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Galizia MS, Attili AK, Truesdell WR, Smith ED, Helms AS, Sulaiman AMA, Madamanchi C, Agarwal PP. Imaging Features of Arrhythmogenic Cardiomyopathies. Radiographics 2024; 44:e230154. [PMID: 38512728 PMCID: PMC10995833 DOI: 10.1148/rg.230154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/09/2023] [Accepted: 08/28/2023] [Indexed: 03/23/2024]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a genetic disease characterized by replacement of ventricular myocardium with fibrofatty tissue, predisposing the patient to ventricular arrhythmias and/or sudden cardiac death. Most cases of ACM are associated with pathogenic variants in genes that encode desmosomal proteins, an important cell-to-cell adhesion complex present in both the heart and skin tissue. Although ACM was first described as a disease predominantly of the right ventricle, it is now acknowledged that it can also primarily involve the left ventricle or both ventricles. The original right-dominant phenotype is traditionally diagnosed using the 2010 task force criteria, a multifactorial algorithm divided into major and minor criteria consisting of structural criteria based on two-dimensional echocardiographic, cardiac MRI, or right ventricular angiographic findings; tissue characterization based on endomyocardial biopsy results; repolarization and depolarization abnormalities based on electrocardiographic findings; arrhythmic features; and family history. Shortfalls in the task force criteria due to the modern understanding of the disease have led to development of the Padua criteria, which include updated criteria for diagnosis of the right-dominant phenotype and new criteria for diagnosis of the left-predominant and biventricular phenotypes. In addition to incorporating cardiac MRI findings of ventricular dilatation, systolic dysfunction, and regional wall motion abnormalities, the new Padua criteria emphasize late gadolinium enhancement at cardiac MRI as a key feature in diagnosis and imaging-based tissue characterization. Conditions to consider in the differential diagnosis of the right-dominant phenotype include various other causes of right ventricular dilatation such as left-to-right shunts and variants of normal right ventricular anatomy that can be misinterpreted as abnormalities. The left-dominant phenotype can mimic myocarditis at imaging and clinical examination. Additional considerations for the differential diagnosis of ACM, particularly for the left-dominant phenotype, include sarcoidosis and dilated cardiomyopathy. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Mauricio S. Galizia
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Anil K. Attili
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - William R. Truesdell
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Eric D. Smith
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Adam S. Helms
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Abdulbaset M. A. Sulaiman
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Chaitanya Madamanchi
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
| | - Prachi P. Agarwal
- From the Department of Radiology (M.S.G., A.K.A., W.R.T., P.P.A.) and
Division of Cardiovascular Medicine, Department of Internal Medicine (E.D.S.,
A.S.H., A.M.A.S., C.M.), Michigan Medicine, University of Michigan, 1500 E
Medical Center Dr, Ann Arbor, MI 48109
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Agarwal D, Côté E, O'Sullivan L, Meurs KM, Steiner J. Investigation of the cardiac effects of exercise testing on apparently healthy Boxer dogs. J Vet Intern Med 2023; 37:1667-1678. [PMID: 37578273 PMCID: PMC10472998 DOI: 10.1111/jvim.16830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Holter electrocardiographic monitoring is a cornerstone of diagnostic testing for arrhythmogenic cardiomyopathy (ACM) in Boxer dogs, but physical activity during monitoring is not controlled. In humans, exercise testing (ExT) can identify latent tachyarrhythmias associated with cardiomyopathy, and exercise increases serum cardiac troponin-I concentrations ([hs-cTnI]). These effects have not yet been investigated in Boxer dogs. HYPOTHESIS/OBJECTIVES Subjecting Boxer dogs to brief, moderate-intensity ExT can identify changes in Holter recordings and [hs-cTnI] compared to baseline results. ANIMALS Thirty overtly healthy, client-owned Boxer dogs. METHODS Prospective interventional study. Dogs underwent baseline diagnostic testing including 24-hour Holter monitoring and [hs-cTnI], followed by brief ExT (accompanied, brisk stair-climbing and -descending for <5 minutes). RESULTS Eleven dogs (37%) had >100 premature ventricular complexes (PVCs)/24 hours at baseline (3), ExT (3), or both (5). After ExT, these dogs had more PVCs/24 hours and greater increases in [hs-cTnI] compared to those with ≤100 PVCs/24 hours. Dogs with the striatin mutation had more PVCs/24 hours and a greater increase in [hs-cTnI] after ExT than did dogs without the striatin mutation. CONCLUSIONS AND CLINICAL IMPORTANCE Exercise testing may improve the binary classification of Boxer dogs with or without ACM by increasing the number of PVCs and [hs-cTnI] in affected dogs to a greater degree than in unaffected dogs. This effect also is associated with presence or absence of the striatin mutation. Exercise should be a controlled variable when screening Boxer dogs for ACM.
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Affiliation(s)
- Deepmala Agarwal
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Etienne Côté
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Lynne O'Sullivan
- Department of Companion Animals, Atlantic Veterinary CollegeUniversity of Prince Edward Island, 550 University AvenueCharlottetown, Prince Edward Island C1A 4P3Canada
| | - Kathryn M. Meurs
- Department of Clinical Sciences, College of Veterinary MedicineNorth Carolina State University, 1060 William Moore DriveRaleigh, North Carolina 27607USA
| | - Jörg Steiner
- Gastrointestinal LaboratorySchool of Veterinary Medicine and Biomedical Sciences, TAMU 4474, Texas A&M UniversityCollege Station, Texas 77843‐4474USA
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Ward KE, Steadman L, Karim AR, Reynolds GM, Pugh M, Chua W, Faustini SE, Veenith T, Thwaites RS, Openshaw PJM, Drayson MT, Shields AM, Cunningham AF, Wraith DC, Richter AG. SARS-CoV-2 infection is associated with anti-desmoglein 2 autoantibody detection. Clin Exp Immunol 2023; 213:243-251. [PMID: 37095599 PMCID: PMC10651225 DOI: 10.1093/cei/uxad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 03/08/2023] [Accepted: 04/24/2023] [Indexed: 04/26/2023] Open
Abstract
Post-acute cardiac sequelae, following SARS-CoV-2 infection, are well recognized as complications of COVID-19. We have previously shown the persistence of autoantibodies against antigens in skin, muscle, and heart in individuals following severe COVID-19; the most common staining on skin tissue displayed an inter-cellular cement pattern consistent with antibodies against desmosomal proteins. Desmosomes play a critical role in maintaining the structural integrity of tissues. For this reason, we analyzed desmosomal protein levels and the presence of anti-desmoglein (DSG) 1, 2, and 3 antibodies in acute and convalescent sera from patients with COVID-19 of differing clinical severity. We find increased levels of DSG2 protein in sera from acute COVID-19 patients. Furthermore, we find that DSG2 autoantibody levels are increased significantly in convalescent sera following severe COVID-19 but not in hospitalized patients recovering from influenza infection or healthy controls. Levels of autoantibody in sera from patients with severe COVID-19 were comparable to levels in patients with non-COVID-19-associated cardiac disease, potentially identifying DSG2 autoantibodies as a novel biomarker for cardiac damage. To determine if there was any association between severe COVID-19 and DSG2, we stained post-mortem cardiac tissue from patients who died from COVID-19 infection. This confirmed DSG2 protein within the intercalated discs and disruption of the intercalated disc between cardiomyocytes in patients who died from COVID-19. Our results reveal the potential for DSG2 protein and autoimmunity to DSG2 to contribute to unexpected pathologies associated with COVID-19 infection.
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Affiliation(s)
- Kerensa E Ward
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Lora Steadman
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Abid R Karim
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Gary M Reynolds
- Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Matthew Pugh
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Winnie Chua
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | - Sian E Faustini
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Tonny Veenith
- Department of Critical Care, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ryan S Thwaites
- National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Mark T Drayson
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Adrian M Shields
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Adam F Cunningham
- Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK
| | - David C Wraith
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
| | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, West Midlands, UK
- Department of Clinical Immunology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Bueno-Beti C, Asimaki A. Cheek-Pro-Heart: What Can the Buccal Mucosa Do for Arrhythmogenic Cardiomyopathy? Biomedicines 2023; 11:biomedicines11041207. [PMID: 37189825 DOI: 10.3390/biomedicines11041207] [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: 03/16/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023] Open
Abstract
Arrhythmogenic cardiomyopathy (ACM) is a heart muscle disease associated with ventricular arrhythmias and a high risk of sudden cardiac death (SCD). Although the disease was described over 40 years ago, its diagnosis is still difficult. Several studies have identified a set of five proteins (plakoglobin, Cx43, Nav1.5, SAP97 and GSK3β), which are consistently re-distributed in myocardial samples from ACM patients. Not all protein shifts are specific to ACM, but their combination has provided us with a molecular signature for the disease, which has greatly aided post-mortem diagnosis of SCD victims. The use of this signature, however, was heretofore restricted in living patients, as the analysis requires a heart sample. Recent studies have shown that buccal cells behave similarly to the heart in terms of protein re-localization. Protein shifts are associated with disease onset, deterioration and favorable response to anti-arrhythmic therapy. Accordingly, buccal cells can be used as a surrogate for the myocardium to aid diagnosis, risk stratification and even monitor response to pharmaceutical interventions. Buccal cells can also be kept in culture, hence providing an ex vivo model from the patient, which can offer insights into the mechanisms of disease pathogenesis, including drug response. This review summarizes how the cheek can aid the heart in the battle against ACM.
