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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Paludan-Müller C, Hassager C, Kjærgaard J, Tfelt-Hansen J, Winkel BG. Toxicological profile using mass spectrometry in sudden cardiac arrest survivors admitted to a tertiary centre. Resuscitation 2024; 198:110197. [PMID: 38582441 DOI: 10.1016/j.resuscitation.2024.110197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND There has been no previous thorough toxicological examination of a cohort of patients with resuscitated sudden cardiac arrest. We aimed to determine the qualitative and quantitative drug composition in a resuscitated sudden cardiac arrest population, using forensic toxicology, with focus on prescribed, non-prescribed, and commonly abused drugs. METHODS Individuals aged 18-90 years with resuscitated sudden cardiac arrest of presumed cardiac causes were prospectively included from a single tertiary center. Data from the sudden cardiac arrest hospitalization was collected from medical reports. Drugs used during resuscitation or before the blood sampling were identified and excluded in each patient. Mass spectrometry-based toxicology was performed to determine the absence or presence of most drugs and to quantify the findings. RESULTS Among 186 consecutively enrolled resuscitated sudden cardiac arrest patients (median age 62 years, 83% male), 90% had a shockable rhythm, and were primarily caused by ischemic heart disease (66%). In total, 90 different drugs (excluding metabolites) were identified, and 82% of patients had at least one drug detected (median of 2 detected drugs (IQR:1-4)) (polypharmacy). Commonly abused drugs were present in 16%, and QT-prolonging drugs were present in 12%. Polypharmacy (≥5drugs) were found in 19% of patients. Importantly, none had potentially lethal concentrations of any drugs. CONCLUSION In resuscitated sudden cardiac arrest patients with cardiac arrest of presumed cardiac cause, routine toxicological screening provides limited extra information. However, the role of polypharmacy in sudden cardiac arrest requires further investigation. No occult overdose-related cardiac arrests were identified.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Paludan-Müller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Stampe NK, Ottenheijm ME, Drici L, Wewer Albrechtsen NJ, Nielsen AB, Christoffersen C, Warming PE, Engstrøm T, Winkel BG, Jabbari R, Tfelt-Hansen J, Glinge C. Discovery of plasma proteins associated with ventricular fibrillation during first ST-elevation myocardial infarction via proteomics. Eur Heart J Acute Cardiovasc Care 2024; 13:264-272. [PMID: 37811694 DOI: 10.1093/ehjacc/zuad125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/23/2023] [Accepted: 10/06/2023] [Indexed: 10/10/2023]
Abstract
AIMS The underlying biological mechanisms of ventricular fibrillation (VF) during acute myocardial infarction are largely unknown. To our knowledge, this is the first proteomic study for this trait, with the aim to identify and characterize proteins that are associated with VF during first ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS We included 230 participants from a Danish ongoing case-control study on patients with first STEMI with VF (case, n = 110) and without VF (control, n = 120) before guided catheter insertion for primary percutaneous coronary intervention. The plasma proteome was investigated using mass spectrometry-based proteomics on plasma samples collected within 24 h of symptom onset, and one patient was excluded in quality control. In 229 STEMI patients {72% men, median age 62 years [interquartile range (IQR): 54-70]}, a median of 257 proteins (IQR: 244-281) were quantified per patient. A total of 26 proteins were associated with VF; these proteins were involved in several biological processes including blood coagulation, haemostasis, and immunity. After correcting for multiple testing, two up-regulated proteins remained significantly associated with VF, actin beta-like 2 [ACTBL2, fold change (FC) 2.25, P < 0.001, q = 0.023], and coagulation factor XIII-A (F13A1, FC 1.48, P < 0.001, q = 0.023). None of the proteins were correlated with anterior infarct location. CONCLUSION Ventricular fibrillation due to first STEMI was significantly associated with two up-regulated proteins (ACTBL2 and F13A1), suggesting that they may represent novel underlying molecular VF mechanisms. Further research is needed to determine whether these proteins are predictive biomarkers or acute phase response proteins to VF during acute ischaemia.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Maud Eline Ottenheijm
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Lylia Drici
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Nicolai J Wewer Albrechtsen
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Annelaura Bach Nielsen
- NNF Center for Protein Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Biochemistry, Copenhagen University Hospital Bispebjerg Hospital, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Centre of Diagnostic Investigation, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peder Emil Warming
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Thomas Engstrøm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital-Rigshospitalet, Inge Lehmanns Vej 7, Copenhagen 2100, Denmark
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Wagner MK, Christensen J, Christensen KA, Dichman C, Gottlieb R, Kolster I, Hansen CM, Hoff H, Hassager C, Folke F, Winkel BG. A multidisciplinary guideline-based approach to improving the sudden cardiac arrest care pathway: The Copenhagen framework. Resusc Plus 2024; 17:100546. [PMID: 38260118 PMCID: PMC10801323 DOI: 10.1016/j.resplu.2023.100546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Although recommended in the European Resuscitation Council (ERC) and European Society of Intensive Care Medicine (ESICM) Guidelines, a framework for delivering post-cardiac arrest care in a systematic manner in dedicated high-volume cardiac arrest centers is lacking in the existing literature. To our knowledge, the Copenhagen Framework is the only established framework of its kind. The framework comprises management of out-of-hospital cardiac arrest (OHCA) survivors, and follow-up, and rehabilitation. The framework also incorporates research projects on cardiac arrest survivors and their close family members. The overall aim of this paper is to describe a framework made in order to bridge the gaps between international recommendations and delivering high-quality post-resuscitation clinical care, improving the continuity of care for OHCA survivors, access to post-CA rehabilitation, a seamless transition to everyday life, and ultimately patient outcomes in the future.
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Affiliation(s)
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kate Allen Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Camilla Dichman
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Rikke Gottlieb
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ida Kolster
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Carolina Malta Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Ballerup, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Helle Hoff
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte University Hospital, Hellerup, Denmark
- Copenhagen Emergency Medical Services, Copenhagen University, Ballerup, Denmark
- Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
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Christensen J, Winkel BG, Kirkeskov L, Folke F, Winther-Jensen M, Eckhardt-Bentsen C, Kjærgaard J, Hassager C, Wagner MK. The ROCK trial-a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol. Trials 2024; 25:99. [PMID: 38303019 PMCID: PMC10835971 DOI: 10.1186/s13063-024-07911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Most cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care. METHODS AND ANALYSIS The ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA. DISCUSSION The ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov NCT05173740. Registered on May 2018.
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Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital-Rigshospitalet, 2100, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lilli Kirkeskov
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christine Eckhardt-Bentsen
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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Pakanen L, Appel H, Ahtikoski A, Holm PH, Kreus M, Olsen KB, Banner J, Winkel BG, Huikuri H, Kaarteenaho R, Junttila J. Primary myocardial fibrosis - a distinct entity characterized by heterogeneous histology. Cardiovasc Pathol 2023; 67:107573. [PMID: 37683738 DOI: 10.1016/j.carpath.2023.107573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
Primary myocardial fibrosis (PMF), defined as myocardial fibrosis in the absence of identifiable causes, may represent a common alternative phenotype in various cardiomyopathies and contribute to sudden cardiac death (SCD). No previous definitions of histopathological characteristics exist for PMF. We aimed to evaluate whether common features of fibrosis could be identified. PMF cases (n = 28) were selected from the FinGesture cohort consisting of 5,869 SCD victims that underwent a medicolegal autopsy. Twelve trauma controls and 10 ischemic heart disease cases were selected as reference groups. Further 3 PMF cases and 5 ischemic heart disease cases from autopsies performed in the University of Copenhagen, Denmark, were selected for a validation substudy. Relative area of fibrosis, amount of diffuse and perivascular fibrosis, and location of fibrosis were assessed from left ventricle myocardial samples stained with Masson trichrome. Further evaluations were performed with alpha-smooth muscle actin (α-SMA), vimentin, and CD68 stainings. Mean relative area of fibrosis was 5.8 ± 10.7%, 1.0 ± 0.7%, and 7.0 ± 7.4% in PMF, trauma controls, and ischemic cases, respectively. Fibrosis in the PMF group was mostly located in other sites than the endocardium. Most cases with fibrosis had vimentin-positive but α-SMA-negative stromal cells within fibrotic areas. Histopathologically, PMF represents a heterogeneous entity with variable fibrotic lesions affecting the whole myocardium and a suggested significant role of fibroblasts. These findings may bring validation to PMF being a common manifestation of cardiomyopathies. Evidently, PMF stands out as a particular entity demanding special attention as a cause of SCD.
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Affiliation(s)
- Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Oulu, Finland; Department of Forensic Medicine, Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu, Oulu, Finland.
| | - Henrik Appel
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Anne Ahtikoski
- Department of Pathology, The Welfare District of Southwest Finland, Turku University Hospital and University of Turku, Turku, Finland
| | - Pernille Heimdal Holm
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mervi Kreus
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center of Internal Medicine and Respiratory Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Kristine Boisen Olsen
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Heikki Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Riitta Kaarteenaho
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Center of Internal Medicine and Respiratory Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center (MRC) Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland; Biocenter Oulu, University of Oulu, Oulu, Finland
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6
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Hansen CJ, Svane J, Lynge TH, Stampe NK, Bhardwaj P, Torp-Pedersen C, Banner J, Tfelt-Hansen J, Winkel BG. Differences among young unwitnessed sudden cardiac death, according to time from last seen alive: Insights from a 15-year nationwide study. Heart Rhythm 2023; 20:1504-1509. [PMID: 37453604 DOI: 10.1016/j.hrthm.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/22/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND More than half of all sudden cardiac deaths (SCDs) are unwitnessed, but the composition of the unwitnessed SCD population is poorly described. OBJECTIVE The purpose of this study was to compare clinical and autopsy characteristics of young unwitnessed SCD subjects, based on the time from last contact to being found dead. METHODS All unwitnessed SCD subjects aged 1-35 years in Denmark from 2000-2014 identified through a multisource approach were included. Time from last seen alive to being found dead was dichotomized to <1 hour or 1-24 hours. Clinical characteristics and autopsy results were compared, and predictors of autopsy were assessed by logistic regression. RESULTS Of 440 unwitnessed SCD subjects, 366 (83%) had not been seen alive within 1 hour of being found dead. Comorbidities differed between the groups, with more epilepsy (17% vs 5%) and psychiatric diseases (13% vs 7%) in the 24-hour group. Patients in the 24-hour group died more frequently during sleep (64% vs 23%), the autopsy rate was higher (75% vs 61%), and deaths were more often unexplained after autopsy (69% vs 53%). Having been seen within 1 hour of death independently decreased the chance of being autopsied (odds ratio 0.51; 95% confidence interval 0.27-1.00; P = .0497). CONCLUSION The majority of unwitnessed SCD subjects had not been seen alive within 1 hour of being found dead. Clinical- and autopsy-related characteristics differed between the 2 groups. Differences were mainly attributable to death-related circumstances and comorbidities. Excluding SCD cases not seen alive within 1 hour of being found dead would severely underestimate the burden of SCD.
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Affiliation(s)
- Carl Johann Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark.
| | - Jesper Svane
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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7
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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Jespersen CHB, Krøll J, Bhardwaj P, Winkel BG, Jacobsen PK, Jøns C, Haarbo J, Kristensen J, Johansen JB, Philbert BT, Riahi S, Torp-Pedersen C, Køber L, Tfelt-Hansen J, Weeke PE. Severity of Brugada syndrome disease manifestation and risk of new-onset depression or anxiety: a Danish nationwide study. Europace 2023; 25:euad112. [PMID: 37129985 PMCID: PMC10228627 DOI: 10.1093/europace/euad112] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 05/03/2023] Open
Abstract
AIMS Reduced psychological health is associated with adverse patient outcomes and higher mortality. We aimed to examine if a Brugada syndrome (BrS) diagnosis and symptomatic disease presentation were associated with an increased risk of new-onset depression or anxiety and all-cause mortality. METHODS AND RESULTS All Danish patients diagnosed with BrS (2006-2018) with no history of psychiatric disease and available for ≥6 months follow-up were identified using nationwide registries and followed for up to 5 years after diagnosis. The development of clinical depression or anxiety was evaluated using the prescription of medication and diagnosis codes. Factors associated with developing new-onset depression or anxiety were determined using a multivariate Cox proportional hazards regression model. Disease manifestation was categorized as symptomatic (aborted cardiac arrest, ventricular tachycardia, or syncope) or asymptomatic/unspecified at diagnosis. A total of 223 patients with BrS and no history of psychiatric disease were identified (72.6% male, median age at diagnosis 46 years, 45.3% symptomatic). Of these, 15.7% (35/223) developed new-onset depression or anxiety after BrS diagnosis (median follow-up 5.0 years). A greater proportion of symptomatic patients developed new-onset depression or anxiety compared with asymptomatic patients [21/101 (20.8%) and 14/122 (11.5%), respectively, P = 0.08]. Symptomatic disease presentation (HR 3.43, 1.46-8.05) and older age (lower vs. upper tertile: HR 4.41, 1.42-13.63) were significantly associated with new-onset depression or anxiety. All-cause mortality in this group of patients treated according to guidelines was low (n = 4, 1.8%); however, 3/4 developed depression or anxiety before death. CONCLUSION Approximately, one-sixth of patients with BrS developed new-onset depression or anxiety following a diagnosis of BrS. Symptomatic BrS disease manifestation was significantly associated with new-onset depression or anxiety.
