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Fan X, Yang G, Duru F, Grilli M, Akin I, Zhou X, Saguner AM, Ei-Battrawy I. Arrhythmogenic Cardiomyopathy: from Preclinical Models to Genotype-phenotype Correlation and Pathophysiology. Stem Cell Rev Rep 2023; 19:2683-2708. [PMID: 37731079 PMCID: PMC10661732 DOI: 10.1007/s12015-023-10615-0] [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] [Accepted: 08/23/2023] [Indexed: 09/22/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a hereditary myocardial disease characterized by the replacement of the ventricular myocardium with fibrous fatty deposits. ACM is usually inherited in an autosomal dominant pattern with variable penetrance and expressivity, which is mainly related to ventricular tachyarrhythmia and sudden cardiac death (SCD). Importantly, significant progress has been made in determining the genetic background of ACM due to the development of new techniques for genetic analysis. The exact molecular pathomechanism of ACM, however, is not completely clear and the genotype-phenotype correlations have not been fully elucidated, which are useful to predict the prognosis and treatment of ACM patients. Different gene-targeted and transgenic animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models, and heterologous expression systems have been developed. Here, this review aims to summarize preclinical ACM models and platforms promoting our understanding of the pathogenesis of ACM and assess their value in elucidating the ACM genotype-phenotype relationship.
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Affiliation(s)
- Xuehui Fan
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China
- Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/ Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Partner Site, Heidelberg-Mannheim, Germany
| | - Guoqiang Yang
- Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Acupuncture and Rehabilitation, the Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, China
- Research Unit of Molecular Imaging Probes, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Firat Duru
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Maurizio Grilli
- Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/ Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Partner Site, Heidelberg-Mannheim, Germany
| | - Xiaobo Zhou
- Key Laboratory of Medical Electrophysiology, Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan Province, Collaborative Innovation Center for Prevention of Cardiovascular Diseases, Institute of Cardiovascular Research, Southwest Medical University, Luzhou, Sichuan, China.
- Cardiology, Angiology, Haemostaseology, and Medical Intensive Care, Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany.
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/ Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Partner Site, Heidelberg-Mannheim, Germany.
- First Department of Medicine, University Medical Centre Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Ardan Muammer Saguner
- Department of Cardiology, University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - Ibrahim Ei-Battrawy
- European Center for AngioScience (ECAS), German Center for Cardiovascular Research (DZHK) Partner Site Heidelberg/ Mannheim, and Centre for Cardiovascular Acute Medicine Mannheim (ZKAM), Medical Centre Mannheim, Heidelberg University, Partner Site, Heidelberg-Mannheim, Germany.
- Department of Cardiology and Angiology, Ruhr University, Bochum, Germany; Institute of Physiology, Department of Cellular and Translational Physiology and Institut für Forschung und Lehre (IFL), Molecular and Experimental Cardiology, Ruhr- University Bochum, Bochum, Germany.
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Çimen T, Wilzeck VC, Montrasio G, Bonetti NR, Medeiros-Domingo A, Grebmer C, Matter CM, Tanner FC, Manka R, Brunckhorst CB, Duru F, Saguner AM. Biventricular Arrhythmogenic Cardiomyopathy Associated with a Novel Heterozygous Plakophilin-2 Early Truncating Variant. J Clin Med 2022; 11:jcm11247513. [PMID: 36556128 PMCID: PMC9782591 DOI: 10.3390/jcm11247513] [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: 11/22/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is a hereditary condition that can cause sudden cardiac death in young, frequently athletic individuals under the age of 35 due to malignant arrhythmias. Competitive and endurance exercise may hasten the onset and progression of ARVC, leading to right ventricular dysfunction and potentially fatal ventricular arrhythmias earlier in life. In this article, we present a novel, pathogenic, early truncating heterozygous variant in the PKP2 gene that causes biventricular arrhythmogenic cardiomyopathy and affects a family, of which the only member with the positive phenotype is a competitive endurance athlete.