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Affiliation(s)
- Carlos Bueno-Beti
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London SW17 0RE, UK
| | - Angeliki Asimaki
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London SW17 0RE, UK
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5
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Alblaihed L, Kositz C, Brady WJ, Al-Salamah T, Mattu A. Diagnosis and management of arrhythmogenic right ventricular cardiomyopathy. Am J Emerg Med 2023; 65:146-153. [PMID: 36638611 DOI: 10.1016/j.ajem.2022.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a genetic disorder of the myocardium that can lead to ventricular arrhythmia and sudden cardiac death. The condition has been identified as a significant cause of arrhythmic death among young people and athletes, therefore, early recognition of the disease by emergency clinicians is critical to prevent subsequent death. The diagnosis of ARVC can be very challenging and requires a systematic approach. This publication reviews the pathophysiology, classification, clinical presentations, and appropriate approach to diagnosis and management of ARVC.
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Affiliation(s)
- Leen Alblaihed
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America.
| | - Christine Kositz
- Depratment of Emergency Medicine, University of Maryland Shore Medical Center at Easton, 219 S Washington St, Easton, MD 21601, United States of America
| | - William J Brady
- Department of Emergency Medicine, University of Virginia School of Medicine, Charlottesville, VA, United States of America
| | - Tareq Al-Salamah
- Department of Emergency Medicine, College of Medicine, King Saud University, PO Box 7805, Riyadh 11472, Saudi Arabia
| | - Amal Mattu
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S Paca Street, 6(th) Floor, Suite 200, Baltimore, MD 21201, United States of America
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6
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Zhu K, Bao X, Wang Y, Lu T, Zhang L. Human induced pluripotent stem cell (hiPSC)-derived cardiomyocyte modelling of cardiovascular diseases for natural compound discovery. Biomed Pharmacother 2023; 157:113970. [PMID: 36371854 DOI: 10.1016/j.biopha.2022.113970] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of death worldwide. Natural compounds extracted from medicinal plants characterized by diverse biological activities and low toxicity or side effects, are increasingly taking center stage in the search for new drugs. Currently, preclinical evaluation of natural products relies mainly on the use of immortalized cell lines of human origin or animal models. Increasing evidence indicates that cardiomyopathy models based on immortalized cell lines do not recapitulate pathogenic phenotypes accurately and a substantial physiological discrepancy between animals and humans casts doubt on the clinical relevance of animal models for these studies. The newly developed human induced pluripotent stem cell (hiPSC) technology in combination with highly-efficient cardiomyocyte differentiation methods provides an ideal tool for modeling human cardiomyopathies in vitro. Screening of drugs, especially screening of natural products, based on these models has been widely used and has shown that evaluation in such models can recapitulate important aspects of the physiological properties of drugs. The purpose of this review is to provide information on the latest developments in this area of research and to help researchers perform screening of natural products using the hiPSC-CM platform.
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Affiliation(s)
- Keyang Zhu
- Zhejiang Key Laboratory of Pathophysiology, School of Public Health, School of Medicine, Ningbo University, Ningbo, Zhejiang 315211, PR China
| | - Xiaoming Bao
- Department of Cardiology, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China; Department of Global Health, Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, PR China
| | - Yingchao Wang
- Innovation Institute for Artificial Intelligence in Medicine of Zhejiang University, Hangzhou, Zhejiang, PR China
| | - Ting Lu
- Clinical Research Center of The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, PR China.
| | - Ling Zhang
- College of Life Science, Zhejiang Chinese Medical University, Hangzhou, PR China.
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7
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Pirruccello JP, Di Achille P, Nauffal V, Nekoui M, Friedman SF, Klarqvist MDR, Chaffin MD, Weng LC, Cunningham JW, Khurshid S, Roselli C, Lin H, Koyama S, Ito K, Kamatani Y, Komuro I, Jurgens SJ, Benjamin EJ, Batra P, Natarajan P, Ng K, Hoffmann U, Lubitz SA, Ho JE, Lindsay ME, Philippakis AA, Ellinor PT. Genetic analysis of right heart structure and function in 40,000 people. Nat Genet 2022; 54:792-803. [PMID: 35697867 PMCID: PMC10313645 DOI: 10.1038/s41588-022-01090-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/26/2022] [Indexed: 01/29/2023]
Abstract
Congenital heart diseases often involve maldevelopment of the evolutionarily recent right heart chamber. To gain insight into right heart structure and function, we fine-tuned deep learning models to recognize the right atrium, right ventricle and pulmonary artery, measuring right heart structures in 40,000 individuals from the UK Biobank with magnetic resonance imaging. Genome-wide association studies identified 130 distinct loci associated with at least one right heart measurement, of which 72 were not associated with left heart structures. Loci were found near genes previously linked with congenital heart disease, including NKX2-5, TBX5/TBX3, WNT9B and GATA4. A genome-wide polygenic predictor of right ventricular ejection fraction was associated with incident dilated cardiomyopathy (hazard ratio, 1.33 per standard deviation; P = 7.1 × 10-13) and remained significant after accounting for a left ventricular polygenic score. Harnessing deep learning to perform large-scale cardiac phenotyping, our results yield insights into the genetic determinants of right heart structure and function.
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Affiliation(s)
- James P Pirruccello
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Paolo Di Achille
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Victor Nauffal
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mahan Nekoui
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Samuel F Friedman
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marcus D R Klarqvist
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Mark D Chaffin
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Lu-Chen Weng
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Jonathan W Cunningham
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Shaan Khurshid
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Carolina Roselli
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Honghuang Lin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Division of Clinical Informatics, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Satoshi Koyama
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Kaoru Ito
- Laboratory for Cardiovascular Genomics and Informatics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Yoichiro Kamatani
- Laboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
- Laboratory for Statistical and Translational Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sean J Jurgens
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emelia J Benjamin
- Framingham Heart Study, Boston University and National Heart, Lung, and Blood Institute, Framingham, MA, USA
- Department of Medicine, Cardiology and Preventive Medicine Sections, Boston University School of Medicine, Boston, MA, USA
- Epidemiology Department, Boston University School of Public Health, Boston, MA, USA
| | - Puneet Batra
- Data Sciences Platform, Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Pradeep Natarajan
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Udo Hoffmann
- Department of Radiology, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Steven A Lubitz
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer E Ho
- Harvard Medical School, Boston, MA, USA
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mark E Lindsay
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Harvard Medical School, Boston, MA, USA
- Thoracic Aortic Center, Massachusetts General Hospital, Boston, MA, USA
| | | | - Patrick T Ellinor
- Cardiology Division, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA, USA.
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8
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Tani H, Tohyama S. Human Engineered Heart Tissue Models for Disease Modeling and Drug Discovery. Front Cell Dev Biol 2022; 10:855763. [PMID: 35433691 PMCID: PMC9008275 DOI: 10.3389/fcell.2022.855763] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/08/2022] [Indexed: 12/29/2022] Open
Abstract
The emergence of human induced pluripotent stem cells (hiPSCs) and efficient differentiation of hiPSC-derived cardiomyocytes (hiPSC-CMs) induced from diseased donors have the potential to recapitulate the molecular and functional features of the human heart. Although the immaturity of hiPSC-CMs, including the structure, gene expression, conduct, ion channel density, and Ca2+ kinetics, is a major challenge, various attempts to promote maturation have been effective. Three-dimensional cardiac models using hiPSC-CMs have achieved these functional and morphological maturations, and disease models using patient-specific hiPSC-CMs have furthered our understanding of the underlying mechanisms and effective therapies for diseases. Aside from the mechanisms of diseases and drug responses, hiPSC-CMs also have the potential to evaluate the safety and efficacy of drugs in a human context before a candidate drug enters the market and many phases of clinical trials. In fact, novel drug testing paradigms have suggested that these cells can be used to better predict the proarrhythmic risk of candidate drugs. In this review, we overview the current strategies of human engineered heart tissue models with a focus on major cardiac diseases and discuss perspectives and future directions for the real application of hiPSC-CMs and human engineered heart tissue for disease modeling, drug development, clinical trials, and cardiotoxicity tests.
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Affiliation(s)
- Hidenori Tani
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shugo Tohyama
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
- *Correspondence: Shugo Tohyama,
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9
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Sampson B, Hammers J, Stram M. Forensic aspects of cardiovascular pathology. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00003-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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10
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Hammer KP, Mustroph J, Stauber T, Birchmeier W, Wagner S, Maier LS. Beneficial effect of voluntary physical exercise in Plakophilin2 transgenic mice. PLoS One 2021; 16:e0252649. [PMID: 34086773 PMCID: PMC8177441 DOI: 10.1371/journal.pone.0252649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/19/2021] [Indexed: 12/31/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy is a hereditary, rare disease with an increased risk for sudden cardiac death. The disease-causing mutations are located within the desmosomal complex and the highest incidence is found in plakophilin2. However, there are other factors playing a role for the disease progression unrelated to the genotype such as inflammation or exercise. Competitive sports have been identified as risk factor, but the type and extend of physical activity as cofactor for arrhythmogenesis remains under debate. We thus studied the effect of light voluntary exercise on cardiac health in a mouse model. Mice with a heterozygous PKP2 loss-of-function mutation were given the option to exercise in a running wheel which was monitored 24 h/d. We analyzed structural and functional development in vivo by echocardiography which revealed that neither the genotype nor the exercise caused any significant structural changes. Ejection fraction and fractional shortening were not influenced by the genotype itself, but exercise did cause a drop in both parameters after 8 weeks, which returned to normal after 16 weeks of training. The electrophysiological analysis revealed that the arrhythmogenic potential was slightly higher in heterozygous animals (50% vs 18% in wt littermates) and that an additional stressor (isoprenaline) did not lead to an increase of arrhythmogenic events pre run or after 8 weeks of running but the vulnerability was increased after 16 weeks. Exercise-induced alterations in Ca handling and contractility of isolated myocytes were mostly abolished in heterozygous animals. No fibrofatty replacements or rearrangement of gap junctions could be observed. Taken together we could show that light voluntary exercise can cause a transient aggravation of the mutation-induced phenotype which is abolished after long term exercise indicating a beneficial effect of long term light exercise.
