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Tawfik A, Amer S, Wu P, Yong SB, Yii CY. Cytomegalovirus seropositivity and its correlation with all-cause mortality among US adults. J Med Virol 2024; 96:e29872. [PMID: 39158054 DOI: 10.1002/jmv.29872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Andro Tawfik
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Sara Amer
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Patrick Wu
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, Florida, USA
| | - Su-Boon Yong
- Department of Allergy and Immunology, China Medical University Children's Hospital, Taichung City, Taiwan
- Department of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
- Center for Allergy, Immunology, and Microbiome (A.I.M.), China Medical University Hospital, Taichung City, Taiwan
| | - Chin-Yuan Yii
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Landseed International Hospital, Taoyuan, Taiwan
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2
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Riccio A, Shilling AM. Unique Medical Considerations for the Athlete Undergoing Anesthesia. Anesthesiol Clin 2024; 42:185-201. [PMID: 38705670 DOI: 10.1016/j.anclin.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Athletes are among a unique group such that they may possess a serious underlying pathologic condition that may often go unnoticed given their high caliber of physical fitness. However, several considerations should be investigated, especially in the perioperative period, in order to minimize morbidity and mortality. Namely, cardiac pathologic condition can result in sudden death, and pulmonary pathologic condition may affect airway and respiratory management. Moreover, patients undergoing orthopedic surgery are at the highest risk for venous thromboembolism. Regardless of the condition, it is crucial to be vigilant and explore the unique medical considerations for the athlete undergoing anesthesia.
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Affiliation(s)
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, MDPO Box 800710, Charlottesville VA 22908, USA.
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3
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Sattler AG, Rozzi S. Identifying Sudden Cardiac Arrest Risk in Adolescent Male Athletes. INTERNATIONAL JOURNAL OF EXERCISE SCIENCE 2024; 17:874-886. [PMID: 39049878 PMCID: PMC11268921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
The purpose of the study was to determine the prevalence of sudden cardiac arrest (SCA) risk factors in high school (HS) athletes. Thirty-three male soccer players from a public HS in the southeastern United States (ages 14-17) self-reported survey data. Participants reported demographic, lifestyle, heart health, COVID-19 history, and symptoms indicative of SCA risk. An electrocardiogram (ECG) assessed heart rate (HR), rhythm, and electrical activity. Resting HR and blood pressure (BP) were measured with a BP monitor. The association between COVID-19 history, HR, and BP were calculated. Participants were divided into ECG groups (normal or abnormal). Independent t-tests assessed comparisons between groups to identify SCA risk. Over 50% of participants (n=17) reported experiencing shortness of breath (SOB) and 30% (n=10) reported chest pain. A history of chest pain was associated with abnormal ECGs (p<0.04). Thirteen (39.4%) participants reported a COVID-19 history. Of these, 5 presented with persisting symptoms, 2 with elevated HR, and 3 with elevated BP. Eleven (33.3%) participants had an abnormal ECG and of these eleven, 8 (72.7%) reported a positive COVID-19 history (p<0.01). The current American Heart Association suggested screening method is limited. An ECG should be used in preparticipation screenings (PPS) and return to participation (RTP) decisions for athletes with a COVID-19 history. Family cardiac history, chest pain during exercise, and an abnormal QRS interval should be used to identify SCA risk.
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Affiliation(s)
- Alexis G Sattler
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
| | - Susan Rozzi
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
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4
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Bhasin R, AlJamal Y, Kitahara H, Blair J, Balkhy HH. Robotic unroofing of myocardial bridge of the left anterior descending coronary artery in a patient with hypertrophic obstructive cardiomyopathy and previous septal myectomy. J Cardiol Cases 2024; 29:222-225. [PMID: 39100519 PMCID: PMC11295015 DOI: 10.1016/j.jccase.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 08/06/2024] Open
Abstract
A 56-year-old female diagnosed with hypertrophic obstructive cardiomyopathy and myocardial bridge (MB) of the left anterior descending (LAD) coronary artery underwent septal myectomy with resolution of her left ventricular outflow tract gradient. She had ongoing refractory symptoms of exertional angina and fatigue for over a decade and finally presented to our clinic to be re-evaluated for treatment. Provocative angiographic testing confirmed significant ischemia secondary to LAD MB. She underwent robotic totally endoscopic off pump unroofing of the LAD MB with complete relief of her symptoms and return to full activity. We conclude that patients undergoing septal myectomy for hypertrophic obstructive cardiomyopathy should be evaluated for MB and undergo unroofing of the bridge at the time of surgery. Learning objective A myocardial bridge (MB) is a condition in which a coronary artery, most often the left anterior descending, takes an intramuscular route and is covered by the myocardium leading to compression and potential ischemia. This case report adds to the growing body of evidence supporting the significance of considering MB in the overall management of hypertrophic obstructive cardiomyopathy, and the symptomatic relief that a patient can obtain from an unroofing procedure.