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Affiliation(s)
- Camilla H B Jespersen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Johanna Krøll
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter Karl Jacobsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Christian Jøns
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jens Haarbo
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jens Brock Johansen
- Department fo Cardiology, Odense University Hospital, J B Winsløws Vej 4, 5000 Odense C, Denmark
| | - Berit T Philbert
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen K, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Frederik V's Vej 11, 2100 Copenhagen Ø, Denmark
| | - Peter E Weeke
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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9
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Holm JT, Stampe NK, Bhardwaj P, Jabbari R, Gustafsson F, Risum N, Tfelt-Hansen J, Winkel BG. Bundle branch block in cardiac arrest survivors without ischemic heart disease. Int J Cardiol Heart Vasc 2023; 45:101188. [PMID: 36896255 PMCID: PMC9989659 DOI: 10.1016/j.ijcha.2023.101188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/19/2023] [Indexed: 03/05/2023]
Abstract
Aims Cardiac arrest (CA) survivors with left/right bundle branch block (LBBB/RBBB) and no ischemic heart disease (IHD) have not been previously characterized. The aim of this study was to describe heart failure, implantable cardioverter defibrillator (ICD) therapy and mortality in this population. Methods Between 2009 and 2019 we consecutively identified all CA survivors with a consistent bundle branch block (BBB) defined as a QRS ≥ 120 ms, who had a secondary prophylactic ICD implanted. Patients with congenital and ischemic heart disease (IHD) were excluded. Results Among 701 CA-survivors who survived to discharge and received an ICD, a total of 58 (8%) were free from IHD and had BBB; 46 (79%) had LBBB, 10 (17%) had RBBB and 2 (3%) had non-specific BBB (NSBBB). The prevalence of LBBB was 7%. Pre-arrest ECG were available in 34 (59%) patients; 20 patients (59%) had LBBB, 6 (18%) had RBBB, 2 (6%) had NSBBB, 1 had (3%) incomplete LBBB, and 4 (12%) without BBB. At discharge, patients with LBBB had a significantly lower left ventricular ejection fraction (LVEF) than patients with other types of BBB, p < 0.001. During follow-up, 7 (12%) died after a median of 3.6 years (IQR: 2.6-5.1) with no difference between BBB subtypes. Conclusion We identified 58 CA-survivors with BBB and no IHD. The prevalence of LBBB among all CA-survivors was high, 7%. During CA hospitalization LBBB patients presented with a significantly lower LVEF than patients with other types of BBB (P < 0.001). ICD treatment and mortality did not differ between BBB subtypes during follow-up.
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Affiliation(s)
- Julie Terp Holm
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Clinical Medicine, Copenhagen University, Blegdamsvej 3, 2100 Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
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10
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Tfelt-Hansen J, Winkel BG, de Riva M, Zeppenfeld K. The '10 commandments' for the 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2023; 44:176-177. [PMID: 36477551 DOI: 10.1093/eurheartj/ehac699] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Marta de Riva
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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11
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Glinge C, Rossetti S, Oestergaard LB, Stampe NK, Lynge TH, Skals R, Winkel BG, Lodder EM, Bezzina CR, Gislason G, Banner J, Behr ER, Torp-Pedersen C, Jabbari R, Tfelt-Hansen J. Risk of Sudden Infant Death Syndrome Among Siblings of Children Who Died of Sudden Infant Death Syndrome in Denmark. JAMA Netw Open 2023; 6:e2252724. [PMID: 36696110 DOI: 10.1001/jamanetworkopen.2022.52724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Sudden infant death syndrome (SIDS) remains a leading cause of death during the first year of life. The etiology of SIDS is complex and remains largely unknown. OBJECTIVE To evaluate whether siblings of children who died of SIDS have a higher risk of SIDS compared with the general pediatric population. DESIGN, SETTING, AND PARTICIPANTS This register-based cohort study used Danish nationwide registers. Participants were all infants (<1 year) in Denmark between January 1, 1978, and December 31, 2016, including siblings of children who died of SIDS. Siblings were followed up from the index cases' date of SIDS, date of birth, or immigration, whichever came first, and until age 1 year, emigration, developing SIDS, death, or study end. The median (IQR) follow-up was 1 (1-1) year. Data analysis was conducted from January 2017 to October 2022. MAIN OUTCOMES AND MEASURES Standardized incidence ratios (SIRs) of SIDS were calculated with Poisson regression models relative to the general population. RESULTS In a population of 2 666 834 consecutive births (1 395 199 [52%] male), 1540 infants died of SIDS (median [IQR] age at SIDS, 3 [2-4] months) during a 39-year study period. A total of 2384 younger siblings (cases) to index cases (first sibling with SIDS) were identified. A higher rate of SIDS was observed among siblings compared with the general population, with SIRs of 4.27 (95% CI, 2.13-8.53) after adjustment for sex, age, and calendar year and of 3.50 (95% CI, 1.75-7.01) after further adjustment for mother's age (<29 years vs ≥29 years) and education (high school vs after high school). CONCLUSIONS AND RELEVANCE In this nationwide study, having a sibling who died of SIDS was associated with a 4-fold higher risk of SIDS compared with the general population. Shared genetic and/or environmental factors may contribute to the observed clustering of SIDS. The family history of SIDS should be considered when assessing SIDS risk in clinical settings. A multidisciplinary genetic evaluation of families with SIDS could provide additional evidence.
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Affiliation(s)
- Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Sára Rossetti
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise Bruun Oestergaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Regitze Skals
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Cardiology Section, St George's, University of London, London, United Kingdom
- St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- Mayo Clinic Healthcare, London, United Kingdom
| | - Christian Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Cardiology, North Zealand University Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Lynge TH, Nielsen JL, Risgaard B, van der Werf C, Winkel BG, Tfelt-Hansen J. Causes of sudden cardiac death according to age and sex in persons aged 1-49 years. Heart Rhythm 2023; 20:61-68. [PMID: 36075534 DOI: 10.1016/j.hrthm.2022.08.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/30/2022] [Accepted: 08/30/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Knowledge of causes of sudden cardiac death (SCD) according to age is important in clinical decision making and to lower the risk of SCD in family members of the deceased. OBJECTIVE The purpose of this study was to report overall and sex-stratified causes of SCD according to age in persons aged 1-49 years. METHODS The study population consisted of all persons in Denmark aged 1-35 years in 2000-2009 and 36-49 years in 2007-2009, which equals 27.1 million person-years. Danish death certificates, discharge summaries, autopsy reports, and data from nationwide registries were used to identify all SCD cases. The SCD cases were divided into 5-year age groups. RESULTS In the 10-year study period, there were 14,294 deaths, of which 1362 (10%) were classified as SCD. Potentially inherited cardiac disease accounted for a high proportion (43%-78%) of autopsied SCD in all age groups. A significant proportion (19%-54%) of SCD was caused by sudden arrhythmic death syndrome in all age groups. Autopsy rates in both sudden unexpected death cases and SCD cases declined significantly with increasing age (74% in the youngest age group vs 35% in the oldest). CONCLUSION The proportion of SCD cases that were identified with a potentially inherited cardiac disease postmortem was high in all studied age groups, while autopsy rates in sudden and unexpected death cases declined markedly with increasing age. Our findings indicate that diagnoses of inherited heart disease are likely missed in some SCD cases, along with the opportunity for treatment and prevention in surviving relatives.
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Affiliation(s)
- Thomas Hadberg Lynge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Jakob Lund Nielsen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bjarke Risgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian van der Werf
- Department of Clinical and Experimental Cardiology, Heart Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Ensam B, Cheung CC, Almehmadi F, Gregers Winkel B, Scrocco C, Brennan P, Leong K, Muir A, Vanarva A, Tfelt-Hansen J, Roberts JD, Krahn AD, Behr ER. The Utility of Sodium Channel Provocation in Unexplained Cardiac Arrest Survivors and Electrocardiographic Predictors of Ventricular Fibrillation Recurrence. Circ Arrhythm Electrophysiol 2022; 15:e011263. [PMID: 36441561 PMCID: PMC10289235 DOI: 10.1161/circep.122.011263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The implications of a drug-induced type 1 Brugada ECG pattern following sodium channel blocker provocation (SCBP) are not fully understood. METHODS Baseline clinical and ECG data were obtained from consecutive unexplained cardiac arrest survivors undergoing SCBP at 3 centers. A further 15 SCBP positive (SCBP+) unexplained cardiac arrest survivors were recruited from 3 additional centers to explore ventricular fibrillation recurrence. RESULTS A total of 121 consecutive unexplained cardiac arrest survivors underwent SCBP. The yield of the drug-induced type 1 Brugada ECG pattern was 17%. A baseline type 2/3 Brugada pattern (T2/3BP) (adjusted odds ratio, 19.36 [2.74-136.61]; P=0.003) and PR interval (odds ratio, 1.03 [1.01-1.05] per ms; P=0.017) were independent predictors of SCBP+ response. A pathogenic SCN5A variant was identified in 36% of the SCBP+ group versus 0% in the SCBP- group (P<0.001). Amongst SCBP+ patients, a spontaneous type 1 Brugada pattern was identified in 19% during follow up and in 24% a type 1 Brugada pattern was identified in a relative. Prior syncope (adjusted hazard ratio, 3.83 [1.36-10.78]; P=0.011) and the presence of global early repolarization (hazard ratio, 7.91 [3.22-19.44]; P<0.001) were independent predictors of 5-year ventricular fibrillation recurrence. There was a nonsignificant trend toward greater 5-year ventricular fibrillation recurrence in the SCBP- group (23/95 [24%] versus 3/34 [9%]; P=0.055). CONCLUSIONS The yield of the drug-induced type 1 Brugada ECG pattern in consecutive unexplained cardiac arrest survivors undergoing SCBP is 17%. A baseline T2/3BP and PR interval were independent predictors of the drug-induced type 1 Brugada ECG pattern. Greater heritability of BrS phenotype in this group was evidenced by a greater prevalence of pathogenic SCN5A variants and relatives with a type 1 Brugada pattern. A history of prior syncope and the presence of global early repolarization were independent predictors of ventricular fibrillation recurrence.
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Affiliation(s)
- Bode Ensam
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
| | - Christopher C. Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver (C.C.C., A.D.K.)
| | - Fahad Almehmadi
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (F.A., J.D.R.)
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
| | - Chiara Scrocco
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
| | - Paul Brennan
- Royal Victoria Hospital, Belfast, United Kingdom (P.B., A.M.)
| | - Kevin Leong
- Imperial College Healthcare NHS Trust, London, United Kingdom (K.L., A.V.)
| | - Alison Muir
- Royal Victoria Hospital, Belfast, United Kingdom (P.B., A.M.)
| | - Amanda Vanarva
- Imperial College Healthcare NHS Trust, London, United Kingdom (K.L., A.V.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark (B.G.W., J.T.-H.)
- Section of Forensic Genetics, Department of Forensic Medicine, Copenhagen University, Denmark (J.T.-H.)
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (F.A., J.D.R.)
| | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver (C.C.C., A.D.K.)
| | - Elijah R. Behr
- Cardiology Clinical Academic Group, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom (B.E., C.S., E.R.B.)
- Institute of Molecular and Clinical Sciences, St George’s University of London, United Kingdom (B.E., C.S., E.R.B.)
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14
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 613] [Impact Index Per Article: 306.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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15
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Hansen CJ, Bhardwaj PK, Svane J, Hadberg-Lynge T, Tfelt-Hansen J, Winkel BG. Effect of time on characterics and cause of death in unwitnessed, young sudden cardiac death cases. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Around 50% of all sudden cardiac death (SCD) cases are unwitnessed. According to the World Health Organization's definition of sudden cardiac death, any unwitnessed death is considered SCD if the person was last seen alive and well within 24 hours of death and with confirmed or suspected cardiac cause of death. The length of this timespan has been debated, as the nature of death in unwitnessed cases is less certain compared to witnessed cases. The effect of time on the composition of the group of unwitnessed SCD cases has not previously been assessed.
Purpose
This study aimed to compare clinical characteristics and causes of death among unwitnessed SCD cases last seen alive within 1 hour or 24 hours.
