from adverse arrhythmic events. RESULTS Seventy-eight patients were included (age 60 ± 14 years, women n = 36 (46%), ejection fraction 57 ± 9%, cardiomyopathy n = 26 (33%), mitral valve prolapse [MVP] n = 9 (12%), positive LGE-CMR scar n = 49 (62%), history of syncope n = 23 (29%)) including patients with primarily premature ventricular contractions (n = 21) or nonsustained VA (n = 57). Patients were followed for 1.6 ± 1.5 years during which 14 patients (18%) experienced VA requiring treatment (n = 14) or syncope due to bradycardia (n = 2). Four/9 patients (44%) with MVP experienced VA (n = 3) or syncope (n = 1). Baseline characteristics between those with and without adverse events were similar (p > 0.05); however, the presence of cardiac scar on LGE-CMR was independently associated with an increased risk of adverse events (hazard ratio: 5.6 95% confidence interval: [1.2-27], p = 0.03, log-rank p = 0.03). CONCLUSIONS In a real-world cohort with long-term follow-up, adverse arrhythmic outcomes occurred in 18% of patients with symptomatic VA despite negative PVS, and this risk was significantly greater in patients with positive DE-CMR scar. Long term-monitoring, including the use of ICM, may be appropriate in these patients.
Collapse
Affiliation(s)
- Trisha Gupte
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jackson J Liang
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Rakesh Latchamsetty
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas Crawford
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Frank Bogun
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michael Ghannam
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
17
|
Kreimer F, Mügge A, Gotzmann M. Survived sudden cardiac death in a patient with arrhythmic mitral valve prolapse syndrome: a case report. Clin Res Cardiol 2023; 112:1860-1865. [PMID: 37043023 PMCID: PMC10697889 DOI: 10.1007/s00392-023-02195-3] [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: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 04/13/2023]
Affiliation(s)
- Fabienne Kreimer
- Department of Cardiology and Rhythmology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Andreas Mügge
- Department of Cardiology and Rhythmology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Michael Gotzmann
- Department of Cardiology and Rhythmology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| |
Collapse
|
18
|
Hussain N, Bhagia G, Doyle M, Rayarao G, Williams RB, Biederman RW. Mitral annular disjunction; how accurate are we? A cardiovascular MRI study defining risk. IJC HEART & VASCULATURE 2023; 49:101298. [PMID: 38035256 PMCID: PMC10682655 DOI: 10.1016/j.ijcha.2023.101298] [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: 10/07/2023] [Revised: 11/02/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
Aims Mitral Annular Disjunction (MAD) refers to embryologic fibrous separation between mitral annular ring and basal left ventricular myocardium. Since its original description, the role of MAD in arrhythmic mitral valve prolapse (MVP) has been the subject of active research. In this study we sought to assess prognostic and imaging characteristics of MVP patients with and without underlying MAD. Methods and results Patients with posterior or bi-leaflet MVP were retrospectively identified via a review of all patients referred to our cardiac magnetic resonance (CMR) imaging laboratory from January 2015 to May 2022. MVP patients were further stratified by underlying MAD status. A total of 100 MVP patients undergoing CMR imaging (52 MVP patients with posterior MAD) were retrospectively identified with female comprising 55 % of the cohort. MVP patients with MAD were more likely to have an abnormal basal inferolateral/ papillary muscles LGE (51 % vs 21 %, p < 0.01). Posterior MAD longitudinal disjunction gap in 'mm' was a predictor of ventricular tachycardia (VT) [1.29, p = 0.01)]. Using ROC curve analysis, a disjunction gap of ≥ 4 mm was predictive of VT (AUC-0.71, p < 0.01), and incorporation of LGE in ROC model further improved AUC to 0.78 confirmed via Akaike information criterion (p < 0.01). Conclusion Abnormal LGE involving basal inferolateral myocardium and papillary muscles may provide etiologic substrate for arrythmia in MVP patients.
Collapse
Affiliation(s)
- Nasir Hussain
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- Wilson Medical Center, United Health Service, Johnson City, NY 13790, USA
| | - Geeta Bhagia
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- Benefis Health System, Great Falls, MT 59404, USA
| | - Mark Doyle
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Geetha Rayarao
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Ronald B. Williams
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
| | - Robert W.W. Biederman
- Allegheny Health Network, Allegheny General Hospital, Center for Cardiovascular MRI, Pittsburgh, PA 15212, USA
- West Virginia University, Morgantown, WV 26506, USA
- Medical University of South Carolina, Charleston, SC 29425, USA
| |
Collapse
|
19
|
Timóteo AT, Ribeiras R, Calé R, Moura B, G Almeida A, Gavina C, Cabral S, António N, Franco F, Ilhão Moreira R, Geraldes F, Machado AP, Palma F, Pires da Silva V, Gonçalves L. Cardiovascular diseases in women - Consensus document of the Sociedade Portuguesa de Cardiologia, Sociedade Portuguesa de Ginecologia, Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal, Sociedade Portuguesa de Contraceção e Associação Portuguesa de Medicina Geral e Familiar. Rev Port Cardiol 2023; 42:1001-1015. [PMID: 36566887 DOI: 10.1016/j.repc.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
Abstract
The main objective of this consensus statement from the Portuguese Society of Cardiology, the Portuguese Society of Gynecology, the Portuguese Society of Obstetrics and Maternal-Fetal Medicine, Portuguese Society of Contraception, Portuguese Association of General Practice and Family Medicine is to improve cardiovascular care for women. It includes a brief review of the state-of-the-art of cardiovascular diseases in women and of the links to other fields such as Gynaecology, Obstetrics and Endocrinology. It also provides final recommendations to help clinicians working in care of women's health.
Collapse
Affiliation(s)
| | | | - Rita Calé
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Brenda Moura
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | - Ana G Almeida
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | - Sofia Cabral
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | - Fátima Franco
- Sociedade Portuguesa de Cardiologia, Lisboa, Portugal
| | | | | | - Ana Paula Machado
- Sociedade Portuguesa de Obstetrícia e Medicina Materno-Fetal, Lisboa, Portugal
| | - Fátima Palma
- Sociedade Portuguesa de Contraceção, Lisboa, Portugal
| | | | | |
Collapse
|
20
|
L'Hoyes W, Robyns T, Moura-Fereira S, De Meester P, Dresselaers T, Herregods MC, Rega F, Masci PG, Willems R, Bogaert J, Vandenberk B. Effectiveness of the risk stratification proposed by the 2022 European Heart Rhythm Association Expert Consensus statement on arrhythmic mitral valve prolapse. Am Heart J 2023; 266:48-60. [PMID: 37595658 DOI: 10.1016/j.ahj.2023.08.004] [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: 05/03/2023] [Revised: 08/04/2023] [Accepted: 08/13/2023] [Indexed: 08/20/2023]
Abstract
BACKGROUND Recently, an expert consensus statement proposed indications where implantation of a primary prevention implantable cardioverter-defibrillator (ICD) may be reasonable in patients with mitral valve prolapse (MVP). The objective was to evaluate the proposed risk stratification by the expert consensus statement. METHODS Consecutive patients with MVP without alternative arrhythmic substrates with cardiac magnetic resonance imaging (CMR) were included in a single-center retrospective registry. Arrhythmic MVP (AMVP) was defined as a total premature ventricular complex burden ≥5%, non-sustained ventricular tachycardia (VT), VT, or ventricular fibrillation. The end point was a composite of SCD, VT, inducible VT, and appropriate ICD shocks. RESULTS In total, 169 patients (52.1% male, median age 51.4 years) were included and 99 (58.6%) were classified as AMVP. Multivariate logistic regression identified the presence of late gadolinium enhancement (OR 2.82, 95%CI 1.45-5.50) and mitral annular disjunction (OR 1.98, 95%CI 1.02-3.86) as only predictors of AMVP. According to the EHRA risk stratification, 5 patients with AMVP (5.1%) had a secondary prevention ICD indication, while in 69 patients (69.7%) the implantation of an ICD may be reasonable. During a median follow-up of 8.0 years (IQR 5.0-15.6), the incidence rate for the composite arrhythmic end point was 0.3%/year (95%CI 0.1-0.8). CONCLUSION More than half of MVP patients referred for CMR met the AMVP diagnostic criteria. Despite low long-term event rates, in 70% of patients with AMVP the implantation of an ICD may be reasonable. Risk stratification of SCD in MVP remains an important knowledge gap and requires urgent investigation.