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Affiliation(s)
- Riya Bhasin
- University of Chicago, Division of Cardiac Surgery, Chicago, IL, USA
| | - Yazan AlJamal
- Mayo Clinic, Division of Cardiac Surgery, Rochester, MN, USA
| | - Hiroto Kitahara
- University of Chicago, Division of Cardiac Surgery, Chicago, IL, USA
| | - John Blair
- University of Chicago, Department of Cardiology, Chicago, IL, USA
| | - Husam H. Balkhy
- University of Chicago, Division of Cardiac Surgery, Chicago, IL, USA
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5
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Nag S, Gollapudi SK, Del Rio CL, Spudich JA, McDowell R. Mavacamten, a precision medicine for hypertrophic cardiomyopathy: From a motor protein to patients. SCIENCE ADVANCES 2023; 9:eabo7622. [PMID: 37506209 DOI: 10.1126/sciadv.abo7622] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/23/2023] [Indexed: 07/30/2023]
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary myocardial disorder characterized by left ventricular hypertrophy, hyperdynamic contraction, and impaired relaxation of the heart. These functional derangements arise directly from altered sarcomeric function due to either mutations in genes encoding sarcomere proteins, or other defects such as abnormal energetics. Current treatment options do not directly address this causal biology but focus on surgical and extra-sarcomeric (sarcolemmal) pharmacological symptomatic relief. Mavacamten (formerly known as MYK-461), is a small molecule designed to regulate cardiac function at the sarcomere level by selectively but reversibly inhibiting the enzymatic activity of myosin, the fundamental motor of the sarcomere. This review summarizes the mechanism and translational progress of mavacamten from proteins to patients, describing how the mechanism of action and pharmacological characteristics, involving both systolic and diastolic effects, can directly target pathophysiological derangements within the cardiac sarcomere to improve cardiac structure and function in HCM. Mavacamten was approved by the Food and Drug Administration in April 2022 for the treatment of obstructive HCM and now goes by the commercial name of Camzyos. Full information about the risks, limitations, and side effects can be found at www.accessdata.fda.gov/drugsatfda_docs/label/2022/214998s000lbl.pdf.
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Affiliation(s)
- Suman Nag
- MyoKardia Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA 94005, USA
| | - Sampath K Gollapudi
- MyoKardia Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA 94005, USA
| | - Carlos L Del Rio
- MyoKardia Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA 94005, USA
- Cardiac Consulting, 1630 S Delaware St. #56426, San Mateo, CA 94403, USA
| | | | - Robert McDowell
- MyoKardia Inc., a wholly owned subsidiary of Bristol Myers Squibb, Brisbane, CA 94005, USA
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6
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Murtha CM, Dobson JR, Olinger AB. A Cadaveric Evaluation of Hypertrophic Obstructive Cardiomyopathy. Cureus 2023; 15:e40870. [PMID: 37489192 PMCID: PMC10363410 DOI: 10.7759/cureus.40870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2023] [Indexed: 07/26/2023] Open
Abstract
Hypertrophic obstructive cardiomyopathy (HOCM) describes a pathologic state in which the subaortic region of the interventricular septum undergoes significant hypertrophy and fibrosis, resulting in septal bowing into the left ventricle. The reduced left ventricular chamber size and altered cardiac function impair diastolic filling, stroke volume, and cardiac output. This case report evaluates the cardiac tissue of a 36-year-old, formalin-embalmed cadaver affected by HOCM, with the goal of providing a comprehensive overview of the gross and pathologic findings associated with the condition. This donor's heart was found to be larger than average, weighing 510.1 g, which is 52% heavier than the predicted value of 335.6 g for a male of similar stature. The thickness of the interventricular septum, right ventricular free wall, and left ventricular free wall was comparable to other reports of HOCM. However, asymmetrical thickening of the left ventricular walls, which is characteristic of HOCM, was less prominent than expected. Histologic staining of the cadaveric tissue, with hematoxylin and eosin, trichrome, and desmin, further bolstered the diagnosis. Importantly, this also showed that histologic examination of embalmed tissue is effective and diagnostic, even 11 months after embalming. The report herein demonstrates that morphologic and histologic analysis of cadaveric cardiac tissue is sufficient to support a diagnosis of HOCM. To the researchers' knowledge, this is the first case report evaluating HOCM in a cadaver donated for medical education.
