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Cazzato F, Grassi S, Brugada R, Oliva A. Letter to the editor regarding the article "Heart weight must not be measured before dissection during autopsies". Int J Legal Med 2024; 138:1663-1665. [PMID: 38374289 DOI: 10.1007/s00414-024-03189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy.
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, Salt, 17190, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
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Cazzato F, Coll M, Grassi S, Fernàndez-Falgueras A, Nogué-Navarro L, Iglesias A, Castellà J, Oliva A, Brugada R. Investigating cardiac genetic background in sudden infant death syndrome (SIDS). Int J Legal Med 2024:10.1007/s00414-024-03264-6. [PMID: 38849547 DOI: 10.1007/s00414-024-03264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 05/30/2024] [Indexed: 06/09/2024]
Abstract
Sudden infant death syndrome (SIDS) is still the leading cause of death for newborns in developed countries. The pathophysiological mechanisms have not been fully clarified, but in some of SIDS cases variants of genes associated with inherited cardiac conditions are found. In this study, an analysis of SCD-related genes was performed to determine the prevalence of rare pathogenic (P) or likely pathogenic (LP) variants that could provide an unambiguous explanation for the fatal event. A cohort of 76 SIDS cases underwent Next-Generation Sequencing (NGS) analysis with a custom panel of SCD-related genes. Rare variants were classified according to the guidelines provided by the American College of Medical Genetics and Genomics (ACMG) and the specifications of the ClinGen association. Post-mortem genetic testing identified 50 (65.8%) carriers of at least one variant in SCD genes. 104 rare genetic variants were found, 65.4% in genes encoding structural proteins. Only 4 out of 76 cases (5.3%) hosted at least a P or LP variant found in genes with structural or structural/arrhythmogenic functions (SLC22A5, SCN5A, MYL3and TTN). 99 variants were classified as of uncertain significance (VUS). The difference in the distribution of variants between gene groups by function was not statistically significant (chi square, p = 0,219). Despite this, most of the variants concerned structural genes that were supposed to have a close interaction with ion channels, thus providing an explanation for the arrhythmic event. Segregation analysis, reclassification of VUS variants and identification of new associated genes could clarify the implications of the current findings.
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Affiliation(s)
- Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Mònica Coll
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, 17190, Salt, Spain
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | | | - Laia Nogué-Navarro
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Vic 08500, Can Baumann, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, 17190, Salt, Spain
| | - Josep Castellà
- Forensic Pathology Service, Institut Medicina Legal Ciències Mèdiques Catalunya, Barcelona, Spain
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168, Rome, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Centre, University of Girona-IDIBGI, 17190, Salt, Spain
- Cardiology Department, Hospital Universitari Doctor Josep Trueta, 17003, Girona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003, Girona, Spain
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He Y, Ma H, Sun N, Zeng S, Zhang Y, Shu Y, Hua W, Zhou T, Zhou L, Li X. Prognosis of Patients with Hypertrophic Obstructive Cardiomyopathy: A Multicenter Cohort Study with Data-Driven Propensity Score Matching Analysis. Rev Cardiovasc Med 2023; 24:267. [PMID: 39076388 PMCID: PMC11270055 DOI: 10.31083/j.rcm2409267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 03/04/2023] [Accepted: 03/15/2023] [Indexed: 07/31/2024] Open
Abstract
Background Hypertrophic obstructive cardiomyopathy (HOCM) patients are reported to have a potential risk of sudden cardiac death (SCD); however, HCM with left ventricular outflow tract (LVOT) obstruction, which is regarded as a risk indicator of SCD, is doubtful since the LVOT gradient is dynamic and may be confounded by various environmental factors and routine activities. The purpose of this study was to explore the clinical prognosis of HOCM through a multicenter cohort study with data-driven propensity score matching (PSM) analysis. Methods The cohort included 2268 patients with HCM from 1996 to 2021 in 13 tertiary hospitals. In the present study, we excluded 458 patients who underwent alcohol septal ablation (ASA) and septal myectomy (SM) surgery so 1810 HCM patients were eventually included. We developed a data-driven propensity score using 24 demographic and clinical variables to create 1:1 propensity-matched cohorts. A Cox proportional hazard regression model was constructed to assess the effect of HOCM on mortality. Results After logit-matching, there were no significant differences in all-cause mortality (log-rank χ 2 = 1.509, p = 0.22), cardiovascular mortality/cardiac transplantation (log-rank χ 2 = 0.020, p = 0.89) or SCD (log-rank χ 2 = 0.503, p = 0.48) between patients with HOCM and hypertrophic nonobstructive cardiomyopathy (HNCM), and according to the Cox proportional hazard regression model, LVOT obstruction was not a risk predictor in patients with HCM. Conclusions In both matched and unmatched cohorts, there were no significant differences in clinical prognosis between HOCM and HNCM patients, and LVOT obstruction was not an independent risk predictor of prognosis in patients with HCM. Clinical Trial Registration ChiCTR1800017330.