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Affiliation(s)
- Karin P. Hammer
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
- * E-mail:
| | - Julian Mustroph
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - Teresa Stauber
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | | | - Stefan Wagner
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
| | - Lars S. Maier
- University Hospital Regensburg, Internal Medicine II, Regensburg, Germany
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11
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Wei J, Ni X, Dai Y, Chen X, Ding S, Bao J, Xing L. Identification of genes associated with sudden cardiac death: a network- and pathway-based approach. J Thorac Dis 2021; 13:3610-3627. [PMID: 34277054 PMCID: PMC8264674 DOI: 10.21037/jtd-21-361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/14/2021] [Indexed: 12/03/2022]
Abstract
Background Sudden cardiac death (SCD) accounts for a large proportion of the total deaths across different age groups. Although numerous candidate genes related to SCD have been identified by genetic association studies and genome wide association studies (GWAS), the molecular mechanisms underlying SCD are still unclear, and the biological functions and interactions of these genes remain obscure. To clarify this issue, we performed a comprehensive and systematic analysis of SCD-related genes by a network and pathway-based approach. Methods By screening the publications deposited in the PubMed and Gene-Cloud Biotechnology Information (GCBI) databases, we collected the genes genetically associated with SCD, which were referred to as the SCD-related gene set (SCDgset). To analyze the biological processes and biochemical pathways of the SCD-related genes, functional analysis was performed. To explore interlinks and interactions of the enriched pathways, pathway crosstalk analysis was implemented. To construct SCD-specific molecular networks, Markov cluster algorithm and Steiner minimal tree algorithm were employed. Results We collected 257 genes that were reported to be associated with SCD and summarized them in the SCDgset. Most of the biological processes and biochemical pathways were related to heart diseases, while some of the biological functions may be noncardiac causes of SCD. The enriched pathways could be roughly grouped into two modules. One module was related to calcium signaling pathway and the other was related to MAPK pathway. Moreover, two different SCD-specific molecular networks were inferred, and 23 novel genes potentially associated with SCD were also identified. Conclusions In summary, by means of a network and pathway-based methodology, we explored the pathogenetic mechanism underlying SCD. Our results provide valuable information in understanding the pathogenesis of SCD and include novel biomarkers for diagnosing potential patients with heart diseases; these may help in reducing the corresponding risks and even aid in preventing SCD.
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Affiliation(s)
- Jinhuan Wei
- Basic Medical Research Center, School of Medicine, Nantong University, Nantong, China
| | - Xuejun Ni
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Yanfei Dai
- Radiology Department, Branch of Affiliated Hospital of Nantong University, Nantong, China
| | - Xi Chen
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Sujun Ding
- Department of Medical Ultrasound, Affiliated Hospital of Nantong University, Nantong, China
| | - Jingyin Bao
- Basic Medical Research Center, School of Medicine, Nantong University, Nantong, China
| | - Lingyan Xing
- Key Laboratory of Neuroregeneration of Jiangsu and the Ministry of Education, Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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12
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Abicht A, Schön U, Laner A, Holinski-Feder E, Diebold I. Actionable secondary findings in arrhythmogenic right ventricle cardiomyopathy genes: impact and challenge of genetic counseling. Cardiovasc Diagn Ther 2021; 11:637-649. [PMID: 33968641 DOI: 10.21037/cdt-20-585] [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] [Indexed: 12/23/2022]
Abstract
Background Comprehensive genetic analysis yields in a higher diagnostic rate but also in a higher number of secondary findings (SF). American College of Medical Genetics and Genomics (ACMG) published a list of 59 actionable genes for which disease causing sequence variants are recommended to be reported as SF including 27 genes linked to inherited cardiovascular disease (CVD) such as arrhythmia syndromes, cardiomyopathies and vascular and connective tissue disorders. One of the selected conditions represented in the actionable gene list is the arrhythmogenic right ventricle cardiomyopathy (ARVC), an inherited heart muscle disease with a particularly high risk of sudden cardiac death (SCD). Since clinical symptoms are frequently absent before SCD, a genetic finding is a promising option for early diagnosis and possible intervention. However, the variant interpretation and the decision to return a SF is still challenging. Methods To determine the frequency of medically actionable SF linked to CVD we analyzed data of 6,605 individuals who underwent high throughput sequencing for noncardiac diagnostic requests. In particular, we critically assessed and classified the variants in the ARVC genes: DSC2, DSG2, DSP, PKP2 and TMEM43 and compared our findings with the population-based genome Aggregation Database (gnomAD) and ARVC-afflicted individuals listed in ClinVar and ARVC database. Results 1% (69/6,605) of tested individuals carried pathogenic SF in one of the 27 genes linked to CVD, of them 13 individuals (0.2%) carried a pathogenic SF in a ARVC gene. Overall, 582 rare variants were identified in all five ARVC genes, 96% of the variants were missense variants and 4% putative LoF variants (pLoF): frameshift, start/stop-gain/loss, splice-site. Finally, we selected 13 of the 24 pLoF variants as pathogenic SF by careful data interpretation. Conclusions Since SF in actionable ARVC genes can allow early detection and prevention of disease and SCD, detected variant must undergo rigorous clinical and laboratory evaluation before it can be described as pathogenic and returned to patients. Returning a SF to a patient should be interdisciplinary, it needs genetic counselling and clinicians experienced in inherited heart disease.
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Affiliation(s)
- Angela Abicht
- Medical Genetics Center, Munich, Germany.,Department of Neurology, Friedrich-Baur-Institute, Klinikum der Ludwig-Maximilians-University, Munich, Germany
| | | | | | | | - Isabel Diebold
- Medical Genetics Center, Munich, Germany.,Department of Pediatrics, Technical University of Munich School of Medicine, Munich, Germany
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13
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Kugamoorthy P, Spears DA. Management of tachyarrhythmias in pregnancy - A review. Obstet Med 2020; 13:159-173. [PMID: 33343692 PMCID: PMC7726166 DOI: 10.1177/1753495x20913448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.
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Affiliation(s)
| | - Danna A Spears
- University Health Network – Toronto General Hospital, Toronto, Canada
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14
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Li J, Hua Y, Miyagawa S, Zhang J, Li L, Liu L, Sawa Y. hiPSC-Derived Cardiac Tissue for Disease Modeling and Drug Discovery. Int J Mol Sci 2020; 21:E8893. [PMID: 33255277 PMCID: PMC7727666 DOI: 10.3390/ijms21238893] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 12/20/2022] Open
Abstract
Relevant, predictive normal, or disease model systems are of vital importance for drug development. The difference between nonhuman models and humans could contribute to clinical trial failures despite ideal nonhuman results. As a potential substitute for animal models, human induced pluripotent stem cell (hiPSC)-derived cardiomyocytes (CMs) provide a powerful tool for drug toxicity screening, modeling cardiovascular diseases, and drug discovery. Here, we review recent hiPSC-CM disease models and discuss the features of hiPSC-CMs, including subtype and maturation and the tissue engineering technologies for drug assessment. Updates from the international multisite collaborators/administrations for development of novel drug discovery paradigms are also summarized.
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Affiliation(s)
- Junjun Li
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
- Department of Cell Design for Tissue Construction, Faculty of Medicine, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ying Hua
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
| | - Jingbo Zhang
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
| | - Lingjun Li
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
| | - Li Liu
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
- Department of Design for Tissue Regeneration, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; (J.L.); (Y.H.); (S.M.); (J.Z.); (L.L.)
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15
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Alexanderson-Rosas E, Garcia-Diaz JA, Escudero-Salamanca M, Alvarez-Santana R, Cano-Zarate R, Fajardo-Juarez IA, Espinola-Zavaleta N. Multimodal assessment of arrhythmogenic right ventricular cardiomyopathy. J Nucl Cardiol 2020; 27:1850-1854. [PMID: 31792914 DOI: 10.1007/s12350-019-01944-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 10/22/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Erick Alexanderson-Rosas
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
- Department of Physiology, Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - Jesus A Garcia-Diaz
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
- Academic Unit of Medicine, Autonomous University of Nayarit, Tepic-Nayarit, Mexico
| | - Mara Escudero-Salamanca
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
- Mexican Faculty of Medicine, University La Salle, Mexico City, Mexico
| | - Ricardo Alvarez-Santana
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
- Institute of Medical Sciences, Autonomous University of Ciudad Juarez, Mexico City, Mexico
| | - Roberto Cano-Zarate
- Department of Cardiac Magnetic Resonance, National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico
| | - Ivan A Fajardo-Juarez
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Department of Nuclear Cardiology, National Institute of Cardiology Ignacio Chavez, Juan Badiano Nº 1, Colonia Sección XVI, Tlalpan, P.C. 14080, Mexico City, Mexico.