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Affiliation(s)
- Celeste M Murtha
- Anatomy, College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - John R Dobson
- Pathology and Anatomical Sciences, College of Osteopathic Medicine, Kansas City University, Kansas City, USA
| | - Anthony B Olinger
- Pathology and Anatomical Sciences, Kansas City University, Kansas City, USA
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7
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Musicante M, Kim HH, Chen Y, Liao F, Bhattacharya SK, Lu L, Sun Y. Regulation of endothelial nitric oxide synthase in cardiac remodeling. Int J Cardiol 2022; 364:96-101. [PMID: 35654172 DOI: 10.1016/j.ijcard.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/25/2022] [Accepted: 05/06/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our previous study demonstrated that endothelial nitric oxide synthase (eNOS) gene serves as a candidate for modifiers of hypertrophic cardiomyopathy (HCM), which alters severity of HCM phenotypes. Herein, we sought to further elucidate the role of eNOS on cardiac myocyte hypertrophy and fibrosis, the major phenotypes of HCM. METHODS Male eNOS-deficient mice (eNOS-/-) and wild type control mice (eNOS+/+, C57B1/6 J) were used in this study. Myocyte size was analyzed in hematoxylin/eosin stained sections using an image analyzing system. Cardiac β-myosin heavy chain (β-MHC) and α-skeletal actin (α-SKA) levels, markers of myocyte hypertrophy were evaluated by Western blot. Cardiac collagen volume fraction (CVF) was examined in picrosirius red stained section using an image analyzing system. Cardiac expression of tissue inhibitor of metalloproteinase 1 (TIMP-1) and transforming growth factor beta 1 (TGF-β1), markers of fibrosis, were determined by Western blot. RESULTS Compared to eNOS+/+ mice, we found that; 1) myocyte size was significantly increased in eNOS-/- mice; 2) cardiac expression of β-MHC was markedly elevated, while α-SKA levels remained unchanged in eNOS-/- mice; 3) cardiac total and interstitial CVF levels were significantly higher in eNOS-/- mice; and 4) cardiac TIMP-1 levels were significantly greater in eNOS-/- mice, however, cardiac TGF-β1 was not differently expressed between the two groups. CONCLUSION The current study revealed that eNOS plays a beneficial role in cardiac remodeling, preventing the heart from development of myocyte hypertrophy and cardiac fibrosis. These findings support our previous report that eNOS may modify the severity of HCM phenotypes.
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Affiliation(s)
- Meryl Musicante
- University of Tennessee Health Science Center, United States of America
| | - Hannah H Kim
- University of Tennessee Health Science Center, United States of America
| | - Yuanjian Chen
- Division of Cardiovascular Diseases, Department of Medicine(,) University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Fang Liao
- Department of Pharmacology, University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Syamal K Bhattacharya
- Division of Cardiovascular Diseases, Department of Medicine(,) University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - Lu Lu
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Science Center, Memphis, TN, United States of America.
| | - Yao Sun
- Division of Cardiovascular Diseases, Department of Medicine(,) University of Tennessee Health Science Center, Memphis, TN, United States of America.
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Savostyanov K, Pushkov A, Zhanin I, Mazanova N, Trufanov S, Pakhomov A, Alexeeva A, Sladkov D, Asanov A, Fisenko A. The prevalence of Fabry disease among 1009 unrelated patients with hypertrophic cardiomyopathy: a Russian nationwide screening program using NGS technology. Orphanet J Rare Dis 2022; 17:199. [PMID: 35578305 PMCID: PMC9109305 DOI: 10.1186/s13023-022-02319-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 04/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is a vast number of screening studies described in the literature from the beginning of the twenty-first century to the present day. Many of these studies are related to the estimation of Fabry disease (FD) morbidity among patients from high-risk groups, including adult patients with hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH). These studies show diverse detection frequencies (0-12%) depending on the methodology. Our study is the only example of large-scale selective FD screening based on the implementation of next-generation sequencing technology (NGS) as a first-level test to estimate FD morbidity in the Russian population over 18 years of age burdened with HCM. METHODS The study included 1009 patients (578 males and 431 females), with a median age of 50 years, who were diagnosed with HCM according to current clinical guidelines. In the first stage of screening, all patients underwent molecular genetic testing (NGS method) of target regions. These regions included the coding sequences of 17 genes and mutations that can lead to the development of HCM. Lysosomal globotriaosylsphingosine (lyso-Gb3) concentrations and α-galactosidase A (α-gal A) enzyme activity were measured in the second stage of screening to reveal pathogenic or likely pathogenic variants in the GLA gene. RESULTS We revealed 8 (0.8%) patients (3 (37.5%) males and 5 (62.5%) females) with an average age of 59 ± 13.3 years who had pathogenic, likely pathogenic variants and variants of uncertain significance (VUS) in the GLA gene (NM_000169.2) as a result of selective screening of 1009 Russian patients with HCM. FD was confirmed via biochemical tests in a male with the pathogenic variant c.902G > A, p.R301Q as well as in two females with likely pathogenic variants c.897C > A, p.D299E and c.1287_1288dup, p.*430Fext*?. These tests showed reduced enzymatic activity and increased substrate concentration. However, a female with the pathogenic variant c.416A > G, p.N139S and with normal enzymatic activity only had increased substrate concentrations. The revealed nucleotide variants and high values of biochemical indicators (lyso-Gb3) in these 4 patients allowed us to estimate the FD diagnosis among 1009 Russian patients with HCM. Mild extracardiac manifestations were observed in these four patients; however, both biochemical values within the reference range in females with the c.971T > G, p.L324W (VUS) variant. α-gal A activity and lyso-Gb3 concentrations were also within the normal range in two males with hemizygous variants, c.546T > C, p.D182D and c.640-794_640-791del (we regarded them as VUS), and in one female with the c.427G > A, p.A143T variant (with conflicting interpretations of pathogenicity). CONCLUSION The prevalence rate of FD among 1,009 adult Russian patients with HCM was 0.4%. We recommend FD screening among adult patients of both sexes with HCM and an undefined genetic cause via NGS method with subsequent analysis of α-gal A activity and lyso-Gb3 concentration in patients with pathogenic, likely pathogenic variants, and VUS. This strategy identifies patients with an atypical form of FD that is characterized by high residual activity of α-gal A, low concentrations of lyso-Gb3, and minor extracardiac manifestations.