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Affiliation(s)
- Ye He
- Visual Computing and Virtual Reality Key Laboratory of Sichuan Province, Sichuan Normal University, 610066 Chengdu, Sichuan, China
| | - Huihui Ma
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072 Chengdu, Sichuan, China
- Department of Cardiology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, 610072 Chengdu, Sichuan, China
| | - Nian Sun
- The First Clinical Institute, Zunyi Medical University, 563000 Zunyi, Guizhou, China
| | - Shengzhi Zeng
- Department of Cardiology, Guanghan People's Hospital, 618300 Guanghan, Sichuan, China
| | - Yanru Zhang
- College of Computer Science and Engineering, University of Electronic Science and Technology of China, 611731 Chengdu, Sichuan, China
| | - Yan Shu
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072 Chengdu, Sichuan, China
- Department of Cardiology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, 610072 Chengdu, Sichuan, China
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Tao Zhou
- College of Computer Science and Engineering, University of Electronic Science and Technology of China, 611731 Chengdu, Sichuan, China
| | - Ling Zhou
- Center of Statistical Research and School of Statistics, Southwestern University of Finance and Economics, 611130 Chengdu, Sichuan, China
| | - Xiaoping Li
- Department of Cardiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072 Chengdu, Sichuan, China
- Department of Cardiology, Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, 610072 Chengdu, Sichuan, China
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
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Grassi S, Campuzano O, Cazzato F, Coll M, Puggioni A, Zedda M, Arena V, Iglesias A, Sarquella-Brugada G, Pinchi V, Brugada R, Oliva A. Postmortem diagnosis of Takotsubo syndrome on autoptic findings: is it reliable? A systematic review. Cardiovasc Pathol 2023; 65:107543. [PMID: 37169210 DOI: 10.1016/j.carpath.2023.107543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 05/13/2023] Open
Abstract
Takotsubo syndrome (TTS) is a cardiac syndrome characterized by transient left ventricular systolic dysfunction in the absence of significant obstructive coronary artery disease. At the autopsy, its diagnosis is often challenging, since it is generally thought that it relates to no characteristic macroscopic or microscopic findings. In order to verify this last statement, we performed a systematic review of the literature following Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement (PRISMA) criteria. To the best of our knowledge, it is the first systematic review addressing this issue. We identified recurring but not pathognomonic (microscopic) features of TTS: contraction band necrosis and non-specific inflammatory changes (e.g., interstitial infiltrates of mononuclear lymphocytes and macrophages) typically in the absence of microscopic findings typical of acute myocardial infarction. In cases of TTS-related sudden death, careful evaluation of anamnesis, autopsy data and post-mortem genetic results (to exclude other causes) should be considered to overcome the complexity of these cases.