- Department of Echocardiography, ABC Medical Center, I.A.P, Mexico City, Mexico.
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16
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Design and Reporting Considerations for Genetic Screening Tests. J Mol Diagn 2020; 22:599-609. [DOI: 10.1016/j.jmoldx.2020.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/16/2020] [Accepted: 01/30/2020] [Indexed: 11/20/2022] Open
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17
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Ghosh A, Shcherbik N. Effects of Oxidative Stress on Protein Translation: Implications for Cardiovascular Diseases. Int J Mol Sci 2020; 21:E2661. [PMID: 32290431 PMCID: PMC7215667 DOI: 10.3390/ijms21082661] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases (CVDs) are a group of disorders that affect the heart and blood vessels. Due to their multifactorial nature and wide variation, CVDs are the leading cause of death worldwide. Understanding the molecular alterations leading to the development of heart and vessel pathologies is crucial for successfully treating and preventing CVDs. One of the causative factors of CVD etiology and progression is acute oxidative stress, a toxic condition characterized by elevated intracellular levels of reactive oxygen species (ROS). Left unabated, ROS can damage virtually any cellular component and affect essential biological processes, including protein synthesis. Defective or insufficient protein translation results in production of faulty protein products and disturbances of protein homeostasis, thus promoting pathologies. The relationships between translational dysregulation, ROS, and cardiovascular disorders will be examined in this review.
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Affiliation(s)
- Arnab Ghosh
- Department for Cell Biology and Neuroscience, School of Osteopathic Medicine, Rowan University, 2 Medical Center Drive, Stratford, NJ 08084, USA
| | - Natalia Shcherbik
- Department for Cell Biology and Neuroscience, School of Osteopathic Medicine, Rowan University, 2 Medical Center Drive, Stratford, NJ 08084, USA
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18
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Leischik R, Dworrak B, Strauss M, Horlitz M, Pareja-Galeano H, de la Guía-Galipienso F, Lippi G, Lavie CJ, Perez MV, Sanchis-Gomar F. Special Article - Exercise-induced right ventricular injury or arrhythmogenic cardiomyopathy (ACM): The bright side and the dark side of the moon. Prog Cardiovasc Dis 2020; 63:671-681. [PMID: 32224113 DOI: 10.1016/j.pcad.2020.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 02/06/2023]
Abstract
There is still debate on the range of normal physiologic changes of the right ventricle or ventricular (RV) function in athletes. Genetic links to arrhythmogenic cardiomyopathy (ACM) are well-established. There is no current consensus on the importance of extensive exercise and exercise-induced injury to the RV. During the intensive exercise of endurance sports, the cardiac structures adapt to athletic load over time. Some athletes develop RV cardiomyopathy possibly caused by genetic predisposition, whilst others develop arrhythmias from the RV. Endurance sports lead to increased volume and pressure load in both ventricles and increased myocardial mass. The extent of volume increase and changes in myocardial structure contribute to impairment of RV function and pose a challenge in cardiovascular sports medicine. Genetic predisposition to ACM may play an important role in the risk of sudden cardiac death of athletes. In this review, we discuss and evaluate existing results and opinions. Intensive training in competitive dynamic/power and endurance sports leads to specific RV adaptation, but physiological adaptation without genetic predisposition does not necessarily lead to severe complications in endurance sports. Discriminating between physiological adaptation and pathological form of ACM or RV impairment provoked by reinforced exercise presents a challenge to clinical sports cardiologists.
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Affiliation(s)
- Roman Leischik
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany.
| | - Birgit Dworrak
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Marcus Strauss
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure Medicine, University Hospital Muenster, Cardiol, 48149 Muenster, Germany
| | - Mark Horlitz
- Department of Cardiology, Section Prevention and Sports Medicine, School of Medicine, Faculty of Health, Witten/Herdecke University, 58095 Witten, Germany
| | - Helios Pareja-Galeano
- Facultad de Ciencias del Deporte y Fisioterapia, Universidad Europea, 28670 Madrid, Spain
| | - Fernando de la Guía-Galipienso
- Cardiology Service of Marina Baixa Hospital, Alicante, Spain; REMA Sports Cardiology Clinic, 03700 Denia, Alicante, Spain
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, 37134 Verona, Italy
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, 70121 New Orleans, LA, USA
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA
| | - Fabian Sanchis-Gomar
- Division of Cardiovascular Medicine, Stanford University School of Medicine, 94305-5110 Stanford, CA, USA; Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, 46010 Valencia, Spain.
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19
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London KS, Hartwell C, Cesar S, Sarquella-Brugada G, White JL. Can Sudden Cardiac Death Risk in the Young be Identified in the Emergency Department? J Emerg Nurs 2020; 46:105-110. [DOI: 10.1016/j.jen.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022]
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20
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Ye JZ, Delmar M, Lundby A, Olesen MS. Reevaluation of genetic variants previously associated with arrhythmogenic right ventricular cardiomyopathy integrating population-based cohorts and proteomics data. Clin Genet 2019; 96:506-514. [PMID: 31402444 DOI: 10.1111/cge.13621] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/12/2019] [Accepted: 07/30/2019] [Indexed: 11/27/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is one of the most common causes of sudden cardiac death in young people. Patients diagnosed with ARVC may experience increased likelihood of development of anxiety and depression, emphasizing the need for accurate diagnosis. To assist future genetic diagnosis and avoidance of misdiagnosis, we evaluated the reported monogenic disease-causing variants in ARVD/C Genetic Variants Database, Human Gene Mutation Database, and ClinVar. Within the aforementioned databases, 630 monogenic disease-causing variants from 18 genes were identified. In the genome Aggregation Database, 226 of these were identified; 68 of which were found at greater than expected prevalence. Furthermore, 37/226 genetic variants were identified amongst the 409 000 UK biobank participants, 23 were not associated with ARVC. Among the 14 remaining variants, 13 were previously found with greater than expected prevalence for a monogenic variant. Nevertheless, they were associated with serious cardiac phenotypes, suggesting that these 13 variants may be disease-modifiers of ARVC, rather than monogenic disease-causing. In summary, more than 10% of variants previously reported to cause ARVC were found unlikely to be associated with highly penetrant monogenic forms of ARVC. Notably, all variants in OBSCN and MYBPC3 were found, making these unlikely to be monogenic causes of ARVC.
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Affiliation(s)
- Johan Z Ye
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.,Department of Health Technology, Section for Bioinformatics, Technical University of Denmark, DTU, Kgs. Lyngby, Denmark
| | - Mario Delmar
- The Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York
| | - Alicia Lundby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.,Novo Nordisk Foundation Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark
| | - Morten S Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen N, Denmark.,Laboratory of Molecular Cardiology, Department of Cardiology, Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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21
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Sattar Y, Abdullah HM, Neisani Samani E, Myla M, Ullah W. Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: An Updated Review of Diagnosis and Management. Cureus 2019; 11:e5381. [PMID: 31616612 PMCID: PMC6786836 DOI: 10.7759/cureus.5381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is a condition caused by the replacement of the normal right ventricular myocardium with fibrofatty tissue. ARVC/D can present with a variety of clinical conditions including right ventricular dysfunction, ventricular tachyarrhythmias, sudden cardiac arrest, and sudden cardiac death (SCD). Since the first report of ARVC/D in 1982, many advances have been made in the diagnosis, genetic findings for pathology, and treatment. The 2010 International Task Force diagnostic criteria distinguish between major and minor criteria and focus on gross structural changes, microscopic changes, repolarization defects, conduction defects, arrhythmias, and family history. Implantable cardiac defibrillators and catheter ablation of the endocardium and epicardium with electromagnetic mapping have emerged as successful tools in the treatment and prevention of ventricular tachyarrhythmias and SCD. This review discusses the pathophysiology, genetics, diagnosis, and treatment advances in ARVC/D.
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Affiliation(s)
- Yasar Sattar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA
| | | | | | - Madhura Myla
- Cardiology, University of New Mexico, New Mexico, USA
| | - Waqas Ullah
- Internal Medicine, Abington Hospital-Jefferson Health, Abington, USA
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22
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Ahmad F, McNally EM, Ackerman MJ, Baty LC, Day SM, Kullo IJ, Madueme PC, Maron MS, Martinez MW, Salberg L, Taylor MR, Wilcox JE. Establishment of Specialized Clinical Cardiovascular Genetics Programs: Recognizing the Need and Meeting Standards: A Scientific Statement From the American Heart Association. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2019; 12:e000054. [DOI: 10.1161/hcg.0000000000000054] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Cardiovascular genetics is a rapidly evolving subspecialty within cardiovascular medicine, and its growth is attributed to advances in genome sequencing and genetic testing and the expanding understanding of the genetic basis of multiple cardiac conditions, including arrhythmias (channelopathies), heart failure (cardiomyopathies), lipid disorders, cardiac complications of neuromuscular conditions, and vascular disease, including aortopathies. There have also been great advances in clinical diagnostic methods, as well as in therapies to ameliorate symptoms, slow progression of disease, and mitigate the risk of adverse outcomes. Emerging challenges include interpretation of genetic test results and the evaluation, counseling, and management of genetically at-risk family members who have inherited pathogenic variants but do not yet manifest disease. With these advances and challenges, there is a need for specialized programs combining both cardiovascular medicine and genetics expertise. The integration of clinical cardiovascular findings, including those obtained from physical examination, imaging, and functional assessment, with genetic information allows for improved diagnosis, prognostication, and cascade family testing to identify and to manage risk, and in some cases to provide genotype-specific therapy. This emerging subspecialty may ultimately require a new cardiovascular subspecialist, the genetic cardiologist, equipped with these combined skills, to permit interpretation of genetic variation within the context of phenotype and to extend the utility of genetic testing. This scientific statement outlines current best practices for delivering cardiovascular genetic evaluation and care in both the pediatric and the adult settings, with a focus on team member expertise and conditions that most benefit from genetic evaluation.