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Affiliation(s)
- K Savostyanov
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia.
| | - A Pushkov
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - I Zhanin
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - N Mazanova
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - S Trufanov
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A Pakhomov
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A Alexeeva
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - D Sladkov
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - A Asanov
- Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - A Fisenko
- Federal State Autonomous Institution, "National Medical Research Center for Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
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Chen CY, Leu JG, Lin KY, Shih CY, Liang YJ. Serotonin receptor subtype-2B signaling is associated with interleukin-18-induced cardiomyoblast hypertrophy in vitro. ASIAN BIOMED 2022; 16:79-87. [PMID: 37551283 PMCID: PMC10321165 DOI: 10.2478/abm-2022-0010] [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: 11/20/2022]
Abstract
Background In patients with heart failure, interleukin-18 (IL-18) levels increase in the circulatory system and injured myocardial tissue. Serotonin (5-hydroxytryptamine) receptors subtype 2B (HTR2B) play an essential role in cardiac function and development, and their overexpression in rats leads to myocardial hypertrophy. Epigallocatechin gallate (EGCG) is cardioprotective in myocardial ischemia-reperfusion injury in rats and can prevent pressure overload-mediated cardiac hypertrophy in vivo. Mice deficient in peroxisome proliferator-activated receptor delta (PPARδ) can have cardiac dysfunction, myocardial hypertrophy, and heart failure. Matrix metalloproteinases (MMPs) are possibly involved in cardiac remodeling. However, the relationship between IL-18 signaling, cardiac hypertrophy, and the molecular mechanisms involved remain to be fully elucidated. Objectives To elucidate the relationship between HTR2B and IL-18-induced myocardial hypertrophy and examine the antihypertrophic effects of EGCG and PPARδ. Methods We induced H9c2 cardiomyoblast hypertrophy with IL-18 in vitro and investigated the downstream signaling by real-time polymerase chain reaction (PCR) and western blotting. Hypertrophy was assessed by flow cytometry. We determined the effects of EGCG and PPARδ on IL-18-induced hypertrophic signaling via HTR2B-dependent mechanisms. Results IL-18-induced H9c2 hypertrophy upregulated brain natriuretic peptide (BNP) protein and mRNA expression by inducing the expression of nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB), and the hypertrophy was attenuated by pretreatment with EGCG (20 μM) and L-165,041 (2 μM), a PPARδ agonist. IL-18 upregulated the expression of HTR2B, which was inhibited by pretreatment with EGCG and L-165,041. SB215505 (0.1 μM), a HTR2B antagonist and siRNA for HTR2B, attenuated H9c2 hypertrophy significantly. Inhibition of HTR2B also downregulated the expression of MMP-3 and MMP-9. Conclusions IL-18 and HTR2B play critical roles in cardiomyoblast hypertrophy. EGCG and L-165,041 inhibit the expression of HTR2B and augment remodeling of H9c2 cardiomyoblasts, possibly mediated by MMP-3 and MMP-9.
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Affiliation(s)
- Chao-Yi Chen
- Graduate Institute of Applied Science and Engineering, Fu-Jen Catholic University, New Taipei City242062, Taiwan
- Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City242062, Taiwan
| | - Jyh-Gang Leu
- Fu-Jen Catholic University School of Medicine, New Taipei City242062, Taiwan
- Division of Nephrology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei111, Taiwan
| | - Kuan-Yu Lin
- Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City242062, Taiwan
| | - Chin-Yu Shih
- Graduate Institute of Applied Science and Engineering, Fu-Jen Catholic University, New Taipei City242062, Taiwan
| | - Yao-Jen Liang
- Graduate Institute of Applied Science and Engineering, Fu-Jen Catholic University, New Taipei City242062, Taiwan
- Department and Institute of Life Science, Fu-Jen Catholic University, New Taipei City242062, Taiwan
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10
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Riccio A, Shilling AM. Unique Medical Considerations for the Athlete Undergoing Anesthesia. Clin Sports Med 2022; 41:185-201. [PMID: 35300834 DOI: 10.1016/j.csm.2021.11.009] [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]
Abstract
Athletes are among a unique group such that they may possess a serious underlying pathologic condition that may often go unnoticed given their high caliber of physical fitness. However, several considerations should be investigated, especially in the perioperative period, in order to minimize morbidity and mortality. Namely, cardiac pathologic condition can result in sudden death, and pulmonary pathologic condition may affect airway and respiratory management. Moreover, patients undergoing orthopedic surgery are at the highest risk for venous thromboembolism. Regardless of the condition, it is crucial to be vigilant and explore the unique medical considerations for the athlete undergoing anesthesia.
