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Petri H, Mohammad BJY, Kristensen AT, Thune JJ, Vissing J, Køber L, Witting N, Bundgaard H, Christensen AH. Natural history of cardiac involvement in myotonic dystrophy type 1 - Emphasis on the need for lifelong follow-up. Int J Cardiol 2024; 406:132070. [PMID: 38643802 DOI: 10.1016/j.ijcard.2024.132070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/19/2024] [Accepted: 04/17/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Cardiac involvement represents a major cause of morbidity and mortality in patients with myotonic dystrophy type 1 (DM1) and prevention of sudden cardiac death (SCD) is a central part of patient care. We investigated the natural history of cardiac involvement in patients with DM1 to provide an evidence-based foundation for adjustment of follow-up protocols. METHODS Patients with genetically confirmed DM1 were identified. Data on patient characteristics, performed investigations (12 lead ECG, Holter monitoring and echocardiography), and clinical outcomes were retrospectively collected from electronic health records. RESULTS We included 195 patients (52% men) with a mean age at baseline evaluation of 41 years (range 14-79). The overall prevalence of cardiac involvement increased from 42% to 66% after a median follow-up of 10.5 years. There was a male predominance for cardiac involvement at end of follow-up (74 vs. 44%, p < 0.001). The most common types of cardiac involvement were conduction abnormalities (48%), arrhythmias (35%), and left ventricular systolic dysfunction (21%). Only 17% of patients reported cardiac symptoms. The standard 12‑lead ECG was the most sensitive diagnostic modality and documented cardiac involvement in 24% at baseline and in 49% at latest follow-up. However, addition of Holter monitoring and echocardiography significantly increased the diagnostic yield with 18 and 13% points at baseline and latest follow-up, respectively. Despite surveillance 35 patients (18%) died during follow-up; seven due to SCD. CONCLUSIONS In patients with DM1 cardiac involvement was highly prevalent and developed during follow-up. These findings justify lifelong follow-up with ECG, Holter, and echocardiography. CLINICAL PERSPECTIVE What is new? What are the clinical implications?
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Affiliation(s)
- Helle Petri
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Batool J Y Mohammad
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Andreas Torp Kristensen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - John Vissing
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nanna Witting
- Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Copenhagen University Hospital - Herlev-Gentofte Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
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2
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Politano L. Is Cardiac Transplantation Still a Contraindication in Patients with Muscular Dystrophy-Related End-Stage Dilated Cardiomyopathy? A Systematic Review. Int J Mol Sci 2024; 25:5289. [PMID: 38791328 PMCID: PMC11121328 DOI: 10.3390/ijms25105289] [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: 03/08/2024] [Revised: 05/05/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Inherited muscular diseases (MDs) are genetic degenerative disorders typically caused by mutations in a single gene that affect striated muscle and result in progressive weakness and wasting in affected individuals. Cardiac muscle can also be involved with some variability that depends on the genetic basis of the MD (Muscular Dystrophy) phenotype. Heart involvement can manifest with two main clinical pictures: left ventricular systolic dysfunction with evolution towards dilated cardiomyopathy and refractory heart failure, or the presence of conduction system defects and serious life-threatening ventricular arrhythmias. The two pictures can coexist. In these cases, heart transplantation (HTx) is considered the most appropriate option in patients who are not responders to the optimized standard therapeutic protocols. However, cardiac transplant is still considered a relative contraindication in patients with inherited muscle disorders and end-stage cardiomyopathies. High operative risk related to muscle impairment and potential graft involvement secondary to the underlying myopathy have been the two main reasons implicated in the generalized reluctance to consider cardiac transplant as a viable option. We report an overview of cardiac involvement in MDs and its possible association with the underlying molecular defect, as well as a systematic review of HTx outcomes in patients with MD-related end-stage dilated cardiomyopathy, published so far in the literature.
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Affiliation(s)
- Luisa Politano
- Cardiomyology and Medical Genetics, University of Campania Luigi Vanvitelli, 80138 Naples, Italy
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3
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Kashyap N, Nikhanj A, Labib D, Prosia E, Rivest S, Flewitt J, Pfeffer G, Bakal JA, Siddiqi ZA, Coulden RA, Thompson R, White JA, Oudit GY. Prognostic Utility of Cardiovascular Magnetic Resonance-Based Phenotyping in Patients With Muscular Dystrophy. J Am Heart Assoc 2023; 12:e030229. [PMID: 37929714 PMCID: PMC10727409 DOI: 10.1161/jaha.123.030229] [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: 05/18/2023] [Accepted: 10/06/2023] [Indexed: 11/07/2023]
Abstract
Background The prognostic utility of cardiovascular magnetic resonance imaging, including strain analysis and tissue characterization, has not been comprehensively investigated in adult patients with muscular dystrophy. Methods and Results We prospectively enrolled 148 patients with dystrophinopathies (including heterozygotes), limb-girdle muscular dystrophy, and type 1 myotonic dystrophy (median age, 36.0 [interquartile range, 23.0-50.0] years; 51 [34.5%] women) over 7.7 years in addition to an age- and sex-matched healthy control cohort (n=50). Cardiovascular magnetic resonance markers, including 3-dimensional strain and fibrosis, were assessed for their respective association with major adverse cardiac events. Our results showed that markers of contractile performance were reduced across all muscular dystrophy groups. In particular, the dystrophinopathies cohort experienced reduced left ventricular (LV) ejection fraction and high burden of replacement fibrosis. Patients with type 1 myotonic dystrophy showed a 26.8% relative reduction in LV mass with corresponding reduction in chamber volumes. Eighty-two major adverse cardiac events occurred over a median follow-up of 5.2 years. Although LV ejection fraction was significantly associated with major adverse cardiac events (adjusted hazard ratio [aHR], 3.0 [95% CI, 1.4-6.4]) after adjusting for covariates, peak 3-dimensional strain amplitude demonstrated greater predictive value (minimum principal amplitude: aHR, 5.5 [95% CI, 2.5-11.9]; maximum principal amplitude: aHR, 3.3 [95% CI, 1.6-6.8]; circumferential amplitude: aHR, 3.4 [95% CI, 1.6-7.2]; longitudinal amplitude: aHR, 3.4 [95% CI, 1.7-6.9]; and radial strain amplitude: aHR, 3.0 [95% CI, 1.4-6.1]). Minimum principal strain yielded incremental prognostic value beyond LV ejection fraction for association with major adverse cardiac events (change in χ2=13.8; P<0.001). Conclusions Cardiac dysfunction is observed across all muscular dystrophy subtypes; however, the subtypes demonstrate distinct phenotypic profiles. Myocardial deformation analysis highlights unique markers of principal strain that improve risk assessment over other strain markers, LV ejection fraction, and late gadolinium enhancement in this vulnerable patient population.