Methods
This nationwide, retrospective study conducted in Denmark included all deceased persons aged 1–35 from 2000–2014. The highly descriptive Danish death certificates were utilized to identify all sudden and unexpected deaths. Through subsequent examination of autopsy reports and discharge summaries, we identified all SCD cases. In addition, witnessed status and time since last seen alive (1 vs. 24 hours) were recorded. Information on comorbidities was collected from the Danish Health Registries.
Results
During the 15-year study period, we identified 857 SCD. Of these, 353 (41%) were witnessed, and 441 (51%) were unwitnessed; 62 (7%) cases had unknown witnessed status. Among the unwitnessed SCD, 75 (17%) were last seen alive within 1 hour, and the remaining 366 (83%) were seen alive within 24 hours.
Comparison of clinical characteristics and cause of death revealed few but distinct differences. Cases seen within 1 hour were of male predominance (82% vs. 65%, p=0.005). The comorbidity burden was similar, except for epilepsy which was significantly more prevalent among the group last seen alive within 24 hours. Circumstances regarding death also differed among the groups: Cases seen alive within 1 hour were more often awake at the time of death (72% vs. 36%, p<0.001) when compared to cases seen alive within 24 hours, and they were less often autopsied (61% vs. 75%, p=0.02). Among autopsied cases, structural heart disease was more often the cause of death among persons last seen alive within 1 hour (58% vs. 40%, p=0.02). In both groups. The most common cause of death was sudden unexpected death, but the proportion was significantly higher in the 24-hour group (60% vs 42%, p=0.03). Arrhythmogenic cardiomyopathy and thoracic aortic dissection were significantly more prevalent among cases seen within 1 hour (11% vs. 3%, p=0.002 for both).
Conclusions
In this 15-year nationwide study of SCD in Denmark, we found few, marked differences in cause of death and clinical characteristics between unwitnessed SCD last seen alive within 1 and 24 hours. Male sex predominated in cases seen within 1 hour, and the autopsy rate was significantly lower. In the autopsied cases structural heart disease was more common in cases seen alive within 1 hour.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Copenhagen
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Affiliation(s)
- C J Hansen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - P K Bhardwaj
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Svane
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - T Hadberg-Lynge
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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16
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Thomsen AF, Winkel BG, Jons C, Bertelsen L, Bhardwaj P, Stampe NK, Kober L, Engstrom T, Vejlstrup NG, Jacobsen PK. Myocardial scarring and recurrence of ventricular arrhythmia in patients surviving a ventricular fibrillation out of hospital cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Prediction of ventricular arrhythmia recurrence in survivors of ventricular fibrillation out of hospital cardiac arrest (VF-OHCA) is important, but currently difficult. Risk of recurrence may be related to presence of myocardial scarring and dedicated late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) software allows for characterization of left ventricular scarring, including differentiation between core, border zone (BZ) and BZ channels that represent potential electrical circuits of slow conductivity responsible for ventricular arrhythmic events.
Purpose
Our study aims to characterize myocardial scarring as defined by LGE-CMR in survivors of a VF-OCHA and investigate its potential role for the risk of new ventricular arrhythmia.
Methods
Between 2018 and 2021, a total of 130 VF-OHCA patients had CMR, of which we included 28 patients with LGE-CMR before ICD implantation for secondary prevention. A total of 15 (54%) patients had signs of acute or chronic ischemic heart disease (IHD); and 13 (46%) patients had arrhythmogenic cardiomyopathy (ACM). Scar tissue including core, BZ and BZ channels were automatically detected by specialized investigational software. To differentiate BZ from healthy tissue and BZ from core, thresholds of 40% ± 5% and 60% ± 5% of the maximum signal intensity were applied. A BZ channel in the LGE-CMR reconstruction was defined as a continuous corridor of BZ between 2 core areas or between a core area and a valve annulus (Figure 1A+B).
Results
The median age was 56 years; 86% were men and the median left ventricular ejection fraction was 50±11%. A total of 16 (57%) patients had an inferior scar on LGE-CMR, and 8 (29%) patients with IHD were incompletely revascularized. After a median follow-up of 98 days, 9 (32%) patients (6/9 with IHD, including 5/6 incompletely revascularized; 3/9 with ACM) had recurrence of ventricular arrhythmia (6/9 monomorphic ventricular tachycardia (VT)). A significantly higher number of patients with BZ channels had recurrence of ventricular arrhythmia compared with patients without BZ channels (7/11 vs. 2/17; P=0.01) (Figure 2). The number of BZ channels (3±1 vs. 2±1; P=0.13); scar mass (21±8g vs. 14±11g; P=0.21); core mass (7±4g vs. 4±5g; P=0.14); and BZ mass (11±5g vs. 9±7g; P=0.42) were insignificantly higher in patients with recurrent ventricular arrhythmia compared with patients without.
Conclusion
Borderzone channels analyzed by LGE-CMR were associated with subsequent recurrence of ventricular arrhythmia in patients with out of hospital cardiac arrest caused by ventricular fibrillation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A F Thomsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - C Jons
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Bertelsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - P Bhardwaj
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - N K Stampe
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - L Kober
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - T Engstrom
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - N G Vejlstrup
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - P K Jacobsen
- Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
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17
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Yonis H, Porsborg Andersen M, Helen Anna Mills E, Gregers Winkel B, Wissenberg M, Køber L, Gislason G, Folke F, Moesgaard Larsen J, Søgaard P, Torp-Pedersen C, Hay Kragholm K. Duration of Resuscitation and Long-Term Outcome After In-Hospital Cardiac Arrest: A Nationwide Observational Study. Resuscitation 2022; 179:267-273. [PMID: 36007858 DOI: 10.1016/j.resuscitation.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Prior studies have investigated the association between duration of resuscitation and short-term outcomes following in-hospital cardiac arrest (IHCA). However, it remains unknown whether there is an association between duration of resuscitation and long-term survival and functional outcomes. METHOD We linked data from the Danish in-hospital cardiac arrest registry with nationwide registries and identified 8,727 patients between 2013 and 2019. Patients were stratified into four groups (A-D) according to quartiles of duration of resuscitation. Standardized average probability of outcomes was estimated using logistic regression. RESULTS Of 8,727 patients, 53.1% (n=4,604) achieved return of spontaneous circulation. Median age was 74 (1st-3rd quartile [Q1-Q3] 65-81 years) and 63.1% were men. Among all IHCA patients the standardized 30-day survival was 62.0% (95% CI 59.8%-64.2%) for group A (< 5 minutes), 32.7% (30.8%-34.6%) for group B (5-11 minutes), 14.4% (12.9%-15.9%) for group C (12-20 minutes) and 8.1% (7.0%-9.1%) for group D (21 minutes or more). Similarly, 1-year survival was also highest for group A (50.4%; 48.2%-52.6%) gradually decreasing to 6.6% (5.6%-7.6%) in group D. Among 30-day survivors, survival without anoxic brain damage or nursing home admission within one-year post-arrest was highest for group A (80.4%; 78.2%-82.6%), decreasing to 73.3% (70.0%-76.6%) in group B, 67.2% (61.7%-72.6%) in group C and 73.3% (66.9%-79.7%) in group D. CONCLUSION Shorter duration of resuscitation attempt during an IHCA is associated with higher 30-day and 1-year survival. Furthermore, we found that the majority of 30-day survivors were still alive 1-year post-arrest without anoxic brain damage or nursing home admission despite prolonged resuscitation.
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Affiliation(s)
- Harman Yonis
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark.
| | | | | | - Bo Gregers Winkel
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital
| | | | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital
| | - Gunnar Gislason
- Dept of Cardiology, Herlev and Gentofte Hospital, Denmark; The Danish Heart Foundation, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Fredrik Folke
- Dept of Cardiology, Herlev and Gentofte Hospital, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
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18
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Bhardwaj P, Stampe NK, Jespersen CH, Tfelt-Hansen J, Winkel BG. Exercise Testing Using Sprint Protocol vs Bruce Protocol in Catecholaminergic Polymorphic Ventricular Tachycardia. JACC Case Rep 2022; 4:996-1000. [PMID: 35935149 PMCID: PMC9350889 DOI: 10.1016/j.jaccas.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 06/15/2022] [Accepted: 06/16/2022] [Indexed: 11/30/2022]
Abstract
We present the case of a relative of a patient with catecholaminergic polymorphic ventricular tachycardia. This relative underwent a standard (Bruce) exercise stress test (EST), which had normal results. He then underwent our modified “sprint” EST, with positive results. This report underlines how the sprint EST may provoke arrhythmias better than the standard Bruce EST. (Level of Difficulty: Advanced.)
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19
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Jespersen CHB, Butt JH, Krøll J, Winkel BG, Kanters JK, Gislason G, Torp-Pedersen C, Bundgaard H, Jensen HK, Køber L, Tfelt-Hansen J, Weeke PE. Workforce attachment after a congenital long QT syndrome diagnosis: a Danish nationwide study. Open Heart 2022; 9:openhrt-2022-002056. [PMID: 35793863 PMCID: PMC9260845 DOI: 10.1136/openhrt-2022-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/15/2022] [Indexed: 11/12/2022] Open
Abstract
Objective To examine workforce attachment among patients with congenital long QT syndrome (cLQTS) following diagnosis and identify factors associated with workforce attachment. Methods and results In this nationwide cohort study, all patients diagnosed with cLQTS in Denmark between 1996 and 2016 aged 18–60 years at diagnosis were identified using nationwide registries. Patients attached to the workforce at diagnosis were included. Attachment to the workforce 1 year after cLQTS diagnosis was examined and compared with a background population matched 1:4 on age, sex and employment status. Multiple logistic regression was performed to identify factors associated with 1-year workforce detachment among patients with cLQTS. 298 patients fulfilled the inclusion criteria. Six months after cLQTS diagnosis, 90.9% of patients with cLQTS were attached to the workforce compared with 95.0% in the background population (p=0.006 for difference). One year after diagnosis, 93.3% of patients with cLQTS were attached to the workforce compared with 93.8% in the background population (p=0.26). Among patients with cLQTS, a severe cLQTS disease manifestation was associated with workforce detachment 1 year after diagnosis (compared with asymptomatic patients; aborted cardiac arrest OR 20.4 (95% CI, 1.7 to 249.9); ventricular tachycardia/syncope OR 10.9 (95% CI, 1.1 to 110.5)). No other associated factors were identified. Conclusions More than 90% of patients with cLQTS remained attached to the workforce 1 year after diagnosis, which was similar to a matched background population. Patients with a severe cLQTS disease manifestation were less likely to be attached to the workforce 1 year after diagnosis.
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Affiliation(s)
- Camilla H B Jespersen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jawad Haider Butt
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Johanna Krøll
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jørgen K Kanters
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Lars Køber
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, Univeristy of Copenhagen, Copenhagen, Denmark
| | - Peter E Weeke
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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20
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Kløvgaard M, Winkel BG. [Sudden unexpected death in epilepsy]. Ugeskr Laeger 2022; 184:V01220053. [PMID: 35786225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Sudden and unexpected death is defined as sudden death without any obvious cause and where the person was seen in habitual conditions within the last 24 hours before death. Persons with epilepsy have a 34-fold increased risk of dying suddenly and unexpectedly compared with the background population. In persons with epilepsy these deaths are referred to as sudden unexpected death in epilepsy (SUDEP). This review finds that the risk is highest in younger adults, and SUDEP is the second leading cause of death in persons with epilepsy aged 1-49 years. Good seizure control is important in the prevention of SUDEP.
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Affiliation(s)
- Marius Kløvgaard
- Afdeling for Hjerne- og Nervesygdomme, Epilepsiklinikken, Københavns Universitetshospital - Rigshospitalet
- Afdeling for Hjerne- og Nervesygdomme, Københavns Universitetshospital - Herlev
| | - Bo Gregers Winkel
- Afdeling for Hjertesygdomme, Københavns Universitetshospital - Rigshospitalet
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21
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Lynge T, Skjelbred T, Svane J, Garcia R, Winkel BG, Tfelt-Hansen J. More than half of all sudden cardiac deaths occur in persons without a history of cardiovascular disease: A study of 54,028 deaths in Denmark. Europace 2022. [DOI: 10.1093/europace/euac053.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Copenhagen University Hospital, Rigshospitalet
Background
Sudden cardiac death (SCD) is a major public health problem accounting for a large proportion of global mortality. Previous studies suggest that SCD often occurs in the general population in persons not previously diagnosed with cardiovascular disease. It is evidently challenging to identify high-risk persons in an overwhelmingly large population of mainly healthy individuals and studies are needed to further characterize these SCD cases.
Purpose
To estimate SCD burden in patients not previously diagnosed with cardiovascular disease and to characterize these SCD cases.