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Affiliation(s)
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, MDPO Box 800710, Charlottesville VA 22908, USA.
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11
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Mitra S, Ramanathan K, MacLaren G. Post-operative management of hypertrophic obstructive cardiomyopathy. Asian Cardiovasc Thorac Ann 2022; 30:57-63. [PMID: 35167344 DOI: 10.1177/02184923211069189] [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: 11/16/2022]
Abstract
Hypertrophic obstructive cardiomyopathy patients are at increased risk of sudden cardiac arrest due to dynamic left ventricular outflow tract obstruction, myocardial ischaemia and arrhythmias. Septal myectomy remains the gold standard therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) refractory to other therapy. This review comprehensively focuses on the post-operative management and complications of HOCM patients undergoing surgical correction. Although these patients are at risk of various perioperative complications from anaesthesia and surgery due to the underlying complexity of their disease, surgical myectomy is associated with excellent long-term outcomes if carried out in experienced centers.
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Affiliation(s)
- Saikat Mitra
- Department of Intensive Care, 3187Lyell McEwin Hospital, Adelaide, Australia
| | - Kollengode Ramanathan
- Department of Cardiac, Thoracic, and Vascular Surgery, Cardiothoracic ICU, National University Hospital, Singapore, Singapore
| | - Graeme MacLaren
- Department of Cardiac, Thoracic, and Vascular Surgery, Cardiothoracic ICU, National University Hospital, Singapore, Singapore
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12
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Das D, Acharya D, Das T, Pramanik S. Mega Coronary Arteries with Obstructive Coronary Artery Disease in Hypertrophic Obstructive Cardiomyopathy: A Case Report and Literature Review. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2022. [DOI: 10.4103/jiae.jiae_44_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Giamouzis G, Dimos A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Left ventricular hypertrophy and sudden cardiac death. Heart Fail Rev 2021; 27:711-724. [PMID: 34184173 DOI: 10.1007/s10741-021-10134-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.
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Affiliation(s)
- Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. .,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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14
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Risk stratification in hypertrophic cardiomyopathy. Herz 2020; 45:50-64. [PMID: 29696341 DOI: 10.1007/s00059-018-4700-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/15/2018] [Accepted: 03/24/2018] [Indexed: 12/20/2022]
Abstract
Sudden cardiac death (SCD) is the most devastating complication of hypertrophic cardiomyopathy (HCM). The greatest challenge in the management of HCM is identifying those at increased risk, since an implantable cardioverter-defibrillator (ICD) is a potentially life-saving therapy. We sought to summarize the available data on SCD in HCM and provide a clinical perspective on the current differing and somewhat conflicting data on risk stratification, with balanced guidance regarding rational clinical decision-making. Additionally, we sought to determine the status of the current implementation of guidelines compiled by HCM experts worldwide. The HCM Risk-SCD model helps improve the risk stratification of HCM patients for primary prevention of SCD by calculating an individual risk estimate that contributes to the clinical decision-making process. Improved risk stratification is important for decision-making before ICD implantation for the primary prevention of SCD.
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Current State of Hypertrophic Cardiomyopathy Clinical Trials. Glob Heart 2019; 14:317-325. [DOI: 10.1016/j.gheart.2019.07.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 02/06/2023] Open
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Bartoszuk U, Keene BW, Baron Toaldo M, Pereira N, Summerfield N, Novo Matos J, Glaus TM. Holter monitoring demonstrates that ventricular arrhythmias are common in cats with decompensated and compensated hypertrophic cardiomyopathy. Vet J 2018; 243:21-25. [PMID: 30606435 DOI: 10.1016/j.tvjl.2018.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 11/05/2018] [Accepted: 11/07/2018] [Indexed: 12/25/2022]
Abstract
Arrhythmias can complicate cardiac disease in cats and are a potential cause of sudden death. The aim of this study was to evaluate the presence and nature of cardiac arrhythmias, and the potential correlation between plasma serum troponin I (cTnI) concentrations and the presence or severity of arrhythmias in cats with decompensated (dHCM) and compensated hypertrophic cardiomyopathy (cHCM). Forty one client-owned cats were studied: 16 with cHCM, 15 with dHCM and 10 healthy control cats. Physical examination, echocardiography, cTnI and 24-h Holter recordings were obtained in all cats and thoracic radiographs in cats with dHCM. Cats in both HCM groups were followed for 1 year after their initial Holter examination. The median (range) number of ventricular premature complexes (VPCs) over 24h was 867 (1-35,160) in cats with dHCM, 431 (0-18,919) in cats with cHCM and 2 (0-13) in healthy control cats. The median number of episodes of ventricular tachycardia (VTach) was 0 (0-1497) in dHCM and 0.5 (0-91) in cats with cHCM. The number of VPCs, VTach episodes and heart rate was not different between the HCM groups. Plasma serum troponin I was highest in the cats with dHCM, but there was no correlation between cTnI concentration and the number of arrhythmias. Thirteen of 31 cats with HCM died, but an association with the presence and complexity of ventricular arrhythmias was not observed. Compared to healthy cats, ventricular arrhythmias were common in cats with cHCM and dHCM, but neither presence nor complexity of arrhythmias could be linked to prognosis.
