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Sherpa MD, Sonkawade SD, Jonnala V, Pokharel S, Khazaeli M, Yatsynovich Y, Kalot MA, Weil BR, Canty JM, Sharma UC. Galectin-3 Is Associated with Cardiac Fibrosis and an Increased Risk of Sudden Death. Cells 2023; 12:1218. [PMID: 37174619 PMCID: PMC10177039 DOI: 10.3390/cells12091218] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/15/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Myocardial fibrosis is a common postmortem finding among individuals with Sudden Cardiac Death (SCD). Numerous in vivo and in vitro studies have shown that increased galectin-3 (gal3) expression into the myocardium is associated with higher incidence of fibrosis. Although elevated gal3 expression is linked with myocardial fibrosis, its role in predicting the risk of SCD is unknown. METHODS We reviewed the clinical datasets and post-mortem examination of 221 subjects who had died suddenly. We examined myocardial pathology including the extent of cardiac hypertrophy, fibrosis, and the degree of coronary atherosclerosis in these subjects. In a select group of SCD subjects, we studied myocardial gal3 and periostin expression using immunohistochemistry. To further examine if a higher level of circulating gal3 can be detected preceding sudden death, we measured serum gal3 in a porcine model of subtotal coronary artery ligation which shows an increased tendency to develop lethal cardiac arrhythmias, including ventricular tachycardia or fibrillation. RESULTS Of the total 1314 human subjects screened, 12.7% had SCD. Comparison of age-matched SCD with non-SCD subjects showed that SCD groups had excessive myocardial fibrosis involving both the left ventricular free wall and interventricular septum. In pigs with subtotal coronary artery ligation and SCD, we detected significantly elevated circulating gal3 levels approximately 10 days preceding the SCD event. Immunohistochemistry showed increased myocardial gal3 and periostin expression in pigs that died suddenly, compared to the controls. CONCLUSION Our study shows that increased gal3 is associated with a higher risk of myocardial fibrosis and the risk of SCD. This supports the importance of larger translational studies to target gal3 to prevent cardiac fibrosis and attenuate the risk of SCD.
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Affiliation(s)
- Mingma D. Sherpa
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Swati D. Sonkawade
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Vinesh Jonnala
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Saraswati Pokharel
- Division of Thoracic Pathology and Oncology, Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14203, USA
| | - Mahyar Khazaeli
- Department of Pathology, Jacob’s School of Medicine and Biomedical Sciences, Buffalo, NY 14203, USA
| | - Yan Yatsynovich
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Mohamad A. Kalot
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Brian R. Weil
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - John M. Canty
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
| | - Umesh C. Sharma
- Division of Cardiology, Department of Medicine, Jacob’s School of Medicine and Biomedical Sciences, University at Buffalo, 875 Ellicott Street, Buffalo, NY 14203, USA; (M.D.S.)
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Koev I, Yarkoni M, Luria D, Amir O, Biton Y. Sudden cardiac death prevention in the era of novel heart failure medications. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100281. [PMID: 38511092 PMCID: PMC10945958 DOI: 10.1016/j.ahjo.2023.100281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/18/2023] [Accepted: 02/19/2023] [Indexed: 03/22/2024]
Abstract
Sudden cardiac death (SCD) occurs unexpectedly and is usually a result of ventricular arrhythmia in patients with structural heart disease. The implantable cardioverter-defibrillator (ICD), with or without biventricular pacing, has been proven to be protective for heart failure patients with reduced ejection fraction of <35 % (HFrEF). This device therapy prevents SCD, with additional optimal medications, namely angiotensin-converting enzyme-inhibitors, angiotensin-II receptor-blockers, beta-blockers and mineralocorticoid receptor-antagonists. HFrEF patients present the majority of SCD incidents, as they are characterized by cardiac fibrosis, the main arrhythmogenic element. The introduction of angiotensin-receptor-neprilysin inhibitors, sodium-glucose co-transporter-2 inhibitors and guanylate-cyclase stimulators was associated with reduction of SCD. Additionally, clinical trials have evaluated the improved outcome of these new medications on left ventricular ejection fraction, arrhythmias and HFrEF. These beneficial effects could possibly lead to important changes in decision-making on ICD implantation for primary prevention in patients with HFrEF and reduce the need for device therapy. In this review, we highlight the pathophysiological mechanisms of the new drug agents, and evaluate the possible effect they could have on the role of device therapy as a primary prevention of SCD.