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23
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Boczar KE, Alqarawi W, Green MS, Redpath C, Burwash IG, Dwivedi G. The echocardiographic assessment of the right ventricle in patients with arrhythmogenic right ventricular cardiomyopathy/dysplasia compared with athletes and matched controls. Echocardiography 2019; 36:666-670. [DOI: 10.1111/echo.14308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/15/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Kevin E. Boczar
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Wael Alqarawi
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Martin S. Green
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Calum Redpath
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Ian G. Burwash
- University of Ottawa Heart InstituteDepartment of Medicine (Cardiology)University of Ottawa Ottawa Ontario Canada
| | - Girish Dwivedi
- Harry Perkins Institute of Medical Research and Fiona Stanley HospitalThe University of Western Australia Perth Western Australia Australia
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24
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Adams S, Gray A, Herity N. Fifty Years of Ventricular Tachycardia in a Single Patient. THE ULSTER MEDICAL JOURNAL 2019; 88:15-16. [PMID: 30675072 PMCID: PMC6342044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/22/2018] [Indexed: 11/05/2022]
Abstract
We report a patient who first presented during childhood in the early 1960's with several episodes of ventricular tachycardia (VT) and we describe her management which reflected the best medical knowledge at the time. She then presented more than 50 years later, again with VT, at which time a definitive diagnosis of the underlying cause was made. Her case illustrates the evolution in the understanding and management of VT over the past 50 years. This in turn reflects the clinical and technological advances in the management of cardiovascular disease over time.
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Affiliation(s)
- Stephen Adams
- Cardiology Department, Belfast HSC Trust,Corresponding author: Dr Stephen Adams,
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25
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Clinical utility of endomyocardial biopsies in the diagnosis of arrhythmogenic right ventricular cardiomyopathy in children. Pediatr Res 2018; 84:552-557. [PMID: 29976970 DOI: 10.1038/s41390-018-0093-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/30/2018] [Accepted: 06/06/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Histomorphometry of endomyocardial biopsies is one component of arrhythmogenic right ventricular cardiomyopathy (ARVC) diagnosis, although there is a need for stricter diagnostic criteria for this disease in pediatrics. The clinical utility of biopsy analysis as a component of ARVC diagnosis was evaluated in pediatric patients. METHODS Histomorphometric analysis of fibrofatty infiltrate was completed on pediatric right ventricular endomyocardial biopsy samples. Myocardial replacement by fat and fibrosis was quantified. ARVC diagnosis was established using the 2010 ARVC Task Force criteria, with the biopsy measures compared across various ARVC diagnoses (definite, borderline, possible, or no ARVC). Receiver-operating characteristic (ROC) curve analysis was also completed using biopsy measures. RESULTS The greatest proportion of fat, fibrosis, and myocardial replacement was in the definite ARVC cohort, and was significantly larger than for the other diagnosis cohorts. ROC curve analysis (with the biopsy analysis removed from the diagnostic classification) produced cutoff values of 15 and 25% myocardial replacement, which is lower than current adult diagnosis criteria. CONCLUSION We propose modifications in pediatric major and minor biopsy diagnosis criteria to allow for improved sensitivity. This study suggests that biopsy analysis in children is most significant for subjects with a more severe disease presentation.
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Steinmetz M, Krause U, Lauerer P, Konietschke F, Aguayo R, Ritter CO, Schuster A, Lotz J, Paul T, Staab W. Diagnosing ARVC in Pediatric Patients Applying the Revised Task Force Criteria: Importance of Imaging, 12-Lead ECG, and Genetics. Pediatr Cardiol 2018; 39:1156-1164. [PMID: 29754204 DOI: 10.1007/s00246-018-1875-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a potentially lethal disease that is well described in adults. In pediatric patients, however, identification of patients at risk of adverse events of ARVC remains a challenge. We aimed to determine which criteria of the revised Task Force Criteria (rTFC), alone or combined, have an impact on diagnosis of ARVC when compared to disease-specific genetic mutations in pediatric patients ≤ 18 years. Between September 2010 and December 2013, 48 consecutive young patients ≤ 18 years of age (mean 14, range of 12.9-15.1 years) underwent contrast-enhanced magnetic resonance imaging (CMR), genetic testing, and comprehensive clinical work-up for ARVC criteria to test for clinically suspected ARVC. As specified by the rTFC, patients were grouped into four categories: "definite," "borderline," "possible," and "none" ARVC. Of the 48 patients, 12 were found to have gene mutations of either the desmoplakin (9/12) or plakophilin (3/12) locus. According to rTFC 12/48 patients were considered as "definite" ARVC (25%), while 10/12 (83.3%) had an ARVC-specific gene mutation. Of the remaining 36 patients, 6 (12.5%) were grouped as "borderline" ARVC, 7 (14.6%) as "possible" ARVC (including the remaining two genetic mutations), and 22 (45.8%) as "none" ARVC, respectively. Statistical analysis of ARVC criteria in patients diagnosed with "definite" ARVC revealed high prevalence of positive findings by imaging (CMR and echocardiography) and positive genetics. The positive predictive value to detect "definite" ARVC by genotyping was 83.3%, while the negative predictive value was 94%. Logistic regression analyses for different criteria combinations revealed that imaging modalities (echo and CMR combined) and abnormalities of 12-lead ECG were significant markers (p < 0.01). Positive results of endomyocardial biopsies or arrhythmia on ECG or Holter as defined by the rTFC were not significant in this analysis. The rTFC for ARVC should be used with caution in children and adolescents suspected for ARVC. 12-Lead ECG and imaging modalities (CMR and echo) were of major value, positive results should prompt genetic testing.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany.
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany.
- Department of Pediatric Cardiology and Intensive Care Medicine, Goettingen Heart Center and DZHK Goettingen, University Medical Center of Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Ulrich Krause
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Peter Lauerer
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Frank Konietschke
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, TX, USA
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Randolph Aguayo
- College of Medicine, American University of Antigua, Coolidge, Antigua and Barbuda
| | - Christian Oliver Ritter
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Wieland Staab
- Department of Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
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27
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Hall CL, Sutanto H, Dalageorgou C, McKenna WJ, Syrris P, Futema M. Frequency of genetic variants associated with arrhythmogenic right ventricular cardiomyopathy in the genome aggregation database. Eur J Hum Genet 2018; 26:1312-1318. [PMID: 29802319 PMCID: PMC6117313 DOI: 10.1038/s41431-018-0169-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/16/2018] [Accepted: 04/03/2018] [Indexed: 01/06/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare inherited heart-muscle disorder, which is the most common cause of life-threatening arrhythmias and sudden cardiac death (SCD) in young adults and athletes. Early and accurate diagnosis can be crucial in effective ARVC management and prevention of SCD.The genome Aggregation Database (gnomAD) population of 138,632 unrelated individuals was searched for previously identified ARVC variants, classified as pathogenic or unknown on the disease genetic variant database ( http://www.arvcdatabase.info/ ), in five most-commonly mutated genes: PKP2, DSP, DSG2, DSC2 and JUP, where variants account for 40-50% of all the ARVC cases. Minor allele frequency (MAF) of 0.001 was used to define variants as rare or common.The gnomAD data contained 117/364 (32%) of the previously reported pathogenic and 152/266 (57%) of the unknown ARVC variants. The cross-ethnic analysis of MAF revealed that 11 previously classified pathogenic and 57 unknown variants were common (MAF ≥ 0.001) in at least one ethnic gnomAD population and therefore unlikely to be ARVC causing.After applying our MAF analysis the overall frequency of pathogenic ARVC variants in gnomAD was one in 257 individuals, but a more stringent cut-off (MAF ≥ 0.0001) gave a frequency of one in 845, closer to the estimated phenotypic frequency of the disease.Our study demonstrates that the analysis of large cross-ethnic population sequencing data can significantly improve disease variant interpretation. Higher than expected frequency of ARVC variants suggests that a proportion of ARVC-causing variants may be inaccurately classified, implying reduced penetrance of some variants, and/or a polygenic aetiology of ARVC.
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Affiliation(s)
- Charlotte L Hall
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Henry Sutanto
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Chrysoula Dalageorgou
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - William John McKenna
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Petros Syrris
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Marta Futema
- Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK.
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Sommariva E, Stadiotti I, Perrucci GL, Tondo C, Pompilio G. Cell models of arrhythmogenic cardiomyopathy: advances and opportunities. Dis Model Mech 2018; 10:823-835. [PMID: 28679668 PMCID: PMC5536909 DOI: 10.1242/dmm.029363] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Arrhythmogenic cardiomyopathy is a rare genetic disease that is mostly inherited as an autosomal dominant trait. It is associated predominantly with mutations in desmosomal genes and is characterized by the replacement of the ventricular myocardium with fibrous fatty deposits, arrhythmias and a high risk of sudden death. In vitro studies have contributed to our understanding of the pathogenic mechanisms underlying this disease, including its genetic determinants, as well as its cellular, signaling and molecular defects. Here, we review what is currently known about the pathogenesis of arrhythmogenic cardiomyopathy and focus on the in vitro models that have advanced our understanding of the disease. Finally, we assess the potential of established and innovative cell platforms for elucidating unknown aspects of this disease, and for screening new potential therapeutic agents. This appraisal of in vitro models of arrhythmogenic cardiomyopathy highlights the discoveries made about this disease and the uses of these models for future basic and therapeutic research. Summary:In vitro models of ACM provide insights into the molecular mechanisms of this disease. This reappraisal offers a comprehensive vision of past discoveries and constitutes a tool for future research.
