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Eliav T, Kuruppu D, Sanchez-Lara PA, Grand K, Schweiger B, Allen-Sharpley M. A Reversible Etiology of Progressive Motor Decline in a Previously Healthy Child. Pediatrics 2024; 154:e2023064093. [PMID: 39091240 DOI: 10.1542/peds.2023-064093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 06/14/2024] [Accepted: 06/17/2024] [Indexed: 08/04/2024] Open
Abstract
We describe the clinical presentation and evaluation of a 10-year-old boy who presented to our medical center with years of progressive proximal muscle weakness, muscle atrophy, and weight loss. In addition to a myopathic phenotype, he was found to have tachycardia, tremor, and learning difficulties. Electromyography revealed chronic myopathic changes and laboratory screening was notable for undetectable thyroid stimulating hormone. Follow-up testing revealed elevated thyroid peroxidase antibodies and thyroid stimulating immunoglobulins. Ultrasound examination revealed an enlarged heterogeneous thyroid gland. Four weeks after treatment with atenolol and methimazole, his strength and cognition began to improve. This case highlights the importance of evaluating for potentially reversible toxic-metabolic etiologies in children presenting with any progressive neurologic symptoms.
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Affiliation(s)
- Tal Eliav
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Deandra Kuruppu
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Pedro A Sanchez-Lara
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Katheryn Grand
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Bahareh Schweiger
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
| | - Michelle Allen-Sharpley
- Department of Pediatrics, Guerin Children's at Cedars-Sinai Medical Center, Los Angeles, California
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2
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Malinow I, Fong DC, Miyamoto M, Badran S, Hong CC. Pediatric dilated cardiomyopathy: a review of current clinical approaches and pathogenesis. Front Pediatr 2024; 12:1404942. [PMID: 38966492 PMCID: PMC11223501 DOI: 10.3389/fped.2024.1404942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 07/06/2024] Open
Abstract
Pediatric dilated cardiomyopathy (DCM) is a rare, yet life-threatening cardiovascular condition characterized by systolic dysfunction with biventricular dilatation and reduced myocardial contractility. Therapeutic options are limited with nearly 40% of children undergoing heart transplant or death within 2 years of diagnosis. Pediatric patients are currently diagnosed based on correlating the clinical picture with echocardiographic findings. Patient age, etiology of disease, and parameters of cardiac function significantly impact prognosis. Treatments for pediatric DCM aim to ameliorate symptoms, reduce progression of disease, and prevent life-threatening arrhythmias. Many therapeutic agents with known efficacy in adults lack the same evidence in children. Unlike adult DCM, the pathogenesis of pediatric DCM is not well understood as approximately two thirds of cases are classified as idiopathic disease. Children experience unique gene expression changes and molecular pathway activation in response to DCM. Studies have pointed to a significant genetic component in pediatric DCM, with variants in genes related to sarcomere and cytoskeleton structure implicated. In this regard, pediatric DCM can be considered pediatric manifestations of inherited cardiomyopathy syndromes. Yet exciting recent studies in infantile DCM suggest that this subset has a distinct etiology involving defective postnatal cardiac maturation, such as the failure of programmed centrosome breakdown in cardiomyocytes. Improved knowledge of pathogenesis is central to developing child-specific treatment approaches. This review aims to discuss the established biological pathogenesis of pediatric DCM, current clinical guidelines, and promising therapeutic avenues, highlighting differences from adult disease. The overarching goal is to unravel the complexities surrounding this condition to facilitate the advancement of novel therapeutic interventions and improve prognosis and overall quality of life for pediatric patients affected by DCM.
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Affiliation(s)
- Ian Malinow
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Daniel C. Fong
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Matthew Miyamoto
- Division of Cardiovascular Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Sarah Badran
- Department of Pediatric Cardiology, Michigan State University College of Human Medicine Helen Devos Children’s Hospital, Grand Rapids, MI, United States
| | - Charles C. Hong
- Department of Medicine, Division of Cardiology, Michigan State University College of Human Medicine, East Lansing, MI, United States
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3
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Bagkaki A, Parthenakis F, Chlouverakis G, Anastasakis A, Papagiannis I, Galanakis E, Germanakis I. Epidemiology of Pediatric Cardiomyopathy in a Mediterranean Population. CHILDREN (BASEL, SWITZERLAND) 2024; 11:732. [PMID: 38929311 PMCID: PMC11202073 DOI: 10.3390/children11060732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Our knowledge regarding the epidemiology of pediatric cardiomyopathy is based on large national population studies reporting an annual incidence of 1 case per 100,000 children, with a higher incidence observed in infancy and among selected populations. The aim here is to document the epidemiology of pediatric cardiomyopathy in a Mediterranean population. METHODS Children younger than 18 years of age living on the Mediterranean island of Crete, Greece, who have been evaluated since the establishment of tertiary pediatric cardiology services (2002-2022) were included in this retrospective study. RESULTS A total of 40 children were included, corresponding to an average annual incidence of pediatric cardiomyopathy of 1.59 cases (95% CI: 1.4-2.3) and a prevalence of 26 cases per 100,000 children. In decreasing order of frequency, most cases corresponded to dilated (50%), followed by hypertrophic (42.5%), arrhythmogenic (5%), and restrictive (2.5%) cardiomyopathy. An etiology was identified in 40%, including a genetic diagnosis in 22.5%. CONCLUSIONS The incidence of pediatric cardiomyopathy in the Mediterranean island of Crete is higher compared with that reported previously for other Caucasian populations. Further study is needed to investigate the exact prevalence and specific genetic factors associated with the epidemiology of pediatric cardiomyopathy in Mediterranean populations.