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Affiliation(s)
- I. Koev
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M. Yarkoni
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D. Luria
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O. Amir
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Y. Biton
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
- Heart Research Follow-Up Program, University of Rochester Medical Center, Rochester, NY, USA
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Wang J, Li H, Lv Z, Luo X, Deng W, Zou T, Zhang Y, Sang W, Wang X. The miR-214-3p/c-Ski axis modulates endothelial-mesenchymal transition in human coronary artery endothelial cells in vitro and in mice model in vivo. Hum Cell 2022; 35:486-497. [PMID: 34978047 DOI: 10.1007/s13577-021-00653-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 11/20/2021] [Indexed: 01/08/2023]
Abstract
Cardiovascular disease (CVD) is a leading non-communicable disease with a high fatality rate worldwide. Hypertension, a common cardiovascular condition, is a significant risk factor for the development of heart failure because the activation of the renin-angiotensin system (RAS) is considered to be the major promoting reason behind myocardial fibrosis (MF). In this study, Angiotensin II (Ang II) stimulation-induced endothelial to mesenchymal transition (End-MT) in HCAECs, including the decrease of CD31 level, the increase of α-SMA, collagen I, slug, snail, and TGF-β1 levels, and the promotion of Smad2/3 phosphorylation. Meanwhile, the c-Ski level was reduced in Ang II-stimulated HCAECs. In HCAECs, Ang II-induced changes could be partially attenuated by c-Ski overexpression. miR-214-3p directly targeted c-Ski and inhibited c-Ski expression. Moreover, miR-214-3p inhibition reduced Ang II-caused End-MT in HCAECs. miR-214-3p overexpression further enhanced Ang II-induced End-MT, while c-Ski overexpression could markedly reverse the effects of miR-214-3p overexpression. In the Ang II-induced mouse cardiac hypertrophic model, Ang II-caused increase of cellular cross-sectional area and cardiac fibrosis were partially ameliorated by LV-c-Ski; when mice were co-treated with LV-c-Ski and agomir-214-3p, the beneficial effects of LV-c-Ski were reversed. In conclusion, the miR-214-3p/c-Ski axis modulated Ang II-induced End-MT in HCAECs and cardiac hypertrophy and fibrosis in the mice model.
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Affiliation(s)
- Juan Wang
- Department of Cardiology, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Hongjian Li
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China.
| | - Zhongying Lv
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Xiaomei Luo
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Wei Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Ting Zou
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Yue Zhang
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Wanyue Sang
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
| | - Xuehua Wang
- Department of Hypertension, The Fifth Affiliated Hospital of Xinjiang Medical University, Urumqi, 830011, China
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Oknińska M, Paterek A, Bierła J, Czarnowska E, Mączewski M, Mackiewicz U. Effect of age and sex on the incidence of ventricular arrhythmia in a rat model of acute ischemia. Biomed Pharmacother 2021; 142:111983. [PMID: 34392089 DOI: 10.1016/j.biopha.2021.111983] [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: 06/21/2021] [Revised: 07/23/2021] [Accepted: 07/26/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The impact of sex and age on the arrhythmic susceptibility within the setting of acute ischemia is masked by the fact that acute coronary events result from coronary artery disease appearing with age much earlier among men than among women. METHODS AND RESULTS LAD ligation or sham operations were performed in rats of both sexes at the age 3 and 24 months. An ECG was recorded continuously for 6 h after the operation. The number of early and late premature ventricular beats (PVBs), episodes of ventricular tachycardia (VT) and fibrillation (VF), heart rate, QRS, QT and Tpeak-Tend duration were analysed. Epicardial action potentials were recorded in vivo, Ca2+ signaling was evaluated in isolated cardiomyocytes, fibrosis and connexin-43 expression and localization were measured in the septum. PVBs, VT and VF episodes are much more common in older males than in young males and females independently from their age. Fibrosis with varying intensity in different muscle layers, hypertrophy of cardiomyocytes, reduced number of gap junctions and their appearance on the lateral myocyte membrane, QT prolongation, increase transmural dispersion of repolarisation and a decreased function of SERCA2a may increase the propensity to arrhythmia within the setting of acute ischemia. CONCLUSION We show that the male sex, especially in case of older individuals is a strong predictor of increased arrhythmic susceptibility within the acute ischemia setting regardless of its impact on the occurrence of cardiovascular diseases. A personalized sex-dependent prevention treatment is needed to reduce the mortality in acute phases of myocardial infarction.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Joanna Bierła
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Elżbieta Czarnowska
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-730 Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813 Warsaw, Poland.