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Affiliation(s)
- Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy; Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
| | - Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
| | - Mònica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
| | - Alessandra Puggioni
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - Massimo Zedda
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Arena
- Institute of Pathological Anatomy, School of Medicine, Catholic University, 00168 Rome, Italy
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain
| | - Vilma Pinchi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, largo Brambilla 3, 50134, Florence, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain; Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Liu Z, Thergarajan P, Antonic-Baker A, Chen Z, Sparks PB, Lannin NA, Kwan P, Jones NC, Casillas-Espinosa PM, Perucca P, O'Brien TJ, Sivathamboo S. Cardiac structural and functional abnormalities in epilepsy: A systematic review and meta-analysis. Epilepsia Open 2023; 8:46-59. [PMID: 36648338 PMCID: PMC9977759 DOI: 10.1002/epi4.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE Epilepsy is associated with an increased risk of cardiovascular disease and mortality. Whether cardiac structure and function are altered in epilepsy remains unclear. To address this, we conducted a systematic review and meta-analysis of studies evaluating cardiac structure and function in patients with epilepsy. METHODS We searched the electronic databases MEDLINE, PubMed, COCHRANE, and Web of Science from inception to 31 December 2021. Primary outcomes of interest included left ventricular ejection fraction (LVEF) for studies reporting echocardiogram findings and cardiac weight and fibrosis for postmortem investigations. Study quality was assessed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tools. RESULTS Among the 10 case-control studies with epilepsy patients (n = 515) and healthy controls (n = 445), LVEF was significantly decreased in epilepsy group compared with controls (MD: -1.80; 95% confidence interval [CI]: -3.56 to -0.04; P = 0.045), whereas A-wave velocity (MD: 4.73; 95% CI: 1.87-7.60; P = 0.001), E/e' ratio (MD: 0.39; 95% CI: 0.06-0.71; P = 0.019), and isovolumic relaxation time (MD: 10.18; 95% CI: 2.05-18.32; P = 0.014) were increased in epilepsy, compared with controls. A pooled analysis was performed in sudden unexpected death in epilepsy (SUDEP) cases with autopsy data (n = 714). Among SUDEP cases, the prevalence of cardiac hypertrophy was 16% (95% CI: 9%-23%); cardiac fibrosis was 20% (95% CI: 15%-26%). We found no marked differences in cardiac hypertrophy, heart weight, or cardiac fibrosis between SUDEP cases and epilepsy controls. SIGNIFICANCE Our findings suggest that epilepsy is associated with altered diastolic and systolic echocardiogram parameters compared with healthy controls. Notably, SUDEP does not appear to be associated with a higher incidence of structural cardiac abnormalities, compared with non-SUDEP epilepsy controls. Longitudinal studies are needed to understand the prognostic significance of such changes. Echocardiography may be a useful noninvasive diagnostic test in epilepsy population.
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Affiliation(s)
- Zining Liu
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Peravina Thergarajan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ana Antonic-Baker
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Zhibin Chen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul B Sparks
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Nigel C Jones
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Pablo M Casillas-Espinosa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Piero Perucca
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.,Department of Neurology, Alfred Health, Melbourne, Victoria, Australia.,Bladin-Berkovic Comprehensive Epilepsy Program, Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine (Austin Health), Epilepsy Research Centre, The University of Melbourne, Heidelberg, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shobi Sivathamboo
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia.,Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Martínez-Barrios E, Grassi S, Brión M, Toro R, Cesar S, Cruzalegui J, Coll M, Alcalde M, Brugada R, Greco A, Ortega-Sánchez ML, Barberia E, Oliva A, Sarquella-Brugada G, Campuzano O. Molecular autopsy: Twenty years of post-mortem diagnosis in sudden cardiac death. Front Med (Lausanne) 2023; 10:1118585. [PMID: 36844202 PMCID: PMC9950119 DOI: 10.3389/fmed.2023.1118585] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/30/2023] [Indexed: 02/12/2023] Open
Abstract