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Affiliation(s)
- Alena Bagkaki
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Fragiskos Parthenakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Gregory Chlouverakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Aris Anastasakis
- Onassis Cardiac Surgery Center, Syggrou Av. 356, 176 74 Athens, Greece; (A.A.); (I.P.)
| | - Ioannis Papagiannis
- Onassis Cardiac Surgery Center, Syggrou Av. 356, 176 74 Athens, Greece; (A.A.); (I.P.)
| | - Emmanouil Galanakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
| | - Ioannis Germanakis
- School of Medicine, University of Crete, 71 003 Heraklion, Greece; (A.B.); (F.P.); (G.C.); (E.G.)
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4
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Spaapen TOM, Bohte AE, Slieker MG, Grotenhuis HB. Cardiac MRI in diagnosis, prognosis, and follow-up of hypertrophic cardiomyopathy in children: current perspectives. Br J Radiol 2024; 97:875-881. [PMID: 38331407 PMCID: PMC11075988 DOI: 10.1093/bjr/tqae033] [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: 04/06/2022] [Revised: 09/15/2023] [Accepted: 02/03/2024] [Indexed: 02/10/2024] Open
Abstract
Hypertrophic Cardiomyopathy (HCM) is an inherited myocardial disease characterised by left ventricular hypertrophy, which carries an increased risk of life-threatening arrhythmias and sudden cardiac death. The age of presentation and the underlying aetiology have a significant impact on the prognosis and quality of life of children with HCM, as childhood-onset HCM is associated with high mortality risk and poor long-term outcomes. Accurate cardiac assessment and identification of the HCM phenotype are therefore crucial to determine the diagnosis, prognostic stratification, and follow-up. Cardiac magnetic resonance (CMR) is a comprehensive evaluation tool capable of providing information on cardiac morphology and function, flow, perfusion, and tissue characterisation. CMR allows to detect subtle abnormalities in the myocardial composition and characterise the heterogeneous phenotypic expression of HCM. In particular, the detection of the degree and extent of myocardial fibrosis, using late-gadolinium enhanced sequences or parametric mapping, is unique for CMR and is of additional value in the clinical assessment and prognostic stratification of paediatric HCM patients. Additionally, childhood HCM can be progressive over time. The rate, timing, and degree of disease progression vary from one patient to the other, so close cardiac monitoring and serial follow-up throughout the life of the diagnosed patients is of paramount importance. In this review, an update of the use of CMR in childhood HCM is provided, focussing on its clinical role in diagnosis, prognosis, and serial follow-up.
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Affiliation(s)
- Tessa O M Spaapen
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Anneloes E Bohte
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Martijn G Slieker
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Heynric B Grotenhuis
- Department of Paediatric Cardiology, University Medical Centre Utrecht/Wilhelmina Children's Hospital, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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5
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Monda E, De Michele G, Diana G, Verrillo F, Rubino M, Cirillo A, Fusco A, Amodio F, Caiazza M, Dongiglio F, Palmiero G, Buono P, Russo MG, Limongelli G. Left Ventricular Non-Compaction in Children: Aetiology and Diagnostic Criteria. Diagnostics (Basel) 2024; 14:115. [PMID: 38201424 PMCID: PMC10871098 DOI: 10.3390/diagnostics14010115] [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: 11/13/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
Left ventricular non-compaction (LVNC) is a heterogeneous myocardial disorder characterized by prominent trabeculae protruding into the left ventricular lumen and deep intertrabecular recesses. LVNC can manifest in isolation or alongside other heart muscle diseases. Its occurrence among children is rising due to advancements in imaging techniques. The origins of LVNC are diverse, involving both genetic and acquired forms. The clinical manifestation varies greatly, with some cases presenting no symptoms, while others typically manifesting with heart failure, systemic embolism, and arrhythmias. Diagnosis mainly relies on assessing heart structure using imaging tools like echocardiography and cardiac magnetic resonance. However, the absence of a universally agreed-upon standard and limitations in diagnostic criteria have led to ongoing debates in the scientific community regarding the most reliable methods. Further research is crucial to enhance the diagnosis of LVNC, particularly in early life stages.