Methods
All deaths in Denmark (population of 5.5 million) in 2010 were manually reviewed case-by-case. Autopsy reports, death certificates, and information from nationwide health registries were systematically examined to identify all SCD in 2010. The Danish National Patient Register contains information on all in- and outpatient activities at Danish hospitals and emergency departments and was used to identify all SCD cases with a previous cardiovascular diagnosis.
Results
There were 54,028 deaths in Denmark in 2010, of which 6,867 (13%) were categorized as SCD. Overall incidence rate of SCD was 124 (95%-CI: 121-127) per 100,000 person-years. Of all SCD, 59% were not diagnosed with cardiovascular disease prior to death. SCD incidence in persons with and without a history of cardiovascular disease was 790 (95%-CI: 762-820) and 78 (95%-CI: 75-80) per 100,000 person-years, respectively. This corresponds to an incidence rate ratio of 10 (95%-CI: 10-11). SCD cases with no previously diagnosed cardiovascular diseases were younger (median age 75 vs. 80 years, p<0.001), more often female (45 vs. 42%, p=0.019), and on average had a lower household income (p=0.002) (Table 1). SCD cases not diagnosed with cardiovascular disease prior to death in general had fewer comorbidities, except for psychiatric diseases, which were more common in the undiagnosed group (Table 1).
Conclusion
In this large and nationwide study of all SCD in Denmark in 2010, more than half of all SCD occurred in persons without a history of cardiovascular disease. This suggests that SCD is often first manifestation of disease. We currently do not have accurate tools for SCD risk stratification in the general population and future research is needed to identify modifiable and easily measured risk factors of SCD in the general population.
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Affiliation(s)
- T Lynge
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - T Skjelbred
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - J Svane
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - R Garcia
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - BG Winkel
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, The Heart Centre, Copenhagen, Denmark
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22
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Hassager C, Kjaergaard J, Tfelt-Hansen J, Winkel BG. Untargeted toxicology in sudden cardiac arrest victims. Europace 2022. [DOI: 10.1093/europace/euac053.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union’s Horizon 2020 research and innovation programme to J.T.-H under acronym ESCAPE-NET
Background
Sudden cardiac arrest (SCA) is a major public health challenge and is associated with poor outcomes. Many drugs are known to increase risk of arrythmias and ultimately sudden cardiac death. To our knowledge an untargeted toxicological analysis has not previously been performed in an initially resuscitated SCA cohort.
Purpose
We aimed to determine the qualitative and quantitative drug composition present in SCA patients by using forensic toxicological analytical chemistry of all illicit, non-prescription and prescribed drugs, and further investigate whether these drugs are in therapeutic levels or overdosed and to correlate the clinical findings with the toxicology results.
Methods
We performed a prospective single-tertiary-center study and included all SCA victims (aged 18-90 years) admitted to our cardiac intensive care unit, between February 2019 to November 2019 (Figure 1). Traumatic and overt overdose related SCA were not included in the study. Drugs used during resuscitation and administered prior to sample collection were identified in each patient and excluded.
Results
We prospectively identified 85 all-cause SCA patients with a median age of 60 years (IQR: 53-71) and male predominance (80%). The majority had a shockable rhythm as first rhythm (95%). The major cause of cardiac arrest was acute and chronic ischemia (56/77, 66%), followed by cardiomyopathy (9/77, 12%), idiopathic ventricular fibrillation (8/77, 10%), bradycardia (2/77, 2.6%), primary arrhythmia (1/77, 1.3%), other (1/77, 1.3%). The remaining 8 patients (9.4%) died prior to diagnosis.
A positive toxicology was identified in 67 patients (79%) with a total of 218 detected drugs. The most frequent drugs were mild analgesics (32/85, 38%), beta-blockers (21/85, 25%) and ACE-inhibitors/ARB (20/85, 24%). A total of 9 (11%) patients had one or more potentially abusable drugs detected, with the most common being opioid agonists in 5 patients (Figure 2). Importantly, all drugs were found at sub-therapeutic or therapeutic concentrations. None had overdose concentrations. Moreover, polypharmacy was common and a median of 2 drugs (IQR: 1-4) were detected (excluding caffeine that was detected in 83 patients).
Conclusion
We found that the majority had drugs detected, and polypharmacy is displayed in a considerable proportion. Potentially abusive drugs were encountered in 11%. However, we did not identify any occult overdose related cardiac arrests among all resuscitated SCA patients. In our setting, toxicological screening in cardiac arrest patients who is not obviously overdosed is excessive.
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Affiliation(s)
- NK Stampe
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Glinge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BS Rasmussen
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - P Bhardwaj
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - K Linnet
- University of Copenhagen, Department of Forensic Medicine, Faculty of Medical Sciences, Copenhagen, Denmark
| | - R Jabbari
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - C Hassager
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Kjaergaard
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
| | - BG Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, The Heart Centre, Copenhagen, Denmark
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23
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Warming PE, Winkel BG, Tfelt-Hansen J. Does depolarization or repolarization play a role in sudden cardiac death in the general population? Heart Rhythm 2022; 19:1304-1305. [PMID: 35562057 DOI: 10.1016/j.hrthm.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Peder Emil Warming
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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24
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Svane J, Nielsen JL, Stampe NK, Feldt-Rasmussen B, Garcia R, Risgaard B, Gislason GH, Winkel BG, Lynge TH, Tfelt-Hansen J. Nationwide study of mortality and sudden cardiac death in young persons diagnosed with chronic kidney disease. Europace 2022; 24:1599-1607. [PMID: 35373838 DOI: 10.1093/europace/euac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study was to compare short- and long-term risk of sudden cardiac death (SCD) among persons aged 18-49 years with and without chronic kidney disease (CKD). METHODS AND RESULTS Using Danish nationwide health registries, all persons aged 18-49 years diagnosed with earlier stages of CKD or chronic kidney failure from 1 July 1995 through 2009 were identified. Non-exposed subjects matched on sex and birth-year were identified. All SCD in the Danish population aged 18-49 years in 2000-2009 have previously been identified using information from the Danish nationwide health registries, death certificates, and autopsy reports. In total, 9308 incident cases of earlier stage CKD and 1233 incident cases of chronic kidney failure were included. Among patients with earlier stage CKD, the absolute risk of SCD 1, 5, and 10 years after diagnosis was 0.14%, 0.37%, and 0.68%, respectively. Compared with age- and sex-matched subjects the corresponding relative risk (RR) was 20.3 [95% confidence interval (CI) 8.4-48.8], 7.1 (95% CI 4.2-12.0), and 6.1 (95% CI 3.8-9.7), respectively. Among patients with chronic kidney failure, the absolute 1-, 5-, and 10-year risk of SCD was 0.17%, 0.56%, and 2.07%, respectively. The corresponding RR was 12.5 (95% CI 1.4-111.6), 7.9 (95% CI 2.3-27.0), and 10.1 (95% CI 4.5-22.6). CONCLUSION Persons with earlier stage CKD and chronic kidney failure had increased risk of SCD compared with the background population with a 6- to 20-fold increased risk of SCD. These findings underline the importance of early cardiovascular risk monitoring and assessment in persons with CKD.
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Affiliation(s)
- Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Jakob Lund Nielsen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Kjær Stampe
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rodrigue Garcia
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,The Department of Cardiology, University Hospital of Poitiers, Poitiers, France
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Hilmar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark.,The National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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25
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Barc J, Tadros R, Glinge C, Chiang DY, Jouni M, Simonet F, Jurgens SJ, Baudic M, Nicastro M, Potet F, Offerhaus JA, Walsh R, Choi SH, Verkerk AO, Mizusawa Y, Anys S, Minois D, Arnaud M, Duchateau J, Wijeyeratne YD, Muir A, Papadakis M, Castelletti S, Torchio M, Ortuño CG, Lacunza J, Giachino DF, Cerrato N, Martins RP, Campuzano O, Van Dooren S, Thollet A, Kyndt F, Mazzanti A, Clémenty N, Bisson A, Corveleyn A, Stallmeyer B, Dittmann S, Saenen J, Noël A, Honarbakhsh S, Rudic B, Marzak H, Rowe MK, Federspiel C, Le Page S, Placide L, Milhem A, Barajas-Martinez H, Beckmann BM, Krapels IP, Steinfurt J, Winkel BG, Jabbari R, Shoemaker MB, Boukens BJ, Škorić-Milosavljević D, Bikker H, Manevy FC, Lichtner P, Ribasés M, Meitinger T, Müller-Nurasyid M, Veldink JH, van den Berg LH, Van Damme P, Cusi D, Lanzani C, Rigade S, Charpentier E, Baron E, Bonnaud S, Lecointe S, Donnart A, Le Marec H, Chatel S, Karakachoff M, Bézieau S, London B, Tfelt-Hansen J, Roden D, Odening KE, Cerrone M, Chinitz LA, Volders PG, van de Berg MP, Laurent G, Faivre L, Antzelevitch C, Kääb S, Arnaout AA, Dupuis JM, Pasquie JL, Billon O, Roberts JD, Jesel L, Borggrefe M, Lambiase PD, Mansourati J, Loeys B, Leenhardt A, Guicheney P, Maury P, Schulze-Bahr E, Robyns T, Breckpot J, Babuty D, Priori SG, Napolitano C, de Asmundis C, Brugada P, Brugada R, Arbelo E, Brugada J, Mabo P, Behar N, Giustetto C, Molina MS, Gimeno JR, Hasdemir C, Schwartz PJ, Crotti L, McKeown PP, Sharma S, Behr ER, Haissaguerre M, Sacher F, Rooryck C, Tan HL, Remme CA, Postema PG, Delmar M, Ellinor PT, Lubitz SA, Gourraud JB, Tanck MW, George AL, MacRae CA, Burridge PW, Dina C, Probst V, Wilde AA, Schott JJ, Redon R, Bezzina CR. Genome-wide association analyses identify new Brugada syndrome risk loci and highlight a new mechanism of sodium channel regulation in disease susceptibility. Nat Genet 2022; 54:232-239. [PMID: 35210625 DOI: 10.1038/s41588-021-01007-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/13/2021] [Indexed: 12/19/2022]
Abstract
Brugada syndrome (BrS) is a cardiac arrhythmia disorder associated with sudden death in young adults. With the exception of SCN5A, encoding the cardiac sodium channel NaV1.5, susceptibility genes remain largely unknown. Here we performed a genome-wide association meta-analysis comprising 2,820 unrelated cases with BrS and 10,001 controls, and identified 21 association signals at 12 loci (10 new). Single nucleotide polymorphism (SNP)-heritability estimates indicate a strong polygenic influence. Polygenic risk score analyses based on the 21 susceptibility variants demonstrate varying cumulative contribution of common risk alleles among different patient subgroups, as well as genetic associations with cardiac electrical traits and disorders in the general population. The predominance of cardiac transcription factor loci indicates that transcriptional regulation is a key feature of BrS pathogenesis. Furthermore, functional studies conducted on MAPRE2, encoding the microtubule plus-end binding protein EB2, point to microtubule-related trafficking effects on NaV1.5 expression as a new underlying molecular mechanism. Taken together, these findings broaden our understanding of the genetic architecture of BrS and provide new insights into its molecular underpinnings.