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Affiliation(s)
- Niharika Kashyap
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - Anish Nikhanj
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - Dina Labib
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Easter Prosia
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Sandra Rivest
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
| | - Jacqueline Flewitt
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Gerald Pfeffer
- Department of Clinical NeurosciencesUniversity of CalgaryCalgaryAlbertaCanada
- Hotchkiss Brain Institute, University of CalgaryCalgaryAlbertaCanada
| | - Jeffrey A. Bakal
- Alberta Strategy for Patient Oriented Research UnitUniversity of CalgaryCalgaryAlbertaCanada
- Provincial Research Data ServicesUniversity of AlbertaEdmontonAlbertaCanada
| | - Zaeem A. Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Richard A. Coulden
- Department of Radiology and Diagnostic ImagingUniversity of Alberta HospitalEdmontonAlbertaCanada
| | - Richard Thompson
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
| | - James A. White
- Department of Cardiac SciencesUniversity of AlbertaEdmontonAlbertaCanada
- Libin Cardiovascular Institute of Alberta, University of CalgaryCalgaryAlbertaCanada
| | - Gavin Y. Oudit
- Division of CardiologyUniversity of AlbertaEdmontonAlbertaCanada
- Department of Medicine, Faculty of Medicine and DentistryMazankowski Alberta Heart Institute, University of AlbertaEdmontonAlbertaCanada
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4
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Fayssoil A, Mansencal N, Nguyen LS, Nardi O, Yaou RB, Leturcq F, Amthor H, Wahbi K, Becane HM, Lofaso F, Prigent H, Bassez G, Behin A, Stojkovic T, Fontaine B, Duboc D, Dubourg O, Clair B, Laforet P, Annane D, Orlikowski D. Prognosis of Right Ventricular Systolic Dysfunction in Patients With Duchenne Muscular Dystrophy. J Am Heart Assoc 2023; 12:e027231. [PMID: 37581390 PMCID: PMC10492954 DOI: 10.1161/jaha.122.027231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 06/30/2023] [Indexed: 08/16/2023]
Abstract
Background Chronic respiratory failure and heart involvement may occur in Duchenne muscular dystrophy. We aimed to assess the prognostic value of the right ventricular (RV) systolic dysfunction in patients with Duchenne muscular dystrophy. Methods and Results We studied 90 genetically proven patients with Duchenne muscular dystrophy from 2010 to 2019, to obtain respiratory function and Doppler echocardiographic RV systolic function. Prognostic value was assessed in terms of death and cardiac events. The median age was 27.5 years, and median forced vital capacity was at 10% of the predicted value: 83 patients (92%) were on home mechanical ventilation. An RV systolic dysfunction was found in 46 patients (51%). In patients without RV dysfunction at inclusion, a left ventricular systolic dysfunction at inclusion was associated with a higher risk of developing RV dysfunction during follow-up with an odds ratio of 4.5 (P=0.03). RV systolic dysfunction was significantly associated with cardiac events, mainly acute heart failure (62%) and cardiogenic shock (23%). In a multivariable Cox model, the adjusted hazard ratio was 4.96 (95% CI [1.09-22.6]; P=0.04). In terms of death, we found a significant difference between patients with RV dysfunction versus patients without RV dysfunction in the Kaplan-Meier curves (log-rank P=0.045). Conclusions RV systolic dysfunction is frequently present in patients with Duchenne muscular dystrophy and is associated with increased risk of cardiac events, irrespective of left ventricular dysfunction and mechanical ventilation. Registration URL: https://www.clinicaltrials.org; unique identifier: NCT02501083.