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Affiliation(s)
- Emanuele Monda
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
| | - Gianantonio De Michele
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Gaetano Diana
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Verrillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Marta Rubino
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Annapaola Cirillo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Adelaide Fusco
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Federica Amodio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Martina Caiazza
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Francesca Dongiglio
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Palmiero
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Pietro Buono
- Department of Maternal and Child Health, General Directorate for Health, 80131 Naples, Italy
| | - Maria Giovanna Russo
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
| | - Giuseppe Limongelli
- Inherited and Rare Cardiovascular Diseases, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; (E.M.); (G.D.M.); (G.D.); (F.V.); (M.R.); (A.C.); (A.F.); (F.A.); (M.C.); (F.D.); (G.P.); (M.G.R.)
- Institute of Cardiovascular Science, University College London, London WC1N 3JH, UK
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6
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Thompson T, Phimister A, Raskin A. Adolescent Onset of Acute Heart Failure. Med Clin North Am 2024; 108:59-77. [PMID: 37951656 DOI: 10.1016/j.mcna.2023.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Heart failure in adolescents can manifest due to a multitude of causes. Presentation is often quite variable ranging from asymptomatic to decompensated heart failure or sudden cardiac death. Because of the diverse nature of this disease, a thoughtful and extensive evaluation is critical to establishing the diagnosis and treatment plan. Identifying and addressing reversible pathologies often leads to functional cardiac recovery. Some disease states are irreversible and progressive, requiring chronic heart failure management and potentially advanced therapies such as transplantation.
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Affiliation(s)
- Tracey Thompson
- Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
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7
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Biedermann P, Sitte-Koch V, Schweiger M, Meinold A, Quandt D, Kretschmar O, Balmer C, Knirsch W. Pulmonary hemodynamics before and after pediatric heart transplantation. Clin Transplant 2024; 38:e15162. [PMID: 37823242 DOI: 10.1111/ctr.15162] [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: 07/07/2023] [Revised: 09/06/2023] [Accepted: 09/23/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Pulmonary hypertension (PH) may limit the outcome of pediatric heart transplantation (pHTx). We evaluated pulmonary hemodynamics in children undergoing pHTx. METHODS Cross-sectional, single-center, observational study analyzing pulmonary hemodynamics in children undergoing pHTx. RESULTS Twenty-three children (female 15) underwent pHTx at median (IQR) age of 3.9 (.9-8.2) years with a time interval between first clinical signs and pHTx of 1.1 (.4-3.2) years. Indications for pHTx included cardiomyopathy (CMP) (n = 17, 74%), congenital heart disease (CHD) (n = 5, 22%), and intracardiac tumor (n = 1, 4%). Before pHTx, pulmonary hemodynamics included elevated pulmonary artery pressure (PAP) 26 (18.5-30) mmHg, pulmonary capillary wedge pressure (PCWP) 19 (14-21) mmHg, left ventricular enddiastolic pressure (LVEDP) 17 (13-22) mmHg. Transpulmonary pressure gradient (TPG) was 6.5 (3.5-10) mmHg and pulmonary vascular resistance (Rp) 2.65 WU*m2 (1.87-3.19). After pHTx, at immediate evaluation 2 weeks after pHTx PAP decreased to 20.5 (17-24) mmHg, PCWP 14.5 (10.5-18) mmHg (p < .05), LVEDP 16 (12.5-18) mmHg, TPG 6.5 (4-12) mmHg, Rp 1.49 (1.08-2.74) WU*m2 resp.at last invasive follow up 4.0 (1.4-6) years after pHTx, to PAP 19.5 (17-21) mmHg (p < .05), PCWP 13 (10.5-14.5) mmHg (p < .05), LVEDP 13 (10.5-14) mmHg, TPG 7 (5-9.5) mmHg, Rp 1.58 (1.38-2.19) WU*m2 (p < .05). In CHD patients PAP increased (p < .05) after pHTx at immediate evaluation and decreased until last follow-up (p < .05), while in CMP patients there was a continuous decline of mean PAP values immediately after HTx (p < .05). CONCLUSIONS While PH before pHTx is frequent, after pHTx the normalization of PH starts immediately in CMP patients but is delayed in CHD patients.