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Affiliation(s)
- U Bartoszuk
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland
| | - B W Keene
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, 1052 William Moore Dr. Raleigh, NC 27607, USA
| | - M Baron Toaldo
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland; Department of Veterinary Medical Sciences, Alma Mater Studiorum - University of Bologna, Via Tolara di Sopra 50, 40064 Ozzano Emilia, Italy
| | - N Pereira
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland; Vet Zentrum, Riedäckerstrasse 7, 8422 Pfungen, Switzerland
| | - N Summerfield
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland; Virtual Veterinary Specialists, P.O. Box 1301, RH10 0NT, UK
| | - J Novo Matos
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland; Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK
| | - T M Glaus
- Division of Cardiology, Clinic for Small Animal Internal Medicine, Vetsuisse Faculty University of Zürich, Winterthurerstrasse 260, CH-8057 Zürich, Switzerland.
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Shackebaei D, Feizollahi F, Hesari M, Bahrami G. The Effect of Diazepam on the Function of Hypertrophied Rats’ Hearts in Ischemia-Reperfusion Conditions. Int Cardiovasc Res J 2016. [DOI: 10.17795/icrj-10(2)89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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18
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Cowie B. The Preoperative Patient With a Systolic Murmur. Anesth Pain Med 2015; 5:e32105. [PMID: 26705529 PMCID: PMC4688819 DOI: 10.5812/aapm.32105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/04/2015] [Indexed: 01/16/2023] Open
Abstract
Context: Patients with undifferentiated systolic murmurs present commonly during the perioperative period. Traditional bedside assessment and auscultation has not changed significantly in almost 200 years and relies on interpreting indirect acoustic events as a means of evaluating underlying cardiac pathology. This is notoriously inaccurate, even in expert cardiology hands, since many different valvular and cardiac diseases present with a similar auditory signal. Evidence Acquisition: The data on systolic murmurs, physical examination, perioperative valvular disease in the setting of non-cardiac surgery is reviewed. Results: Significant valvular heart disease increases perioperative risk in major non-cardiac surgery and increases long term patient morbidity and mortality. We propose a more modern approach to physical examination that incorporates the use of focused echocardiography to allow direct visualization of cardiac structure and function. This improves the diagnostic accuracy of clinical assessment, allows rational planning of surgery and anaesthesia technique, risk stratification, postoperative monitoring and appropriate referral to physicians and cardiologists. Conclusions: With a thorough preoperative assessment incorporating focused echocardiography, anaesthetists are in the unique position to enhance their role as perioperative physicians and influence short and long term outcomes of their patients.
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Affiliation(s)
- Brian Cowie
- Department of Anaesthesia, St. Vincent’s Hospital, Melbourne, Australia
- Corresponding author: Brian Cowie, Department of Anaesthesia, St. Vincent’s Hospital, 41 Victoria Parade, Fitzroy 3065, Melbourne, Australia. Tel: +61-39288 2211, E-mail:
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Cai Y, Tu J, Pan S, Jiang J, Shou Q, Ling Y, Chen Y, Wang D, Yang W, Shan L, Chen M. Medicinal effect and its JP2/RyR2-based mechanism of Smilax glabra flavonoids on angiotensin II-induced hypertrophy model of cardiomyocytes. JOURNAL OF ETHNOPHARMACOLOGY 2015; 169:435-440. [PMID: 25926285 DOI: 10.1016/j.jep.2015.04.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 04/08/2015] [Accepted: 04/18/2015] [Indexed: 06/04/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Rhizome and root of Smilax glabra Roxb (Liliaceae family) is a widely used traditional Chinese medicine (TCM) named Tu-fu-ling (TFL) for cardiac disease therapy. The TFL flavonoids (TFLF) has been extracted and proven to possess the anti-cardiac hypertrophy effect in our previous reports. Such effect could be mediated by the modulation of intracellular Ca(2+) flux in myocardial cells, in which junctophilin-2 (JP2) and ryanodine receptor 2 (RyR2) play an important role. However, its mechanism of the anti-cardiac hypertrophy effect remains unclarified. MATERIALS AND METHODS 2μmol/L Ang II was applied to induce hypertrophy model of rat primary cardiomyocytes. After treatment of TFLF at 0.25, 0.5 and 1.0mg/ml, the cell size was microscopic measured, and the protein and mRNA expressions of JP2 and RyR2 in cardiomyocytes were estimated by immunofluorescence imaging, ELISA and real-time PCR assay. RESULTS Obvious hypertrophy of cardiomyocytes was induced by Ang II but reversed by TFLF from 0.5 to 1.0mg/ml. The protein and mRNA expressions of JP2 and RyR2 in cardiomyocytes were also inhibited by Ang II but restored by TFLF at its dose range. Such effect of TFLF was exerted at a dose dependent manner, which was even better than that of verapamil. CONCLUSIONS Our findings may evidence the correlation between JP2/RyR2 and myocardiac hypertrophy, and indicate the JP2/RyR2-mediated anti-hypertrophy mechanism of TFLF for the first time. It deserves to be developed as a promising TCM candidate of new drug for myocardial hypertrophy treatment.
