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Russo V, Capolongo A, Bottino R, Carbone A, Palladino A, Liccardo B, Nigro G, Marchel M, Golino P, D’Andrea A. Echocardiographic Features of Cardiac Involvement in Myotonic Dystrophy 1: Prevalence and Prognostic Value. J Clin Med 2023; 12:jcm12051947. [PMID: 36902735 PMCID: PMC10004242 DOI: 10.3390/jcm12051947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/24/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Myotonic dystrophy type 1 (DM1) is the most common muscular dystrophy in adults. Cardiac involvement is reported in 80% of cases and includes conduction disturbances, arrhythmias, subclinical diastolic and systolic dysfunction in the early stage of the disease; in contrast, severe ventricular systolic dysfunction occurs in the late stage of the disease. Echocardiography is recommended at the time of diagnosis with periodic revaluation in DM1 patients, regardless of the presence or absence of symptoms. Data regarding the echocardiographic findings in DM1 patients are few and conflicting. This narrative review aimed to describe the echocardiographic features of DM1 patients and their prognostic role as predictors of cardiac arrhythmias and sudden death.
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Affiliation(s)
- Vincenzo Russo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
- Correspondence: ; Tel.: +39-0817062815
| | - Antonio Capolongo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Roberta Bottino
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Andreina Carbone
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Alberto Palladino
- Cardiomyology and Genetic Section, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Biagio Liccardo
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Paolo Golino
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80121 Naples, Italy
| | - Antonello D’Andrea
- Department of Cardiology, Umberto I Hospital, 84014 Nocera Inferiore, Italy
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Russo V, Sperlongano S, Gallinoro E, Rago A, Papa AA, Golino P, Politano L, Nazarian S, Nigro G. Prevalence of Left Ventricular Systolic Dysfunction in Myotonic Dystrophy Type 1: A Systematic Review. J Card Fail 2019; 26:849-856. [PMID: 31415861 DOI: 10.1016/j.cardfail.2019.07.548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 06/24/2019] [Accepted: 07/12/2019] [Indexed: 10/26/2022]
Abstract
Cardiac involvement is recorded in about 80% of patients affected by myotonic dystrophy type 1 (DM1). The prevalence of cardiac conduction abnormalities and arrhythmias has been well described. Data regarding the prevalence of left ventricle systolic dysfunction (LVSD) and heart failure (HF) are still conflicting. The primary objective of this review was to assess the prevalence of LVSD and HF in DM1. The secondary aim was to examine the association of clinical features with LVSD and to detect predisposing and influencing prognosis factors. A systematic search was developed in MEDLINE, EMBASE, Cochrane Register of Controlled Trials, and Web of Science databases to identify original reports between January 1, 2009, and September 30, 2017, assessing the prevalence of LVSD and HF in populations with DM1. Retrospective and prospective cohort studies and case series describing the prevalence of LVSD, as evaluated by echocardiography, and HF in patients with DM1 were included. Case reports, simple reviews, commentaries and editorials were excluded. Seven studies were identified as eligible, of which 1 was a retrospective population-based cohort study, and 6 were retrospective single-center-based cohort studies. Echocardiographic data concerning LV function were available for 647 of the 876 patients with DM1 who were included in the analysis. The prevalence of LVSD in patients with DM1, defined as LVEF < 55%, was 13.8%, 4.5-fold higher than in general population. Patients with DM1 and LVSD were older, were more likely to be male, had longer baseline atrioventricular and intraventricular conduction-time durations, had higher incidences of atrial arrhythmias, and were more likely to have undergone device implantation. Also, symptomatic HF is more prevalent in patients with DM1 despite their limited levels of physical activity. Further studies are needed to evaluate the prevalence of LVSD and HF in patients with DM1 and to investigate electrocardiographic abnormalities and other clinical features associated with this condition.
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Affiliation(s)
- Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy.
| | - Simona Sperlongano
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
| | - Emanuele Gallinoro
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
| | - Anna Rago
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
| | - Andrea Antonio Papa
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
| | - Paolo Golino
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
| | - Luisa Politano
- Cardiomiology and Medical Genetics, Department of Experimental Medicine, University of Campania, Naples, Italy
| | - Saman Nazarian
- Cardiac Electrophysiology, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Gerardo Nigro
- Department of Translational Medical Sciences, University of Campania, Monaldi Hospital, Naples, Italy
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Chakraborty M, Selma-Soriano E, Magny E, Couso JP, Pérez-Alonso M, Charlet-Berguerand N, Artero R, Llamusi B. Pentamidine rescues contractility and rhythmicity in a Drosophila model of myotonic dystrophy heart dysfunction. Dis Model Mech 2015; 8:1569-78. [PMID: 26515653 PMCID: PMC4728315 DOI: 10.1242/dmm.021428] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 10/19/2015] [Indexed: 02/01/2023] Open
Abstract
Up to 80% of individuals with myotonic dystrophy type 1 (DM1) will develop cardiac abnormalities at some point during the progression of their disease, the most common of which is heart blockage of varying degrees. Such blockage is characterized by conduction defects and supraventricular and ventricular tachycardia, and carries a high risk of sudden cardiac death. Despite its importance, very few animal model studies have focused on the heart dysfunction in DM1. Here, we describe the characterization of the heart phenotype in a Drosophila model expressing pure expanded CUG repeats under the control of the cardiomyocyte-specific driver GMH5-Gal4. Morphologically, expression of 250 CUG repeats caused abnormalities in the parallel alignment of the spiral myofibrils in dissected fly hearts, as revealed by phalloidin staining. Moreover, combined immunofluorescence and in situ hybridization of Muscleblind and CUG repeats, respectively, confirmed detectable ribonuclear foci and Muscleblind sequestration, characteristic features of DM1, exclusively in flies expressing the expanded CTG repeats. Similarly to what has been reported in humans with DM1, heart-specific expression of toxic RNA resulted in reduced survival, increased arrhythmia, altered diastolic and systolic function, reduced heart tube diameters and reduced contractility in the model flies. As a proof of concept that the fly heart model can be used for in vivo testing of promising therapeutic compounds, we fed flies with pentamidine, a compound previously described to improve DM1 phenotypes. Pentamidine not only released Muscleblind from the CUG RNA repeats and reduced ribonuclear formation in the Drosophila heart, but also rescued heart arrhythmicity and contractility, and improved fly survival in animals expressing 250 CUG repeats.