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Affiliation(s)
- Tolga Çimen
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Verena C. Wilzeck
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Giulia Montrasio
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Nicole R. Bonetti
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Christian Grebmer
- Department of Cardiology, Luzerner Kantonsspital, 6000 Lucerne, Switzerland
| | - Christian M. Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Felix C. Tanner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Corinna B. Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Center for Integrative Human Physiology, University of Zurich, 8091 Zurich, Switzerland
| | - Ardan M. Saguner
- Department of Cardiology, University Heart Center, University Hospital Zurich, 8091 Zurich, Switzerland
- Correspondence: ; Tel.: +41-(0)44-255-2111
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Çimen T, Saguner AM. What’s New in Arrhythmogenic Cardiomyopathies. J Clin Med 2022; 11:jcm11164764. [PMID: 36013003 PMCID: PMC9409703 DOI: 10.3390/jcm11164764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Ardan M. Saguner
- Correspondence: ; Tel.: +41-(0)44-255-2111; Fax: +41-(0)44-255-4004
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Martínez-Solé J, Sabater-Molina M, Braza-Boïls A, Santos-Mateo JJ, Molina P, Martínez-Dolz L, Gimeno JR, Zorio E. Facts and Gaps in Exercise Influence on Arrhythmogenic Cardiomyopathy: New Insights From a Meta-Analysis Approach. Front Cardiovasc Med 2021; 8:702560. [PMID: 34733888 PMCID: PMC8558346 DOI: 10.3389/fcvm.2021.702560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 09/09/2021] [Indexed: 12/29/2022] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic cardiac condition characterized by fibrofatty myocardial replacement, either at the right ventricle, at the left ventricle, or with biventricular involvement. Ventricular arrhythmias and heart failure represent its main clinical features. Exercise benefits on mental and physical health are worldwide recognized. However, patients with ACM appear to be an exception. A thorough review of the literature was performed in PubMed searching for original papers with the terms “ARVC AND sports/exercise” and “sudden cardiac death AND sports/exercise.” Additional papers were then identified through other sources and incorporated to the list. All of them had to be based on animal models or clinical series. Information was structured in a regular format, although some data were not available in some papers. A total of 34 papers were selected and processed regarding sports-related sudden cardiac death, pre-clinical models of ACM and sport, and clinical series of ACM patients engaged in sports activities. Eligible papers were identified to obtain pooled data in order to build representative figures showing the global incidence of the most important causes of sudden cardiac death in sports and the global estimates of life-threatening arrhythmic events in ACM patients engaged in sports. Tables and figures illustrate their major characteristics. The scarce points of controversy were discussed in the text. Fundamental concepts were summarized in three main issues: sports may accelerate ACM phenotype with either structural and/or arrhythmic features, restriction may soften the progression, and these rules also apply to phenotype-negative mutation carriers. Additionally, remaining gaps in the current knowledge were also highlighted, namely, the applicability of those fundamental concepts to non-classical ACM phenotypes since left dominant ACM or non-plakophillin-2 genotypes were absent or very poorly represented in the available studies. Hopefully, future research endeavors will provide solid evidence about the safest exercise dose for each patient from a personalized medicine perspective, taking into account a big batch of genetic, epigenetic, and epidemiological variables, for instance, in order to assist clinicians to provide a final tailored recommendation.
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Affiliation(s)
- Julia Martínez-Solé
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - María Sabater-Molina
- Laboratorio de Cardiogenética, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, Spain.,Unidad CSUR (Centros, Servicios y Unidades de Referencia) en Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain
| | - Aitana Braza-Boïls
- CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan J Santos-Mateo
- Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Pilar Molina
- Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain.,Instituto de Medicina Legal y Ciencias Forenses de Valencia, Histology Unit, Universitat de València, Valencia, Spain
| | - Luis Martínez-Dolz
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain
| | - Juan R Gimeno
- Unidad CSUR (Centros, Servicios y Unidades de Referencia) en Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Esther Zorio
- Cardiology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,CIBERCV, Center for Biomedical Network Research on Cardiovascular Diseases, Madrid, Spain.,Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Valencia, Spain
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Verwijs SM, Pinto YM, Kuster DWD, van der Velden J, Limpens J, van Hattum JC, van der Crabben SN, Lekanne Deprez RH, Wilde AAM, Jørstad HT. Beneficial effects of cardiomyopathy-associated genetic variants on physical performance: a hypothesis-generating scoping review. Cardiology 2021; 147:90-97. [PMID: 34706369 DOI: 10.1159/000520471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/26/2021] [Indexed: 11/19/2022]
Abstract
Background Genetic variants associated with cardiomyopathies (CMPs) are prevalent in the general population. In young athletes, CMPs account for roughly a quarter of sudden cardiac death, with further unexplained clustering in specific sports. Consequently, most CMPs form a contra-indication for competitive sports. We hypothesized that genetic variants might (paradoxically) improve physical performance early in life while impairing cardiac function later in life. Methods Systematic PubMed search to investigate whether genetic variants in genes associated with CMPs could be related to beneficial performance phenotypes. Summary In a limited number of studies (n=6), 2860 individuals/ subjects with genetic variants were able to outperform those without said variants, as measured by running speed (~38 m/min in heterozygous (HET) mice, n=6 vs ~32 m/min in wild type (WT) mice, n=7, P=0.004) and distance (966±169 km HET mice vs 561±144 km WT mice, P=0.0035, n=10), elite athlete status in endurance athletes (n=1672, P=1.43*10-8), maximal oxygen uptake in elite athletes (absolute difference not provided, n=32, P=0.005), maximal oxygen uptake in unrelated individuals (n=473, P=0.0025), personal records in highly trained marathon runners (2:26:28±0:06:23 min HET, n=32 vs. 2:28:53±0:05:50 min without polymorphism, n=108, P=0.020), and peripheral muscle force contraction in patients following a cardiac rehabilitation programme (absolute values not provided, n=260). Key message Beneficial effects in genetic variants associated with CMPs could hypothetically play a role in the selection of young athletes, consequently explaining the prevalence of such genetic variants in athletes and the general population.