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Affiliation(s)
- Elena Sommariva
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino-IRCCS, via Parea 4, Milan 20138, Italy
| | - Ilaria Stadiotti
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino-IRCCS, via Parea 4, Milan 20138, Italy
| | - Gianluca L Perrucci
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino-IRCCS, via Parea 4, Milan 20138, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy
| | - Claudio Tondo
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy.,Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino-IRCCS, via Parea 4, Milan 20138, Italy
| | - Giulio Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino-IRCCS, via Parea 4, Milan 20138, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Via Festa del Perdono 7, Milan 20122, Italy
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Waki H, Eguchi K, Toriumi S, Ikemoto T, Suzuki T, Fukushima N, Kario K. Isolated Cardiac Sarcoidosis Mimicking Arrhythmogenic Right Ventricular Cardiomyopathy. Intern Med 2018; 57:835-839. [PMID: 29225258 PMCID: PMC5891523 DOI: 10.2169/internalmedicine.9395-17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/27/2017] [Indexed: 11/06/2022] Open
Abstract
The diagnosis of cardiac sarcoidosis (CS) has become easier due to advances in imaging modalities, but we sometimes encounter difficult-to-diagnose patients. We herein report the case of a 60-year-old Japanese woman who was diagnosed with isolated CS, although she also met the diagnostic criteria of arrhythmogenic right ventricular cardiomyopathy (ARVC). A histological examination by an endomyocardial biopsy of the right ventricle revealed the typical findings of granulomatous change for CS. Although she did not show any characteristics of systemic sarcoidosis, oral prednisolone treatment was introduced, and she achieved a good response. This case shows that the characteristics of CS can overlap with the diagnostic criteria of ARVC, and that a histological examination is essential for the correct diagnosis of CS.
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Affiliation(s)
- Hirotaka Waki
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Shinichi Toriumi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tomokazu Ikemoto
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
| | - Tsukasa Suzuki
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Noriyoshi Fukushima
- Department of Diagnostic Pathology, Jichi Medical University Hospital, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Japan
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30
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Li KHC, Bazoukis G, Liu T, Li G, Wu WKK, Wong SH, Wong WT, Chan YS, Wong MCS, Wassilew K, Vassiliou VS, Tse G. Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in clinical practice. J Arrhythm 2018; 34:11-22. [PMID: 29721109 PMCID: PMC5828272 DOI: 10.1002/joa3.12021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/14/2017] [Indexed: 01/01/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited myocardial disease characterized by fibro-fatty replacement of the right ventricular myocardium, and associated with paroxysmal ventricular arrhythmias and sudden cardiac death (SCD). It is currently the second most common cause of SCD after hypertrophic cardiomyopathy in young people <35 years of age, causing up to 20% of deaths in this patient population. This condition has a male preponderance and is more commonly found in individuals of Italian and Greek descent. To date, there is no single diagnostic test for ARVC/D and the diagnosis is made based on clinical, electrocardiographic, and radiological findings according to the Revised 2010 Task Force Criteria. In this review, we will discuss the mainstay treatment which includes pharmacotherapy, implantable cardioverter-defibrillator insertion for abortion of sudden cardiac death, and in the advanced stages of the disease cardiac transplantation.
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Affiliation(s)
| | - George Bazoukis
- Second Department of CardiologyLaboratory of Cardiac Electrophysiology“Evangelismos” General Hospital of AthensAthensGreece
| | - Tong Liu
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - Guangping Li
- Tianjin Key Laboratory of Ionic‐Molecular Function of Cardiovascular diseaseDepartment of CardiologyTianjin Institute of CardiologySecond Hospital of Tianjin Medical UniversityTianjinChina
| | - William K. K. Wu
- Department of Anaesthesia and Intensive CareFaculty of MedicineChinese University of Hong KongHong KongChina
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Sunny Hei Wong
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Wing Tak Wong
- School of Life SciencesChinese University of Hong KongHong KongChina
| | - Yat Sun Chan
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
| | - Martin C. S. Wong
- The Jockey Club School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Katharina Wassilew
- Department of PathologyRigshospitaletUniversity Hospital of CopenhagenCopenhagenDenmark
| | - Vassilios S. Vassiliou
- Norwich Medical SchoolUniversity of East AngliaNorwichUK
- Royal Brompton Hospital and Imperial College LondonLondonUK
| | - Gary Tse
- Li Ka Shing Institute of Health SciencesFaculty of MedicineChinese University of Hong KongHong KongChina
- Department of Medicine and TherapeuticsFaculty of MedicineChinese University of Hong KongHong KongChina
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31
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Massively Parallel Sequencing of Genes Implicated in Heritable Cardiac Disorders: A Strategy for a Small Diagnostic Laboratory. Med Sci (Basel) 2017; 5:medsci5040022. [PMID: 29099038 PMCID: PMC5753651 DOI: 10.3390/medsci5040022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/20/2017] [Accepted: 10/02/2017] [Indexed: 12/16/2022] Open
Abstract
Sudden cardiac death (SCD) in people before the age of 35 years is a devastating event for any family. The causes of SCD in the young can be broadly divided into two groups: heritable cardiac disorders that affect the heart structure (cardiomyopathies) and primary electrical disorders (cardiac ion channelopathies). Genetic testing is vital as those suffering from cardiac ion channelopathies have structurally normal hearts, and those with cardiomyopathies may only show subtle abnormalities in the heart and these signs may not be detected during an autopsy. Post-mortem genetic testing of SCD victims is important to identify the underlying genetic cause. This is important as family cascade screening may be undertaken to identify those who may be at risk and provide vital information about risk stratification and clinical management. The development of massively parallel sequencing (MPS) has made it possible for the simultaneous screening of multiple patients for hundreds of genes. In light of this, we opted to develop an MPS approach for SCD analysis that would allow us to screen for mutations in genes implicated in cardiomyopathies and cardiac ion channelopathies. The rationale behind this panel was to limit it to genes carrying the greatest mutation load. If no likely pathogenic gene variant were found then testing could cascade to whole exome/genome sequencing as a gene-discovery exercise. The overarching aim was to design and validate a custom-cardiac panel that satisfies the diagnostic requirements of LabPLUS (Auckland City Hospital, Auckland, NZ) and the guidelines provided by the Royal College of Pathologists of Australasia and the Association for Clinical Genetic Science.
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32
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Biggs R, Patel B, Martinez MW, McCambridge M, Kim S, Marcus N. Cardiac sarcoidosis mimicking arrhythmogenic right ventricular dysplasia in a patient presenting with monomorphic ventricular tachycardia. HeartRhythm Case Rep 2017; 3:418-421. [PMID: 28948146 PMCID: PMC5601329 DOI: 10.1016/j.hrcr.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ross Biggs
- Division of Internal Medicine, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Brijesh Patel
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Matthew W. Martinez
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Matthew McCambridge
- Division of Pulmonary/Critical Care, Lehigh Valley Hospital Network, Allentown, Pennsylvania
| | - Susan Kim
- Division of Rheumatology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Norman Marcus
- Division of Cardiology, Lehigh Valley Hospital Network, Allentown, Pennsylvania
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Al Lawati H, Al Dhuhli H. First Reported Case of Arrhythmogenic Right Ventricular Cardiomyopathy in Oman. Oman Med J 2017; 32:339-343. [PMID: 28804588 DOI: 10.5001/omj.2017.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare genetic disorder characterized by fatty degeneration of the right ventricular myocardium with variable involvement of the left ventricle. The condition is associated with exercise-mediated ventricular tachycardia and is one of the recognized causes of sudden cardiac death in the young and in athletes. Here, we report the first confirmed case of ARVC in Oman and present its electrocardiographic, echocardiographic features, and radiological findings on gated, contrast-enhanced cardiac computed tomography. Our patient was a 22-year-old male who had presented to our hospital for evaluation and investigation of syncope and symptomatic palpitations.
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Affiliation(s)
- Hatim Al Lawati
- Division of Cardiology, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Humoud Al Dhuhli
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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34
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Romero J, Grushko M, Briceño DF, Natale A, Di Biase L. Radiofrequency Ablation in Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). Curr Cardiol Rep 2017; 19:82. [DOI: 10.1007/s11886-017-0893-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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35
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Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) in a young female athlete at 36 weeks gestation: a case report. Pathol Res Pract 2017; 213:1302-1305. [PMID: 28843747 DOI: 10.1016/j.prp.2017.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/17/2017] [Accepted: 07/18/2017] [Indexed: 12/16/2022]
Abstract
A 26year old east African professional athlete presented to the obstetric clinic for a routine visit at 36 weeks gestation. She had a history of Right Ventricular Outflow Tract - Ventricular Tachycardia (RVOT-VT) with an episode of cardiac arrest in the past, and had been treated with ablation 4 years earlier. Her current visit was uneventful, her pregnancy progressing normally. Following the visit she went to a local restaurant where she suffered a cardiac arrest that was unresponsive to therapy. Chest compressions were continued from the time of her collapse until an emergency caesarian section was performed, delivering a healthy female infant. At autopsy a focal area of subtle pallor and myocardial thinning was present at the apex of the right ventricle. Histology showed myocyte degeneration and loss with focal full thickness replacement of myocardium by adipose tissue, consistent with the fatty form of arrhythmogenic right ventricular cardiomyopathy (ARVC). Molecular studies revealed a variant of unknown significance in the MYBPC3 gene, but no variant known to be associated with ARVC. In view of the subtlety of the lesion on gross examination this diagnosis could have been easily missed, emphasizing the importance of performing histologic examination of subtle gross cardiac lesions.