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Affiliation(s)
- Abdallah Fayssoil
- Cardiology DepartmentAssistance Publique des Hôpitaux de Paris (AP‐HP), Raymond Poincaré HospitalGarchesFrance
- INSERM U1179, END‐ICAPMontigny‐le‐BretonneuxFrance
- Cardiology Department, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou raresAP‐HP, Ambroise Paré Hospital, Université de Versailles‐Saint Quentin (UVSQ)Boulogne‐BillancourtFrance
- Service de Réanimation médicale et unité de ventilation à domicileCHU Raymond Poincaré, APHP, UVSQGarchesFrance
| | - Nicolas Mansencal
- Cardiology Department, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou raresAP‐HP, Ambroise Paré Hospital, Université de Versailles‐Saint Quentin (UVSQ)Boulogne‐BillancourtFrance
- INSERM U‐1018, Centre de recherche en Epidémiologie et Santé des Populations (CESP)Equipe Epidémiologie Clinique, UVSQVillejuifFrance
| | - Lee S. Nguyen
- Department of PharmacologySorbonne University, INSERM CIC Paris‐Est, AP‐HP, ICAN, Regional Pharmacovigilance Centre, Pitié‐Salpêtrière HospitalParisFrance
- CMC Ambroise Paré, Research & Innovation (RICAP)Neuilly‐sur‐SeineFrance
| | - Olivier Nardi
- Service de Réanimation médicale et unité de ventilation à domicileCHU Raymond Poincaré, APHP, UVSQGarchesFrance
| | - Rabah Ben Yaou
- Institut de Myologie, CHU Pitié SalpetrièreParisFrance
- Centre de Recherche en MyologieSorbonne Universités, UPMC Univ Paris 06, INSERM UMRS974, Institut de Myologie, G.H. Pitié SalpêtrièreParisFrance
- Laboratoire de biochimie et génétique moléculairehôpital Cochin, AP‐HP, université Paris Descartes‐Sorbonne Paris CitéParisFrance
| | - France Leturcq
- Institut de Myologie, CHU Pitié SalpetrièreParisFrance
- Centre de Recherche en MyologieSorbonne Universités, UPMC Univ Paris 06, INSERM UMRS974, Institut de Myologie, G.H. Pitié SalpêtrièreParisFrance
- Laboratoire de biochimie et génétique moléculairehôpital Cochin, AP‐HP, université Paris Descartes‐Sorbonne Paris CitéParisFrance
| | - Helge Amthor
- Service de Pédiatrie, CHU Raymond Poincaré, APHPUniversité de Versailles saint Quentin en YvelinesGarchesFrance
| | - Karim Wahbi
- Cardiology DepartmentAP‐HP, Cochin HospitalParisFrance
- Université Paris Descartes‐Sorbonne Paris CitéParisFrance
| | - Henri Marc Becane
- Service de NeurologieCHU Raymond Poincaré, APHP, Université de Versailles Saint Quentin en YvelinesGarchesFrance
| | - Frederic Lofaso
- Service de Physiologie, Explorations fonctionnelles, CHU Raymond Poincaré, APHPUniversité de Versailles saint Quentin en YvelinesGarchesFrance
| | - Helene Prigent
- Service de Physiologie, Explorations fonctionnelles, CHU Raymond Poincaré, APHPUniversité de Versailles saint Quentin en YvelinesGarchesFrance
| | - Guillaume Bassez
- APHP, Sorbonne Université, Centre de référence neuro musculaire Paris EstParisFrance
- Institut de MyologieHôpital Universitaire Pitié SalpetrièreParisFrance
| | - Anthony Behin
- APHP, Sorbonne Université, Centre de référence neuro musculaire Paris EstParisFrance
- Institut de MyologieHôpital Universitaire Pitié SalpetrièreParisFrance
| | - Tanya Stojkovic
- APHP, Sorbonne Université, Centre de référence neuro musculaire Paris EstParisFrance
- Institut de MyologieHôpital Universitaire Pitié SalpetrièreParisFrance
| | - Bertrand Fontaine
- APHP, Sorbonne Université, Centre de référence neuro musculaire Paris EstParisFrance
- Institut de MyologieHôpital Universitaire Pitié SalpetrièreParisFrance
| | - Denis Duboc
- Cardiology DepartmentAP‐HP, Cochin HospitalParisFrance
- Université Paris Descartes‐Sorbonne Paris CitéParisFrance
| | - Olivier Dubourg
- Cardiology Department, Centre de référence des cardiomyopathies et des troubles du rythme cardiaque héréditaires ou raresAP‐HP, Ambroise Paré Hospital, Université de Versailles‐Saint Quentin (UVSQ)Boulogne‐BillancourtFrance
| | - Bernard Clair
- Service de Réanimation médicale et unité de ventilation à domicileCHU Raymond Poincaré, APHP, UVSQGarchesFrance
| | - Pascal Laforet
- Service de NeurologieCHU Raymond Poincaré, APHP, Université de Versailles Saint Quentin en YvelinesGarchesFrance
| | - Djillali Annane
- Service de Réanimation médicale et unité de ventilation à domicileCHU Raymond Poincaré, APHP, UVSQGarchesFrance
| | - David Orlikowski
- Service de Réanimation médicale et unité de ventilation à domicileCHU Raymond Poincaré, APHP, UVSQGarchesFrance
- Centre d’Investigation clinique et Innovation technologique CIC 14.29, INSERMGarchesFrance
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5
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Mercuri E, Seferian A, Servais L, Deconinck N, Stevenson H, Ni X, Zhang W, East L, Yonren S, Muntoni F, Deconinck N, Van Coster R, Vanlander A, Seferian A, De Lucia S, Gidaro T, Brande LV, Servais L, Kirschner J, Borell S, Mercuri E, Brogna C, Pane M, Fanelli L, Norcia G, Muntoni F, Brusa C, Chesshyre M, Maresh K, Pitchforth J, Schottlaender L, Scoto M, Silwal A, Trucco F. Safety, tolerability and pharmacokinetics of eteplirsen in young boys aged 6–48 months with Duchenne muscular dystrophy amenable to exon 51 skipping. Neuromuscul Disord 2023; 33:476-483. [PMID: 37207382 DOI: 10.1016/j.nmd.2023.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023]
Abstract
Eteplirsen is FDA-approved for the treatment of Duchenne muscular dystrophy (DMD) in exon 51 skip-amenable patients. Previous studies in boys > 4 years of age indicate eteplirsen is well tolerated and attenuates pulmonary and ambulatory decline compared with matched natural history cohorts. Here the safety, tolerability and pharmacokinetics of eteplirsen in boys aged 6-48 months is evaluated. In this open-label, multicenter, dose-escalation study (NCT03218995), boys with a confirmed mutation of the DMD gene amenable to exon 51 skipping (Cohort 1: aged 24-48 months, n = 9; Cohort 2: aged 6 to < 24 months, n = 6) received ascending doses (2, 4, 10, 20, 30 mg/kg) of once-weekly eteplirsen intravenously over 10 weeks, continuing at 30 mg/kg up to 96 weeks. Endpoints included safety (primary) and pharmacokinetics (secondary). All 15 participants completed the study. Eteplirsen was well tolerated with no treatment-related discontinuations, deaths or evidence of kidney toxicity. Most treatment-emergent adverse events were mild; most common were pyrexia, cough, nasopharyngitis, vomiting, and diarrhea. Eteplirsen pharmacokinetics were consistent between both cohorts and with previous clinical experience in boys with DMD > 4 years of age. These data support the safety and tolerability of eteplirsen at the approved 30-mg/kg dose in boys as young as 6 months old.