Collapse
Affiliation(s)
- Wouter L'Hoyes
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Robyns
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Sara Moura-Fereira
- Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Pieter De Meester
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Tom Dresselaers
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Marie-Christine Herregods
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Pier Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas Hospital, London, United Kingdom
| | - Rik Willems
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Jan Bogaert
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
| |
Collapse
|
21
|
Gulati A, Gulati V, Hu R, Rajiah PS, Stojanovska J, Febbo J, Litt HI, Pavri B, Sundaram B. Mitral Annular Disjunction: Review of an Increasingly Recognized Mitral Valve Entity. Radiol Cardiothorac Imaging 2023; 5:e230131. [PMID: 38166341 PMCID: PMC11163248 DOI: 10.1148/ryct.230131] [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: 05/14/2023] [Revised: 08/22/2023] [Accepted: 10/30/2023] [Indexed: 01/04/2024]
Abstract
Mitral annular disjunction (MAD) refers to atrial displacement of the hinge point of the mitral valve annulus from the ventricular myocardium. MAD leads to paradoxical expansion of the annulus in systole and may often be associated with mitral valve prolapse (MVP), leaflet degeneration, myocardial and papillary muscle fibrosis, and, potentially, malignant cardiac arrhythmias. Patients with MAD and MVP may present similarly, and MAD is potentially the missing link in explaining why some patients with MVP experience adverse outcomes. Patients with a 5 mm or longer MAD distance have an elevated risk of malignant cardiac arrhythmia compared with those with a shorter MAD distance. Evaluation for MAD is an important component of cardiac imaging, especially in patients with MVP and unexplained cardiac arrhythmias. Cardiac MRI is an important diagnostic tool that aids in recognizing and quantifying MAD, MVP, and fibrosis in the papillary muscle and myocardium, which may predict and help improve outcomes following electrophysiology procedures and mitral valve surgery. This article reviews the history, pathophysiology, controversy, prevalence, clinical implications, and imaging considerations of MAD, focusing on cardiac MRI. Keywords: MR-Dynamic Contrast Enhanced, Cardiac, Mitral Valve, Mitral Annular Disjunction, Mitral Valve Prolapse, Floppy Mitral Valve, Cardiac MRI, Arrhythmia, Sudden Cardiac Death, Barlow Valve © RSNA, 2023.
Collapse
Affiliation(s)
- Aishwarya Gulati
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Vaibhav Gulati
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Ray Hu
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Jadranka Stojanovska
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Jennifer Febbo
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Harold I. Litt
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Behzad Pavri
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| | - Baskaran Sundaram
- From the Department of Radiology (A.G., B.S.) and Department of
Internal Medicine, Division of Cardiology (B.P.), Thomas Jefferson University
Hospital, 132 S 10th St, Philadelphia, PA 19107; Department of Radiology, Mercy
Fitzgerald Hospital, Darby, Pa (V.G.); Division of Cardiovascular Medicine
(R.H., H.I.L.) and Department of Radiology (H.I.L.), University of Pennsylvania
Perelman School of Medicine, Philadelphia, Pa; Department of Radiology, Mayo
Clinic, Rochester, Minn (P.S.R.); Department of Radiology, New York University
Hospital, New York, NY (J.S.); and Department of Radiology, University of New
Mexico, Albuquerque, NM (J.F.)
| |
Collapse
|
22
|
Suna G, Mellor GJ. Explaining the Unexplained: A Practical Approach to Investigating the Cardiac Arrest Survivor. Arrhythm Electrophysiol Rev 2023; 12:e27. [PMID: 38124802 PMCID: PMC10731537 DOI: 10.15420/aer.2023.06] [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: 03/11/2023] [Accepted: 10/12/2023] [Indexed: 12/23/2023] Open
Abstract
Sudden cardiac arrest (SCA) is a common cause of death. The majority of SCA is caused by ventricular arrhythmia due to underlying CHD. Aborted SCA with no apparent diagnosis after initial assessment with ECG, echocardiography and coronary assessment is referred to as unexplained cardiac arrest (UCA). Systematic evaluation of such patients may reveal a specific diagnosis in up to half of patients before a diagnosis of idiopathic VF is assigned. Specific diagnoses include inherited cardiac conditions, such as latent cardiomyopathies or inherited primary electrical disease. Identifying the cause of UCA is therefore not only critical for appropriate management of the SCA survivors to prevent recurrence, but also for their family members who may be at risk of the same condition. This review provides a tiered, systematic approach for the investigation of UCA.
Collapse
Affiliation(s)
- Gonca Suna
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| | - Greg J Mellor
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust Cambridge, UK
| |
Collapse
|
23
|
Louradour J, Ottersberg R, Segiser A, Olejnik A, Martínez-Salazar B, Siegrist M, Egle M, Barbieri M, Nimani S, Alerni N, Döring Y, Odening KE, Longnus S. Simultaneous assessment of mechanical and electrical function in Langendorff-perfused ex-vivo mouse hearts. Front Cardiovasc Med 2023; 10:1293032. [PMID: 38028448 PMCID: PMC10663365 DOI: 10.3389/fcvm.2023.1293032] [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: 09/12/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Langendorff-perfused ex-vivo isolated heart model has been extensively used to study cardiac function for many years. However, electrical and mechanical function are often studied separately-despite growing proof of a complex electro-mechanical interaction in cardiac physiology and pathology. Therefore, we developed an isolated mouse heart perfusion system that allows simultaneous recording of electrical and mechanical function. Methods Isolated mouse hearts were mounted on a Langendorff setup and electrical function was assessed via a pseudo-ECG and an octapolar catheter inserted in the right atrium and ventricle. Mechanical function was simultaneously assessed via a balloon inserted into the left ventricle coupled with pressure determination. Hearts were then submitted to an ischemia-reperfusion protocol. Results At baseline, heart rate, PR and QT intervals, intra-atrial and intra-ventricular conduction times, as well as ventricular effective refractory period, could be measured as parameters of cardiac electrical function. Left ventricular developed pressure (DP), left ventricular work (DP-heart rate product) and maximal velocities of contraction and relaxation were used to assess cardiac mechanical function. Cardiac arrhythmias were observed with episodes of bigeminy during which DP was significantly increased compared to that of sinus rhythm episodes. In addition, the extrasystole-triggered contraction was only 50% of that of sinus rhythm, recapitulating the "pulse deficit" phenomenon observed in bigeminy patients. After ischemia, the mechanical function significantly decreased and slowly recovered during reperfusion while most of the electrical parameters remained unchanged. Finally, the same electro-mechanical interaction during episodes of bigeminy at baseline was observed during reperfusion. Conclusion Our modified Langendorff setup allows simultaneous recording of electrical and mechanical function on a beat-to-beat scale and can be used to study electro-mechanical interaction in isolated mouse hearts.