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Identification of a High-risk Subgroup With Malignant Mitral Valve Prolapse Who Are Predisposed to Sudden Cardiac Death: A Review. Crit Pathw Cardiol 2021; 20:31-35. [PMID: 32947378 DOI: 10.1097/hpc.0000000000000242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mitral valve prolapse (MVP) affects approximately 170 million people worldwide; however, phenotypically, there is a wide variety of heterogeneity. In particular subsets, the incidence of sudden cardiac death is calculated to be 998 per 100,000 person-years, which is significantly increased when compared with the general population of MVP patients. Individuals with high-risk features have been identified as young females with bileaflet MVP and electrocardiogram findings of frequent complex ectopy, ST-T wave changes, and inferior T wave inversions. Supplemental imaging modalities in this subgroup demonstrate redundant leaflets and chordae on 2-dimensional transthoracic echocardiography along with varying severity of mitral annular disjunction. Detailed morphologic assessment by 3-dimensional echocardiography provides a quantitative assessment of annular disjunction along with left ventricular longitudinal and basal circumferential strain patterns. Late gadolinium enhancement on cardiac magnetic resonance imaging identifies diffuse and isolated left ventricle fibrosis involving the fascicles and papillary muscles, which has been visualized in isolation during autopsy. Findings of this review propose that sudden cardiac death as a result of malignant arrhythmias arises from automaticity, complex ectopy, and reentry at the level of the fascicles and papillary muscles. The repetitive mechanical stress provides a nidus for the development of both micro- and macrofibrosis easily identified by late gadolinium enhancement on cardiac magnetic resonance imaging. Escalation to electrophysiology studies and early intervention could provide new targeted lifesaving therapies.
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Asouzu Johnson J, Ihunwo A, Chimuka L, Mbajiorgu EF. Cardiotoxicity in African clawed frog (Xenopus laevis) sub-chronically exposed to environmentally relevant atrazine concentrations: Implications for species survival. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2019; 213:105218. [PMID: 31203168 DOI: 10.1016/j.aquatox.2019.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 06/09/2023]
Abstract
The toxic effects of different atrazine concentrations on tadpoles and adult male African clawed frogs (Xenopus laevis) were assessed in a controlled laboratory environment following 90 days' exposure. The aim was to elucidate the danger of atrazine exposure on the cardiac tissue relative to its critical function of rhythmic contractility, fundamental for optimal blood circulation and homeostasis. Tadpoles and adult frogs were exposed to 0 μg/L (control), 0.01 μg L-1, 200 μg L-1 and 500 μg L-1 concentrations of atrazine for 90 days. Mortality was concenration-dependent and significantly increased in juvenile group (77%, 43%, 23% and 0 respectively for 500 μg L-1, 200 μg L-1, 0.01 μg L-1, and control group). While the mean juvenile heart area decreased concentration-dependently, adult frog mean heart area significantly increased in the 200 μg L-1 group only and mean heart weight change was variable across all exposure levels. Light microscopy of hematoxylin and eosin (H&E) and Mallory-Heidenhain rapid one-step staining techniques on cardiac tissue sections of the juvenile and adult frogs revealed shrinkage of cardiac muscle cells into thin wavy myocytes. Additionally, disorganized branching of muscle fibres with reduced striations were observed in 0.01 μg L-1 and 200 μg L-1 but hypertrophied myocytes, thickened intensely staining myofibrils in the 500 μg L-1 group in juvenile and adult frogs. Significant increase in the mean percentage area of connective tissue in all the treated groups (p < 0.036) were also recorded. Immunohistochemistry analysis showed decreased eNOS localization in cardiac tissue in 200 μg L-1 and 500 μg L-1 of both juvenile and adult group, suggestive of decreased cardiac contractility due to atrazine exposure. The results indicate that environmentally relevant atrazine concentrations cause significant mortality in tadpoles while concentrations ≥200 μg L-1 adversely affect cardiac muscle morphology and may induce functional perturbations in cardiac tissue contractility and consequent dysfunction which generally may have an adverse impact on their survival and longevity.