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6
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Kashyap N, Nikhanj A, Gagnon LR, Moukaskas B, Siddiqi ZA, Oudit GY. Cardiac manifestations and clinical management of X-linked Emery-Dreifuss muscular dystrophy: a case series. Eur Heart J Case Rep 2023; 7:ytad013. [PMID: 36727127 PMCID: PMC9879840 DOI: 10.1093/ehjcr/ytad013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
Background Heart disease is an under-recognized cause of morbidity and mortality in patients with Emery-Dreifuss muscular dystrophy (EDMD). Arrhythmias and conduction delays are highly prevalent and given the rarity of this disease the patient care process remains poorly defined. Case summary This study closely followed four adult patients from the Neuromuscular Multidisciplinary Clinic (Alberta, Canada) that presented with X-linked recessive EDMD. Patients were assessed and managed on a case-by-case basis. Clinical status and cardiac function were assessed through clinical history, physical examination, and investigations (12-lead electrocardiogram, 24 hour Holter monitor, transthoracic echocardiogram, and plasma biomarkers). Conduction disease, requiring permanent pacemaker, was prevalent in all patients. With appropriate medical therapy over a median follow-up period five years the cardiac status was shown to have stabilized in all these patients. Discussion We demonstrate the presentation of arrhythmias, conduction abnormalities, and chamber dilation in adult patients with X-linked EDMD. Cardiac medications and pacemaker therapy are shown to prevent adverse outcomes from these complications. Patients with EDMD are expected to develop heart disease early and prior to the development of an overt neuromuscular phenotype. These patients should be closely monitored in a multidisciplinary setting for effective management to improve their clinical outcomes.
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Affiliation(s)
- Niharika Kashyap
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta T6G 2J2, Canada
| | - Anish Nikhanj
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta T6G 2J2, Canada
| | - Luke R Gagnon
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta T6G 2J2, Canada
| | - Basel Moukaskas
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta T6G 2J2, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta T6G 2R7, Canada
| | - Gavin Y Oudit
- Corresponding author. Tel: +780 407 8569, Fax: +780 407 6452,
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7
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Nikhanj A, Kashyap N, Wang K, Phan CL, Siddiqi ZA, Becher H, Oudit GY. Trajectory of left ventricular ejection fraction in response to therapies in patients with muscular dystrophy. Echocardiography 2022; 39:1328-1337. [PMID: 36198087 DOI: 10.1111/echo.15460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/21/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Patients with muscular dystrophy (MD) are at elevated risk of serious cardiac complications and clinical assessment is limited due to inherent physical limitations. We assessed the utility of left ventricular ejection fraction (LVEF) derived from transthoracic echocardiogram (TTE) as a prognostic marker for major adverse cardiac events (MACE) in a mixed adult MD cohort. METHODS One hundred and sixty-five MD patients (median age: 36 (interquartile range [IQR]: 23.0-49.0) years; 65 [39.4%] females) were enrolled in our prospective cohort study. Diagnoses included dystrophinopathies (n = 42), limb-girdle MD (n = 31), type 1 myotonic dystrophy (n = 71), and facioscapulohumeral MD (n = 21). Left ventricular ejection fraction, ventricular dimensions at end-diastole and end-systole, and serial measures (n = 124; follow-up period: 2.19 [IQR: 1.05-3.32] years) stratified patients for MACE risk. RESULTS Cardiomyopathy was diagnosed in 60 (36.4%) patients of the broader cohort (median LVEF: 45.0 [IQR: 35.0-50.0] %). Ninety-eight MACE occurred over the 7-year study period. At baseline, patients with a LVEF < 55.0% had a high risk of MACE (adjusted odds ratio: 8.30; 95% confidence interval [CI]: 3.18-21.7), concordant with the analysis of LV dimensions. Forty-one percent of these patients showed an improvement in LVEF with the optimization of medical and device therapies. Relative to patients with preserved LVEF, patients with reduced LVEF were at an elevated risk of MACE (adjusted hazard ratio [aHR]: 7.21; 95% CI: 1.99-26.1), and improved LVEF resulted in comparable outcomes (aHR: 1.84; 95% CI: .49-6.91) associated with optimization of medical and device therapies. Reduction in QRS duration by CRT therapy was associated with an improvement in LVEF (average improvement: 12.8 [± 2.30] %; p = .04). CONCLUSIONS Reduction in LVEF indicates an increased risk of cardiovascular events in patients with MD. Baseline and serial LVEF obtained by TTE can prognosticate patients for MACE and guide clinical management.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Niharika Kashyap
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Kaiming Wang
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Cecile L Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Harald Becher
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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8
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Groh WJ, Bhakta D, Tomaselli GF, Aleong RG, Teixeira RA, Amato A, Asirvatham SJ, Cha YM, Corrado D, Duboc D, Goldberger ZD, Horie M, Hornyak JE, Jefferies JL, Kääb S, Kalman JM, Kertesz NJ, Lakdawala NK, Lambiase PD, Lubitz SA, McMillan HJ, McNally EM, Milone M, Namboodiri N, Nazarian S, Patton KK, Russo V, Sacher F, Santangeli P, Shen WK, Sobral Filho DC, Stambler BS, Stöllberger C, Wahbi K, Wehrens XHT, Weiner MM, Wheeler MT, Zeppenfeld K. 2022 HRS expert consensus statement on evaluation and management of arrhythmic risk in neuromuscular disorders. Heart Rhythm 2022; 19:e61-e120. [PMID: 35500790 DOI: 10.1016/j.hrthm.2022.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
This international multidisciplinary document is intended to guide electrophysiologists, cardiologists, other clinicians, and health care professionals in caring for patients with arrhythmic complications of neuromuscular disorders (NMDs). The document presents an overview of arrhythmias in NMDs followed by detailed sections on specific disorders: Duchenne muscular dystrophy, Becker muscular dystrophy, and limb-girdle muscular dystrophy type 2; myotonic dystrophy type 1 and type 2; Emery-Dreifuss muscular dystrophy and limb-girdle muscular dystrophy type 1B; facioscapulohumeral muscular dystrophy; and mitochondrial myopathies, including Friedreich ataxia and Kearns-Sayre syndrome, with an emphasis on managing arrhythmic cardiac manifestations. End-of-life management of arrhythmias in patients with NMDs is also covered. The document sections were drafted by the writing committee members according to their area of expertise. The recommendations represent the consensus opinion of the expert writing group, graded by class of recommendation and level of evidence utilizing defined criteria. The recommendations were made available for public comment; the document underwent review by the Heart Rhythm Society Scientific and Clinical Documents Committee and external review and endorsement by the partner and collaborating societies. Changes were incorporated based on these reviews. By using a breadth of accumulated available evidence, the document is designed to provide practical and actionable clinical information and recommendations for the diagnosis and management of arrhythmias and thus improve the care of patients with NMDs.