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Affiliation(s)
- Philipp Biedermann
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Vanessa Sitte-Koch
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Martin Schweiger
- University of Zurich, Zurich, Switzerland
- Pediatric Congenital Heart Surgery, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Anke Meinold
- University of Zurich, Zurich, Switzerland
- Pediatric Intensive Care and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Daniel Quandt
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Oliver Kretschmar
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Christian Balmer
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Walter Knirsch
- Pediatric Cardiology, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
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8
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Zampieri M, Di Filippo C, Zocchi C, Fico V, Golinelli C, Spaziani G, Calabri G, Bennati E, Girolami F, Marchi A, Passantino S, Porcedda G, Capponi G, Gozzini A, Olivotto I, Ragni L, Favilli S. Focus on Paediatric Restrictive Cardiomyopathy: Frequently Asked Questions. Diagnostics (Basel) 2023; 13:3666. [PMID: 38132249 PMCID: PMC10742619 DOI: 10.3390/diagnostics13243666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023] Open
Abstract
Restrictive cardiomyopathy (RCM) is characterized by restrictive ventricular pathophysiology determined by increased myocardial stiffness. While suspicion of RCM is initially raised by clinical evaluation and supported by electrocardiographic and echocardiographic findings, invasive hemodynamic evaluation is often required for diagnosis and management of patients during follow-up. RCM is commonly associated with a poor prognosis and a high incidence of heart failure, and PH is reported in paediatric patients with RCM. Currently, only a few therapies are available for specific RCM aetiologies. Early referral to centres for advanced heart failure treatment is often necessary. The aim of this review is to address questions frequently asked when facing paediatric patients with RCM, including issues related to aetiologies, clinical presentation, diagnostic process and prognosis.
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Affiliation(s)
- Mattia Zampieri
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Chiara Di Filippo
- Local Health Unit, Outpatient Cardiology Clinic, 84131 Salerno, Italy
| | - Chiara Zocchi
- Cardiovascular Department, San Donato Hospital, 52100 Arezzo, Italy
| | - Vera Fico
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Cristina Golinelli
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio—Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Gaia Spaziani
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Giovanni Calabri
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Elena Bennati
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Francesca Girolami
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Alberto Marchi
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Silvia Passantino
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Giulio Porcedda
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Guglielmo Capponi
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Alessia Gozzini
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
| | - Iacopo Olivotto
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
- Cardiomyopathy Unit, Careggi University Hospital, 50134 Florence, Italy
| | - Luca Ragni
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio—Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
| | - Silvia Favilli
- Pediatric Cardiology, Meyer Children’s University Hospital IRCCS, 50134 Florence, Italy (S.F.)
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9
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Conway J, Barrett O, Pidborochynski T, Schroeder K, Cunningham C, Jeewa A, Kaul P. Administrative Databases: Friend or Foe in Paediatric Cardiomyopathy. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2023; 2:490-493. [PMID: 38205436 PMCID: PMC10777199 DOI: 10.1016/j.cjcpc.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 01/12/2024]
Abstract
Background Cardiomyopathy (CM) is a rare childhood disease associated with morbidity and mortality. Limited data exist on paediatric CM in Canada. Given the rare nature, single-centre studies are not sufficiently powered to address important questions. Therefore, administrative health data may serve as a resource for the study of childhood CM. The goal of this study was to validate the accuracy of International Classification of Diseases (ICD)-based algorithms to identify paediatric CM in health databases using a clinical registry as the gold standard. Methods The clinical registry was compiled from outpatient and inpatient records at the Stollery Children's Hospital (January 1, 2013, to December 31, 2021). Patients were categorized as having CM or screened without CM. Data were linked to administrative health databases using the patient's Unique Lifetime Identifier. Algorithms based on the presence of ICD, 10th Revision, codes for CM were then evaluated, and cross-tabulations against the clinical registry were generated. Accuracy, positive predictive value, negative predictive value, sensitivity, and specificity were calculated. Results The clinical registry had 90 patients with CM and 249 screened without CM. The algorithms ruled out CM (high negative predictive value) but had variability in the ability to diagnose CM positive predictive value. The algorithm that performed the best was based on a diagnosis of CM in a hospitalization or 2 ambulatory visits. Conclusions A combination of inpatient and outpatient databases can be used, with acceptable accuracy, to identify paediatric patients with CM. This finding allows for the use of the identified algorithm for the comprehensive study of paediatric CM in Canada.