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Affiliation(s)
- Julien Barc
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France. .,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, .
| | - Rafik Tadros
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Charlotte Glinge
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - David Y Chiang
- Medicine, Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Mariam Jouni
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Floriane Simonet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Sean J Jurgens
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Manon Baudic
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Michele Nicastro
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Franck Potet
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Joost A Offerhaus
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Roddy Walsh
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Arie O Verkerk
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Yuka Mizusawa
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Soraya Anys
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Damien Minois
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Arnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Josselin Duchateau
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Alison Muir
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Michael Papadakis
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Silvia Castelletti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Margherita Torchio
- Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Cristina Gil Ortuño
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Javier Lacunza
- Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Daniela F Giachino
- Clinical and Biological Sciences, Medical Genetics, University of Torino, Orbassano, Italy.,Medical Genetics, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Natascia Cerrato
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Raphaël P Martins
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Oscar Campuzano
- Cardiovascular Genetics Center, University of Girona-IDIBGI, Girona, Spain.,Medical Science Department, University of Girona, Girona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Biochemistry and Molecular Genetics Department, Hospital Clinic, University of Barcelona-IDIBAPS, Barcelona, Spain
| | - Sonia Van Dooren
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centre for Medical Genetics, research group Reproduction and Genetics, research cluster Reproduction, Genetics and Regenerative Medicine, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium
| | - Aurélie Thollet
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Florence Kyndt
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | | | - Anniek Corveleyn
- Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | - Birgit Stallmeyer
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Sven Dittmann
- University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Johan Saenen
- Cardiology, Electrophysiology - Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Noël
- Department of Cardiology, University Hospital of Brest, Brest, France
| | | | - Boris Rudic
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Halim Marzak
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France
| | - Matthew K Rowe
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Claire Federspiel
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | | | - Leslie Placide
- Department of Cardiology, CHU Montpellier, Montpellier, France
| | - Antoine Milhem
- Department of Cardiology, CH La Rochelle, La Rochelle, France
| | | | - Britt-Maria Beckmann
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,University Hospital of the Johann Wolfgang Goethe University Frankfurt, Institute of Legal Medicine, Frankfurt, Germany
| | - Ingrid P Krapels
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Johannes Steinfurt
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany
| | - Bo Gregers Winkel
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Reza Jabbari
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Moore B Shoemaker
- Medicine, Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bas J Boukens
- Department of Medical Biology, University of Amsterdam, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Doris Škorić-Milosavljević
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hennie Bikker
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Genome Diagnostics Laboratory, Clinical Genetics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Federico C Manevy
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter Lichtner
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Marta Ribasés
- Psychiatric Genetics Unit, Institute Vall d'Hebron Research (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Neuherberg, Germany
| | - Martina Müller-Nurasyid
- Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,IBE, LMU Munich, Munich, Germany.,Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg University, Mainz, Germany.,Department of Internal Medicine I (Cardiology), Hospital of the Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | | | - Jan H Veldink
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Philip Van Damme
- Neurology Department University Hospital Leuven, Neuroscience Department KU Leuven, Center for Brain & Disease Research VIB, Leuven, Belgium
| | - Daniele Cusi
- Scientific Unit, Bio4Dreams - Business Nursery for Life Sciences, Milan, Italy
| | - Chiara Lanzani
- Nephrology, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Milan, Italy
| | - Sidwell Rigade
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Eric Charpentier
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Estelle Baron
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Bonnaud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Simon Lecointe
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Audrey Donnart
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,Université de Nantes, CHU Nantes, Inserm, CNRS, SFR Santé, Inserm UMS 016, CNRS UMS 3556, Nantes, France
| | - Hervé Le Marec
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphanie Chatel
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Matilde Karakachoff
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Stéphane Bézieau
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Barry London
- Department of Internal Medicine, Division of Cardiovascular Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dan Roden
- Medicine, Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Medicine, Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center, University Freiburg, Freiburg, Germany.,Department of Cardiology, Translational Cardiology, University Hospital Bern, Bern, Switzerland
| | - Marina Cerrone
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Larry A Chinitz
- Medicine, Leon H. Charney Division of Cardiology, Heart Rhythm Center and Cardiovascular Genetics Program, New York University School of Medicine, New York, NY, USA
| | - Paul G Volders
- Department of Cardiology, CARIM, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maarten P van de Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gabriel Laurent
- Cardiology Department, ImVia lab team IFTIM, University Hospital Dijon, Dijon, France
| | | | | | - Stefan Kääb
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Medicine I, University Hospital, LMU Munich, Munich, Germany.,German Center for Cardiovascular Research (DZHK), Partnersite Munich, Munich, Germany
| | | | | | - Jean-Luc Pasquie
- Department of Cardiology, CNRS UMR9214 - Inserm U1046 - PHYMEDEXP, Université de Montpellier et CHU Montpellier, Montpellier, France
| | - Olivier Billon
- Department of Cardiovascular Medicine, Vendée Hospital, Service de Cardiologie, La Roche sur Yon, France
| | - Jason D Roberts
- Medicine, Cardiology, Western University, London, Ontario, Canada
| | - Laurence Jesel
- Department of Cardiology, University Hospital of Strasbourg, Strasbourg, France.,INSERM 1260 - Regenerative Nanomedecine, University of Strasbourg, Strasbourg, France
| | - Martin Borggrefe
- Department 1st of Medicine, Cardiology, University Medical Center Mannheim, Mannheim, Germany.,German Center for Cardiovascular Research (DZHK), Mannheim, Germany
| | - Pier D Lambiase
- Cardiology, Medicine, Barts Heart Centre, London, UK.,Institute of Cardiovasculr Science, UCL, Population Health, UCL, London, UK
| | | | - Bart Loeys
- Center for Medical Genetics, Cardiogenetics, University of Antwerp/Antwerp University Hospital, Edegem, Belgium
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Cardiology, Hopital Bichat, Paris, France
| | - Pascale Guicheney
- Sorbonne Université, Paris, France.,UMR_S1166, Faculté de médecine, Sorbonne Université, INSERM, Paris, France
| | - Philippe Maury
- Service de cardiologie, Hôpital Rangueil, CHU de Toulouse, Toulouse, France
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,University Hospital Münster, Institute for Genetics of Heart Diseases (IfGH), Münster, Germany
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Human Genetics, Catholic University Leuven, Leuven, Belgium
| | | | - Silvia G Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Carlo Napolitano
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular Cardiology, ICS Maugeri, IRCCS and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Carlo de Asmundis
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing Universitair Ziekenhuis, Brussel-Vrije Universiteit Brussel, ERN Heart Guard Center, Brussels, Belgium.,IDIBAPS, Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ramon Brugada
- Hospital Trueta, CiberCV, University of Girona, IDIBGI, Girona, Spain, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Philippe Mabo
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Nathalie Behar
- Cardiologie et Maladies vasculaires, Université Rennes1 - CHU Rennes, Rennes, France
| | - Carla Giustetto
- Medical Sciences, Cardiology, University of Torino, Torino, Italy
| | - Maria Sabater Molina
- Cardiogenetic, Unidad de Cardiopatías Familiares, Instituto Murciano de Investigación Biosanitaria, Universidad de Murcia, Murcia, Spain
| | - Juan R Gimeno
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Cardiology, Unidad de Cardiopatías Familiares, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, Murcia, Spain
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Bornova, Turkey
| | - Peter J Schwartz
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy
| | - Lia Crotti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano IRCCS, Cusano Milanino, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano IRCCS, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Pascal P McKeown
- Cardiology, Belfast Health and Social Care Trust and Queen's University Belfast, Belfast, UK
| | - Sanjay Sharma
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Molecular and Clinical Sciences Research Institute, St. George's, University of London, London, UK.,Cardiology Clinical Academic Group, St. George's University Hospitals' NHS Foundation Trust, London, UK
| | - Michel Haissaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Frédéric Sacher
- IHU Liryc, Electrophysiology and Heart Modeling Institute, fondation Bordeaux Université, Pessac-Bordeaux, France.,Université Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.,Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Caroline Rooryck
- CHU Bordeaux, Service de Génétique Médicale, Bordeaux, France.,Université de Bordeaux, Maladies Rares: Génétique et Métabolisme (MRGM), INSERM U1211, Bordeaux, France
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - Carol A Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mario Delmar
- Medicine, Cardiology, New York University School of Medicine, New York, NY, USA
| | - Patrick T Ellinor
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Steven A Lubitz
- Cardiac Arrhythmia Service and Cardiovascular Research Center, Massachusetts General Hospital and Cardiovascular Disease Initiative, The Broad Institute of MIT and Harvard, Boston, MA, USA
| | - Jean-Baptiste Gourraud
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Michael W Tanck
- Clinical Epidemiology, Biostatistics and Bioinformatics, Clinical Methods and Public Health, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Alfred L George
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Calum A MacRae
- Medicine, Cardiovascular Medicine, Genetics and Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Paul W Burridge
- Department of Pharmacology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Center for Pharmacogenomics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christian Dina
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Arthur A Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart.,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jean-Jacques Schott
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Richard Redon
- Université de Nantes, CHU Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France.,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart
| | - Connie R Bezzina
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart: ERN GUARD-Heart, . .,Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
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Gray B, Baruteau AE, Antolin AA, Pittman A, Sarganas G, Molokhia M, Blom MT, Bastiaenen R, Bardai A, Priori SG, Napolitano C, Weeke PE, Shakir SA, Haverkamp W, Mestres J, Winkel BG, Witney AA, Chis-Ster I, Sangaralingam A, Camm AJ, Tfelt-Hansen J, Roden DM, Tan HL, Garbe E, Sturkenboom M, Behr ER. Rare Variation in Drug Metabolism and Long QT Genes and the Genetic Susceptibility to Acquired Long QT Syndrome. Circ Genom Precis Med 2022; 15:e003391. [PMID: 35113648 DOI: 10.1161/circgen.121.003391] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Acquired long QT syndrome (aLQTS) is a serious unpredictable adverse drug reaction. Pharmacogenomic markers may predict risk. METHODS Among 153 aLQTS patients (mean age 58 years [range, 14-88], 98.7% White, 85.6% symptomatic), computational methods identified proteins interacting most significantly with 216 QT-prolonging drugs. All cases underwent sequencing of 31 candidate genes arising from this analysis or associating with congenital LQTS. Variants were filtered using a minor allele frequency <1% and classified for susceptibility for aLQTS. Gene-burden analyses were then performed comparing the primary cohort to control exomes (n=452) and an independent replication aLQTS exome sequencing cohort. RESULTS In 25.5% of cases, at least one rare variant was identified: 22.2% of cases carried a rare variant in a gene associated with congenital LQTS, and in 4% of cases that variant was known to be pathogenic or likely pathogenic for congenital LQTS; 7.8% cases carried a cytochrome-P450 (CYP) gene variant. Of 12 identified CYP variants, 11 (92%) were in an enzyme known to metabolize at least one culprit drug to which the subject had been exposed. Drug-drug interactions that affected culprit drug metabolism were found in 19% of cases. More than one congenital LQTS variant, CYP gene variant, or drug interaction was present in 7.8% of cases. Gene-burden analyses of the primary cohort compared to control exomes (n=452), and an independent replication aLQTS exome sequencing cohort (n=67) and drug-tolerant controls (n=148) demonstrated an increased burden of rare (minor allele frequency<0.01) variants in CYP genes but not LQTS genes. CONCLUSIONS Rare susceptibility variants in CYP genes are emerging as potentially important pharmacogenomic risk markers for aLQTS and could form part of personalized medicine approaches in the future.
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Affiliation(s)
- Belinda Gray
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
| | - Albert A Antolin
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Alan Pittman
- Genetics Research Centre (A.P.), St George's University of London, United Kingdom
| | - Giselle Sarganas
- Clinical Pharmacology & Toxicology, Charite Universitaetsmedizin, Berlin, Germany (G.S.)
| | - Mariam Molokhia
- Department of Population Health Sciences, King's College London, United Kingdom (M.M.)
| | - Marieke T Blom
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Abdenasser Bardai
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Silvia G Priori
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Carlo Napolitano
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy (S.G.P., C.N.)
- Department of Molecular Medicine, University of Pavia, Italy (S.G.P., C.N.)
| | - Peter E Weeke
- L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France (A.-E.B.)
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Saad A Shakir
- Drug Safety Research Unit, Bursledon Hall, Blundell Lane, Southampton, United Kingdom (S.A.S.)
- Associate Department of the School of Pharmacy & Biomedical Sciences, University of Portsmouth, United Kingdom (S.A.S.)
| | - Wilhelm Haverkamp
- Charité-Campus Virchow-Klinikum (CVK), Department of Cardiology, Berlin, Germany (W.H.)
| | - Jordi Mestres
- Systems Pharmacology, Research Program on Biomedical Informatics (GRIB), IMIM Hospital del Mar Medical Research Institute & University Pompeu Fabra, Parc de Recerca Biomedica, Barcelona, Catalonia, Spain (A.A.A., M.J.M.)
| | - Bo Gregers Winkel
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
| | - Adam A Witney
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Irina Chis-Ster
- Institute of Infection & Immunity (A.A.W., I.C.-S.), St George's University of London, United Kingdom
| | - Ajanthah Sangaralingam
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - A John Camm
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (P.E.W., B.W., J.T.-H.)
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark (B.W., J.T.-H.)
| | - Dan M Roden
- Departments of Medicine, Pharmacology & Biomedical Informatics Vanderbilt University Medical Centre (P.E.W., D.M.R.)
| | - Hanno L Tan
- Heart Centre AMC, Department of Experimental & Clinical Cardiology, Academic Medical Center, Amsterdam, the Netherlands (M.T.B., A.B., H.L.T.)
| | - Edeltraut Garbe
- Leibniz Institute for Prevention Research & Epidemiology - BIPS, Bremen, Germany (E.G.)
| | - Miriam Sturkenboom
- Julius Global Health, University Medical Center Utrecht, the Netherlands (M.S.)
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular & Clinical Sciences Research Institute, St George's, University of London & St George's University Hospitals NHS Foundation Trust, London, United Kingdom (B.G., A.-E.B., R.B., A.S., A.J.C., E.R.B.)