In the forensic medicine field, molecular autopsy is the post-mortem genetic analysis performed to attempt to unravel the cause of decease in cases remaining unexplained after a comprehensive forensic autopsy. This negative autopsy, classified as negative or non-conclusive, usually occurs in young population. In these cases, in which the cause of death is unascertained after a thorough autopsy, an underlying inherited arrhythmogenic syndrome is the main suspected cause of death. Next-generation sequencing allows a rapid and cost-effectives genetic analysis, identifying a rare variant classified as potentially pathogenic in up to 25% of sudden death cases in young population. The first symptom of an inherited arrhythmogenic disease may be a malignant arrhythmia, and even sudden death. Early identification of a pathogenic genetic alteration associated with an inherited arrhythmogenic syndrome may help to adopt preventive personalized measures to reduce risk of malignant arrhythmias and sudden death in the victim's relatives, at risk despite being asymptomatic. The current main challenge is a proper genetic interpretation of variants identified and useful clinical translation. The implications of this personalized translational medicine are multifaceted, requiring the dedication of a specialized team, including forensic scientists, pathologists, cardiologists, pediatric cardiologists, and geneticists.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Simone Grassi
- Forensic Medical Sciences, Department of Health Science, University of Florence, Florence, Italy
| | - María Brión
- Family Heart Disease Unit, Cardiology Service, Santiago de Compostela University Hospital, Santiago de Compostela, Spain,Cardiovascular Genetics, Santiago de Compostela Health Research Institute, Santiago de Compostela, Spain,Genomic Medicine Group, Universidade de Santiago de Compostela, Santiago de Compostela, Spain,Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain
| | - Rocío Toro
- Medicine Department, School of Medicine, University of Cádiz, Cádiz, Spain
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Mònica Coll
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Mireia Alcalde
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Cardiology Department, Hospital Josep Trueta, Girona, Spain
| | - Andrea Greco
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - María Luisa Ortega-Sánchez
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine, Universitat Autònoma de Barcelona, Cerdanyola del Vallés, Spain
| | - Eneko Barberia
- Forensic Pathology Department, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), Barcelona, Spain,School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, Barcelona, Spain,European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart, Amsterdam, Netherlands,Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,*Correspondence: Georgia Sarquella-Brugada,
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, Madrid, Spain,Medical Science Department, School of Medicine, University of Girona, Girona, Spain,Cardiovascular Genetics Center, Institut d’Investigacions Biomèdiques de Girona (IDIBGI), University of Girona, Girona, Spain,Oscar Campuzano,
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7
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Martinez-Barrios E, Sarquella-Brugada G, Perez-Serra A, Fernandez-Falgueras A, Cesar S, Alcalde M, Coll M, Puigmulé M, Iglesias A, Ferrer-Costa C, del Olmo B, Picó F, Lopez L, Fiol V, Cruzalegui J, Hernandez C, Arbelo E, Díez-Escuté N, Cerralbo P, Grassi S, Oliva A, Toro R, Brugada J, Brugada R, Campuzano O. Reevaluation of ambiguous genetic variants in sudden unexplained deaths of a young cohort. Int J Legal Med 2023; 137:345-351. [PMID: 36693943 PMCID: PMC9902310 DOI: 10.1007/s00414-023-02951-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/16/2023] [Indexed: 01/26/2023]
Abstract
Sudden death cases in the young population remain without a conclusive cause of decease in almost 40% of cases. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Molecular autopsy may reveal a genetic defect in up to 20% of families. Most than 80% of rare variants remain classified with an ambiguous role, impeding a useful clinical translation. Our aim was to update rare variants originally classified as of unknown significance to clarify their role. Our cohort included fifty-one post-mortem samples of young cases who died suddenly and without a definite cause of death. Five years ago, molecular autopsy identified at least one rare genetic alteration classified then as ambiguous following the American College of Medical Genetics and Genomics' recommendations. We have reclassified the same rare variants including novel data. About 10% of ambiguous variants change to benign/likely benign mainly because of improved population frequencies. Excluding cases who died before one year of age, almost 21% of rare ambiguous variants change to benign/likely benign. This fact makes it important to discard these rare variants as a cause of sudden unexplained death, avoiding anxiety in relatives' carriers. Twenty-five percent of the remaining variants show a tendency to suspicious deleterious role, highlighting clinical follow-up of carriers. Periodical reclassification of rare variants originally classified as ambiguous is crucial, at least updating frequencies every 5 years. This action aids to increase accuracy to enable and conclude a cause of death as well as translation into the clinic.