Collapse
Affiliation(s)
- Julien Louradour
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Rahel Ottersberg
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adrian Segiser
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Agnieszka Olejnik
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Division of Clinical Chemistry and Laboratory Hematology, Department of Medical Laboratory Diagnostics, Faculty of Pharmacy, Wroclaw Medical University, Wroclaw, Poland
| | - Berenice Martínez-Salazar
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Mark Siegrist
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuel Egle
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Miriam Barbieri
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Saranda Nimani
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Nicolò Alerni
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Heart Alliance Munich, Munich, Germany
| | - Katja E. Odening
- Department of Physiology, Translational Cardiology/Electrophysiology, Institute of Physiology, University of Bern, Bern, Switzerland
- Department of Cardiology, Translational Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sarah Longnus
- Department for BioMedical Research, University of Bern, Bern, Switzerland
- Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
24
|
Five CK, Hasselberg NE, Aaserud LT, Castrini AI, Vlaisavljevic K, Lie Ø, Rootwelt-Norberg C, Aabel EW, Haugaa KH. Lifetime exercise dose and ventricular arrhythmias in patients with mitral valve prolapse. Europace 2023; 25:euad309. [PMID: 37851515 PMCID: PMC10616587 DOI: 10.1093/europace/euad309] [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: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
AIMS Patients with mitral valve prolapse (MVP) have high risk of life-threatening ventricular arrhythmias (VAs). Data on the impact of exercise on arrhythmic risk in these patients are lacking. We explored whether lifetime exercise dose was associated with severe VA and with established risk factors in patients with MVP. Furthermore, we explored the circumstances at the VA event. METHODS AND RESULTS In this retrospective cohort study, we included patients with MVP and assessed lifetime exercise dose as metabolic equivalents of task (MET) hours/week. Severe VA was defined as sustained ventricular tachycardia or fibrillation, aborted cardiac arrest, and appropriate shock by a primary preventive implantable cardioverter defibrillator. We included 136 MVP patients (48 years [interquartile range (IQR) 35-59], 61% female), and 17 (13%) had previous severe VA. The lifetime exercise dose did not differ in patients with and without severe VA (17 MET h/week [IQR 9-27] vs. 14 MET h/week [IQR 6-31], P = 0.34). Lifetime exercise dose > 9.6 MET h/week was a borderline significant marker for severe VA (OR 3.38, 95% CI 0.92-12.40, P = 0.07), while not when adjusted for age (OR 2.63, 95% CI 0.66-10.56, P = 0.17). Ventricular arrhythmia events occurred most frequently during wakeful rest (53%), followed by exercise (29%) and sleep (12%). CONCLUSION We found no clear association between moderate lifetime exercise dose and severe VA in patients with MVP. We cannot exclude an upper threshold for safe levels of exercise. Further studies are needed to explore exercise and risk of severe VA.
Collapse
Affiliation(s)
- Christian K Five
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Nina E Hasselberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Linda T Aaserud
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
| | - Anna Isotta Castrini
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Katarina Vlaisavljevic
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Øyvind Lie
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Christine Rootwelt-Norberg
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Eivind W Aabel
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, PO Box 4950 Nydalen, 0424 Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1078 Blindern, 0316 Oslo, Norway
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Deng Y, Liu J, Wu S, Li X, Yu H, Tang L, Xie M, Zhang C. Arrhythmic Mitral Valve Prolapse: A Comprehensive Review. Diagnostics (Basel) 2023; 13:2868. [PMID: 37761235 PMCID: PMC10528205 DOI: 10.3390/diagnostics13182868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Mitral valve prolapse (MVP) is a prevalent cardiac disorder that impacts approximately 2% to 3% of the overall population. While most patients experience a benign clinical course, there is evidence suggesting that a subgroup of MVP patients face an increased risk of sudden cardiac death (SCD). Although a conclusive causal link between MVP and SCD remains to be firmly established, various factors have been associated with arrhythmic mitral valve prolapse (AMVP). This study aims to provide a comprehensive review encompassing the historical background, epidemiology, pathology, clinical manifestations, electrocardiogram (ECG) findings, and treatment of AMVP patients. A key focus is on utilizing multimodal imaging techniques to accurately diagnose AMVP and to highlight the role of mitral annular disjunction (MAD) in AMVP.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Chun Zhang
- Department of Interventional Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China; (Y.D.); (J.L.); (S.W.); (X.L.); (H.Y.); (L.T.); (M.X.)
| |
Collapse
|
27
|
Essayagh B, Sabbag A, El-Am E, Cavalcante JL, Michelena HI, Enriquez-Sarano M. Arrhythmic mitral valve prolapse and mitral annular disjunction: pathophysiology, risk stratification, and management. Eur Heart J 2023; 44:3121-3135. [PMID: 37561995 DOI: 10.1093/eurheartj/ehad491] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/11/2023] [Accepted: 07/19/2023] [Indexed: 08/12/2023] Open
Abstract
Mitral valve prolapse (MVP) is the most frequent valve condition but remains a conundrum in many aspects, particularly in regard to the existence and frequency of an arrhythmic form (AMVP) and its link to sudden cardiac death. Furthermore, the presence, frequency, and significance of the anatomic functional feature called mitral annular disjunction (MAD) have remained widely disputed. Recent case series and cohorts have shattered the concept that MVP is most generally benign and have emphasized the various phenotypes associated with clinically significant ventricular arrhythmias, including AMVP. The definition, evaluation, follow-up, and management of AMVP represent the focus of the present review, strengthened by recent coherent studies defining an arrhythmic MVP phenotypic that would affect a small subset of patients with MVP at concentrated high risk. The role of MAD in this context is of particular importance, and this review highlights the characteristics of AMVP phenotypes and MAD, their clinical, multimodality imaging, and rhythmic evaluation. These seminal facts lead to proposing a risk stratification clinical pathway with consideration of medical, rhythmologic, and surgical management and have been objects of recent expert consensus statements and of proposals for new research directions.
Collapse
Affiliation(s)
- Benjamin Essayagh
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
- Department of Echocardiography, Cardio X Clinic, Cannes, France
| | - Avi Sabbag
- The Davidai Center for Rhythm Disturbances and Pacing, Chaim Sheba Medical Center, Tel Hashomer and the Sackler School of Medicine, Tel Aviv University, Ramat-Gan, Israel
| | - Edward El-Am
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - João L Cavalcante
- Department of Cardiovascular Medicine, Allina Health Minneapolis Heart Institute - Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| | - Hector I Michelena
- From the Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Medicine, Allina Health Minneapolis Heart Institute - Abbott Northwestern Hospital, 800 E 28th St, Minneapolis, MN 55407, USA
| |
Collapse
|
28
|
Levy S, Sharaf Dabbagh G, Giudicessi JR, Haqqani H, Khanji MY, Obeng-Gyimah E, Betts MN, Ricci F, Asatryan B, Bouatia-Naji N, Nazarian S, Chahal CAA. Genetic mechanisms underlying arrhythmogenic mitral valve prolapse: Current and future perspectives. Heart Rhythm O2 2023; 4:581-591. [PMID: 37744942 PMCID: PMC10513923 DOI: 10.1016/j.hroo.2023.08.003] [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] [Indexed: 09/26/2023] Open
Abstract
Mitral valve prolapse (MVP) is a heart valve disease that is often familial, affecting 2%-3% of the general population. MVP with or without mitral regurgitation can be associated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD). Research on familial MVP has specifically focused on genetic factors, which may explain the heritable component of the disease estimated to be present in 20%-35%. Furthermore, the structural and electrophysiological substrates underlying SCD/ventricular arrhythmia risk in MVP have been studied postmortem and in the electrophysiology laboratory, respectively. Understanding how familial MVP and rhythm disorders are related may help patients with MVP by individualizing risk and working to develop effective management strategies. This contemporary, state-of-the-art, expert review focuses on genetic factors and familial components that underlie MVP and arrhythmia and encapsulates clinical, genetic, and electrophysiological issues that should be the objectives of future research.
Collapse
Affiliation(s)
- Sydney Levy
- Byram Hills High School, Armonk, New York
- Harvard College, Cambridge, Massachusetts
| | - Ghaith Sharaf Dabbagh
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - John R. Giudicessi
- Divisions of Heart Rhythm Services and Circulatory Failure, Departments of Cardiovascular Medicine, Molecular Pharmacology, and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | | | - Mohammed Y. Khanji
- Byram Hills High School, Armonk, New York
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
- Newham University Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Edmond Obeng-Gyimah
- Clinical Cardiac Electrophysiology, VT and Complex Ablation Program, WellSpan Health, York, Pennsylvania
| | - Megan N. Betts
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University of Chieti-Pescara, Chieti, Italy
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Fondazione Villaserena per la Ricerca, Città Sant’Angelo, Italy
| | - Babken Asatryan
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Saman Nazarian
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - C. Anwar A. Chahal
- Center for Inherited Cardiovascular Diseases, WellSpan Health, Lancaster, Pennsylvania
- Barts Heart Centre, Barts Health NHS Trust, London, West Smithfield, United Kingdom
- Cardiac Electrophysiology, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
29
|
Rahbari-Oskoui FF. Management of Hypertension and Associated Cardiovascular Disease in Autosomal Dominant Polycystic Kidney Disease. ADVANCES IN KIDNEY DISEASE AND HEALTH 2023; 30:417-428. [PMID: 38097332 DOI: 10.1053/j.akdh.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 03/02/2023] [Accepted: 03/15/2023] [Indexed: 12/18/2023]
Abstract
Autosomal dominant polycystic kidney disease is the most commonly inherited disease of the kidneys affecting an estimated 12,000,000 people in the world. Autosomal dominant polycystic kidney disease is a systemic disease, with a wide range of associated features that includes hypertension, valvular heart diseases, cerebral aneurysms, aortic aneurysms, liver cysts, abdominal hernias, diverticulosis, gross hematuria, urinary tract infections, nephrolithiasis, pancreatic cysts, and seminal vesicle cysts. The cardiovascular anomalies are somewhat different than in the general population and also chronic kidney disease population, with higher morbidity and mortality rates. This review will focus on cardiovascular diseases associated with autosomal dominant polycystic kidney disease and their management.