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Affiliation(s)
- Jennifer Conway
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Katie Schroeder
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Chentel Cunningham
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Aamir Jeewa
- Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Padma Kaul
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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10
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 371] [Impact Index Per Article: 371.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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11
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Ruijmbeek CW, Housley F, Idrees H, Housley MP, Pestel J, Keller L, Lai JK, van der Linde HC, Willemsen R, Piesker J, Al-Hassnan ZN, Almesned A, Dalinghaus M, van den Bersselaar LM, van Slegtenhorst MA, Tessadori F, Bakkers J, van Ham TJ, Stainier DY, Verhagen JM, Reischauer S. Biallelic variants in FLII cause pediatric cardiomyopathy by disrupting cardiomyocyte cell adhesion and myofibril organization. JCI Insight 2023; 8:e168247. [PMID: 37561591 PMCID: PMC10544232 DOI: 10.1172/jci.insight.168247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/20/2023] [Indexed: 08/12/2023] Open
Abstract
Pediatric cardiomyopathy (CM) represents a group of rare, severe disorders that affect the myocardium. To date, the etiology and mechanisms underlying pediatric CM are incompletely understood, hampering accurate diagnosis and individualized therapy development. Here, we identified biallelic variants in the highly conserved flightless-I (FLII) gene in 3 families with idiopathic, early-onset dilated CM. We demonstrated that patient-specific FLII variants, when brought into the zebrafish genome using CRISPR/Cas9 genome editing, resulted in the manifestation of key aspects of morphological and functional abnormalities of the heart, as observed in our patients. Importantly, using these genetic animal models, complemented with in-depth loss-of-function studies, we provided insights into the function of Flii during ventricular chamber morphogenesis in vivo, including myofibril organization and cardiomyocyte cell adhesion, as well as trabeculation. In addition, we identified Flii function to be important for the regulation of Notch and Hippo signaling, crucial pathways associated with cardiac morphogenesis and function. Taken together, our data provide experimental evidence for a role for FLII in the pathogenesis of pediatric CM and report biallelic variants as a genetic cause of pediatric CM.
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Affiliation(s)
- Claudine W.B. Ruijmbeek
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Filomena Housley
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Hafiza Idrees
- Medical Clinic I (Cardiology/Angiology) and Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
| | - Michael P. Housley
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jenny Pestel
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Leonie Keller
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Jason K.H. Lai
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Herma C. van der Linde
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rob Willemsen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Janett Piesker
- Scientific Service Group Microscopy, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Zuhair N. Al-Hassnan
- Department of Medical Genetics, and
- Cardiovascular Genetics Program, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | | | - Michiel Dalinghaus
- Department of Pediatric Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lisa M. van den Bersselaar
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marjon A. van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Federico Tessadori
- Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht, Netherlands
| | - Jeroen Bakkers
- Hubrecht Institute-KNAW and University Medical Center Utrecht, Utrecht, Netherlands
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tjakko J. van Ham
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Didier Y.R. Stainier
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), RheinMain partner site, Bad Nauheim, Germany
| | - Judith M.A. Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sven Reischauer
- Department of Developmental Genetics, Max Planck Institute for Heart and Lung Research, Bad Nauheim, Germany
- Medical Clinic I (Cardiology/Angiology) and Campus Kerckhoff, Justus-Liebig-University Giessen, Giessen, Germany
- Excellence Cluster Cardio-Pulmonary Institute (CPI), Giessen/Bad Nauheim, Germany
- German Centre for Cardiovascular Research (DZHK), RheinMain partner site, Bad Nauheim, Germany
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12
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Dai HL, Wang QH, Su X, Ding YC, Guang XF. Pediatric restrictive cardiomyopathy: a case report. J Int Med Res 2023; 51:3000605231188276. [PMID: 37646638 PMCID: PMC10469232 DOI: 10.1177/03000605231188276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/29/2023] [Indexed: 09/01/2023] Open
Abstract
Restrictive cardiomyopathy (RCM) is a rare childhood cardiomyopathy that is a challenging diagnostic problem for clinicians. We describe a case of an 8-year-old girl with a 2-year history of shortness of breath on exertion. Electrocardiogram and echocardiography showed biatrial enlargement, while cardiac magnetic resonance showed biatrial dilation and normal pericardial thickness. Left and right heart catheterization revealed a left ventricular (LV) end-diastolic pressure (EDP) of 20 mmHg, right ventricular (RV) EDP of 13 mmHg, and pulmonary arterial systolic pressure of 51 mmHg. LV and RV pressure traces showed that LV and RV pressures moved concordantly with respiration, and that the systolic area index was 0.98. Cardiac catheterization data were therefore supportive of RCM. Next-generation sequencing identified a heterozygous variant of the troponin I gene (TNNI3; c.574C>T). Combining these findings led to a diagnosis of RCM. The patient's parents chose conservative treatment, but at the 12-month follow-up she died of worsening heart failure and cerebral infarction. This case emphasizes the need for cardiac catheterization and genetic testing in RCM, and suggests that anticoagulants should be recommended to reduce the risk of thromboembolic events.