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36
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Camargo-Ariza WA, Galvis-Blanco SJ, Camacho-Enciso TDP, Quiroz-Romero CA, Bermudez-Echeverry JJ. [Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Literature review and case report]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017. [PMID: 28623036 DOI: 10.1016/j.acmx.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia is an inherited autosomal dominant disease, with an estimated prevalence of 1:2,500 to 1:5,000, being higher in males (3:1). It is characterised histologically by the substitution of cardiomyocytes for fibrous-adipose tissue, which predisposes to ventricular arrhythmias, right ventricular failure, and sudden cardiac death. The main aim of treatment is to reduce the risk of sudden death and improve the quality of life of patients. The case is presented of a 23 year old woman whose clinical symptoms started with palpitations, chest pain with physical activity, syncope, and headache, 6 years ago during her first pregnancy. Due to an increase in symptomatology, a stress test was performed, during which she collapsed with a sustained monomorphic ventricular tachycardia. A cardiac magnetic resonance scan showed dilation, an increase in trabeculae, and decreased function of the right ventricle. A 3-dimensional mapping and ablation was performed, and during the isoproterenol infusion test, a polymorphic ventricular flutter was generated that required electrical cardioversion. The decision was made to implant a dual chamber cardioverter defibrillator and perform stellate ganglion ablation as secondary prevention. After her discharge, the patient re-consulted many times due to discharges of the device associated with palpitations. A comprehensive review of the patient's medical records was performed, finding characteristics that may suggest arrhythmogenic right ventricular dysplasia. The Task Force criteria was applied, concluding that, as she met more than 2 major criteria, the patient had a definitive diagnosis of this disease.
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Affiliation(s)
| | | | | | | | - Juan José Bermudez-Echeverry
- Facultad de Medicina, Universidad Industrial de Santander, Bucaramanga, Santander, Colombia; Departamento de Electrofisiología, Fundación Cardiovascular de Colombia, Floridablanca, Santander, Colombia
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Guo HC, Ren CW, Dai J, Lai YQ. Surgical Treatment of Arrhythmogenic Right Ventricular Cardiomyopathy with Absent Pulmonary Valve. Chin Med J (Engl) 2017; 130:1383-1384. [PMID: 28524842 PMCID: PMC5455052 DOI: 10.4103/0366-6999.206344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hong-Chang Guo
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Chang-Wei Ren
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Jiang Dai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Yong-Qiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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38
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Manuel A, Brunger F. Embodying a New Meaning of Being At Risk: Living With an Implantable Cardioverter Defibrillator for Arrhythmogenic Right Ventricular Cardiomyopathy. Glob Qual Nurs Res 2017; 3:2333393616674810. [PMID: 28462346 PMCID: PMC5342860 DOI: 10.1177/2333393616674810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/20/2016] [Accepted: 09/27/2016] [Indexed: 11/16/2022] Open
Abstract
Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia (ARVC/D) is a genetic condition that can cause fatal arrhythmias. The implantable cardioverter defibrillation (ICD) is a primary treatment for ARVC/D. Using a grounded theory approach, this study examines the experiences of 15 individuals living with an ICD. The ability to cope with and adjust to having an ICD is influenced by the acceptance of the ICD as something needed to survive, an understanding of the ICD's function, existing support networks, and ones' ability to manage everyday challenges. Coping well requires reshaping ideas about the meaning of being at risk and understanding how the ICD fits into that changing personal risk narrative. A thorough understanding of the unique needs of individuals with ARVC/D and of the specific factors contributing to the psychosocial distress related to having an ICD (vs. having the disease itself) is needed. Nurses must be prepared to provide ongoing support and education to this population.
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Affiliation(s)
- April Manuel
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Fern Brunger
- Memorial University, St. John's, Newfoundland and Labrador, Canada
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39
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Buikema JW, Wu SM. Untangling the Biology of Genetic Cardiomyopathies with Pluripotent Stem Cell Disease Models. Curr Cardiol Rep 2017; 19:30. [DOI: 10.1007/s11886-017-0842-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Poloni G, De Bortoli M, Calore M, Rampazzo A, Lorenzon A. Arrhythmogenic right-ventricular cardiomyopathy: molecular genetics into clinical practice in the era of next generation sequencing. J Cardiovasc Med (Hagerstown) 2017; 17:399-407. [PMID: 26990921 DOI: 10.2459/jcm.0000000000000385] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sudden death, ventricular arrhythmia and heart failure are common features in arrhythmogenic right-ventricular cardiomyopathy (ARVC), an inheritable heart muscle disease, characterized by clinical and genetic heterogeneity. So far, 13 disease genes have been identified, responsible for around 60% of all ARVC cases. In this review, we summarize the main clinical and pathological aspects of ARVC, focusing on the importance of the genetic testing and the application of the new sequencing techniques referred to next generation sequencing technology.
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Affiliation(s)
- Giulia Poloni
- aDepartment of Biology, University of Padua, Padua, Italy bDepartment of Cardiology, School for Cardiovascular Diseases, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
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Current Concepts on Diagnosis and Prognosis of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia. J Thorac Imaging 2016; 31:324-335. [DOI: 10.1097/rti.0000000000000171] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Qasem M, Utomi V, George K, Somauroo J, Zaidi A, Forsythe L, Bhattacharrya S, Lloyd G, Rana B, Ring L, Robinson S, Senior R, Sheikh N, Sitali M, Sandoval J, Steeds R, Stout M, Willis J, Oxborough D. A meta-analysis for echocardiographic assessment of right ventricular structure and function in ARVC. Echo Res Pract 2016; 3:ERP-16-0028. [PMID: 27686556 PMCID: PMC5076568 DOI: 10.1530/erp-16-0028] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) is an inherited pathology that can increase the risk of sudden death. Current Task Force Criteria for echocardiographic diagnosis do not include new, regional assessment tools which may be relevant in a phenotypically diverse disease. We adopted a systematic review and meta-analysis approach to highlight echocardiographic indices that differentiated ARVC patients and healthy controls. METHODS Data was extracted and analysed from prospective trials that employed a case-control design meeting strict inclusion and exclusion as well as a-priori quality criteria. Structural indices included proximal RV outflow tract(RVOT1) and RV diastolic area(RVDarea). Functional indices included RV fractional area change (RVFAC), Tricuspid Annular Systolic Excursion(TAPSE), peak systolic and early diastolic myocardial velocities (S' and E' respectively) and myocardial strain. RESULTS Patients with ARVC had larger RVOT1 (mean SD; 34 vs. 28 mm P<0.001) and RVDarea (23 vs. 18 cm2 P<0.001) compared to healthy controls. ARVC patients also had lower RVFAC (38 vs. 46 % P<0.001), TAPSE(17 vs. 23 mm P<0.001), S' (9 vs. 12 cm.s-1 P<0.001), E' (9 vs. 13 cm.s-1 P<0.001) and myocardial strain (-17 vs. -30% P<0.001). CONCLUSION The data from this meta-analysis support current Task Force criteria for the diagnosis of ARVC. In addition, other RV measures that reflect the complex geometry and function in ARVC clearly differentiated between ARVC and healthy controls and may provide additional diagnostic and management value. We recommend that future working groups consider this data when proposing new / revised criteria for the echocardiographic diagnosis of ARVC.
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Affiliation(s)
- M Qasem
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - V Utomi
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - K George
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - J Somauroo
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - A Zaidi
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - L Forsythe
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - S Bhattacharrya
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - G Lloyd
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - B Rana
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - L Ring
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - S Robinson
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - R Senior
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - N Sheikh
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - M Sitali
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - J Sandoval
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - R Steeds
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - M Stout
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - J Willis
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
| | - D Oxborough
- M Qasem, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKV Utomi, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKK George, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKJ Somauroo, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKA Zaidi, Barts Heart Centre, St Bartholomew's Hospital, London, UKL Forsythe, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UKS Bhattacharrya, Barts Heart Centre, St Bartholomew's Hospital, London, UKG Lloyd, Barts Heart Centre, St Bartholomew's Hospital, London, UKB Rana, Papworth Hospital NHS Trust, Cambridge, UKL Ring, West Suffolk NHS Trust, Bury St Edmonds, UKS Robinson, Papworth Hospital NHS Trust, Cambridge, UKR Senior, National Heart and Lung Institute, Imperial College, London, UKN Sheikh, St Georges University Hospital, London, UKM Sitali, Guys and St Thomas's NHS Trust, London, UKJ Sandoval, Leeds Teaching Hospitals NHS Trust, Leeds, UKR Steeds, University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UKM Stout, Cardiology Department, University Hospital of South Manchester, Manchester, UKJ Willis, Royal United Hospital, Bath, UKD Oxborough, Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Middlesbrough, UK
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Ross SB, Fraser ST, Semsarian C. Induced pluripotent stem cells in the inherited cardiomyopathies: From disease mechanisms to novel therapies. Trends Cardiovasc Med 2016; 26:663-672. [PMID: 27296521 DOI: 10.1016/j.tcm.2016.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/04/2016] [Accepted: 05/06/2016] [Indexed: 01/17/2023]
Abstract
Inherited cardiomyopathies lead to diverse clinical outcomes including heart failure, arrhythmias, and sudden death. Mutations in over 100 genes have been implicated in the pathogenesis of genetic heart diseases, including the main inherited cardiomyopathies, such as hypertrophic, dilated, and arrhythmogenic right ventricular cardiomyopathies. Understanding how these gene mutations lead to clinical disease and the various secondary genetic and environmental factors, which may modify the clinical phenotype, are key areas of research ultimately influencing diagnosis and management of patients. The emergence of patient-derived induced pluripotent stem cells (iPSCs), which can be differentiated into functional cardiomyocytes (CMs) in vitro, may provide an exciting new approach to understand disease mechanisms underpinning inherited heart diseases. This review will focus specifically on the key role of iPSC-based studies in the inherited cardiomyopathies, both in their potential utility as well as the significant challenges they present.