Collapse
Affiliation(s)
- Frederic F Rahbari-Oskoui
- Director of the PKD Center of Excellence, Department of Medicine-Renal Division, Emory University School of Medicine, 101 Woodruff Circle, Atlanta, GA.
| |
Collapse
|
30
|
Dell'Italia LJ, Ahmed MI. Time to Connect Pathophysiology and State-of-the-Art Imaging. JACC Clin Electrophysiol 2023; 9:1717-1718. [PMID: 37648341 DOI: 10.1016/j.jacep.2023.05.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Louis J Dell'Italia
- Division of Cardiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA; Birmingham Veterans Affairs Health Care System, Birmingham, Alabama, USA.
| | - Mustafa I Ahmed
- Division of Cardiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA
| |
Collapse
|
31
|
Apostolou F, Ioannides M, Mitsis A, Koutsofti C, Deltas C, Avraamides P. Case report: Aborted sudden cardiac death as a first presentation of severe mitral annulus disjunction-a case series and review of the literature. Front Cardiovasc Med 2023; 10:1171226. [PMID: 37547253 PMCID: PMC10400284 DOI: 10.3389/fcvm.2023.1171226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Mitral annulus disjunction (MAD) is defined as a systolic displacement between the ventricular myocardium and the posterior mitral annulus supporting the posterior mitral leaflet. This structural abnormality is associated with the loss of mechanical annular function manifested as an abnormal systolic excursion of the leaflet hinge point into the left atrium but with maintained electrical function, separating the left atrium and ventricle electrophysiologically. The mitro-aortic fibrous continuity limits MAD anteriorly, between the aortic cusps and the anterior leaflet of the mitral valve. Consequently, MAD has been observed only at the insertion of the posterior leaflet. It can extend preferentially at the central posterior scallop. The first diagnostic modality aiding the diagnosis is transthoracic echocardiography (TTE), although in some cases adjunctive cardiac imaging modality might be suggested. MAD carries a strong association with malignant ventricular arrhythmogenesis and a profound predisposition for sudden cardiac death (SCD). In this context, a thorough investigation of this morphological and functional abnormality is vital in estimating the risk assessment and stratification for optimal management and elimination of the risk of the patient for SCD. Based on the current scientific data and literature, we will discuss the diagnosis, clinical implications, risk stratification, and therapeutic management of MAD.
Collapse
Affiliation(s)
- Fay Apostolou
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Marios Ioannides
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Andreas Mitsis
- Department of Cardiology, Nicosia General Hospital,Strovolos, Cyprus
| | - Constantina Koutsofti
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
| | - Constantinos Deltas
- Biobank.cy Center of Excellence in Biobanking and Biomedical Research, University of Cyprus,Nicosia, Cyprus
- School of Medicine, University of Cyprus, Nicosia, Cyprus
| | | |
Collapse
|
32
|
Segreti A, Celeski M, Monticelli LM, Perillo A, Crispino SP, Di Gioia G, Cammalleri V, Fossati C, Mega S, Papalia R, Pigozzi F, Ussia GP, Grigioni F. Mitral and Tricuspid Valve Disease in Athletes. J Clin Med 2023; 12:jcm12103562. [PMID: 37240669 DOI: 10.3390/jcm12103562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/29/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Observing mitral or tricuspid valve disease in an athlete raises many considerations for the clinician. Initially, the etiology must be clarified, with causes differing depending on whether the athlete is young or a master. Notably, vigorous training in competitive athletes leads to a constellation of structural and functional adaptations involving cardiac chambers and atrioventricular valve systems. In addition, a proper evaluation of the athlete with valve disease is necessary to evaluate the eligibility for competitive sports and identify those requiring more follow-up. Indeed, some valve pathologies are associated with an increased risk of severe arrhythmias and potentially sudden cardiac death. Traditional and advanced imaging modalities help clarify clinical doubts, allowing essential information about the athlete's physiology and differentiating between primary valve diseases from those secondary to training-related cardiac adaptations. Remarkably, another application of multimodality imaging is evaluating athletes with valve diseases during exercise to reproduce the sport setting and better characterize the etiology and valve defect mechanism. This review aims to analyze the possible causes of atrioventricular valve diseases in athletes, focusing primarily on imaging applications in diagnosis and risk stratification.
Collapse
Affiliation(s)
- Andrea Segreti
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Mihail Celeski
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Luigi Maria Monticelli
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Alfonso Perillo
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Simone Pasquale Crispino
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Giuseppe Di Gioia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
- Institute of Sports Medicine, Sport and Health, National Italian Olympic Committee, Largo Piero Gabrielli, 00197 Roma, Italy
| | - Valeria Cammalleri
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Simona Mega
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Fabio Pigozzi
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro de Bosis, 00135 Roma, Italy
| | - Gian Paolo Ussia
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| | - Francesco Grigioni
- Unit of Cardiovascular Science, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 00128 Roma, Italy
| |
Collapse
|
33
|
Spampinato RA, Marin-Cuartas M, Kampen A, Fahr F, Sieg F, Strotdrees E, Jahnke C, Klaeske K, Wiesner K, Morningstar JE, Nagata Y, Izquierdo-Garcia D, Dieterlen MT, Norris RA, Levine RA, Paetsch I, Borger MA. Left Ventricular Fibrosis and CMR Tissue Characterization of Papillary Muscles in Mitral Valve Prolapse Patients. RESEARCH SQUARE 2023:rs.3.rs-2936590. [PMID: 37292932 PMCID: PMC10246246 DOI: 10.21203/rs.3.rs-2936590/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Mitral valve prolapse (MVP) is associated with left ventricle (LV) fibrosis, including the papillary muscles (PM), which is in turn linked to malignant arrhythmias. This study aims to evaluate comprehensive tissue characterization of the PM by cardiovascular magnetic resonance (CMR) imaging and its association with LV fibrosis observed by intraoperative biopsies. Methods MVP patients with indication for surgery due to severe mitral regurgitation (n=19) underwent a preoperative CMR with characterization of the PM: dark-appearance on cine, T1 mapping, conventional bright blood (BB) and dark blood (DB) late gadolinium enhancement (LGE). CMR T1 mapping was performed on 21 healthy volunteers as controls. LV inferobasal myocardial biopsies were obtained in MVP patients and compared to CMR findings. Results MVP patients (54±10 years old, 14 male) had a dark-appearance of the PM with higher native T1 and extracellular volume (ECV) values compared with healthy volunteers (1096±78ms vs 994±54ms and 33.9±5.6% vs 25.9±3.1%, respectively, p<0.001). Seventeen MVP patients (89.5%) had fibrosis by biopsy. BB-LGE+ in LV and PM was identified in 5 (26.3%) patients, while DB-LGE+ was observed in LV in 9 (47.4%) and in PM in 15 (78.9%) patients. DB-LGE+ in PM was the only technique that showed no difference with detection of LV fibrosis by biopsy. Posteromedial PM was more frequently affected than the anterolateral (73.7% vs 36.8%, p=0.039) and correlated with biopsy-proven LV fibrosis (Rho 0.529, p=0.029). Conclusions CMR imaging in MVP patients referred for surgery shows a dark-appearance of the PM with higher T1 and ECV values compared with healthy volunteers. The presence of a positive DB-LGE at the posteromedial PM by CMR may serve as a better predictor of biopsy-proven LV inferobasal fibrosis than conventional CMR techniques.