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Affiliation(s)
- Hai-Long Dai
- Department of Cardiology, Key Laboratory of Cardiovascular Disease of Yunnan Province, Clinical Medicine Center for Cardiovascular Disease of Yunnan Province, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
| | - Qing-Hui Wang
- Department of Ultrasound, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
| | - Xuan Su
- Department of Ultrasound, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
| | - Yun-Chuan Ding
- Department of Ultrasound, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
| | - Xue-Feng Guang
- Department of Cardiology, Key Laboratory of Cardiovascular Disease of Yunnan Province, Clinical Medicine Center for Cardiovascular Disease of Yunnan Province, Yan’an Affiliated Hospital of Kunming Medical University, Kunming, P. R. China
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13
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Koshy L, Ganapathi S, Jeemon P, Madhuma M, Vysakh Y, Lakshmikanth L, Harikrishnan S. Sarcomeric gene variants among Indians with hypertrophic cardiomyopathy: A scoping review. Indian J Med Res 2023; 158:119-135. [PMID: 37787257 PMCID: PMC10645028 DOI: 10.4103/ijmr.ijmr_3567_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 10/04/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease that frequently causes sudden cardiac death (SCD) among young adults. Several pathogenic mutations in genes encoding the cardiac sarcomere have been identified as diagnostic factors for HCM and proposed as prognostic markers for SCD. The objective of this review was to determine the scope of available literature on the variants encoding sarcomere proteins associated with SCD reported among Indian patients with HCM. The eligibility criteria for the scoping review included full text articles that reported the results of genetic screening for sarcomeric gene mutations in HCM patients of Indian south Asian ancestry. We systematically reviewed studies from the databases of Medline, Scopus, Web of Science core collection and Google Scholar. The electronic search strategy included a combination of generic terms related to genetics, disease and population. The protocol of the study was registered with Open Science Framework (https://osf.io/53gde/). A total of 19 articles were identified that reported pathogenic or likely pathogenic (P/LP) variants within MYH7, MYBPC3, TNNT2, TNNI3 and TPM1 genes, that included 16 singletons, one de novo and one digenic mutation (MYH7/ TPM1) associated with SCD among Indian patients. Evidence from functional studies and familial segregation implied a plausible mechanistic role of these P/LP variants in HCM pathology. This scoping review has compiled all the P/LP variants reported to-date among Indian patients and summarized their association with SCD. Single homozygous, de novo and digenic mutations were observed to be associated with severe phenotypes compared to single heterozygous mutations. The abstracted genetic information was updated with reference sequence ID (rsIDs) and compiled into freely accessible HCMvar database, available at https://hcmvar.heartfailure.org.in/. This can be used as a population specific genetic database for reference by clinicians and researchers involved in the identification of diagnostic and prognostic markers for HCM.
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Affiliation(s)
- Linda Koshy
- Centre for Advance Research & Excellence in Heart Failure, Thiruvananthapuram, Kerala, India
| | - Sanjay Ganapathi
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
| | - M. Madhuma
- Centre for Advance Research & Excellence in Heart Failure, Thiruvananthapuram, Kerala, India
| | - Y. Vysakh
- Centre for Advance Research & Excellence in Heart Failure, Thiruvananthapuram, Kerala, India
| | - L.R. Lakshmikanth
- Centre for Advance Research & Excellence in Heart Failure, Thiruvananthapuram, Kerala, India
| | - Sivadasanpillai Harikrishnan
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences & Technology, Thiruvananthapuram, Kerala, India
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14
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Tsatsopoulou A, Protonotarios I, Xylouri Z, Papagiannis I, Anastasakis A, Germanakis I, Patrianakos A, Nyktari E, Gavras C, Papadopoulos G, Meditskou S, Lazarou E, Miliou A, Lazaros G. Cardiomyopathies in children: An overview. Hellenic J Cardiol 2023; 72:43-56. [PMID: 36870438 DOI: 10.1016/j.hjc.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 02/14/2023] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Paediatric cardiomyopathies form a heterogeneous group of disorders characterized by structural and electrical abnormalities of the heart muscle, commonly due to a gene variant of the myocardial cell structure. Mostly inherited as a dominant or occasionally recessive trait, they might be part of a syndromic disorder of underlying metabolic or neuromuscular defects or combine early developing extracardiac abnormalities (i.e., Naxos disease). The annual incidence of 1 per 100,000 children appears higher during the first two years of life. Dilated and hypertrophic cardiomyopathy phenotypes share an incidence of 60% and 25%, respectively. Arrhythmogenic right ventricular cardiomyopathy (ARVC), restrictive cardiomyopathy, and left ventricular noncompaction are less commonly diagnosed. Adverse events such as severe heart failure, heart transplantation, or death usually appear early after the initial presentation. In ARVC patients, high-intensity aerobic exercise has been associated with worse clinical outcomes and increased penetrance in at-risk genotype-positive relatives. Acute myocarditis in children has an incidence of 1.4-2.1 cases/per 100,000 children per year, with a 6-14% mortality rate during the acute phase. A genetic defect is considered responsible for the progression to dilated cardiomyopathy phenotype. Similarly, a dilated or arrhythmogenic cardiomyopathy phenotype might emerge with an episode of acute myocarditis in childhood or adolescence. This review provides an overview of childhood cardiomyopathies focusing on clinical presentation, outcome, and pathology.