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Affiliation(s)
- Estefanía Martinez-Barrios
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain ,Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Alexandra Perez-Serra
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Anna Fernandez-Falgueras
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Sergi Cesar
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Mireia Alcalde
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Mónica Coll
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Marta Puigmulé
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Carles Ferrer-Costa
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Bernat del Olmo
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Ferran Picó
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Laura Lopez
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Victoria Fiol
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - José Cruzalegui
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Clara Hernandez
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Elena Arbelo
- Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain ,Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Nuria Díez-Escuté
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Patricia Cerralbo
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Simone Grassi
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy ,Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Rocío Toro
- Medicine Department, School of Medicine, 11003 Cadiz, Spain
| | - Josep Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain ,Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), European Reference Network for Rare, 1105 AZ Amsterdam, The Netherlands ,Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Esplugues de Llobregat, 08950 Barcelona, Spain ,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain ,Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Ramon Brugada
- Medical Science Department, School of Medicine, University of Girona, 17003, Girona, Spain. .,Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190, Girona, Spain. .,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain. .,Cardiology Service, Hospital Josep Trueta, University of Girona, 17007, Girona, Spain.
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, University of Girona, 17003, Girona, Spain. .,Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190, Girona, Spain. .,Centro de Investigación Biomédica en Red. Enfermedades Cardiovasculares (CIBERCV), 28029, Madrid, Spain.
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8
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Adolfsson E, Kling D, Gunnarsson C, Jonasson J, Gréen H, Gréen A. Whole exome sequencing of FFPE samples—expanding the horizon of forensic molecular autopsies. Int J Legal Med 2022:10.1007/s00414-022-02906-x. [PMID: 36346469 PMCID: PMC10247852 DOI: 10.1007/s00414-022-02906-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/14/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Forensic molecular autopsies have emerged as a tool for medical examiners to establish the cause of death. It is particularly useful in sudden unexplained deaths where the cause of death cannot be determined with a regular medical autopsy. We provide the first study of exome data from formalin-fixed paraffin-embedded samples (FFPE) paired with data from high-quality blood samples in forensic applications. The approach allows exploration of the potential to use FFPE samples for molecular autopsies and identify variants in extensive exome data. We leverage the high uniformity of the hybridization capture approach provided by Twist Bioscience to target the complete exome and sequence the libraries on a NextSeq 550. Our findings suggest that exome sequencing is feasible for 24 out of a total of 35 included FFPE samples. When successful, the coverage across the exome is comparatively high (> 90% covered to 20X) and uniform (fold80 below 1.5). Detailed variant comparisons for matched FFPE and blood samples show high concordance with few false variants (positive predictive value of 0.98 and a sensitivity of 0.97) with no distinct FFPE artefacts. Ultimately, we apply carefully constructed forensic gene panels in a stepwise manner to find genetic variants associated with the clinical phenotype and with relevance to the sudden unexplained death.
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9
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Coll M, Fernandez-Falgueras A, Iglesias A, del Olmo B, Nogue-Navarro L, Simon A, Perez Serra A, Puigmule M, Lopez L, Pico F, Corona M, Vallverdu-Prats M, Tiron C, Campuzano O, Castella J, Brugada R, Alcalde M. Unpredicted Aberrant Splicing Products Identified in Postmortem Sudden Cardiac Death Samples. Int J Mol Sci 2022; 23:ijms232012640. [PMID: 36293497 PMCID: PMC9604081 DOI: 10.3390/ijms232012640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022] Open
Abstract
Molecular screening for pathogenic mutations in sudden cardiac death (SCD)-related genes is common practice for SCD cases. However, test results may lead to uncertainty because of the identification of variants of unknown significance (VUS) occurring in up to 70% of total identified variants due to a lack of experimental studies. Genetic variants affecting potential splice site variants are among the most difficult to interpret. The aim of this study was to examine rare intronic variants identified in the exonic flanking sequence to meet two main objectives: first, to validate that canonical intronic variants produce aberrant splicing; second, to determine whether rare intronic variants predicted as VUS may affect the splicing product. To achieve these objectives, 28 heart samples of cases of SCD carrying rare intronic variants were studied. Samples were analyzed using 85 SCD genes in custom panel sequencing. Our results showed that rare intronic variants affecting the most canonical splice sites displayed in 100% of cases that they would affect the splicing product, possibly causing aberrant isoforms. However, 25% of these cases (1/4) showed normal splicing, contradicting the in silico results. On the contrary, in silico results predicted an effect in 0% of cases, and experimental results showed >20% (3/14) unpredicted aberrant splicing. Thus, deep intron variants are likely predicted to not have an effect, which, based on our results, might be an underestimation of their effect and, therefore, of their pathogenicity classification and family members’ follow-up.