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Affiliation(s)
- Jaclyn Asouzu Johnson
- School of Anatomical Sciences, University of the Witwatersrand, P Bag 3, Wits, 2050, Johannesburg, South Africa.
| | - Amadi Ihunwo
- School of Anatomical Sciences, University of the Witwatersrand, P Bag 3, Wits, 2050, Johannesburg, South Africa
| | - Luke Chimuka
- School of Chemistry, University of the Witwatersrand, P Bag 3, Wits, 2050, Johannesburg, South Africa
| | - Ejikeme F Mbajiorgu
- School of Anatomical Sciences, University of the Witwatersrand, P Bag 3, Wits, 2050, Johannesburg, South Africa
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8
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Baskar S, Horne P, Fitzsimmons S, Khoury PR, Vettukattill J, Niwa K, Agaki T, Spence M, Sakazaki H, Veldtman G. Arrhythmia burden and related outcomes in Eisenmenger syndrome. CONGENIT HEART DIS 2017; 12:512-519. [DOI: 10.1111/chd.12481] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/01/2017] [Accepted: 05/04/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Shankar Baskar
- Cincinnati Children's Hospital Medical Center; Cincinnati Ohio
| | | | - Samantha Fitzsimmons
- Southampton University Hospital, Southampton University School of Medicine; Southampton United Kingdom
| | | | | | | | | | - Mark Spence
- Royal Victoria Hospital; Belfast, Northern Ireland
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Sarapultsev PA, Sarapultsev AP. Stress cardiomyopathy: Is it limited to Takotsubo syndrome? Problems of definition. Int J Cardiol 2016; 221:698-718. [PMID: 27424315 DOI: 10.1016/j.ijcard.2016.07.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/04/2016] [Indexed: 02/09/2023]
Abstract
In 2006, Takotsubo syndrome (TTC) was described as a distinct type of stress-induced cardiomyopathy (stress cardiomyopathy). However, when thinking about Takotsubo cardiomyopathy from the viewpoints of the AHA and ESC classifications, 2 possible problems may arise. The first potential problem is that a forecast of disease outcome is lacking in the ESC classification, whereas the AHA only states that 'outcome is favorable with appropriate medical therapy'. However, based on the literature data, one can make a general conclusion that occurrence of myocardial lesions in TTC (i.e., myocardial fibrosis and contraction-band necrosis) causes the same effects as in other diseases with similar levels of myocardial damage and should not be considered to have a lesser impact on mortality. To summarise, TTC can cause not only severe complications such as pulmonary oedema, cardiogenic shock, and dangerous ventricular arrhythmias, but also damage to the myocardium, which can result in the development of potentially fatal conditions even after the disappearance of LV apical ballooning. The second potential problem arises from the definition of TTC as a stress cardiomyopathy in the AHA classification. In fact, the main factors leading to TTC are stress and microvascular anginas, since, as has been already discussed, coronary spasm can cause myocardium stunning, resulting in persistent apical ballooning. Thus, based on this review, 3 distinct types of stress cardiomyopathies exist (variant angina, microvascular angina, and TTC), with poor prognosis. Adding these diseases to the classification of cardiomyopathies will facilitate diagnosis and preventive prolonged treatment, which should include intensive anti-stress therapy.