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Christensen J, Winkel BG, Eskildsen SJ, Gottlieb R, Hassager C, Wagner MK. OUP accepted manuscript. Eur J Cardiovasc Nurs 2022; 22:328-331. [PMID: 35766177 DOI: 10.1093/eurjcn/zvac039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 11/14/2022]
Abstract
Patient-reported return-to-work and job functioning 6 and 12 months after hospital discharge and received rehabilitation interventions and unmet rehabilitation needs were explored in a consecutive population of out-of-hospital cardiac arrest survivors. Patients working prior to cardiac arrest were invited to participate in a telephone administered survey. Thirty-eight surveys were conducted and included for analysis, equivalent to a minimum response rate of 95%. Survivors of out-of-hospital cardiac arrest had extensive challenges returning to work. Six- and 12-months post-arrest, 58% and 45% were respectively on full time sick leave or working notably less (>10 h/week) and with extensive unmet rehabilitation needs.
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Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rikke Gottlieb
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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28
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Matthiesen S, Diederichsen SZ, Hansen MKH, Villumsen C, Lassen MCH, Jacobsen PK, Risum N, Winkel BG, Philbert BT, Svendsen JH, Andersen TO. Clinician Preimplementation Perspectives of a Decision-Support Tool for the Prediction of Cardiac Arrhythmia Based on Machine Learning: Near-Live Feasibility and Qualitative Study. JMIR Hum Factors 2021; 8:e26964. [PMID: 34842528 PMCID: PMC8665383 DOI: 10.2196/26964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/23/2021] [Accepted: 10/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background Artificial intelligence (AI), such as machine learning (ML), shows great promise for improving clinical decision-making in cardiac diseases by outperforming statistical-based models. However, few AI-based tools have been implemented in cardiology clinics because of the sociotechnical challenges during transitioning from algorithm development to real-world implementation. Objective This study explored how an ML-based tool for predicting ventricular tachycardia and ventricular fibrillation (VT/VF) could support clinical decision-making in the remote monitoring of patients with an implantable cardioverter defibrillator (ICD). Methods Seven experienced electrophysiologists participated in a near-live feasibility and qualitative study, which included walkthroughs of 5 blinded retrospective patient cases, use of the prediction tool, and questionnaires and interview questions. All sessions were video recorded, and sessions evaluating the prediction tool were transcribed verbatim. Data were analyzed through an inductive qualitative approach based on grounded theory. Results The prediction tool was found to have potential for supporting decision-making in ICD remote monitoring by providing reassurance, increasing confidence, acting as a second opinion, reducing information search time, and enabling delegation of decisions to nurses and technicians. However, the prediction tool did not lead to changes in clinical action and was found less useful in cases where the quality of data was poor or when VT/VF predictions were found to be irrelevant for evaluating the patient. Conclusions When transitioning from AI development to testing its feasibility for clinical implementation, we need to consider the following: expectations must be aligned with the intended use of AI; trust in the prediction tool is likely to emerge from real-world use; and AI accuracy is relational and dependent on available information and local workflows. Addressing the sociotechnical gap between the development and implementation of clinical decision-support tools based on ML in cardiac care is essential for succeeding with adoption. It is suggested to include clinical end-users, clinical contexts, and workflows throughout the overall iterative approach to design, development, and implementation.
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Affiliation(s)
- Stina Matthiesen
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Vital Beats, Copenhagen, Denmark
| | - Søren Zöga Diederichsen
- Vital Beats, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | | | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels Risum
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Berit T Philbert
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tariq Osman Andersen
- Department of Computer Science, Faculty of Science, University of Copenhagen, Copenhagen, Denmark.,Vital Beats, Copenhagen, Denmark
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29
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Kløvgaard M, Lynge TH, Tsiropoulos I, Uldall PV, Banner J, Winkel BG, Ryvlin P, Tfelt-Hansen J, Sabers A. Epilepsy-Related Mortality in Children and Young Adults in Denmark: A Nationwide Cohort Study. Neurology 2021; 98:e213-e224. [PMID: 34795050 DOI: 10.1212/wnl.0000000000013068] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 11/02/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Mortality is increased in epilepsy, but the important issue is that a proportion of epilepsy-related death is potentially preventable by optimized therapy and needs therefore to be identified. A new systematic classification of epilepsy-related mortality has been suggested by Devinsky et al. in 2016 to identify these preventable deaths. We applied this classification to an analysis of premature mortality in persons with epilepsy younger than 50 years. METHODS The study was a population-based retrospective cohort of all Danish citizens with and without epilepsy aged 1-49 years during 2007-2009. Information on all deaths was retrieved from the Danish Cause of Death Registry, autopsy reports, death certificates, and the Danish National Patient Registry. The primary cause of death in persons with epilepsy was evaluated independently by three neurologist, one neuro-pediatrician, and two cardiologists. In case of uncertainty a pathologist was consulted. All deaths were classified as either epilepsy- or not-epilepsy-related, and the underlying causes or modes of death were compared between persons with and without epilepsy. RESULTS During the study period 700 deaths were identified in persons with epilepsy, and 440 (62.9%) of these were epilepsy-related, hereof, 169 (38%) directly related to seizures and 181 (41%) due to an underlying neurological disease. SUDEP accounted for 80% of deaths directly related to epilepsy. Aspiration pneumonia was the cause of death in 80% of cases indirectly related to epilepsy.Compared with the background population, persons with epilepsy had a nearly four-fold increased all-cause mortality (adjusted mortality hazard ratio of 3.95 [95% CI 3.64-4.27], p<0.0001) and a higher risk of dying from various underlying causes including alcohol-related conditions (hazard ratio of 2.91 [95% CI 2.23-3.80], p<0.0001) and suicide (hazard ratio of 2.10 [95% CI 1.18-3.73], p=0.01). DISCUSSION The newly proposed classification for mortality in persons with epilepsy was useful in an unselected nationwide cohort. It helped classifying unnatural causes of death as epilepsy-related or not, and it helped identifying potentially preventable deaths. The leading causes of premature mortality in persons younger than 50 years were related to epilepsy and were thus potentially preventable by good seizure control.
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Affiliation(s)
- Marius Kløvgaard
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital / Rigshospitalet
| | - Thomas Hadberg Lynge
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital / Rigshospitalet
| | - Ioannis Tsiropoulos
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital / Rigshospitalet
| | - Peter Vilhelm Uldall
- The Neuropediatric Clinic, Department of Pediatrics, Copenhagen University Hospital / Rigshospitalet.,Danish Epilepsy Centre, Dianalund
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen
| | - Bo Gregers Winkel
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital / Rigshospitalet
| | - Philippe Ryvlin
- Service de Neurologie, Département des Neurosciences Cliniques, Centre Hospitalier Universitaire Vaudois (CHUV)
| | - Jacob Tfelt-Hansen
- The Heart Centre, Department of Cardiology, Copenhagen University Hospital / Rigshospitalet.,Section of Forensic Genetics, Department of Forensic Medicine, Faculty of Health Sciences, University of Copenhagen
| | - Anne Sabers
- The Epilepsy Clinic, Department of Neurology, Copenhagen University Hospital / Rigshospitalet
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30
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Skjelbred T, Rajan D, Svane J, Lynge TH, Winkel BG, Tfelt-Hansen J. Sex differences in sudden cardiac death: a nationwide study of 54,028 deaths in Denmark. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Sudden cardiac death (SCD) is a leading cause of death. SCD is more common among males. In women SCD is, however, still the leading cause of death. The SCD epidemiology among women is less studied.
Purpose
The aim of this study was to examine how incidence rates, clinical characteristics and causes of SCD vary between males and females.
Methods
All deaths in Denmark in the 2010 (54,028) were included in the study. Autopsy reports, death certificates, discharge summaries and nationwide health registries were reviewed to identify cases of SCD. Sex and age specific SCD incidence rates in the general population were calculated, and age-adjusted clinical characteristics were compared using logistic regression.
Results
A total of 6,867 SCD cases were identified, of which 3,859 (56%) were males and 3,008 (44%) were females. Incidence rates increased with age and was higher for males across all age groups in the adult population. Average age of SCD was 71.3±14.3 years among males compared to 79.4±13.3 among females (mean ± standard deviation, p<0.0001). The greatest difference in incidence between males and females was found among the 35–50-year group with an incidence rate ratio of 3.7 (95% confidence interval: 2.8–4.8). Although the males were younger, males more often had cardiovascular diseases and diabetes mellitus prior to SCD. Among autopsied cases, coronary artery disease (CAD) was the leading cause of death among both sexes. Structural causes of SCD, other than CAD, were more common among women (p<0.01).
Conclusion
In this nationwide study of sex differences in SCD across all age groups, the differences in incidence rates between males and females were greatest among young adults and the middle-aged. Incidence rates of SCD among older females approached that of the male population, despite significantly more cardiovascular disease and diabetes mellitus in the male population in the 10 years prior to SCD.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Affiliation(s)
- T Skjelbred
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - D Rajan
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Svane
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T H Lynge
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - J Tfelt-Hansen
- Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark
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31
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Stampe NK, Tfelt-Hansen J, Winkel BG. [Cardiac arrest in a patient with long QT syndrome receiving androgen deprivation therapy]. Ugeskr Laeger 2021; 183:V11200808. [PMID: 34704930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This is a case report of a 72-year-old male with a newly diagnosed prostate cancer, who was treated with androgen deprivation therapy and anti-androgen. The patient was diagnosed with congenital long QT syndrome (LQTS), and a markedly worsening of the QT-prolongation was observed, after the hormonal therapy was initiated. He ultimately suffered an initially resuscitated cardiac arrest but did not survive to discharge. Pharmaceutical treatments in patients with LQTS should always be handled with caution, and if a treatment with a known or probable QT-prolonging drug is initiated, a cardiologist should be consulted.
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Abstract
The overall incidence of sudden cardiac death is considerably lower among women than men, reflecting significant and often under-recognized sex differences. Women are older at time of sudden cardiac death, less likely to have a prior cardiac diagnosis, and less likely to have coronary artery disease identified on postmortem examination. They are more likely to experience their death at home, during sleep, and less likely witnessed. Women are also more likely to present in pulseless electrical activity or systole rather than ventricular fibrillation or ventricular tachycardia. Conversely, women are less likely to receive bystander cardiopulmonary resuscitation or receive cardiac intervention post-arrest. Underpinning sex disparities in sudden cardiac death is a paucity of women recruited to clinical trials, coupled with an overall lack of prespecified sex-disaggregated evidence. Thus, predominantly male-derived data form the basis of clinical guidelines. This review outlines the critical sex differences concerning epidemiology, cause, risk factors, prevention, and outcomes. We propose 4 broad areas of importance to consider: physiological, personal, community, and professional factors.
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Affiliation(s)
- Alexandra Butters
- Cardio Genomics Program at Centenary Institute (A.B., J.I.), The University of Sydney.,Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney
| | - Clare Arnott
- Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia.,The George Institute for Global Health (C.A.), Sydney, Australia
| | | | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Denmark (B.G.W.)
| | - Christopher Semsarian
- Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney.,Agnes Ginges Centre for Molecular Cardiology at Centenary Institute (C.S.), The University of Sydney.,Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia
| | - Jodie Ingles
- Cardio Genomics Program at Centenary Institute (A.B., J.I.), The University of Sydney.,Faculty of Medicine and Health (A.B., C.S., J.I.), The University of Sydney.,Department of Cardiology, Royal Prince Alfred Hospital (C.A., C.S., J.I.), Sydney, Australia
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Svane J, Lynge TH, Hansen CJ, Risgaard B, Winkel BG, Tfelt-Hansen J. Witnessed and unwitnessed sudden cardiac death: a nationwide study of persons aged 1-35 years. Europace 2021; 23:898-906. [PMID: 33595080 DOI: 10.1093/europace/euab017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 01/10/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS The aim of this study is to compare clinical characteristics and causes of death among witnessed and unwitnessed sudden cardiac death (SCD) cases aged 1-35 years. METHODS AND RESULTS In this retrospective nationwide study, all deaths in persons aged 1-35 years in Denmark during 2000-09 were included (23.7 million person-years). Using the in-depth descriptive Danish death certificates and Danish nationwide registries, 860 cases of sudden, unexpected death were identified. Through review of autopsy reports and register data, we identified 635 cases of SCD of which 266 (42%) were witnessed and 326 (51%) were unwitnessed. In 43 cases (7%), witnessed status was missing. Clinical characteristics were overall similar between the two groups. We found a male predominance among unwitnessed SCD compared to witnessed SCD (71% and 62%, respectively, P-value 0.012), as well as more psychiatric comorbidity (20% and 13%, respectively, P-value 0.029). Unwitnessed SCD more often occurred during sleep whereas witnessed SCD more often occurred while the individual was awake and relaxed (P-value < 0.001). The autopsy rate among all SCD cases was 70% with no significant difference in autopsy rate between the two groups. Sudden unexplained death, which was the leading autopsy conclusion in both groups, was more frequent among unwitnessed SCD (P-value 0.001). CONCLUSION Several clinical characteristics and autopsy findings were similar between witnessed and unwitnessed SCD cases. Our data support the inclusion of both witnessed and unwitnessed cases in epidemiological studies of SCD cases aged 1-35 years, although the risk of misclassification is higher among unwitnessed and non-autopsied cases of SCD.