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Affiliation(s)
- Monica Coll
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | | | - Anna Iglesias
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Bernat del Olmo
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Laia Nogue-Navarro
- Faculty of Medicine, University of Vic-Central University of Catalonia (UVic-UCC), Can Baumann, 08500 Vic, Spain
| | - Adria Simon
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Alexandra Perez Serra
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Marta Puigmule
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
- Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Laura Lopez
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Ferran Pico
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Monica Corona
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Marta Vallverdu-Prats
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
| | - Coloma Tiron
- Cardiology Service, Hospital Dr. Josep Trueta, University of Girona, 17007 Girona, Spain
- Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
| | - Oscar Campuzano
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
- Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
| | - Josep Castella
- Forensic Pathology Service, Institut de Medicina Legal i Ciències Forenses de Catalunya (IMLCFC), 08075 Barcelona, Spain
| | - Ramon Brugada
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
- Cardiology Service, Hospital Dr. Josep Trueta, University of Girona, 17007 Girona, Spain
- Centro Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Correspondence: (R.B.); (M.A.)
| | - Mireia Alcalde
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica de Girona (IdIBGi), 17190 Salt, Spain
- Correspondence: (R.B.); (M.A.)
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10
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Eosinophilic Infiltration of the Sino-Atrial Node in Sudden Cardiac Death Caused by Long QT Syndrome. Int J Mol Sci 2022; 23:ijms231911666. [PMID: 36232963 PMCID: PMC9569895 DOI: 10.3390/ijms231911666] [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: 08/31/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Sudden death is defined as the unexpected death of a healthy person that occurs within the first hour of the onset of symptoms or within 24 h of the victim being last seen alive. In some of these cases, rare deleterious variants of genes associated with inherited cardiac disorders can provide a highly probable explanation for the fatal event. We report the case of a 21-year-old obese woman who lost consciousness suddenly in a public place and was pronounced dead after hospital admission. Clinical autopsy showed an inconclusive gross examination, while in the histopathological analysis an eosinophilic inflammatory focus and interstitial fibrosis in the sino-atrial node were found. Molecular autopsy revealed an intronic variant in the KCNQ1 gene (c.683 + 5G > A), classified as likely pathogenic for long QT syndrome according to the guidelines provided by the American College of Medical Genetics and Genomics. Therefore, there were many anomalies that could have played a role in the causation of the sudden death, such as the extreme obesity, the cardiac anomalies and the KNCQ1 variant. This case depicts the difficult interpretation of rare cardiac structural abnormalities in subjects carrying rare variants responsible for inherited arrhythmic disorders and the challenge for the forensic pathologist to make causal inferences in the determinism of the unexpected decease.