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Affiliation(s)
- Mouli Chakraborty
- Translational Genomics Group, Incliva Health Research Institute, Avda. Menendez Pelayo 4 acc 46010, Valencia, Spain Department of Genetics and Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Dr Moliner 50, Burjasot 46100, Spain
| | - Estela Selma-Soriano
- Department of Genetics and Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Dr Moliner 50, Burjasot 46100, Spain
| | - Emile Magny
- School of Life Sciences, University of Sussex, Falmer, Brighton, East Sussex, BN1 9QG, UK
| | - Juan Pablo Couso
- School of Life Sciences, University of Sussex, Falmer, Brighton, East Sussex, BN1 9QG, UK
| | - Manuel Pérez-Alonso
- Translational Genomics Group, Incliva Health Research Institute, Avda. Menendez Pelayo 4 acc 46010, Valencia, Spain Department of Genetics and Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Dr Moliner 50, Burjasot 46100, Spain
| | - Nicolas Charlet-Berguerand
- Translational Medicine and Neurogenetics, Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), 1 Rue Laurent Fries, 67400 Illkirch-Graffenstaden, France
| | - Ruben Artero
- Translational Genomics Group, Incliva Health Research Institute, Avda. Menendez Pelayo 4 acc 46010, Valencia, Spain Department of Genetics and Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Dr Moliner 50, Burjasot 46100, Spain
| | - Beatriz Llamusi
- Translational Genomics Group, Incliva Health Research Institute, Avda. Menendez Pelayo 4 acc 46010, Valencia, Spain Department of Genetics and Estructura de Recerca Interdisciplinar en Biotecnologia i Biomedicina (ERI BIOTECMED), Universitat de València, Dr Moliner 50, Burjasot 46100, Spain
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Bezak BJ, Arce KA, Jacob A, Van Ess J. Orthognathic Surgery in Patients With Congenital Myopathies and Congenital Muscular Dystrophies: Case Series and Review of the Literature. J Oral Maxillofac Surg 2015; 74:601-9. [PMID: 26292175 DOI: 10.1016/j.joms.2015.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 07/27/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE This case series examined preoperative findings and the surgical, anesthetic, and postoperative management of 6 patients with congenital myopathies (CMs) and congenital muscular dystrophies (CMDs) treated at a tertiary medical institution with orthognathic surgery over 15 years to describe pertinent considerations for performing orthognathic surgery in these complex patients. MATERIALS AND METHODS According to the institutional review board-approved protocol, chart records were reviewed for all orthognathic surgical patients with a clinical, genetic, or muscle biopsy-proved diagnosis of CM or CMD. RESULTS Six patients (5 male, 1 female) qualified, and they were treated by 4 surgeons in the division of oral and maxillofacial surgery from 1992 through 2007. Average age was 19.5 years at the time of orthognathic surgery. Five patients had Class III malocclusions and 1 patient had Class II malocclusion. All 6 patients had apertognathia with lip incompetence. Nasoendotracheal intubation with a difficulty of 0/3 (0=easiest, 3=most difficult) was performed in all cases. Routine induction and maintenance anesthetics, including halogenated agents and nondepolarizing muscle relaxants, were administered without malignant hyperthermia. All 6 patients underwent Le Fort level osteotomies; 4 also had mandibular setback surgery with or without balancing mandibular inferior border osteotomies. Five patients required planned intensive care unit care postoperatively (average, 18.4 days; range, 4 to 65 days). Postoperative respiratory complications resulting in major blood oxygen desaturations occurred in 5 patients; 4 of these patients required reintubation during emergency code response. Five patients required extended postoperative intubation (average, 4.2 days; range, 3 to 6 days) and ventilatory support. Average hospital length of stay was 21.8 days (range, 6 to 75 days). Average postoperative follow-up interval was 29.8 weeks (range, 6 to 128 weeks). CONCLUSIONS Patients with CMs or CMDs often have characteristic dentofacial malocclusions that contribute to functional problems with feeding and drooling and psychosocial problems. Orthognathic surgery, usually bimaxillary, can be judiciously considered in these patients; these procedures typically require multidisciplinary pre- and postoperative evaluation and care over lengthy hospital stays with a high risk of respiratory complications that bear consideration in treatment planning.
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Affiliation(s)
- Brett J Bezak
- Resident, Division of Oral and Maxillofacial Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
| | - Kevin A Arce
- Assistant Professor, Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN
| | - Adam Jacob
- Associate Professor, Department of Anesthesiology, College of Medicine, Mayo Clinic, Rochester, MN
| | - James Van Ess
- Assistant Professor, Department of Surgery, College of Medicine, Mayo Clinic, Rochester, MN
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Petri H, Witting N, Ersbøll MK, Sajadieh A, Dunø M, Helweg-Larsen S, Vissing J, Køber L, Bundgaard H. High prevalence of cardiac involvement in patients with myotonic dystrophy type 1: A cross-sectional study. Int J Cardiol 2014; 174:31-6. [DOI: 10.1016/j.ijcard.2014.03.088] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 03/10/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
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