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Affiliation(s)
- Samantha Barratt Ross
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stuart T Fraser
- Disciplines of Physiology, Anatomy & Histology, School of Medical Sciences, University of Sydney, Sydney, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
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Gonzalez JA, Kramer CM. Role of Imaging Techniques for Diagnosis, Prognosis and Management of Heart Failure Patients: Cardiac Magnetic Resonance. Curr Heart Fail Rep 2016; 12:276-83. [PMID: 26041670 DOI: 10.1007/s11897-015-0261-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cardiac magnetic resonance (CMR) has evolved into a major tool for the diagnosis and assessment of prognosis of patients suffering from heart failure. Anatomical and structural imaging, functional assessment, T1 and T2 mapping tissue characterization, and late gadolinium enhancement (LGE) have provided clinicians with tools to distinguish between non-ischemic and ischemic cardiomyopathies and to identify the etiology of non-ischemic cardiomyopathies. LGE is a useful tool to predict the likelihood of functional recovery after revascularization in patients with CAD and to guide the left ventricular (LV) lead placement in those who qualify for cardiac resynchronization (CRT) therapy. In addition, the presence of LGE and its extent in myocardial tissue relate to overall cardiovascular outcomes. Emerging roles for cardiac imaging in heart failure with preserved ejection fraction (HFpEF) are being studied, and CMR continues to be among the most promising noninvasive imaging alternatives in the diagnosis of this disease.
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Affiliation(s)
- Jorge A Gonzalez
- Department of Medicine (Division of Cardiology), and the Cardiovascular Imaging Center, University of Virginia Health System, Charlottesville, VA, USA
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45
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Sampson B, Hammers J. Forensic Aspects of Cardiovascular Pathology. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kant S, Krusche CA, Gaertner A, Milting H, Leube RE. Loss of plakoglobin immunoreactivity in intercalated discs in arrhythmogenic right ventricular cardiomyopathy: protein mislocalization versus epitope masking. Cardiovasc Res 2015; 109:260-71. [PMID: 26676851 DOI: 10.1093/cvr/cvv270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 11/27/2015] [Indexed: 01/13/2023] Open
Abstract
AIMS To examine the relevance and cause of reduced plakoglobin IF in intercalated discs for arrhythmogenic right ventricular cardiomyopathy (ARVC) and ARVC-like disease in mouse and human. METHODS AND RESULTS Normalized semi-quantitative IF measurements were performed in a standardized format in desmoglein 2-mutant mice with an ARVC-like phenotype (n = 6) and in cardiac biopsies from humans with ARVC and non-ARVC heart disease (n = 10). Reduced plakoglobin staining was detectable in ARVC only with one antibody directed against a defined epitope but not with three other antibodies reacting with different epitopes of plakoglobin. CONCLUSIONS Reduced plakoglobin staining in intercalated discs of heart tissue from human ARVC patients and in a murine ARVC model is caused by alterations in epitope accessibility and not by protein relocalization.
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Affiliation(s)
- Sebastian Kant
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Claudia A Krusche
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
| | - Anna Gaertner
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Hendrik Milting
- Herz- und Diabeteszentrum NRW, Klinik für Thorax- und Kardiovaskularchirurgie, Erich und Hanna Klessmann-Institut für Kardiovaskuläre Forschung und Entwicklung, Bad Oeynhausen, Germany
| | - Rudolf E Leube
- Institute of Molecular and Cellular Anatomy, RWTH Aachen University, Wendlingweg 2, Aachen 52074, Germany
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Bansal S, Luu BE, Storey KB. MicroRNA regulation in heart and skeletal muscle over the freeze–thaw cycle in the freeze tolerant wood frog. J Comp Physiol B 2015; 186:229-41. [DOI: 10.1007/s00360-015-0951-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 11/09/2015] [Accepted: 11/25/2015] [Indexed: 01/14/2023]
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Perceived economic burden associated with an inherited cardiac condition: a qualitative inquiry with families affected by arrhythmogenic right ventricular cardiomyopathy. Genet Med 2015; 18:584-92. [PMID: 26513349 DOI: 10.1038/gim.2015.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/18/2015] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Significant gaps remain in the literature on the economic burden of genetic illness. We explored perceived economic burden associated with one inherited cardiac condition, arrhythmogenic right ventricular cardiomyopathy (ARVC). METHODS Semistructured interviews were held with individuals from families affected by ARVC. Data on the perceived financial and economic impacts of ARVC were used to identify emerging categories and themes using the method of constant comparison. RESULTS Data analysis revealed four themes that described participants' perceptions of the economic impact ARVC had on them and their families: (i) economic impact during childhood, (ii) impact on current and future employment, (iii) impact on current and future financial well-being, and (iv) no perceived economic impact. CONCLUSIONS This study is the first to explore the economic burden of ARVC from the perspective of affected families. It revealed a number of perceived burdens, from employment and career choices to worry about insurance for self and children, decreased household spending, and the need for childhood employment. Findings highlight potential areas of discussion for genetic counseling sessions, as well as areas for future research.Genet Med 18 6, 584-592.
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Regional differences in WT-1 and Tcf21 expression during ventricular development: implications for myocardial compaction. PLoS One 2015; 10:e0136025. [PMID: 26390289 PMCID: PMC4577115 DOI: 10.1371/journal.pone.0136025] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 07/29/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Morphological and functional differences of the right and left ventricle are apparent in the adult human heart. A differential contribution of cardiac fibroblasts and smooth muscle cells (populations of epicardium-derived cells) to each ventricle may account for part of the morphological-functional disparity. Here we studied the relation between epicardial derivatives and the development of compact ventricular myocardium. RESULTS Wildtype and Wt1CreERT2/+ reporter mice were used to study WT-1 expressing cells, and Tcf21lacZ/+ reporter mice and PDGFRα-/-;Tcf21LacZ/+ mice to study the formation of the cardiac fibroblast population. After covering the heart, intramyocardial WT-1+ cells were first observed at the inner curvature, the right ventricular postero-lateral wall and left ventricular apical wall. Later, WT-1+ cells were present in the walls of both ventricles, but significantly more pronounced in the left ventricle. Tcf21-LacZ + cells followed the same distribution pattern as WT-1+ cells but at later stages, indicating a timing difference between these cell populations. Within the right ventricle, WT-1+ and Tcf21-lacZ+ cell distribution was more pronounced in the posterior inlet part. A gradual increase in myocardial wall thickness was observed early in the left ventricle and at later stages in the right ventricle. PDGFRα-/-;Tcf21LacZ/+ mice showed deficient epicardium, diminished number of Tcf21-LacZ + cells and reduced ventricular compaction. CONCLUSIONS During normal heart development, spatio-temporal differences in contribution of WT-1 and Tcf21-LacZ + cells to right versus left ventricular myocardium occur parallel to myocardial thickening. These findings may relate to lateralized differences in ventricular (patho)morphology in humans.
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Cook TS, Zimmerman SL, Jha S. Analysis of statistical biases in studies used to formulate guidelines: the case of arrhythmogenic right ventricular cardiomyopathy (ARVC) the case of ARVC. Acad Radiol 2015; 22:1010-5. [PMID: 26100190 DOI: 10.1016/j.acra.2015.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 04/20/2015] [Accepted: 04/28/2015] [Indexed: 11/18/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the statistical biases in the studies used to derive cardiac magnetic resonance-based major and minor criteria for the diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC). MATERIALS AND METHODS ARVC is a rare disorder of the heart that can lead to sudden death in young adults. Cardiac magnetic resonance imaging (CMR) plays a role in the diagnosis by contributing to the criteria set by experts. The original criteria emphasized qualitative analysis of CMR. The criteria were modified in 2010 to provide quantitative cutoffs. RESULTS We apply the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool for systematic review of diagnostic accuracy to the studies cited in the guidelines written in 1994 and revised in 2010. We use the signaling questions in QUADAS-2 to identify different types of statistical bias. CONCLUSIONS The studies have understandable biases that affect the sensitivity and specificity of CMR in the diagnosis of ARVC, as well as the truth of the disease state. There is potential to overdiagnose ARVC particularly in low prevalence populations.
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Affiliation(s)
- Tessa S Cook
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104.
| | - Stefan L Zimmerman
- Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saurabh Jha
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, 1 Silverstein, Philadelphia, PA 19104
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