Collapse
|
34
|
Daniłowicz-Szymanowicz L, Zienciuk-Krajka A, Wabich E, Fijałkowski M, Fijałkowska J, Młodziński K, Raczak G. Left Ventricle Segmental Longitudinal Strain and Regional Myocardial Work Index Could Help Determine Mitral Valve Prolapse Patients with Increased Risk of Ventricular Arrhythmias. J Cardiovasc Dev Dis 2023; 10:jcdd10040181. [PMID: 37103060 PMCID: PMC10145267 DOI: 10.3390/jcdd10040181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023] Open
Abstract
Mitral valve prolapse (MVP) could associate with malignant ventricular arrhythmias (VAs). Mitral annular disjunction, a putative mechanism for an arrhythmic substrate, leads to excessive mobility, stretch, and damage of some segments. Speckle tracking echocardiography (STE), with particular attention to the segmental longitudinal strain and myocardial work index (MWI), could be an indicator of the segments we aimed to check. Seventy-two MVP patients and twenty controls underwent echocardiography. Complex VAs documented prospectively after the enrollment was qualified as the primary endpoint, which was noticed in 29 (40%) patients. Pre-specified cut-off values for peak segmental longitudinal strain (PSS) and segmental MWI for basal lateral (-25%, 2200 mmHg%), mid-lateral (-25%, 2500 mmHg%), mid-posterior (-25%, 2400 mmHg%), and mid-inferior (-23%, 2400 mmHg%) segments were accurate predictors of complex VAs. A combination of PSS and MWI increased the probability of the endpoint, reaching the highest predictive value for the basal lateral segment: odds ratio 32.15 (3.78-273.8), p < 0.001 for PSS ≥ -25% and MWI ≥ 2200 mmHg%. STE may be a valuable tool for assessing the arrhythmic risk in MVP patients. Excessively increased segmental longitudinal strain with an augmented regional myocardial work index identifies patients with the highest risk of complex VAs.
Collapse
Affiliation(s)
| | - Agnieszka Zienciuk-Krajka
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Elżbieta Wabich
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Marcin Fijałkowski
- I Department of Cardiology, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Jadwiga Fijałkowska
- II Department of Radiology, Faculty of Health and Sciences, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Krzysztof Młodziński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdansk, 80-210 Gdansk, Poland
| |
Collapse
|
35
|
Qin X, Cai P, Liu C, Chen K, Jiang X, Chen W, Li J, Jiao X, Guo E, Yu Y, Sun L, Tian H. Cardioprotective effect of ultrasound-targeted destruction of Sirt3-loaded cationic microbubbles in a large animal model of pathological cardiac hypertrophy. Acta Biomater 2023; 164:604-625. [PMID: 37080445 DOI: 10.1016/j.actbio.2023.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 04/22/2023]
Abstract
Pathological cardiac hypertrophy occurs in response to numerous increased afterload stimuli and precedes irreversible heart failure (HF). Therefore, therapies that ameliorate pathological cardiac hypertrophy are urgently required. Sirtuin 3 (Sirt3) is a main member of histone deacetylase class III and is a crucial anti-oxidative stress agent. Therapeutically enhancing the Sirt3 transfection efficiency in the heart would broaden the potential clinical application of Sirt3. Ultrasound-targeted microbubble destruction (UTMD) is a prospective, noninvasive, repeatable, and targeted gene delivery technique. In the present study, we explored the potential and safety of UTMD as a delivery tool for Sirt3 in hypertrophic heart tissues using adult male Bama miniature pigs. Pigs were subjected to ear vein delivery of human Sirt3 together with UTMD of cationic microbubbles (CMBs). Fluorescence imaging, western blotting, and quantitative real-time PCR revealed that the targeted destruction of ultrasonic CMBs in cardiac tissues greatly boosted Sirt3 delivery. Overexpression of Sirt3 ameliorated oxidative stress and partially improved the diastolic function and prevented the apoptosis and profibrotic response. Lastly, our data revealed that Sirt3 may regulate the potential transcription of catalase and MnSOD through Foxo3a. Combining the advantages of ultrasound CMBs with preclinical hypertrophy large animal models for gene delivery, we established a classical hypertrophy model as well as a strategy for the targeted delivery of genes to hypertrophic heart tissues. Since oxidative stress, fibrosis and apoptosis are indispensable in the evolution of cardiac hypertrophy and heart failure, our findings suggest that Sirt3 is a promising therapeutic option for these diseases. STATEMENT OF SIGNIFICANCE: : Pathological cardiac hypertrophy is a central prepathology of heart failure and is seen to eventually precede it. Feasible targets that may prevent or reverse disease progression are scarce and urgently needed. In this study, we developed surface-filled lipid octafluoropropane gas core cationic microbubbles that could target the release of human Sirt3 reactivating the endogenous Sirt3 in hypertrophic hearts and protect against oxidative stress in a pig model of cardiac hypertrophy induced by aortic banding. Sirt3-CMBs may enhance cardiac diastolic function and ameliorate fibrosis and apoptosis. Our work provides a classical cationic lipid-based, UTMD-mediated Sirt3 delivery system for the treatment of Sirt3 in patients with established cardiac hypertrophy, as well as a promising therapeutic target to combat pathological cardiac hypertrophy.
Collapse
Affiliation(s)
- Xionghai Qin
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Peian Cai
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Chang Liu
- Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Kegong Chen
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Department of Thoracic Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China
| | - Xingpei Jiang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Wei Chen
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Jiarou Li
- Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Xuan Jiao
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China
| | - Erliang Guo
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Department of Thoracic Surgery, Harbin Medical University Cancer Hospital, Harbin 150081, China
| | - Yixiu Yu
- Department of Stomatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Lu Sun
- Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Department of Cardiovascular Surgery, Peking University Shenzhen Hospital, Shenzhen 518036, China
| | - Hai Tian
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China; Future Medical Laboratory, The Second Affiliated Hospital of Harbin Medical University, Harbin 150081, China.
| |
Collapse
|
36
|
Chung JH, Tsai YJ, Lin KL, Weng KP, Huang MH, Chen GB, Tuan SH. Comparison of Cardiorespiratory Fitness between Patients with Mitral Valve Prolapse and Healthy Peers: Findings from Serial Cardiopulmonary Exercise Testing. J Cardiovasc Dev Dis 2023; 10:jcdd10040167. [PMID: 37103046 PMCID: PMC10141154 DOI: 10.3390/jcdd10040167] [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: 02/18/2023] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 04/28/2023] Open
Abstract
Individuals with mitral valve prolapse (MVP) have exercise intolerance even without mitral valve regurgitation. Mitral valve degeneration may progress with aging. We aimed to evaluate the influence of MVP on the cardiopulmonary function (CPF) of individuals with MVP through serial follow-ups from early to late adolescence. Thirty patients with MVP receiving at least two cardiopulmonary exercise tests (CPETs) using a treadmill (MVP group) were retrospectively analyzed. Age-, sex-, and body mass index-matched healthy peers, who also had serial CPETs, were recruited as the control group. The average time from the first CPET to the last CPET was 4.28 and 4.06 years in the MVP and control groups, respectively. At the first CPET, the MVP group had a significantly lower peak rate pressure product (PRPP) than the control group (p = 0.022). At the final CEPT, the MVP group had lower peak metabolic equivalent (MET, p = 0.032) and PRPP (p = 0.031). Moreover, the MVP group had lower peak MET and PRPP as they aged, whereas healthy peers had higher peak MET (p = 0.034) and PRPP (p = 0.047) as they aged. Individuals with MVP had poorer CPF than healthy individuals as they develop from early to late adolescence. It is important for individuals with MVP to receive regular CPET follow-ups.