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Affiliation(s)
- William J Groh
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | - Deepak Bhakta
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Anthony Amato
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Denis Duboc
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Minoru Horie
- Shiga University of Medical Sciences, Otsu, Japan
| | | | | | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, University College London, and St Bartholomew's Hospital London, London, United Kingdom
| | | | - Hugh J McMillan
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute, Bordeaux, France
| | | | | | | | | | - Claudia Stöllberger
- Second Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstraße, Vienna, Austria
| | - Karim Wahbi
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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9
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Nikhanj A, Bautista J, Siddiqi ZA, Phan CL, Oudit GY. Low Prevalence of Cardiomyopathy in Patients with Mitochondrial Disease and Neurological Manifestations. J Cardiovasc Dev Dis 2022; 9:jcdd9070221. [PMID: 35877583 PMCID: PMC9320353 DOI: 10.3390/jcdd9070221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 02/01/2023] Open
Abstract
Patients with mitochondrial diseases can develop cardiomyopathy but with variable expressivity and penetrance. Our prospective study enrolled and evaluated a cohort of 53 patients diagnosed with chronic progressive ophthalmoplegia (CPEO, n = 34), Kearns-Sayre syndrome (KSS, n = 3), neuropathy ataxia and retinitis pigmentosa (NARP, n = 1), myoclonic epilepsy with ragged red fibers (MERRF, n = 1), Harel-Yoon Syndrome (HYS, n = 1) and 13 patients with undefined mitochondrial diseases, presenting primarily with neurological symptoms. Over a 4-year period, six patients in our study cohort were diagnosed with heart disease (11.3%), with only three patients having defined cardiomyopathy (5.7%). Cardiomyopathy was present in a 21-year-old patient with HYS and two CPEO patients having mild cardiomyopathy at an older age. Two CPEO patients had congenital heart disease, and a third CPEO had LV hypertrophy secondary to hypertension. In three patients, traditional risk factors for heart disease, including dyslipidemia, hypertension, and respiratory disease, were present. The majority of our adult cohort of patients have normal cardiac investigations with a median left ventricular (LV) ejection fraction of 59.0%, indexed LV mass of 67.0 g/m2, and normal diastolic and valvular function at baseline. A 12-lead electrocardiogram showed normal cardiac conduction across the study cohort. Importantly, follow-up assessments showed consistent cardiac structure and function. Our study shows a low prevalence of cardiomyopathy and highlights the breadth of phenotypic variability in patients with mitochondrial disorders. The presence of cardiovascular risk factors and aging are important comorbidities in our cohort.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Jesi Bautista
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.B.); (Z.A.S.); (C.L.P.)
| | - Zaeem A. Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.B.); (Z.A.S.); (C.L.P.)
| | - Cecile L. Phan
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada; (J.B.); (Z.A.S.); (C.L.P.)
| | - Gavin Y. Oudit
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 2R3, Canada;
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Correspondence: ; Tel.: +780-407-8569; Fax: +780-407-6452
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10
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Mejia EJ, Lin KY, Okunowo O, Iacobellis KA, Matesanz SE, Brandsema JF, Wittlieb-Weber CA, Katcoff H, Griffis H, Edelson JB. Health Care Use of Cardiac Specialty Care in Children With Muscular Dystrophy in the United States. J Am Heart Assoc 2022; 11:e024722. [PMID: 35411787 PMCID: PMC9238456 DOI: 10.1161/jaha.121.024722] [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] [Indexed: 12/02/2022]
Abstract
Background Duchenne and Becker muscular dystrophy are progressive disorders associated with cardiac mortality. Guidelines recommend routine surveillance; we assess cardiac resource use and identify gaps in care delivery. Methods and Results Male patients, aged 1 to 18 years, with Duchenne and Becker muscular dystrophy between January 2013 and December 2017 were identified in the IBM MarketScan Research Database. The cohort was divided into <10 and 10 to 18 years of age. The primary outcome was rate of annual health care resource per person year. Resource use was assessed for place of service, cardiac testing, and medications. Adjusted incidence rate ratios (IRRs) were estimated using a Poisson regression model. Medication use was measured by proportion of days covered. There were 1386 patients with a median follow‐up time of 3.0 years (interquartile range, 1.9–4.7 years). Patients in the 10 to 18 years group had only 0.40 (95% CI, 0.35–0.45) cardiology visits per person year and 0.66 (95% CI, 0.62–0.70) echocardiography/magnetic resonance imaging per person year. Older patients had higher rates of inpatient admissions (IRR, 1.46; 95% CI, 1.03–2.09), outpatient cardiology visits (IRR, 2.0; 95% CI, 1.66–2.40), cardiac imaging (IRR, 1.59; 95% CI, 1.40–1.80), and Holter monitoring (IRR, 3.33; 95% CI, 2.35–4.73). A proportion of days covered >80% for angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers was observed in 13.6% (419/3083) of total person years among patients in the 10 to 18 years group. Conclusions Children 10 to 18 years of age have higher rates of cardiac resource use compared with those <10 years of age. However, rates in both age groups fall short of guidelines. Opportunities exist to identify barriers to resource use and optimize cardiac care for patients with Duchenne and Becker muscular dystrophy.