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Affiliation(s)
- Yueqin Cai
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Jue Tu
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Shuizhen Pan
- Zhejiang Academy of Medical Sciences, Hangzhou 310007, China
| | - Jianping Jiang
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Qiyang Shou
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yun Ling
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Yunxiang Chen
- Zhejiang Academy of Medical Sciences, Hangzhou 310007, China
| | - Dejun Wang
- Zhejiang Chinese Medical University, Hangzhou 310053, China.
| | - Weiji Yang
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Letian Shan
- Zhejiang Chinese Medical University, Hangzhou 310053, China
| | - Minli Chen
- Zhejiang Chinese Medical University, Hangzhou 310053, China
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Vriesendorp PA, Schinkel AFL, Liebregts M, Theuns DAMJ, van Cleemput J, Ten Cate FJ, Willems R, Michels M. Validation of the 2014 European Society of Cardiology guidelines risk prediction model for the primary prevention of sudden cardiac death in hypertrophic cardiomyopathy. Circ Arrhythm Electrophysiol 2015; 8:829-35. [PMID: 25922410 DOI: 10.1161/circep.114.002553] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 04/17/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND The recently released 2014 European Society of Cardiology guidelines of hypertrophic cardiomyopathy (HCM) use a new clinical risk prediction model for sudden cardiac death (SCD), based on the HCM Risk-SCD study. Our study is the first external and independent validation of this new risk prediction model. METHODS AND RESULTS The study population consisted of a consecutive cohort of 706 patients with HCM without prior SCD event, from 2 tertiary referral centers. The primary end point was a composite of SCD and appropriate implantable cardioverter-defibrillator therapy, identical to the HCM Risk-SCD end point. The 5-year SCD risk was calculated using the HCM Risk-SCD formula. Receiver operating characteristic curves and C-statistics were calculated for the 2014 European Society of Cardiology guidelines, and risk stratification methods of the 2003 American College of Cardiology/European Society of Cardiology guidelines and 2011 American College of Cardiology Foundation/American Heart Association guidelines. During follow-up of 7.7±5.3 years, SCD occurred in 42 (5.9%) of 706 patients (ages 49±16 years; 34% women). The C-statistic of the new model was 0.69 (95% CI, 0.57-0.82; P=0.008), which performed significantly better than the conventional risk factor models based on the 2003 guidelines (C-statistic of 0.55: 95% CI, 0.47-0.63; P=0.3), and 2011 guidelines (C-statistic of 0.60: 95% CI, 0.50-0.70; P=0.07). CONCLUSIONS The HCM Risk-SCD model improves the risk stratification of patients with HCM for primary prevention of SCD, and calculating an individual risk estimate contributes to the clinical decision-making process. Improved risk stratification is important for the decision making before implantable cardioverter-defibrillator implantation for the primary prevention of SCD.
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Affiliation(s)
- Pieter A Vriesendorp
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.).
| | - Arend F L Schinkel
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Max Liebregts
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Dominic A M J Theuns
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Johan van Cleemput
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Folkert J Ten Cate
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Rik Willems
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
| | - Michelle Michels
- From the Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (P.A.V., A.F.L.S., D.A.M.J.T., F.J.t.C., M.M.); Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands (M.L.); and Department of Cardiovascular Diseases of the University of Leuven, Leuven, Belgium (J.v.C., R.W.)
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Lear-Kaul KC. Investigation of Sudden Death in Athletes: The Fittest Bodies in the Morgue. Acad Forensic Pathol 2014. [DOI: 10.23907/2014.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Sporting events are generally viewed as regulated activities with fit and healthy participants; therefore, when deaths occur, they draw considerable public interest. Athletic participants can be considered a vulnerable population based on inherent risks within certain sports and the associated physiologic stresses, which may complicate underlying medical conditions. Sudden deaths in young athletes participating in high school and collegiate organized sports occur at an average of four to six deaths per year; however, sudden deaths related to exercise outside of an organized sport setting remain unaccounted for in the overall prevalence of these deaths. A typical forensic pathology practice will see not only these higher-profile deaths occurring during an organized sporting event, but also lower-profile occurrences of individuals dying during more recreational or unstructured exercise. Sport-related deaths can essentially be categorized as those that occur due to dangers inherent in the sport itself, such as forms of heat-related illnesses, blunt force trauma, and water-related deaths, and those that occur due to susceptibilities of a given predisposed participant, including sickle cell trait, hypertrophic cardiomyopathy, and other cardiovascular diseases. This article will address both types of vulnerabilities and provide guidance for appropriate and specific medicolegal death investigation and autopsy procedures in these deaths.