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11
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Alcalde M, Nogué-Navarro L, Tiron C, Fernandez-Falgueras A, Iglesias A, Simon A, Buxó M, Pérez-Serra A, Puigmulé M, López L, Picó F, del Olmo B, Corona M, Campuzano O, Moral S, Castella J, Coll M, Brugada R. Rare variants in genes encoding structural myocyte contribute to a thickened ventricular septum in sudden death population without ventricular alterations. Forensic Sci Int Genet 2022; 58:102688. [PMID: 35316720 DOI: 10.1016/j.fsigen.2022.102688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 03/08/2022] [Accepted: 03/12/2022] [Indexed: 01/09/2023]
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12
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Filograna L, Manenti G, Grassi S, Zedda M, Mecchia D, Briganti F, Ryan CP, Pascali VL, Floris R, Oliva A. Analysis of the role of PMCT during the COVID-19 pandemic: a systematic review. FORENSIC IMAGING 2022. [PMCID: PMC9134788 DOI: 10.1016/j.fri.2022.200505] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives During COVID-19 pandemic PMCT has been proposed as a forensic investigation method. This systematic review is aimed to systematize evidence and peer-reviewed opinions reported during the first two years of pandemic, to evaluate the role of PMCT during the COVID-19 pandemic. Materials and methods An online literature search was performed to identify publications on PMCT during the COVID-19 pandemic between December 2019 and March 2022. For each publication included, the following data were collected: title and abstract, year of publication, type of article, number and type of individuals examined. The selected publications were also categorized based on PMCT findings, histopathological results, the comparison between PMCT and histopathological findings, cause of death and proposed role of PMCT during the pandemic. Results A total of 20 publications were included, mostly case reports (9/20). All cases examined included adults. The most frequent PMCT pattern in positive cases was diffuse mixed densities with prevalence of consolidations (pattern 1) (54%). In 97% of the cases where a comparison between PMCT and histological results was performed, a correspondence was found. In 82% of the cases the principal cause of death was COVID-19 pneumonia. PMCT has been proposed as a pre-autopsy screening tool in 62%, and as a method for augmenting post-mortem data in 50% of the papers reporting this issue. Conclusion This systematic review suggests that PMCT should be regarded as a highly valuable investigative technique for the forensic evaluation of deaths with ascertained or suspected COVID-19 pneumonia.
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13
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Martínez-Valdez L, Richardson V, Bautista-Márquez A, Hernández-Ávila M. Epidemiology of sudden infant death syndrome in Mexico, 2005-2020. Front Pediatr 2022; 10:1001089. [PMID: 36568434 PMCID: PMC9773828 DOI: 10.3389/fped.2022.1001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. METHODS National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. RESULTS In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. CONCLUSION In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.
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Affiliation(s)
- Libny Martínez-Valdez
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Vesta Richardson
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Aurora Bautista-Márquez
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Mauricio Hernández-Ávila
- Dirección de Prestaciones Económicas y Sociales, El Instituto Mexicano del Seguro Social, Mexico City, Mexico
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Pelletti G, Leone O, Gavelli S, Rossi C, Foà A, Agostini V, Pelotti S. Sudden Unexpected Death after a mild trauma: The complex forensic interpretation of cardiac and genetic findings. Forensic Sci Int 2021; 328:111004. [PMID: 34597909 DOI: 10.1016/j.forsciint.2021.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
A 55-year-old man affected by a psychotic disorder suddenly died during a quarrel with his father. The autopsy excluded traumatic causes of death, and the cardiac examination identified a severe cardiomegaly with biventricular dilatation of very likely multifactorial origin. Toxicological and pharmacogenetic analyses excluded a fatal intoxication and identified the presence of the antipsychotic drug fluphenazine in the therapeutic range in a normal metabolizer. The screening for genetic variations highlighted a novel heterozygous single-nucleotide variant in the exon 36: c 0.4750C>A (p.Pro1584Thr) of the Ryanodine Receptor Type 2 (RYR2) gene. The mutation detected can be classified as Likely Pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria. RYR2 variation has been associated to catecholaminergic polymorphic ventricular tachycardia (CPVT), a disease currently recognized as one of the most malignant cardiac channelopathies, expressed mostly in young patients, normally in the absence of structural heart disease. The victim late middle age, compared to juvenile onset of CPVT reported in literature, his clinical history, his structurally altered heart, circumstances at death and the absence of phenotype-related variations of dilated cardiomyopathy genes, suggested that the fatal arrhythmia could have been caused by an acquired form of dilated cardiopathy/cardiomyopathy. However, the contribution of the genetic variant to death cannot be completely ruled out, since the significance of a VUS or of a novel variant depends on the data available at the time of investigation, and should be periodically evaluated. We discuss the contribution of the structural alteration and of the variant detected, as well as the role of the molecular autopsy in forensic examination, which can make a significant contribution for inferring both cause and manner of death.