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Affiliation(s)
- Erika J Mejia
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Kimberly Y Lin
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Oluwatimilehin Okunowo
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Katherine A Iacobellis
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Susan E Matesanz
- Division of Neurology Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - John F Brandsema
- Division of Neurology Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Carol A Wittlieb-Weber
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Hannah Katcoff
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Heather Griffis
- Data Science & Biostatistics Unit Department of Biomedical and Health Informatics Children's Hospital of Philadelphia University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
| | - Jonathan B Edelson
- Division of Cardiology Children's Hospital of PhiladelphiaUniversity of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania
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11
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Visrodia P, Patel NJ, Burford M, Hamilton MA, Patel JK, Kobashigawa JA, Kittleson MM. Heart transplantation in muscular dystrophy: Single-center analysis. Clin Transplant 2022; 36:e14645. [PMID: 35293038 DOI: 10.1111/ctr.14645] [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: 01/06/2022] [Revised: 03/04/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cardiac involvement may occur in many forms of muscular dystrophy (MD). While cardiac disease may progress to warrant heart transplantation (HTx), there may be contraindications related to extra-cardiac disease including pulmonary and skeletal muscle involvement that limit overall survival and impairs post-transplant rehabilitation efforts. This study describes the MD HTx experience at a single high-volume center. METHODS We examined the clinical characteristics and outcomes of patients with MD with heart failure (HF) (n = 28), patients with MD status post HTx (n = 20) and non-MD HTx control group (n = 40) matched 2:1 for age at transplant, sex, listing status, and antibody sensitization. RESULTS Patients with MD who underwent HTx had increased ventilator days (2 vs 1 days, p = 0.013), increased hospital length of stay (20 vs 12 days, p = 0.022), and increased discharge to inpatient rehab (60% vs 8%, p<0.001). By one year post HTx, patients with MD more often required assistive devices for walking (55% vs 10%, p = 0.01). Nonetheless, post-HTx survival was similar at 1 year (100% vs 97.5%, p = 0.48) and 5 years (95.0% vs 87.5%, p = 0.36). Of the HTx recipients with MD, 95% were followed by a neurologist, 60% by a neuromuscular specialist as part of the Muscular Dystrophy Association Clinic at our center. CONCLUSION Transplantation is a feasible option for patients with MD and advanced heart failure. MD patients who undergo transplantation may benefit from multidisciplinary specialized care to optimize MD-related morbidity. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Parth Visrodia
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Nikhil J Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Matthew Burford
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michele A Hamilton
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jignesh K Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jon A Kobashigawa
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
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12
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Nikhanj A, Yogasundaram H, Kimber S, Siddiqi ZA, Oudit GY. Clinical utility of 12-lead electrocardiogram in evaluating heart disease in patients with muscular dystrophy: Assessment of left ventricular hypertrophy, conduction disease, and cardiomyopathy. Ann Noninvasive Electrocardiol 2021; 26:e12876. [PMID: 34250701 PMCID: PMC8588368 DOI: 10.1111/anec.12876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/29/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction Heart disease remains a leading cause of mortality in patients with muscular dystrophy (MD), and cardiac assessment by standard imaging modalities is challenging due to the prominence of physical limitations. Methods In this prospective cohort study of 169 MD patients and 34 negative control patients, we demonstrate the clinical utility of a 12‐lead electrocardiogram (ECG) as an effective modality for the assessment of cardiac status in patients with MD. We assessed the utility of conventional criteria for electrocardiogram‐indicated left ventricular hypertrophy (ECG‐LVH) as well as ECG morphologies. Results Cornell voltage, Cornell voltage‐duration, Sokolow–Lyon voltage, and Romhilt‐Estes point score criteria demonstrated low sensitivity and minimal positive predictive value for ECG‐LVH when compared with cardiac imaging. Patients with LBBB had a high probability of a cardiomyopathy (relative risk [RR], 2.75; 95% confidence interval [CI], 2.14–3.53; p < .001), and patients with QRS fragmentation (fQRS) had a high probability of a cardiomyopathy (RR, 1.76; 95% CI, 1.20–2.59; p = .004), requiring cardiac medication and device intervention. We found that an R/S ratio >1 in V1 and V2 is highly specific (specificity, 0.89; negative predictive value [NPV], 0.89 and specificity, 0.82; NPV, 0.89, respectively) for patients with dystrophinopathies compared with other types of MD. Conclusion The identification of LBBB and fQRS was linked to cardiomyopathy in patients with MD, while ECG‐LVH was of limited utility. Importantly, these findings can be applied to effectively screen a broad cohort of MD patients for structural heart disease and prompt further evaluation and therapeutic intervention.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology.,Mazankowski Alberta Heart Institute
| | | | - Shane Kimber
- Division of Cardiology.,Mazankowski Alberta Heart Institute
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology.,Mazankowski Alberta Heart Institute
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13
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Russo V, Papa AA, Lioncino M, Rago A, Di Fraia F, Palladino A, Politano L, Golino P, Nigro G. Prevalence of atrial fibrillation in myotonic dystrophy type 1: A systematic review. Neuromuscul Disord 2021; 31:281-290. [PMID: 33573883 DOI: 10.1016/j.nmd.2021.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/22/2020] [Accepted: 01/02/2021] [Indexed: 12/26/2022]
Abstract
Cardiac involvement is recorded in about 80% of patients affected by myotonic dystrophy type 1 (DM1). The prevalence of cardiac conduction abnormalities is well described. Data regarding the prevalence of atrial fibrillation (AF) are still conflicting. The primary objective of this review was to assess the prevalence of AF in DM1. The secondary aim was to examine the association of clinical features with AF, to detect predisposing and/or influencing prognosis factors. A systematic search was developed in MEDLINE, EMBASE, Cochrane Register of Controlled Trials and Web of Science databases, to identify original reports between January 1, 2002 and January 30, 2020, assessing the prevalence of AF in DM1 population. Retrospective/prospective cohort studies and case series describing the prevalence of atrial fibrillation evaluated by periodic electrocardiogram (ECG) and/or ECG Holter 24 h, external loop recording (ELR) and implantable devices interrogation in DM1 patients were included. Case reports, simple reviews, commentaries and editorials were excluded. Thirteen reports fulfilled eligibility criteria and were included in our systematic review. According to the results from all the evaluated studies, the mean prevalence of AF in DM1 patients was 10.9% (n = 404) in 3677 DM1 patients. Male sex, conduction defects, echocardiographic findings of prolonged atrial electromechanical delay seem to be strongly associated with atrial fibrillation, representing factors favoring its onset. DM1 patients who develop AF seem to have a higher risk of cardiovascular and non-cardiovascular death. Further studies are needed to assess the prevalence of AF in DM1 patients and to investigate ECG abnormalities and other clinical features associated with this condition.