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Affiliation(s)
- Kelly C. Lear-Kaul
- Forensic Pathologist and the Coroner at the Arapahoe County (Colorado) Coroner's Office and University of Colorado Anschutz Medical Campus
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Yim ES, Gillis EF, Ojala K, MacDonald J, Basilico FC, Corrado GD. Focused transthoracic echocardiography by sports medicine physicians: measurements relevant to hypertrophic cardiomyopathy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:333-338. [PMID: 23341391 DOI: 10.7863/jum.2013.32.2.333] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether sports medicine physicians can use portable echocardiography to obtain measurements pertinent to hypertrophic cardiomyopathy. METHODS Thirty male collegiate athletes, aged 18 to 21 years, were prospectively enrolled. Focused portable echocardiography was performed by a board-certified sports medicine physician and a resident physician, followed by comprehensive echocardiography within 2 weeks by a registered diagnostic cardiac sonographer. A left parasternal long-axis view was acquired to measure 3 dimensions: (1) end-diastolic interventricular septal thickness (IVSd), (2) end-diastolic left ventricular internal diameter (LVIDd), and (3) end-diastolic left ventricular posterior wall thickness (LVPWd). RESULTS Intraclass correlation coefficients between the sports medicine physician and the sonographer were strong: 0.77 for IVSd, 0.73 for LVIDd, and 0.64 for LVPWd. Intraclass correlation coefficients between measurements by the resident physician and sonographer were strong to moderate: 0.61 for IVSd, 0.62 for LVIDd, and 0.63 for LVPWd. Across all 3 readers, intraclass correlation coefficient calculations were 0.77 for IVSd, 0.81 LVIDd, and 0.75 for LVPWd, which indicated strong inter-rater reliability. CONCLUSIONS Sports medicine physicians are able to obtain measurements relevant to the diagnosis of hypertrophic cardiomyopathy with focused portable echocardiography that are consistent with comprehensive echocardiography by a registered sonographer.
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Affiliation(s)
- Eugene S Yim
- Division of Sports Medicine, Children's Hospital Boston, Boston, MA 02115 USA.
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CME Prescreening of adolescent athletes: How much evaluation is enough? JAAPA 2012; 25:54-9. [DOI: 10.1097/01720610-201211000-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Capek P, Vondrasek J, Skvor J, Brdicka R. Hypertrophic cardiomyopathy: from mutation to functional analysis of defective protein. Croat Med J 2012; 52:384-91. [PMID: 21674835 PMCID: PMC3118724 DOI: 10.3325/cmj.2011.52.384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim To analyze the genesis of hypertrophic cardiomyopathy on a large cohort of patients from molecular genetics point of view and perform the functional analysis of the 3D molecular model of defective myosin-7 protein in silico. Methods The study enrolled 153 patients with diagnosed hypertrophic cardiomyopathy from different parts of the Czech Republic. DNA samples were analyzed for mutations in exons 21 and 22 of the MYH7 gene, which have been associated with high mutation clustering. The 3D model of human myosin-7 was built using the x-ray structure of nucleotide-free scallop myosin S1 as the structural template. We performed de novo structure prediction of mutant and wild type peptides spanning the 769-788 amino acids region of the myosin-7 protein. Results The Arg870His and Asp778Val amino acid alterations were found in 2 unrelated patients with a severe form of hypertrophic cardiomyopathy. The Asp778Val variation was chosen for subsequent 3D molecular modeling in silico. The mutation of the Asp by Val not only changes the character of the interaction pattern with other amino acids or ions but Val, being a small hydrophobic amino acid, can also completely change the stability of the region. Conclusion Mutation location in the MYH7 gene and changes in amino acid composition may have a crucial negative impact on the outcome of the disease in patients with hypertrophic cardiomyopathy. In addition, a mutation that changes the charge of the amino acid is more likely to affect protein function than a conservative mutation.
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Affiliation(s)
- Pavel Capek
- Department of Anthropology and Human Genetics, Charles University, Prague, Czech Republic.
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Vílchez JA, Hernández-Romero D, Ruiz-Espejo F, Garcia-Honrubia A, Valdés M, Martínez-Hernández P, Marín F. Collagen peptides, interstitial remodelling and sudden cardiac death in hypertrophic cardiomyopathy. Clin Chem Lab Med 2011; 49:1569-71. [DOI: 10.1515/cclm.2011.642] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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