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Affiliation(s)
- Adalena Tsatsopoulou
- General Paediatrics and Clinical Research, Private Clinic, Naxos, Greece; Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece; Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece; Laboratory of Histology and Embryology, Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Protonotarios
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Zafeirenia Xylouri
- University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, Hampshire, SO16 6YD, UK
| | - Ioannis Papagiannis
- Department of Paediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Centre, Athens, Greece
| | - Ioannis Germanakis
- Department of Paediatrics, University Hospital Heraklion, School of Medicine, University of Crete, Heraklion, Greece
| | | | | | | | | | - Soultana Meditskou
- Laboratory of Histology and Embryology, Department of Medicine, School of Life Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Emilia Lazarou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Antigoni Miliou
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - George Lazaros
- Unit of Inherited Cardiac Conditions and Sports Cardiology, 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece.
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15
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Walter A, Calite E, Geipel A, Strizek B, Recker F, Herberg U, Berg C, Gembruch U. Spectrum and Outcome of Prenatally Diagnosed Fetal Primary Cardiomyopathies-A Twenty-Year Overview. J Clin Med 2023; 12:4366. [PMID: 37445401 DOI: 10.3390/jcm12134366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/22/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE to assess the course and outcome of fetuses affected by primary cardiomyopathy (CM). METHODS Retrospective study of 21 cases with prenatal diagnosis of a primary CM in one tertiary center over a period of 20 years. Charts were reviewed for echocardiographic findings, pregnancy outcome, and postnatal course. The utility of prenatal evaluation was discussed. RESULTS The mean gestational age (GA) at diagnosis was 26.7 (±5.1) weeks. A total of 33.3% (7/21) had associated anomalies. Genetic etiology was confirmed in 50.0% (10/20, with one case lost to follow up). The overall survival rate of the entire study population was 40% (8/20) including termination of pregnancy in 20% (4/20) and an intrauterine mortality rate of 5% (1/20). Of the initial survivors (n = 15), a neonatal and early infant mortality rate of 46.7% (7/15) was calculated. Prenatal isolated right ventricular involvement was the only identified significant parameter for survival (p = 0.035). Four phenotypical groups were identified: 42.9% (9/21) hypertrophic (HCM), 38.1% (8/21) dilated (DCM), 14.3% (3/21) isolated noncompaction (NCCM), and 4.8% (1/21) restrictive CM (RCM). Fetuses assigned to isolated NCCM revealed a 100% survival rate. CONCLUSION Prenatal detection is feasible but needs to a introduce classification method for better consulting and management practices. A poor outcome is still observed in many cases, but an increase in examiners' awareness may influence optimal multispecialized care.
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Affiliation(s)
- Adeline Walter
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Elina Calite
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Annegret Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Brigitte Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Florian Recker
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Christoph Berg
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
- Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, 53127 Bonn, Germany
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16
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Fu X, Mishra R, Chen L, Arfat MY, Sharma S, Kingsbury T, Gunasekaran M, Saha P, Hong C, Yang P, Li D, Kaushal S. Exosomes mediated fibrogenesis in dilated cardiomyopathy through a MicroRNA pathway. iScience 2023; 26:105963. [PMID: 36818289 PMCID: PMC9932122 DOI: 10.1016/j.isci.2023.105963] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 11/02/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
Cardiac fibrosis is a hallmark in late-stage familial dilated cardiomyopathy (DCM) patients, although the underlying mechanism remains elusive. Cardiac exosomes (Exos) have been reported relating to fibrosis in ischemic cardiomyopathy. Thus, we investigated whether Exos secreted from the familial DCM cardiomyocytes could promote fibrogenesis. Using human iPSCs differentiated cardiomyocytes we isolated Exos of angiotensin II stimulation conditioned media from either DCM or control (CTL) cardiomyocytes. Of interest, cultured cardiac fibroblasts had increased fibrogenesis following exposure to DCM-Exos rather than CTL-Exos. Meanwhile, injecting DCM-Exos into mouse hearts enhanced cardiac fibrosis and impaired cardiac function. Mechanistically, we identified the upregulation of miRNA-218-5p in the DCM-Exos as a critical contributor to fibrogenesis. MiRNA-218-5p activated TGF-β signaling via suppression of TNFAIP3, a master inflammation inhibitor. In conclusion, our results illustrate a profibrotic effect of cardiomyocytes-derived Exos that highlights an additional pathogenesis pathway for cardiac fibrosis in DCM.