Collapse
Affiliation(s)
- Jin-Hui Chung
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- Department of Physical Therapy, Shu-Zen junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
| | - Yi-Ju Tsai
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No.1, University Rd., Tainan City 70101, Taiwan
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Ko-Long Lin
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 8073748, Taiwan
- Department of Post-Baccalaureate Medicine, National Sun Yat-Sen University, Kaohsiung 804315, Taiwan
| | - Ken-Pen Weng
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Congenital Structural Heart Disease Center, Department of Pediatrics, Kaohsiung Veterans General Hospital, Kaohsiung 813414, Taiwan
| | - Ming-Hsuan Huang
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Kaohsiung City 813414, Taiwan
| | - Guan-Bo Chen
- Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 802301, Taiwan
| | - Sheng-Hui Tuan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, No.1, University Rd., Tainan City 70101, Taiwan
- Department of Rehabilitation Medicine, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung 84247, Taiwan
| |
Collapse
|
37
|
Nagata Y, Bertrand PB, Baliyan V, Kochav J, Kagan RD, Ujka K, Alfraidi H, van Kampen A, Morningstar JE, Dal-Bianco JP, Melnitchouk S, Holmvang G, Borger MA, Moore R, Hua L, Sultana R, Calle PV, Yum B, Guerrero JL, Neilan TG, Picard MH, Kim J, Delling FN, Hung J, Norris RA, Weinsaft JW, Levine RA. Abnormal Mechanics Relate to Myocardial Fibrosis and Ventricular Arrhythmias in Patients With Mitral Valve Prolapse. Circ Cardiovasc Imaging 2023; 16:e014963. [PMID: 37071717 PMCID: PMC10108844 DOI: 10.1161/circimaging.122.014963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/08/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND The relation between ventricular arrhythmia and fibrosis in mitral valve prolapse (MVP) is reported, but underlying valve-induced mechanisms remain unknown. We evaluated the association between abnormal MVP-related mechanics and myocardial fibrosis, and their association with arrhythmia. METHODS We studied 113 patients with MVP with both echocardiogram and gadolinium cardiac magnetic resonance imaging for myocardial fibrosis. Two-dimensional and speckle-tracking echocardiography evaluated mitral regurgitation, superior leaflet and papillary muscle displacement with associated exaggerated basal myocardial systolic curling, and myocardial longitudinal strain. Follow-up assessed arrhythmic events (nonsustained or sustained ventricular tachycardia or ventricular fibrillation). RESULTS Myocardial fibrosis was observed in 43 patients with MVP, predominantly in the basal-midventricular inferior-lateral wall and papillary muscles. Patients with MVP with fibrosis had greater mitral regurgitation, prolapse, and superior papillary muscle displacement with basal curling and more impaired inferior-posterior basal strain than those without fibrosis (P<0.001). An abnormal strain pattern with distinct peaks pre-end-systole and post-end-systole in inferior-lateral wall was frequent in patients with fibrosis (81 versus 26%, P<0.001) but absent in patients without MVP with basal inferior-lateral wall fibrosis (n=20). During median follow-up of 1008 days, 36 of 87 patients with MVP with >6-month follow-up developed ventricular arrhythmias associated (univariable) with fibrosis, greater prolapse, mitral annular disjunction, and double-peak strain. In multivariable analysis, double-peak strain showed incremental risk of arrhythmia over fibrosis. CONCLUSIONS Basal inferior-posterior myocardial fibrosis in MVP is associated with abnormal MVP-related myocardial mechanics, which are potentially associated with ventricular arrhythmia. These associations suggest pathophysiological links between MVP-related mechanical abnormalities and myocardial fibrosis, which also may relate to ventricular arrhythmia and offer potential imaging markers of increased arrhythmic risk.
Collapse
Affiliation(s)
- Yasufumi Nagata
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Philippe B. Bertrand
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Vinit Baliyan
- Department of Radiology (V.B., G.H.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jonathan Kochav
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Ruth D. Kagan
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Kristian Ujka
- School of Cardiovascular Disease, University of Pisa, Italy (K.U.)
| | - Hassan Alfraidi
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Antonia van Kampen
- Cardiac Surgery (A.v.K., S.M.), Massachusetts General Hospital, Harvard Medical School, Boston
- University Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Saxony, Germany (A.v.K., M.A.B.)
| | - Jordan E. Morningstar
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Jacob P. Dal-Bianco
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Serguei Melnitchouk
- Cardiac Surgery (A.v.K., S.M.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Godtfred Holmvang
- Department of Radiology (V.B., G.H.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Michael A. Borger
- University Department for Cardiac Surgery, Leipzig Heart Center, University of Leipzig, Saxony, Germany (A.v.K., M.A.B.)
| | - Reece Moore
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Lanqi Hua
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Razia Sultana
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Pablo Villar Calle
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Brian Yum
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - J. Luis Guerrero
- Surgical Cardiovascular Laboratory (J.L.G.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Tomas G. Neilan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston (T.G.N.)
| | - Michael H. Picard
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Jiwon Kim
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Francesca N. Delling
- Division of Cardiovascular Medicine, University of California, San Francisco (F.N.D.)
| | - Judy Hung
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| | - Russell A. Norris
- Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston (J.E.M., R.M., R.A.N.)
| | - Jonathan W. Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, NY (J. Kochav, R.D.K., R.S., P.V.C., B.Y., J. Kim, J.W.W.)
| | - Robert A. Levine
- Cardiac Ultrasound Laboratory (Y.N., P.B.B., H.A., J.P.D.-B., L.H., M.H.P., J.H., R.A.L.), Massachusetts General Hospital, Harvard Medical School, Boston
| |
Collapse
|
38
|
Lancellotti P, Go YY. New Kid on the Block: Double-Peak Strain Pattern in Arrhythmic Mitral Valve Prolapse. Circ Cardiovasc Imaging 2023; 16:e015397. [PMID: 37071715 PMCID: PMC10473021 DOI: 10.1161/circimaging.123.015397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Affiliation(s)
- Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium (P.L.)
- Division of Cardiovascular Surgery and Research, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, Italy (P.L.)
- Anthea Hospital, Bari, Italy (P.L.)
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore (Y.Y.G.)
| |
Collapse
|
39
|
Conti S, Sabatino F, Caserta C, Sgarito G. Papillary muscle ventricular ectopy ablation in a malignant mitral valve prolapse: Ablation in Malignant Mitral Valve Prolapse: Ablation in Malignant Mitral Valve Prolapse. Echocardiography 2023; 40:271-275. [PMID: 36722012 DOI: 10.1111/echo.15529] [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: 09/10/2022] [Revised: 12/21/2022] [Accepted: 01/08/2023] [Indexed: 02/02/2023] Open
Abstract
Patients with mitral valve prolapse (MVP) have a heterogeneous clinical spectrum, ranging from benign to severe clinical presentations such as sudden cardiac death (SCD). Some of the markers of "arrhythmic MVP" include inverted/biphasic T-waves, QT prolongation, and polymorphic premature ventricular contractions (PVCs) originating from the left ventricular outflow tract and papillary muscles (PMs). The genesis of arrhythmias in MVP recognizes the combination of the substrate (fibrosis) and the trigger (mechanical stretch). Therefore, ablation of ventricular arrhythmias originating from PMs in a patient with MVP can be considered an adjunctive strategy to lower the arrhythmic burden and reduce the risk of ICD shocks.
Collapse
Affiliation(s)
- Sergio Conti
- Department of Cardiology, Electrophysiology Department, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Francesco Sabatino
- Department of Cardiology, Electrophysiology Department, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Carlo Caserta
- Department of Cardiology, cardiovascular imaging division, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Sgarito
- Department of Cardiology, Electrophysiology Department, ARNAS Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| |
Collapse
|
40
|
Hurley M, Kaur S, Walton R, Power A, Haïssaguerre M, Bernus O, Ward ML, White E. Endocardial role in arrhythmias induced by acute ventricular stretch and the involvement of Purkinje fibres, in isolated rat hearts. Curr Res Physiol 2023; 6:100098. [PMID: 36814643 PMCID: PMC9939534 DOI: 10.1016/j.crphys.2023.100098] [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: 10/21/2022] [Revised: 01/13/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Purkinje fibres (PFs) play an important role in some ventricular arrhythmias and acute ventricular stretch can evoke mechanically-induced arrhythmias. We tested whether PFs and specifically TRPM4 channels, play a role in these mechanically-induced arrhythmias. Pseudo-ECGs and left ventricular (LV) activation, measured by optical mapping, were recorded in isolated, Langendorff-perfused, rat hearts. The LV endocardial surface was irrigated with experimental agents, via an indwelling catheter. The number and period of ectopic activations was measured during LV lumen inflation via an indwelling fluid-filled balloon (100 μL added over 2 s, maintained for 38 s). Mechanically-induced arrhythmias occurred during balloon inflation: they were multifocal, maximal in the first 5 s and ceased within 20 s. Optical mapping revealed activation patterns indicating PF-mediated and ectopic focal sources. Irrigation of the LV lumen with Lugol solution (IK/I2) for 10s reduced ectopics by 93% (n = 16, P < 0.001); with ablation of endocardial PFs confirmed by histology. Five min irrigation of the LV lumen with 50 μM 9-Phenanthrol, a blocker of TRPM4 channels, reduced ectopics by 39% (n = 15, P < 0.01). Immunohistochemistry confirmed that TRPM4 was more abundant in PFs than myocardium. Our results show that the endocardial surface plays an important role in these mechanically-induced ectopic activations. Ectopic activation patterns indicate a participation of PFs in these arrhythmias, with a potential involvement of TRPM4 channels, shown by the reduction of arrhythmias by 9-Phenanthrol.