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Affiliation(s)
- Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy.
| | - Michele Lioncino
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
| | - Francesco Di Fraia
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
| | - Alberto Palladino
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Luisa Politano
- Cardiomyology and Medical Genetics, Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Golino
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" Monaldi Hospital, Naples, Italy
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14
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Zhang H, Viveiros A, Nikhanj A, Nguyen Q, Wang K, Wang W, Freed DH, Mullen JC, MacArthur R, Kim DH, Tymchak W, Sergi CM, Kassiri Z, Wang S, Oudit GY. The Human Explanted Heart Program: A translational bridge for cardiovascular medicine. Biochim Biophys Acta Mol Basis Dis 2021; 1867:165995. [PMID: 33141063 PMCID: PMC7581399 DOI: 10.1016/j.bbadis.2020.165995] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/12/2020] [Accepted: 10/15/2020] [Indexed: 12/17/2022]
Abstract
The progression of cardiovascular research is often impeded by the lack of reliable disease models that fully recapitulate the pathogenesis in humans. These limitations apply to both in vitro models such as cell-based cultures and in vivo animal models which invariably are limited to simulate the complexity of cardiovascular disease in humans. Implementing human heart tissue in cardiovascular research complements our research strategy using preclinical models. We established the Human Explanted Heart Program (HELP) which integrates clinical, tissue and molecular phenotyping thereby providing a comprehensive evaluation into human heart disease. Our collection and storage of biospecimens allow them to retain key pathogenic findings while providing novel insights into human heart failure. The use of human non-failing control explanted hearts provides a valuable comparison group for the diseased explanted hearts. Using HELP we have been able to create a tissue repository which have been used for genetic, molecular, cellular, and histological studies. This review describes the process of collection and use of explanted human heart specimens encompassing a spectrum of pediatric and adult heart diseases, while highlighting the role of these invaluable specimens in translational research. Furthermore, we highlight the efficient procurement and bio-preservation approaches ensuring analytical quality of heart specimens acquired in the context of heart donation and transplantation.
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Affiliation(s)
- Hao Zhang
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Anissa Viveiros
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anish Nikhanj
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Quynh Nguyen
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Kaiming Wang
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Wei Wang
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Darren H Freed
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - John C Mullen
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Roderick MacArthur
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel H Kim
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Wayne Tymchak
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Consolato M Sergi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Anatomical Pathology, Department of Laboratory Medicine & Pathology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Zamaneh Kassiri
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Department of Physiology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shaohua Wang
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiac Surgery, Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
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15
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Itoh H, Hisamatsu T, Tamura T, Segawa K, Takahashi T, Takada H, Kuru S, Wada C, Suzuki M, Suwazono S, Sasaki S, Okumura K, Horie M, Takahashi MP, Matumura T. Cardiac Conduction Disorders as Markers of Cardiac Events in Myotonic Dystrophy Type 1. J Am Heart Assoc 2020; 9:e015709. [PMID: 32812471 PMCID: PMC7660777 DOI: 10.1161/jaha.119.015709] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Myotonic dystrophy type 1 involves cardiac conduction disorders. Cardiac conduction disease can cause fatal arrhythmias or sudden death in patients with myotonic dystrophy type 1. Methods and Results This study enrolled 506 patients with myotonic dystrophy type 1 (aged ≥15 years; >50 cytosine-thymine-guanine repeats) and was treated in 9 Japanese hospitals for neuromuscular diseases from January 2006 to August 2016. We investigated genetic and clinical backgrounds including health care, activities of daily living, dietary intake, cardiac involvement, and respiratory involvement during follow-up. The cause of death or the occurrence of composite cardiac events (ie, ventricular arrhythmias, advanced atrioventricular blocks, and device implantations) were evaluated as significant outcomes. During a median follow-up period of 87 months (Q1-Q3, 37-138 months), 71 patients expired. In the univariate analysis, pacemaker implantations (hazard ratio [HR], 4.35; 95% CI, 1.22-15.50) were associated with sudden death. In contrast, PQ interval ≥240 ms, QRS duration ≥120 ms, nutrition, or respiratory failure were not associated with the incidence of sudden death. The multivariable analysis revealed that a PQ interval ≥240 ms (HR, 2.79; 95% CI, 1.9-7.19, P<0.05) or QRS duration ≥120 ms (HR, 9.41; 95% CI, 2.62-33.77, P < 0.01) were independent factors associated with a higher occurrence of cardiac events than those observed with a PQ interval <240 ms or QRS duration <120 ms; these cardiac conduction parameters were not related to sudden death. Conclusions Cardiac conduction disorders are independent markers associated with cardiac events. Further investigation on the prediction of occurrence of sudden death is warranted.