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Affiliation(s)
- Petr A Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia
| | - Alexey P Sarapultsev
- Federal State Autonomous Educational Institution of Higher Professional Education, Ural Federal University named after the first President of Russia B. N. Yeltsin, Russia; Institute of Immunology and Physiology of the Ural Branch of the RAS, Russia.
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Left ventricular sphericity independently predicts appropriate implantable cardioverter-defibrillator therapy. Heart Rhythm 2015; 13:490-7. [PMID: 26409099 DOI: 10.1016/j.hrthm.2015.09.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Whether echocardiographic markers of remodeling are associated with ventricular tachyarrhythmias is unknown. OBJECTIVE The purpose of this study was to determine whether a transthoracic echocardiographic (TTE) marker of spherical left ventricular (LV) remodeling is associated with appropriate implantable cardioverter-defibrillator (ICD) therapy in patients with primary prevention ICDs. METHODS From TTE images, we calculated sphericity index (SI), the ratio of biplane LV end-diastolic volume to the volume of a hypothetical sphere with a diameter of the LV end-diastolic length, and examined the relation between SI and therapy for ventricular tachyarrhythmias in 278 patients with primary prevention ICDs and in 50 controls without structural heart disease or ventricular arrhythmias. RESULTS SI in normal healthy adult subjects and in subjects receiving ICDs was 0.44 ± 0.02 and 0.65 ± 0.04, respectively (P <.001). Median time to first appropriate ICD therapy was significantly shorter in ICD patients with SI in the upper vs lower 50% of SI values (1.40 vs 2.38 years, P = .02 for conventional ICD patients; 1.54 vs 2.65 years, P = .02 for cardiac resynchronization therapy-defibrillator [CRT-D] patients). In multivariable Cox regression analysis, SI in the upper 50% was independently associated with appropriate ICD therapy after multivariable adjustment (hazard ratio 2.2, P = .03 for ICD cohort; hazard ratio 4.4, P = .01 for CRT-D cohort). SI was not associated with total mortality in either cohort. CONCLUSION SI is associated with appropriate ICD therapy, but not total mortality, in patients receiving primary prevention ICDs. These observations suggest spherical LV remodeling may predispose to ventricular arrhythmias. Furthermore, SI appears to add predictive accuracy for appropriate ICD therapy in patients with reduced ejection fraction.
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Turillazzi E, Neri M, Riezzo I, Di Paolo M, Evangelisti L, Fineschi V. Cardiac fibrosis, arrhythmia and sudden death in myotonic dystrophy type 1: Could TGF-ß1 improve the predictive accuracy of patients at risk, opening new therapeutic challenges? Int J Cardiol 2013; 168:4976-8. [PMID: 23931970 DOI: 10.1016/j.ijcard.2013.07.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2013] [Accepted: 07/13/2013] [Indexed: 10/26/2022]
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Karagueuzian HS, Nguyen TP, Qu Z, Weiss JN. Oxidative stress, fibrosis, and early afterdepolarization-mediated cardiac arrhythmias. Front Physiol 2013; 4:19. [PMID: 23423152 PMCID: PMC3573324 DOI: 10.3389/fphys.2013.00019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 01/25/2013] [Indexed: 01/06/2023] Open
Abstract
Animal and clinical studies have demonstrated that oxidative stress, a common pathophysiological factor in cardiac disease, reduces repolarization reserve by enhancing the L-type calcium current, the late Na, and the Na-Ca exchanger, promoting early afterdepolarizations (EADs) that can initiate ventricular tachycardia and ventricular fibrillation (VT/VF) in structurally remodeled hearts. Increased ventricular fibrosis plays a key facilitatory role in allowing oxidative-stress induced EADs to manifest as triggered activity and VT/VF, since normal non-fibrotic hearts are resistant to arrhythmias when challenged with similar or higher levels of oxidative stress. The findings imply that antifibrotic therapy, in addition to therapies designed to suppress EAD formation at the cellular level, may be synergistic in reducing the risk of sudden cardiac death.
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Affiliation(s)
- Hrayr S Karagueuzian
- Cardiovascular Research Laboratory, Translational Arrhythmia Research Section, David Geffen School of Medicine at UCLA Los Angeles, CA, USA
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