Collapse
Affiliation(s)
- Miriam Hurley
- School of Biomedical Sciences, University of Leeds, Leeds, UK
| | - Sarbjot Kaur
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Richard Walton
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Amelia Power
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Michel Haïssaguerre
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, Pessac, France
| | - Olivier Bernus
- Université Bordeaux, INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Pessac, Bordeaux, France,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac, Bordeaux, France
| | - Marie-Louise Ward
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ed White
- School of Biomedical Sciences, University of Leeds, Leeds, UK,Corresponding author. Garstang Building, School of Biomedical Sciences, University of Leeds, LS29JT, Leeds, UK.
| |
Collapse
|
41
|
Comparison of the Results of Cardiopulmonary Exercise Testing between Healthy Peers and Pediatric Patients with Different Echocardiographic Severity of Mitral Valve Prolapse. Life (Basel) 2023; 13:life13020302. [PMID: 36836660 PMCID: PMC9958875 DOI: 10.3390/life13020302] [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: 12/28/2022] [Revised: 01/15/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Patients with mitral valve prolapse (MVP) have been reported to have exercise intolerance. However, the underlying pathophysiological mechanisms and their physical fitness remain unclear. We aimed to determine the exercise capacity of patients with MVP through the cardiopulmonary exercise test (CPET). We retrospectively collected the data of 45 patients with a diagnosis of MVP. Their CPET and echocardiogram results were compared with 76 healthy individuals as primary outcomes. No significant differences regarding the patient's baseline characteristics and echocardiographic data were found between the two groups, except for the lower body mass index (BMI) of the MVP group. Patients in the MVP group demonstrated a similar peak metabolic equivalent (MET), but a significantly lower peak rate pressure product (PRPP) (p = 0.048). Patients with MVP possessed similar exercise capacity to healthy individuals. The reduced PRPP may indicate compromised coronary perfusion and subtle left ventricular function impairment.
Collapse
|
42
|
Zheng Y, Guo X, Chen C, Chi L, Guo Z, Liang J, Wei L, Chen X, Ye X, He J. Cardiovascular Toxicities of Ibrutinib: A Pharmacovigilance Study Based on the United States Food and Drug Administration Adverse Event Reporting System Database. Pharmaceuticals (Basel) 2023; 16:ph16010098. [PMID: 36678594 PMCID: PMC9863914 DOI: 10.3390/ph16010098] [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: 10/13/2022] [Revised: 12/29/2022] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Background: Although ibrutinib has been widely used to treat haematological malignancies, many studies have reported associated cardiovascular events. These studies were primarily animal experiments and clinical trials. For more rational clinical drug use, a study based on post-marketing data is necessary. Aim: Based on post-marketing data, we investigated the clinical features, time to onset, and outcomes of potential cardiovascular toxicities of ibrutinib. Methods: This disproportionality study utilised data from the 2014−2021 United States Food and Drug Administration Adverse Event Reporting System (FAERS) database. We used two disproportionality methods information component (IC) and reporting odds ratio (ROR)) to detect the potential cardiovascular toxicities of ibrutinib. Positive signals were defined as IC025 > 0 and ROR025 > 1. Results: A total of 10 cardiovascular events showed positive signals: supraventricular tachyarrhythmias, haemorrhagic central nervous system vascular conditions, ventricular tachyarrhythmias, cardiac failure, ischaemic central nervous system vascular conditions, cardiomyopathy, conduction defects, myocardial infarction, myocardial infarction disorders of sinus node function, and torsade de pointes/QT prolongation. Cardiomyopathy and supraventricular tachyarrhythmias were the two most common signals. Disorders of sinus node function were observed for the first time, which may be a new adverse effect of ibrutinib. Conclusions: This pharmacovigilance study systematically explored the adverse cardiovascular events of ibrutinib and provided new safety signals based on past safety information. Attention should be paid to some high-risk signals.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Xiaofei Ye
- Correspondence: (X.Y.); (J.H.); Tel.: +86-138-1626-2536 (X.Y.); +86-133-8627-7040 (J.H.)
| | - Jia He
- Correspondence: (X.Y.); (J.H.); Tel.: +86-138-1626-2536 (X.Y.); +86-133-8627-7040 (J.H.)
| |
Collapse
|
43
|
Vermes E, Altes A, Iacuzio L, Levy F, Bohbot Y, Renard C, Grigioni F, Maréchaux S, Tribouilloy C. The evolving role of cardiovascular magnetic resonance in the assessment of mitral valve prolapse. Front Cardiovasc Med 2023; 10:1093060. [PMID: 36937904 PMCID: PMC10020178 DOI: 10.3389/fcvm.2023.1093060] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Mitral valve prolapse (MVP), characterized by a displacement > 2 mm above the mitral annulus of one or both bileaflets, with or without leaflet thickening, is a common valvular heart disease, with a prevalence of approximately 2% in western countries. Although this population has a generally good overall prognosis, MVP can be associated with mitral regurgitation (MR), left ventricular (LV) remodeling leading to heart failure, ventricular arrhythmia, and, the most devastating complication, sudden cardiac death, especially in myxomatous bileaflet prolapse (Barlow's disease). Among several prognostic factors reported in the literature, LV fibrosis and mitral annular disjunction may act as an arrhythmogenic substrate in this population. Cardiac magnetic resonance (CMR) has emerged as a reliable tool for assessing MVP, MR severity, LV remodeling, and fibrosis. Indeed, CMR is the gold standard imaging modality to assess ventricular volume, function, and wall motion abnormalities; it allows accurate calculation of the regurgitant volume and regurgitant fraction in MR using a combination of LV volumetric measurement and aortic flow quantification, independent of regurgitant jet morphology and valid in cases of multiple valvulopathies. Moreover, CMR is a unique imaging modality that can assess non-invasively focal and diffuse fibrosis using late gadolinium enhancement sequences and, more recently, T1 mapping. This review describes the use of CMR in patients with MVP and its role in identifying patients at high risk of ventricular arrhythmia.
Collapse
Affiliation(s)
- Emmanuelle Vermes
- Department of Cardiology, Amiens University Hospital, Amiens, France
- *Correspondence: Emmanuelle Vermes
| | - Alexandre Altes
- Department of Cardiology, Heart Valve Center, Lille Catholic Hospitals, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille Catholic University, Lille, France
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain, Brussels, Belgium
| | - Laura Iacuzio
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco, Monaco
| | - Franck Levy
- Department of Cardiology, Centre Cardio-Thoracique de Monaco, Monaco, Monaco
| | - Yohann Bohbot
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Cédric Renard
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - Francesco Grigioni
- Division of Cardiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma and Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Sylvestre Maréchaux
- Department of Cardiology, Heart Valve Center, Lille Catholic Hospitals, GCS-Groupement des Hôpitaux de l'Institut Catholique de Lille, Lille Catholic University, Lille, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| |
Collapse
|
44
|
Gerber BL. The Risk of Arrhythmic Events in Mitral Valve Prolapse. Radiology 2023; 306:122-123. [PMID: 36098646 DOI: 10.1148/radiol.221838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bernhard L Gerber
- From the Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St Luc, Av Hippocrate 10/2803, B-1200 Woluwe St, Lambert, Belgium; and CARD Unit, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels, Belgium
| |
Collapse
|
45
|
Carpenito M, Gelfusa M, Mega S, Cammalleri V, Benfari G, De Stefano D, Ussia GP, Tribouilloy C, Enriquez-Sarano M, Grigioni F. Watchful surgery in asymptomatic mitral valve prolapse. Front Cardiovasc Med 2023; 10:1134828. [PMID: 37123469 PMCID: PMC10130568 DOI: 10.3389/fcvm.2023.1134828] [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: 12/30/2022] [Accepted: 03/14/2023] [Indexed: 05/02/2023] Open
Abstract
The most common organic etiology of mitral regurgitation is degenerative and consists of mitral valve prolapse (MVP). Volume overload because of mitral regurgitation is the most common complication of MVP. Advocating surgery before the consequences of volume overload become irreparable restores life expectancy, but carries a risk of mortality in patients who are often asymptomatic. On the other hand, the post-surgical outcome of symptomatic patients is dismal and life expectancy is impaired. In the present article, we aim to bridge the gap between these two therapeutic approaches, unifying the concepts of watchful waiting and early surgery in a "watchful surgery approach".