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Affiliation(s)
- Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Carl Johann Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Copenhagen, Denmark
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Castelletti S, Winkel BG, Schwartz PJ. Remote Monitoring of the QT Interval and Emerging Indications for Arrhythmia Prevention. Card Electrophysiol Clin 2021; 13:523-530. [PMID: 34330378 DOI: 10.1016/j.ccep.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
QT interval prolongation is a marker of increased risk for life-threatening arrhythmias, and needs to be promptly recognized. Many effective drugs, however, prolong QTc (QT interval corrected for heart rate) in genetically predisposed subjects. The possibility of remote monitoring and QTc measurement for up to 2 weeks, continuously providing physicians with real time data, allows life-saving interventions or changes in drug therapy. This applies especially to patients with the long QT syndrome and to those taking drugs blocking the IKr current and prolonging the QT interval. Patch monitors recording ECG traces continuously are available and contribute to effective arrhythmic prevention.
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Affiliation(s)
- Silvia Castelletti
- Istituto Auxologico Italiano, IRCCS-Center for Cardiac Arrhythmias of Genetic Origin, Via Pier Lombardo 22, 20135 Milan, Italy
| | - Bo Gregers Winkel
- University Hospital Copenhagen, Rigshospitalet, Department of Cardiology, 2142 Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Peter J Schwartz
- Istituto Auxologico Italiano, IRCCS-Center for Cardiac Arrhythmias of Genetic Origin, Via Pier Lombardo 22, 20135 Milan, Italy.
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35
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Hansen BL, Jacobsen EM, Kjerrumgaard A, Tfelt-Hansen J, Winkel BG, Bundgaard H, Christensen AH. Diagnostic yield in victims of sudden cardiac death and their relatives. Europace 2021; 22:964-971. [PMID: 32307520 DOI: 10.1093/europace/euaa056] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/25/2020] [Indexed: 01/07/2023] Open
Abstract
AIMS International guidelines recommend cardiogenetic screening in families with sudden cardiac death (SCD) if the suspected cause is an inherited cardiac disease. The aim was to assess the diagnostic yield of inherited cardiac diseases in consecutively referred SCD families. METHODS AND RESULTS In this single-centre retrospective study, we consecutively included families referred to our tertiary unit between 2005 and 2018 for screening due to SCD. Following evaluation of premortem medical records and postmortem findings for the proband, the families underwent a guideline-based screening protocol. Relatives were followed and cardiovascular events registered. In total, 304 families with 695 relatives were included. In probands, mean age at death was 39 years (75% males) and in relatives mean age at screening was 35 years (47% males). The proband-diagnosis was established through autopsy findings (n = 89), genetic analyses (n = 7), or based on premortem findings (n = 21). In the remaining 187 families with borderline/no diagnosis in the proband, screening of relatives yielded a diagnosis in 26 additional families. In total, an inherited cardiac disease was identified in 143 out of 304 families (47%). In relatives, 73 (11%) were diagnosed. Arrhythmogenic right ventricular cardiomyopathy (n = 16) was the most common diagnosis. During follow-up (mean 5.5 years), a low rate of serious cardiac events was observed (no SCD events). CONCLUSION Forty-seven percent of SCD families were diagnosed. Eleven percent of the screened relatives received a definite diagnosis and were offered treatment according to guidelines. A low rate of serious cardiovascular events was observed among SCD relatives.
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Affiliation(s)
- Benjamin Lautrup Hansen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Elisabeth Mütze Jacobsen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Amalie Kjerrumgaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Forensic Medicine, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte, Copenhagen University Hospital, Copenhagen, Denmark
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Lynge TH, Risgaard B, Banner J, Nielsen JL, Jespersen T, Stampe NK, Albert CM, Winkel BG, Tfelt-Hansen J. Nationwide burden of sudden cardiac death: A study of 54,028 deaths in Denmark. Heart Rhythm 2021; 18:1657-1665. [PMID: 33965606 DOI: 10.1016/j.hrthm.2021.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of all deaths are sudden cardiac deaths (SCDs). Reliable estimates of nationwide incidence of SCD, however, are missing. OBJECTIVES The goals of this study were to estimate SCD burden across all age groups in Denmark and to compare it with the estimates of other common causes of death. METHODS All deaths in Denmark (population of 5.5 million) in 2010 were manually reviewed case by case. Autopsy reports, death certificates, and information from nationwide health registries were systematically examined to identify all SCD cases in 2010. According to the level of detail of the available information, all deaths were categorized as either non-SCD, definite SCD, probable SCD, or possible SCD. RESULTS There were 54,028 deaths in Denmark in 2010, of which 6867 (13%) were categorized as SCD (591 (9%) definite SCD, 1568 (23%) probable SCD, and 4708 (68%) possible SCD). The incidence rate of definite SCD was 11 (95% confidence interval 10-12) per 100,000 person-years. Including definite, probable, and possible SCD cases, the highest possible overall SCD incidence rate was 124 (95% confidence interval 121-127) per 100,000 person-years. Estimated SCD burden was similar to or greater than the estimates of all other common causes of death. Of all SCD cases, 49% were not diagnosed with cardiovascular disease before death. CONCLUSION SCD accounted for up to 13% of all deaths. Almost half of all SCD cases occurred in persons without a history of cardiovascular disease. Consequently, the optimization of risk stratification and prevention of SCD in the general population should be given high priority.
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Affiliation(s)
- Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Bjarke Risgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
| | - Jakob Lund Nielsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christine M Albert
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark; Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
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Christensen J, Eskildsen SJ, Winkel BG, Dichman CK, Wagner MK. Motor and process skills in activities of daily living in survivors of out-of-hospital cardiac arrest: a cross-sectional study at hospital discharge. Eur J Cardiovasc Nurs 2021; 20:775-781. [PMID: 33755128 DOI: 10.1093/eurjcn/zvab020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/16/2020] [Accepted: 03/01/2021] [Indexed: 01/10/2023]
Abstract
AIMS An individuals' ability to perform basic activities of daily living (ADL) is said to be one of the strongest predictors of performance ability and independent living within the community. The Assessment of Motor and Process Skills (AMPS) tool was designed to assess global functional level during ADL by investigating motor and process skills. The purpose of this study was to assess ADL performance ability by investigating motor and process skills in a consecutive cohort of adult survivors of out-of-hospital cardiac arrest at the time of discharge from hospital. METHODS AND RESULTS This cross-sectional study uses data from a prospective cohort of cardiac arrest survivors admitted to the Copenhagen University Hospital, Rigshospitalet. The specific data used in this study were obtained at the time of the days or the day before hospital discharge. Adult survivors of out-of-hospital cardiac arrest due to cardiac causes were eligible for inclusion. Assessment of Motor and Process Skills was used to assess ADL performance ability by investigating motor and process skills. The ADL ability of 61 individuals was assessed. The mean ADL ability measures recorded were AMPS process 1.40 logits (0.48) and AMPS motor 1.82 logits (0.40). Based on the dichotomized AMPS results, 23% were most likely to need assistance to live independently in the community. CONCLUSION Performance ability during ADL revealed difficulty in the performance of process skill and an increased need for rehabilitation among survivors of out-of-hospital cardiac arrest at the time of hospital discharge.
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Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen East, Rigshospitalet, Denmark
| | - Signe Janum Eskildsen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen East, Rigshospitalet, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Centre For Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen East, Rigshospitalet, Denmark
| | - Camilla Kofoed Dichman
- Department of Cardiology, Centre For Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen East, Rigshospitalet, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Centre For Cardiac, Vascular, Pulmonary and Infectious Diseases, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen East, Rigshospitalet, Denmark
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Waaler Loland V, Ågesen FN, Lynge TH, Pinborg A, Jabbari R, Warming PE, Pedersen MA, Risgaard B, Winkel BG, Tfelt-Hansen J. Low Birth Weight Increases the Risk of Sudden Cardiac Death in the Young: A Nationwide Study of 2.2 Million People. J Am Heart Assoc 2021; 10:e018314. [PMID: 33749305 PMCID: PMC8174349 DOI: 10.1161/jaha.120.018314] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Sudden cardiac death (SCD) constitutes a major health problem worldwide. We investigated whether birth weight (BW), small for gestational age (SGA), and large for gestational age are associated with altered risk of SCD among the young (aged 1-36 years). Methods and Results We included all people born in Denmark from 1973 to 2008 utilizing the Danish Medical Birth Register. All SCDs in Denmark in 2000 to 2009 have previously been identified. We defined 5 BW groups, SGA, and large for gestational age as exposure and SCD as the outcome. We estimated the age-specific relative risk of SCD with 95% CI. Additionally, we investigated if SGA and large for gestational age are associated with pathological findings at autopsy. The study population for the BW analyses comprised 2 234 501 people with 389 SCD cases, and the SGA and large for gestational age analyses comprised 1 786 281 people with 193 SCD cases. The relative risk for SCD was 6.69 for people with BW between 1500 and 2499 g (95% CI, 2.38-18.80, P<0.001) and 5.89 for people with BW ≥4500 g (95% CI, 1.81-19.12, P=0.003) at age 5 years. BW 2500 to 3400 g was the reference group. Compared with an appropriate gestational age, the relative risk for SGA was 2.85 (95% CI, 1.35-6.00, P=0.006) at age 10 years. For the autopsied cases, the relative risk of sudden arrhythmic death syndrome at age 5 years was 4.19 for SGA (95% CI, 1.08-16.22, P=0.038). Conclusions We found an association between BW and SCD in the young, with an increased risk among SGA infants. In addition, we found an association between SGA and sudden arrhythmic death syndrome.
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Affiliation(s)
- Vilde Waaler Loland
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Frederik Nybye Ågesen
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Anja Pinborg
- Fertility Department Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Reza Jabbari
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Peder Emil Warming
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Morten Akhøj Pedersen
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.,Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Bjarke Risgaard
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Bo Gregers Winkel
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark.,Department of Forensic Medicine Faculty of Medical Sciences University of Copenhagen Copenhagen Denmark
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Hansen BL, Winkel BG, Bundgaard H, Christensen AH. Cardiogenetic screening amongst families of sudden cardiac death victims: Authors’ reply. Europace 2020; 22:1754-1755. [DOI: 10.1093/europace/euaa183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 06/04/2020] [Indexed: 11/12/2022] Open
Affiliation(s)
- Benjamin Lautrup Hansen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Lynge TH, Svane J, Pedersen-Bjergaard U, Gislason G, Torp-Pedersen C, Banner J, Risgaard B, Winkel BG, Tfelt-Hansen J. Sudden cardiac death among persons with diabetes aged 1-49 years: a 10-year nationwide study of 14 294 deaths in Denmark. Eur Heart J 2020; 41:2699-2706. [PMID: 31848583 PMCID: PMC7377578 DOI: 10.1093/eurheartj/ehz891] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/08/2019] [Accepted: 12/03/2019] [Indexed: 12/24/2022] Open
Abstract
AIMS The aim of this study was to compare nationwide incidence rate (IR) of sudden cardiac death (SCD) in persons aged 1-49 years with and without diabetes mellitus (DM). METHODS AND RESULTS The study population consisted of all persons in Denmark aged 1-49 years in 2000-09, which equals 27.1 million person-years. All 14 294 deaths in the 10-year period were included. By using the highly descriptive Danish death certificates, 1698 cases of sudden and unexpected death were identified. Through review of autopsy reports, discharge summaries, and the Danish registries, we identified 1363 cases of SCD. The Danish Register of Medicinal Product Statistics was used to identify persons with type 1 DM and type 2 DM. Among the 14 294 decedents, there were 669 with DM, of which 118 suffered SCD (9% of all SCD), making SCD the leading cause of death among young persons with DM. Among those aged 1-35 years, the IR of SCD-DM was 21.9 per 100 000 person-years compared to 2.6 per 100 000 person-years among persons without DM [IR ratio 8.6, 95% confidence interval (CI) 5.8-28.6]. Within the age range 36-49 years, the IR among persons with DM was 119.8 per 100 000 person-years compared to 19.7 per 100 000 person-years among persons without DM (IR ratio 6.1, 95% CI 4.7-7.8). CONCLUSION We found that young persons with DM aged 1-35 years had >8-fold higher SCD IR compared to young persons without DM. Our study highlights the need for early cardiovascular risk monitoring and assessment in young persons with DM.