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Affiliation(s)
- Sjoerd M Verwijs
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Diederik W D Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Jacqueline Limpens
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Juliette C van Hattum
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Saskia N van der Crabben
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ronald H Lekanne Deprez
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Harald T Jørstad
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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Heart Failure in Patients with Arrhythmogenic Cardiomyopathy. J Clin Med 2021; 10:jcm10204782. [PMID: 34682905 PMCID: PMC8540844 DOI: 10.3390/jcm10204782] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 10/10/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiomyopathy characterized as fibro-fatty replacement, and a common cause for sudden cardiac death in young athletes. Development of heart failure (HF) has been an under-recognized complication of ACM for a long time. The current clinical management guidelines for HF in ACM progression have nowadays been updated. Thus, a comprehensive review for this great achievement in our understanding of HF in ACM is necessary. In this review, we aim to describe the research progress on epidemiology, clinical characteristics, risk stratification and therapeutics of HF in ACM.
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Cainap SS, Kovalenko I, Bonamano E, Crousen N, Tirpe A, Cismaru A, Iacob D, Lazea C, Negru A, Cismaru G. Anatomical-MRI Correlations in Adults and Children with Arrhythmogenic Right Ventricular Cardiomyopathy. Diagnostics (Basel) 2021; 11:diagnostics11081388. [PMID: 34441321 PMCID: PMC8392323 DOI: 10.3390/diagnostics11081388] [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: 07/01/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 12/04/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare disease in which the right ventricular myocardium is replaced by islands of fibro-adipose tissue. Therefore, ventricular re-entry circuits can occur, predisposing the patient to ventricular tachyarrhythmias, as well as dilation of the right ventricle that eventually leads to heart failure. Although it is a rare disease with low prevalence in Europe and the United States, many patients are addressed disproportionately for cardiac magnetic resonance imaging (MRI). The most severe consequence of this condition is sudden cardiac death at a young age due to untreated cardiac arrhythmias. The purpose of this paper is to revise the magnetic resonance characteristics of ARVC, including the segmental contraction abnormalities, fatty tissue replacement, decrease of the ejection fraction, and the global RV dilation. Herein, we also present several recent improvements of the 2010 Task Force criteria that are not included within the ARVC diagnosis guidelines. In our opinion, these features will be considered in a future Task Force Consensus.
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Affiliation(s)
- Simona-Sorana Cainap
- 2nd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Ilana Kovalenko
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Edoardo Bonamano
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Niclas Crousen
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Alexandru Tirpe
- “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania; (I.K.); (E.B.); (N.C.); (A.T.)
| | - Andrei Cismaru
- Research Center for Functional Genomics, Biomedicine and Translational Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 23 Marinescu Street, 400337 Cluj-Napoca, Romania;
| | - Daniela Iacob
- 3rd Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Cecilia Lazea
- 1st Pediatric Discipline, Mother and Child Department, Emergency Clinical Hospital for Children, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania;
| | - Alina Negru
- Department of Cardiology, ‘Victor Babeș’ University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania;
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
- Correspondence: ; Tel.: +40-721926230
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