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Affiliation(s)
- Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Ornella Leone
- Cardiovascular Pathology Unit, Division of Pathology, IRCCS S.Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Simone Gavelli
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Cesare Rossi
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Alberto Foà
- Cardiology Unit, Department of Experimental Diagnostic and Specialty Medicine, IRCCS S. Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Valentina Agostini
- Cardiovascular Pathology Unit, Division of Pathology, IRCCS S.Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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15
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Sudden cardiac death in the young: Are we still missing the opportunity to prevent recurrences in the family? Heart Rhythm 2021; 18:1645-1646. [PMID: 34157372 DOI: 10.1016/j.hrthm.2021.06.1179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/17/2021] [Indexed: 11/20/2022]
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16
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Grassi S, Vidal MC, Campuzano O, Arena V, Alfonsetti A, Rossi SS, Scarnicci F, Iglesias A, Brugada R, Oliva A. Sudden Death without a Clear Cause after Comprehensive Investigation: An Example of Forensic Approach to Atypical/Uncertain Findings. Diagnostics (Basel) 2021; 11:diagnostics11050886. [PMID: 34067575 PMCID: PMC8156818 DOI: 10.3390/diagnostics11050886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 12/18/2022] Open
Abstract
Sudden death (SD) is defined as the unexpected natural death occurred within an hour after the onset of symptoms or from the last moment the subject has been seen in a healthy condition. Brugada syndrome (BrS) is one of the most remarkable cardiac causes of SD among young people. We report the case of a 20-year-old man who suddenly died after reportedly having smoked cannabis. Autopsy, toxicology, and genetic testing were performed. Autopsy found a long and thick myocardial bridging (MB) at 2 cm from the beginning of the left anterior descending coronary artery. Furthermore, at the histopathological examination, fibrosis and disarray in myocardial area above the MB, fatty tissue in the right ventricle and fibrosis of the sino-atrial node area were found. Toxicology testing was inconclusive, while genetic testing found a rare missense variant of the TTN gene, classified as likely benign, and a variant of unknown significance in the SLMAP gene (a gene that can be associated with BrS). Hence, despite several atypical features were found, no inference on the cause of the death could be made under current evidence.
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Affiliation(s)
- Simone Grassi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.A.); (S.S.R.); (F.S.); (A.O.)
- Correspondence: ; Tel.: +39-0630154398
| | - Mònica Coll Vidal
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17290 Salt, Girona, Spain; (M.C.V.); (O.C.); (A.I.); (R.B.)
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17290 Salt, Girona, Spain; (M.C.V.); (O.C.); (A.I.); (R.B.)
| | - Vincenzo Arena
- Institute of Anatomical Pathology, Department of Woman and Child Health and Public Health, Catholic University of the Sacred Heart, 00168 Rome, Italy;
| | - Alessandro Alfonsetti
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.A.); (S.S.R.); (F.S.); (A.O.)
| | - Sabina Strano Rossi
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.A.); (S.S.R.); (F.S.); (A.O.)
| | - Francesca Scarnicci
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.A.); (S.S.R.); (F.S.); (A.O.)
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17290 Salt, Girona, Spain; (M.C.V.); (O.C.); (A.I.); (R.B.)
| | - Ramon Brugada
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17290 Salt, Girona, Spain; (M.C.V.); (O.C.); (A.I.); (R.B.)
| | - Antonio Oliva
- Section of Legal Medicine, Department of Health Surveillance and Bioethics, Catholic University of the Sacred Heart, 00168 Rome, Italy; (A.A.); (S.S.R.); (F.S.); (A.O.)
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