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Affiliation(s)
- Xuebin Fu
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Rachana Mishra
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Ling Chen
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Mir Yasir Arfat
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Sudhish Sharma
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Tami Kingsbury
- Center for Stem Cell Biology & Regenerative Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Muthukumar Gunasekaran
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Progyaparamita Saha
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Charles Hong
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Peixin Yang
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deqiang Li
- Department of Surgery, Center for Vascular & Inflammatory Diseases, University of Maryland School of Medicine, Baltimore, MD, USA,Corresponding author
| | - Sunjay Kaushal
- Department of Cardiovascular-Thoracic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA,Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA,Corresponding author
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17
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Ghasemi S, Mahdavi M, Maleki M, Salahshourifar I, Kalayinia S. A novel likely pathogenic variant in the FBXO32 gene associated with dilated cardiomyopathy according to whole‑exome sequencing. BMC Med Genomics 2022; 15:234. [PMID: 36344977 PMCID: PMC9641816 DOI: 10.1186/s12920-022-01388-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Background Familial dilated cardiomyopathy (DCM) is a genetic heart disorder characterized by progressive heart failure and sudden cardiac death. Over 250 genes have been reported in association with DCM; nonetheless, the genetic cause of most DCM patients has been unknown. The goal of the present study was to determine the genetic etiology of familial DCM in an Iranian family. Methods Whole-exome sequencing was performed to identify the underlying variants in an Iranian consanguineous family with DCM. The presence of the candidate variant was confirmed and screened in available relatives by PCR and Sanger sequencing. The pathogenic effect of the candidate variant was assessed by bioinformatics analysis, homology modeling, and docking. Results One novel likely pathogenic deletion, c.884_886del: p.Lys295del, in F-box only protein 32 (muscle-specific ubiquitin-E3 ligase protein; FBXO32) was identified. Based on bioinformatics and modeling analysis, c.884_886del was the most probable cause of DCM in the studied family. Conclusions Our findings indicate that variants in FBXO32 play a role in recessive DCM. Variants in FBXO32 may disturb the degradation of target proteins in the ubiquitin–proteasome system and lead to severe DCM. We suggest considering this gene variants in patients with recessively inherited DCM.
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18
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Racolta A, Ahn JHJ, Kantzis M, Milting H, Lauenroth V, Körperich H, Sandica E, Schubert S, Laser KT. Cardiac Muscle Training-A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111681. [PMID: 36362836 PMCID: PMC9698751 DOI: 10.3390/life12111681] [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: 09/20/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 12/02/2022]
Abstract
Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD.
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Affiliation(s)
- Anca Racolta
- Clinic for Pediatric Cardiology, Center for Congenital Heart Defects, University Hospital RWTH Aachen, 52074 Aachen, Germany
| | - Jae-Hyun Johannes Ahn
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Marinos Kantzis
- University Hospital Leicester, NHS Trust EMCHC, Leicester LE1 5WW, UK
| | - Hendrik Milting
- Erich and Hanna Klessmann Institute, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Volker Lauenroth
- Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Eugen Sandica
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Stephan Schubert
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
| | - Kai Thorsten Laser
- Pediatric Heart Center and Center for Congenital Heart Defects, Heart and Diabetes Center NRW, University Hospitals Ruhr University of Bochum, 32545 Bad Oeynhausen, Germany
- Correspondence:
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19
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Adebiyi EO, Edigin E, Shaka H, Hunter J, Swaminathan S. Pediatric Heart Failure Inpatient Mortality: A Cross-Sectional Analysis. Cureus 2022; 14:e26721. [PMID: 35959177 PMCID: PMC9360623 DOI: 10.7759/cureus.26721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Heart failure constitutes significant morbidity and mortality among the pediatric population. Few data exist on the prevalence and mortality rate of pediatric heart failure (pHF) in the United States. Objectives This study aimed to determine the in-hospital mortality and the principal diagnoses in pediatric patients with heart failure who died while being hospitalized in the United States. Methods This is a retrospective cross-sectional study using data from the 2019 Kid Inpatient Database (KID). The KID contained data on hospitalized children below 21 years of age. Using Stata 17 software (StataCorp LLC, College Station, Texas), the data were searched for heart failure diagnoses using International Classification of Diseases 10th revision Clinical Modification (ICD-10-CM) codes. By using the “rank” command in Stata, the most common principal diagnoses were placed in descending order of frequency, and these were further divided into different ICD-10 code categories. Results There were 16,206 pHF admissions in 2019. Of these admissions, 1,023 (6.31%) patients died. The top five principal ICD 10 code categories among all pHF deaths in descending order were circulatory system (17.95%), congenital/chromosomal abnormalities (17.43%), respiratory system (10.28%), infectious diseases (9.24%, and perinatal diseases (7.90%). Among all pHF deaths, sepsis of unspecified organisms (5.14%), hypoplastic left heart syndrome (HLHS) (3.19%), and acute respiratory failure with hypoxia (3.14%) were the most common primary diagnoses. Conclusion and significance Pediatric heart failure in-hospital overall mortality is 6.31%, and sepsis of unspecified organisms, HLHS, and acute respiratory failure are the most common principal diagnoses among these children. Preventive measures and prompt treatment of infections are paramount to reducing pHF mortality.
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