Collapse
Affiliation(s)
- Myriam Carpenito
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Martina Gelfusa
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Simona Mega
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Valeria Cammalleri
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Domenico De Stefano
- Research Unit of Diagnostic Imaging and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France
- UR UPJV 7517, Jules Verne University of Picardie, Amiens, France
| | - Maurice Enriquez-Sarano
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, United States
| | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Università e Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Correspondence: Francesco Grigioni
| |
Collapse
|
46
|
Delwarde C, Capoulade R, Mérot J, Le Scouarnec S, Bouatia-Naji N, Yu M, Huttin O, Selton-Suty C, Sellal JM, Piriou N, Schott JJ, Dina C, Le Tourneau T. Genetics and pathophysiology of mitral valve prolapse. Front Cardiovasc Med 2023; 10:1077788. [PMID: 36873395 PMCID: PMC9978496 DOI: 10.3389/fcvm.2023.1077788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/23/2023] [Indexed: 02/18/2023] Open
Abstract
Mitral valve prolapse (MVP) is a common condition affecting 2-3% of the general population, and the most complex form of valve pathology, with a complication rate up to 10-15% per year in advanced stages. Complications include mitral regurgitation which can lead to heart failure and atrial fibrillation, but also life-threatening ventricular arrhythmia and cardiovascular death. Sudden death has been recently brought to the forefront of MVP disease, increasing the complexity of management and suggesting that MVP condition is not properly understood. MVP can occur as part of syndromic conditions such as Marfan syndrome, but the most common form is non-syndromic, isolated or familial. Although a specific X-linked form of MVP was initially identified, autosomal dominant inheritance appears to be the primary mode of transmission. MVP can be stratified into myxomatous degeneration (Barlow), fibroelastic deficiency, and Filamin A-related MVP. While FED is still considered a degenerative disease associated with aging, myxomatous MVP and FlnA-MVP are recognized as familial pathologies. Deciphering genetic defects associated to MVP is still a work in progress; although FLNA, DCHS1, and DZIP1 have been identified as causative genes in myxomatous forms of MVP thanks to familial approaches, they explain only a small proportion of MVP. In addition, genome-wide association studies have revealed the important role of common variants in the development of MVP, in agreement with the high prevalence of this condition in the population. Furthermore, a potential genetic link between MVP and ventricular arrhythmia or a specific type of cardiomyopathy is considered. Animal models that allow to advance in the genetic and pathophysiological knowledge of MVP, and in particular those that can be easily manipulated to express a genetic defect identified in humans are detailed. Corroborated by genetic data and animal models, the main pathophysiological pathways of MVP are briefly addressed. Finally, genetic counseling is considered in the context of MVP.
Collapse
Affiliation(s)
- Constance Delwarde
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Romain Capoulade
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Jean Mérot
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Solena Le Scouarnec
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | | | - Mengyao Yu
- Human Phenome Institute, Fudan University, Shanghai, China
| | - Olivier Huttin
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Christine Selton-Suty
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Jean-Marc Sellal
- Service de Cardiologie, Institut Lorrain du Coeur et des Vaisseaux Louis Mathieu, CHU de Nancy, Nancy, France
| | - Nicolas Piriou
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| | - Thierry Le Tourneau
- Nantes Université, CHU Nantes, CNRS, INSERM, L'institut du Thorax, Nantes, France
| |
Collapse
|
47
|
Hurley M, Walton R, Vigmond EJ, Haïssaguerre M, Bernus O, White E. Attenuation of stretch-induced arrhythmias following chemical ablation of Purkinje fibres, in isolated rabbit hearts. Front Physiol 2023; 14:1154157. [PMID: 37089427 PMCID: PMC10115947 DOI: 10.3389/fphys.2023.1154157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/23/2023] [Indexed: 04/25/2023] Open
Abstract
Purkinje fibres (PFs) play an important role in some ventricular arrhythmias and acute ventricular stretch can evoke mechanically-induced arrhythmias. We tested whether Purkinje fibres, play a role in these arrhythmias. Pseudo-ECGs were recorded in isolated, Langendorff-perfused, rabbit hearts in which the left ventricular endocardial surface was also irrigated with Tyrode, via an indwelling catheter placed in the left ventricular lumen. The number and period of ectopic activations was measured during left ventricular lumen inflation via an indwelling fluid-filled balloon (500 μL added over 2 s and maintained for 15 s in total). Mechanically-induced arrhythmias occurred in 70% of balloon inflations: they were maximal in the first 5 s and ceased within 15 s. Brief, (10 s) irrigation of the left ventricular lumen with Lugol solution (IK/I2), via the indwelling catheter, reduced inflation-induced ectopics by 98% (p < 0.05). Ablation of endocardial PFs by Lugol was confirmed by Triphenyltetrazolium Chloride staining. Optical mapping revealed the left ventricular epicardial activation patterns of ectopics could have PF-mediated and focal sources. In silico modelling predicted ectopic sources originating in the endocardial region propagate to and through the Purkinje fibres network. Acute distention-induced ectopics are multi-focal, their attenuation by Lugol, their activation patterns and in silico modelling indicate a participation of Purkinje fibres in these arrhythmias.
Collapse
Affiliation(s)
- Miriam Hurley
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Richard Walton
- INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Université Bordeaux, Pessac-Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac-Bordeaux, France
| | - Edward J. Vigmond
- INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Université Bordeaux, Pessac-Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Université Bordeaux, Pessac-Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac-Bordeaux, France
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Olivier Bernus
- INSERM Centre de recherche Cardio-Thoracique de Bordeaux, Université Bordeaux, Pessac-Bordeaux, France
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation, Bordeaux Université, Pessac-Bordeaux, France
| | - Ed White
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
- *Correspondence: Ed White,
| |
Collapse
|
48
|
Stop the Madness: Mitral Annular Disjunction. CASE 2023; 7:116-118. [PMID: 37065832 PMCID: PMC10102981 DOI: 10.1016/j.case.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
49
|
Doran M, Reemst G, Ng K, Shaw C, Stoodley P. Mitral annular disjunction identified peripartum: A case highlighting key features of a recently classified syndrome. SONOGRAPHY 2022. [DOI: 10.1002/sono.12341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Monique Doran
- Royal North Shore Hospital St Leonards New South Wales Australia
- Western Sydney University Penrith New South Wales Australia
| | - Gemma Reemst
- Royal North Shore Hospital St Leonards New South Wales Australia
| | - Kenny Ng
- Royal North Shore Hospital St Leonards New South Wales Australia
- Western Sydney University Penrith New South Wales Australia
| | - Courtney Shaw
- Western Sydney University Penrith New South Wales Australia
| | - Paul Stoodley
- Western Sydney University Penrith New South Wales Australia
| |
Collapse
|
50
|
Aabel EW, Dejgaard LA, Chivulescu M, Helle-Valle TM, Edvardsen T, Hasselberg NE, Hegbom F, Lie ØH, Haugaa KH. Flecainide in patients with arrhythmic mitral valve syndrome: A case series. Heart Rhythm 2022; 20:635-636. [PMID: 36566890 DOI: 10.1016/j.hrthm.2022.12.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Eivind W Aabel
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars A Dejgaard
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Thomas M Helle-Valle
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Nina E Hasselberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Finn Hegbom
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Øyvind H Lie
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Medicine, Huddinge, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
| |
Collapse
|