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Affiliation(s)
- Hideki Itoh
- Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan.,Division of Patient Safety Hiroshima University Hospital Hiroshima Japan
| | - Takashi Hisamatsu
- Department of Public Health Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan
| | - Takuhisa Tamura
- Department of Neurology National Hospital Organization Higashisaitama National Hospital Saitama Japan
| | - Kazuhiko Segawa
- Department of Cardiology National Center Hospital National Center of Neurology and Psychiatry Tokyo Japan
| | - Toshiaki Takahashi
- Department of Neurology National Hospital Organization Sendai-Nishitaga Hospital Sendai Japan
| | - Hiroto Takada
- Department of Neurology National Hospital Organization Aomori National Hospital Aomori Japan
| | - Satoshi Kuru
- Department of Neurology National Hospital Organization Suzuka National Hospital Suzuka Japan
| | - Chizu Wada
- Department of Neurology National Hospital Organization Akita National Hospital Akita Japan
| | - Mikiya Suzuki
- Department of Neurology National Hospital Organization Higashisaitama National Hospital Saitama Japan
| | - Shugo Suwazono
- Division of Neurology and Center for Clinical Neuroscience National Hospital Organization Okinawa National Hospital Ginowan Japan
| | - Shingo Sasaki
- Department of Advanced Management of Cardiac Arrhythmias Hirosaki University Graduate School of Medicine Hirosaki Japan
| | - Ken Okumura
- Advanced Arrhythmia Therapeutic Branch Division of Cardiology Saiseikai Kumamoto Hospital Cardiovascular Center Kumamoto Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine Shiga University of Medical Science Otsu Japan.,Center for Epidemiologic Research in Asia and Department of Cardiology Shiga University of Medical Science Otsu Japan
| | - Masanori P Takahashi
- Department of Functional Diagnostic Science Osaka University Graduate School of Medicine Suita Japan
| | - Tsuyoshi Matumura
- Department of Neurology National Hospital Organization Osaka Toneyama Medical Center 5-1-1 Toyonaka Japan
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16
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Nikhanj A, Nichols BM, Wang K, Siddiqi ZA, Oudit GY. Evaluating the Diagnostic and Prognostic Value of Biomarkers for Heart Disease and Major Adverse Cardiac Events in Patients With Muscular Dystrophy. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 7:564-573. [PMID: 32687175 DOI: 10.1093/ehjqcco/qcaa059] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
AIMS Heart disease is recognized as the leading cause of morbidity and mortality in patients with muscular dystrophy (MD). Our study demonstrates the clinical utility of cardiac biomarkers to improve the diagnosis of cardiomyopathy and prognostication of major adverse cardiac events (MACE) in these vulnerable patients. METHODS AND RESULTS We prospectively followed 117 patients (median age, 42 (interquartile range [IQR], 26-50) years; 49 [41.9%] women) at the Neuromuscular Multidisciplinary clinic diagnosed with a dystrophinopathy, limb-girdle MD, type 1 myotonic dystrophy, or facioscapulohumeral MD. We determined that B-type natriuretic peptide (BNP) and high-sensitive troponin I (hsTnI) were effective diagnostic markers of cardiomyopathy (area under the curve [AUC], 0.64; P=0.017; and AUC, 0.69; P=0.001, respectively). Patient risk stratification for MACE was based on cutoff values of BNP and hsTnI defined a priori as 30.5000 pg/mL and 7.6050 ng/L, respectively. Over a median follow-up period of 2.09 (IQR, 1.17-2.81) years there were 36 confirmed MACE. Multivariate regression analyses showed that patients with BNP and hsTnI levels above the respective cutoff values had a 3.70-fold (P=0.001) and 3.24-fold (P=0.002) greater risk of MACE, respectively, compared to patients with biomarker levels below. Furthermore, patients with biomarker levels above both cutoff values had a 4.08-fold (P=0.001) greater risk of MACE. Inflammatory biomarkers did not show clinical utility for heart disease in these patients. CONCLUSION Our study demonstrates important diagnostic and prognostic value of BNP and hsTnI as part of a comprehensive cardiac assessment to augment the management and treatment of heart disease in patients with MD.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Bailey Miskew Nichols
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Kaiming Wang
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Gavin Y Oudit
- Division of Cardiology, University of Alberta, Edmonton, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada
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Nikhanj A, Yogasundaram H, Miskew Nichols B, Richman-Eisenstat J, Phan C, Bakal JA, Siddiqi ZA, Oudit GY. Cardiac Intervention Improves Heart Disease and Clinical Outcomes in Patients With Muscular Dystrophy in a Multidisciplinary Care Setting. J Am Heart Assoc 2020; 9:e014004. [PMID: 31931688 PMCID: PMC7033817 DOI: 10.1161/jaha.119.014004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Patients with muscular dystrophy (MD) represent a vulnerable patient population with no clearly defined care model in modern‐day clinical practice to manage a high burden of heart disease and comorbidities. We demonstrate the effectiveness of cardiac interventions, namely the initiation and optimization of medical and device therapies, as part of a multidisciplinary care approach to improve clinical outcomes in patients with MD. Methods and Results We conducted a prospective cohort study at the Neuromuscular Multidisciplinary clinic following patients with dystrophinopathies, limb‐girdle MD, type 1 myotonic dystrophy, and facioscapulohumeral MD. A negative control group classified as non‐MD myopathies without heart disease, was also tracked. Our cohort of 185 patients (median age: 42 years; 79 [42.7%] women), included 145 patients with MD. Cardiomyopathy was present in 65.6% of the patients with dystrophinopathies (21 of 32) and 27.3% of the patients with limb‐girdle MD (9 of 33). Conduction abnormalities were common in type 1 myotonic dystrophy (33.3% [20/60] patients). Cardiac intervention reversed systolic dysfunction, with left ventricular ejection fraction improving from 43% to 50.0% over a 3‐year period. A sustained reduction in healthcare utilization was also observed. The number of outpatient clinic visits decreased from 3.0 to 1.5 visits per year, the duration of hospitalizations was reduced from 14.2 to 0.9 days per year, and the number of cardiac‐related hospitalizations decreased from 0.4 to 0.1 hospitalizations per year associated with low mortality. Conclusions Our study demonstrates that cardiac intervention as part of a comprehensive multidisciplinary care approach to treating patients with MD leads to a sustained improvement in clinical outcomes.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Mazankowski Alberta Heart Institute Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Haran Yogasundaram
- Division of Cardiology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Mazankowski Alberta Heart Institute Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Bailey Miskew Nichols
- Division of Cardiology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Mazankowski Alberta Heart Institute Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Janice Richman-Eisenstat
- Division of Pulmonary Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Cecile Phan
- Division of Neurology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Jeffrey A Bakal
- Department of Medicine Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Zaeem A Siddiqi
- Division of Neurology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
| | - Gavin Y Oudit
- Division of Cardiology Faculty of Medicine and Dentistry University of Alberta Edmonton Canada.,Mazankowski Alberta Heart Institute Faculty of Medicine and Dentistry University of Alberta Edmonton Canada
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