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Affiliation(s)
- Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jesper Svane
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Danish Heart Foundation, Vognmagergade 7, 3., 1120 Copenhagen, Denmark
- The National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology and Clinical Investigation, Nordsjaellands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Frederik V's Vej 11, 2100 Copenhagen, Denmark
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Jacobsen EM, Hansen BL, Kjerrumgaard A, Tfelt-Hansen J, Hassager C, Kjaergaard J, Christensen AH, Bundgaard H, Winkel BG. Diagnostic yield and long-term outcome of nonischemic sudden cardiac arrest survivors and their relatives: Results from a tertiary referral center. Heart Rhythm 2020; 17:1679-1686. [PMID: 32615163 DOI: 10.1016/j.hrthm.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac arrest may be the first manifestation of most inherited cardiac diseases. International guidelines recommend screening of relatives of sudden cardiac arrest (SCA) survivors if an inherited cardiac disorder is suspected. OBJECTIVE The purpose of this study was to assess the prevalence and spectrum of inherited cardiac diseases and the long-term outcome in a consecutive cohort of nonischemic SCA survivors (probands) and their relatives. METHODS This retrospective study consecutively included probands and their relatives referred to our tertiary center for family screening between 2005 and 2018. All participants underwent a systematic workup and follow-up protocol. Data were retrieved from medical records. RESULTS We included 155 probands (age 41.2 ± 15.5 years; 61% male) and 282 relatives (age 35.7 ± 18.8 years; 51% male). Mean follow-up was 7.1 years for probands and 4.4 years for relatives. We identified an inherited cardiac disease in 76 (49%) probands and 42 (15%) relatives. An implantable cardioverter-defibrillator was inserted in 147 (95%) probands and 9 (3%) relatives. During follow-up, 4 (3%) probands and 3 (1%) relatives died, and 37 probands and 2 relatives received appropriate shock therapy. All relatives received genetic counseling, and 18 (6%) relatives started pharmacologic treatment during follow-up. CONCLUSION Systematic workup of nonischemic SCA survivors and their relatives identified an inherited cardiac disease in 49% of referred probands and 15% of their relatives. The favorable long-term prognosis of diagnosed relatives probably not only reflects lower age but also the effects of early diagnosis, treatment, and follow-up. These findings support systematic workup of SCA survivors and their relatives.
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Affiliation(s)
- Elisabeth Mütze Jacobsen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark.
| | - Benjamin Lautrup Hansen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Amalie Kjerrumgaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjaergaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Herlev-Gentofte Hospital, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
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Yazdanfard PD, Christensen AH, Tfelt-Hansen J, Bundgaard H, Winkel BG. Non-diagnostic autopsy findings in sudden unexplained death victims. BMC Cardiovasc Disord 2020; 20:58. [PMID: 32019512 PMCID: PMC7001247 DOI: 10.1186/s12872-020-01361-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/24/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several inherited cardiac diseases may lead to sudden cardiac death (SCD) a devastating event in the families. It is crucial to establish a post mortem diagnosis to facilitate relevant work-up and treatment of family members. Sudden unexplained death (SUD) victims constitute roughly one third of all SCD cases in Denmark. METHODS This was a single center, retrospective study investigating SUD cases. Victims who died unexplained due to suspected or confirmed cardiac disease were consecutively referred to a third line referral center established in 2005. All autopsy reports were investigated. Victims were divided into two groups: non-diagnostic cardiac findings and normal cardiac findings. None of the included victims had findings consistent with a diagnosis based on existing criteria. RESULTS In total, 99 SUD cases were referred. The mean age of the victims was 37 years (range 0-62 years, 75% males). A total of 14 (14%) victims had a cardiovascular diagnosis pre-mortem. Thirty-seven cases had normal cardiac findings and non-diagnostic cardiac findings were found in 62 cases (63%). The five most common findings included ventricular hypertrophy and/or enlarged heart (n = 35, 35%), coronary atheromatosis (n = 31, 31%), myocardial fibrosis (n = 19, 19%), dilated chambers (n = 7, 7%) and myocardial inflammation (n = 5, 5%). CONCLUSION One third of SUD victims had normal cardiac findings and non-diagnostic cardiac findings were seen in almost two thirds of the SUD victims. These non-diagnostic findings may be precursors or early markers for underlying structural cardiac disorders or may be innocent bystanders in some cases. Further studies and improved post-mortem examination methods are needed for optimization of diagnostics in SUD.
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Affiliation(s)
- Puriya Daniel Yazdanfard
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
| | - Alex Hørby Christensen
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology The Heart Center, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, 2142, 2100 Copenhagen, Denmark
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Skjelbred T, Lynge TH, Nielsen J, Winkel BG, Tfelt-Hansen J. Symptoms and healthcare contact preceding sudden cardiac death in persons aged 1-49 years. Trends Cardiovasc Med 2020; 31:119-124. [PMID: 31987774 DOI: 10.1016/j.tcm.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/03/2020] [Accepted: 01/03/2020] [Indexed: 01/17/2023]
Abstract
Sudden Cardiac Death (SCD) is a leading cause of death among persons in their youth and early middle-age. To prevent SCD it is crucial to identify persons at high-risk of SCD. Knowledge of symptoms and medical contact prior to SCD could potentially aid in the identification of high-risk persons in the general population who would benefit from further investigation. This review aims to summarize the current knowledge of symptoms and healthcare contact preceding SCD in persons aged 1-49 years, and to explore how the symptoms differ according to SCD cause and age of the deceased. There was a high frequency of both cardiac and non-specific symptoms prior to SCD. Additionally, many SCD victims contacted the healthcare system prior to death on the basis of their symptoms and only a few were diagnosed with cardiovascular disease. This information underlines that young persons reporting potential cardiac symptoms should also be thoroughly examined. Furthermore, such symptoms could be used in combination with other easily accessible information in non-invasive prediction models aiming at identifying persons at high risk of SCD that would benefit from further investigation and possibly treatment.
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Affiliation(s)
- Tobias Skjelbred
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark.
| | - Jakob Nielsen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Section 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Medicine and Surgery, University of Copenhagen, Copenhagen, Denmark
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Winkel BG, Tfelt-Hansen J. Editorial commentary: When should the patient with an inherited cardiac disease have an ICD? Trends Cardiovasc Med 2019; 30:422-423. [PMID: 31812250 DOI: 10.1016/j.tcm.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 11/06/2019] [Indexed: 11/28/2022]
Abstract
The implantable cardioverter defibrillator (ICD) is often considered a routine intervention for an inherited heart rhythm disorder (IHRD) despite there being little to no randomized data for non-ischemic indications. Furthermore, existing IHRD studies often do not report adverse ICD outcomes, and observational data increasingly show that complications are under-recognized. Only recently have tools emerged to address the rational use of ICDs for specific forms of IHRD, although the acceptable risk of device complications remains unestablished. Here, we summarize the evidence of ICD benefit and harm in IHRD, highlight current knowledge gaps, and propose alternative and adjunctive options to the transvenous ICD.
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Affiliation(s)
- Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Section of Forensic Pathology, Department of Forensic Medicine, Copenhagen University, Denmark.
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Affiliation(s)
- Iben Mundbjerg Gjødsbøl
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | - Bo Gregers Winkel
- Centre for Cardiac, Vascular, Pulmonary, and Infectious Diseases, Department of Cardiology, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Henning Bundgaard
- Centre for Cardiac, Vascular, Pulmonary, and Infectious Diseases, Department of Cardiology, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen Ø, Denmark
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Muetze Jacobsen E, Kjerrumgaard AJ, Hansen BL, Winkel BG, Christensen AH, Bundgaard H. P2821Diagnostic yield and outcomes of systematic work-up of aborted sudden cardiac death victims and their relatives. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Cardiac arrest can be the first manifestation of most inherited cardiac diseases. This motivates the international guidelines recommending screening of relatives of cardiac arrest survivors (aSCD) if an inherited cardiac disorder might have caused the cardiac arrest.
Purpose
To assess the presence of inheritable cardiac diseases in cardiac arrest survivors and their relatives.
Methods
In this retrospective study we consecutively included cardiac arrest survivors (probands) and their relatives referred to our tertiary referral center from 2005 to 2018. All probands and relatives underwent a systematic screening protocol. Data were retrieved from medical files. Only probands with non-ischemic heart disease were included.
Results
We included 155 probands (41±16 years old, 94 (61%) male) and 284 relatives (36±19 years old, 144 (51%) male). We identified an inheritable cardiac disease in 70 (45%) probands, most frequently cardiomyopathies (41, 26%) followed by channelopathies (27, 17%) (figure). A borderline diagnosis was found in 32 (21%) probands. In the relatives, an inheritable diagnosis was identified in 38 (13%) individuals, most frequently channelopathies (23, 8%), and a borderline diagnosis was identified in 33 (12%) individuals.
Conclusion
Clinical assessment of aSCD cases on a non-ischemic basis identified an inheritable cardiac disease as the most likely etiology in almost half of the probands and in 13% of the relatives.
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Affiliation(s)
- E Muetze Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A J Kjerrumgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B L Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A H Christensen
- Herlev Hospital - Copenhagen University Hospital, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Kjerrumgaard A, Jacobsen EM, Hansen BL, Winkel BG, Christensen AH, Bundgaard H. P2830Clinical and genetic findings in relatives to young sudden cardiac death victims without post-mortem examination (autopsy). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Guidelines recommend clinical assessment of relatives to young sudden cardiac death (SCD) victims (<50 years) to protect the surviving relatives by pre-symptomatic interventions, in case the SCD was due to an inherited cardiac disorder. The etiology is an inherited cardiac disease in about 50% of young SCD cases. The work-up of relatives is generally guided by findings in the SCD victim. If post-mortem examinations (autopsies) have not been performed the work-up of relatives is challenged. The diagnostic hit-ratio of screening of relatives under these circumstances is unclear.
Purpose
To assess the diagnostic yield of inherited cardiac diseases of cardiac work-up in relatives of SCD victims, where no autopsy had been performed.
Methods
This retrospective study consecutively included families referred to our tertiary referral centre, specialised in hereditary cardiac diseases, during the period 2005 to 2018 due to SCD in the family. No autopsy had been performed in any of the SCD victims. The relatives underwent standard cardiac work-up according to guidelines. Based on the findings in the relatives the families were categorised into: 1) definite diagnosis, 2) borderline diagnosis or 3) undiagnosed.
Results
We assessed 149 relatives (43±16 age, 48% men) to 84 SCD un-autopsied cases (44±11 age, 79% men). In 11 (13%) families a definite diagnosis was established, in 8 (10%) families a borderline diagnosis was found and the remaining 65 (77%) families remained undiagnosed. The most common diagnosis was premature IHD (36%) followed by cardiomyopathies (27%) and channelopathies (27%). A disease-causing mutation was identified in 3 families out of 15 genetically examined families.
Conclusion
Systematic cardiac work-up of relatives to not-autopsied SCD victims, revealed a definite hereditary cardiac disease in 13% of the referred families, and a borderline diagnosis in additionally 10% of the families. Despite a reduced diagnostic yield in family members of non-autopsied SCD victims, work-up of relatives is clearly still justified.
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Affiliation(s)
- A Kjerrumgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - E M Jacobsen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B L Hansen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - B G Winkel
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - A H Christensen
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - H Bundgaard
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
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Lynge TH, Nielsen TS, Gregers Winkel B, Tfelt-Hansen J, Banner J. Sudden cardiac death caused by myocarditis in persons aged 1-49 years: a nationwide study of 14 294 deaths in Denmark. Forensic Sci Res 2019; 4:247-256. [PMID: 31489390 PMCID: PMC6713107 DOI: 10.1080/20961790.2019.1595352] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/11/2019] [Indexed: 02/08/2023] Open
Abstract
Myocarditis is associated with an increased risk of sudden cardiac death (SCD) in the young. However, information on nationwide burden of SCD caused by myocarditis (SCD-myocarditis) is sparse. For this study all deaths among persons in Denmark aged 1–35 years in 2000–2009 and 36–49 years in 2007–2009 (27.1 million person-years) were included. Autopsy reports, death certificates, discharge summaries, and nationwide registries were used to identify all cases of SCD-myocarditis. In the 10-year study period, there were 14 294 deaths, of which we identified 1 363 (10%) SCD. Among autopsied SCD (n = 753, 55%), cause of death was myocarditis in 42 (6%) cases corresponding to an SCD-myocarditis incidence of 0.16 (95%CI: 0.11–0.21) per 100 000 person-years. Males had significantly higher incidence rates of SCD-myocarditis compared to females with an incidence rate ratio of 2.2 (95%CI: 1.1–4.1). Myocarditis was not registered as cause of death in any of the non-autopsied SCD (n = 610, 45%). In conclusion, after nationwide unselected inclusion of 14 294 deaths, we found that 6% of all autopsied SCD was caused by myocarditis. No cases of SCD-myocarditis were reported in the non-autopsied SCD, which could reflect underdiagnosing of myocarditis in non-autopsied SCD. Furthermore, our data suggest a female protection towards SCD-myocarditis.
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Affiliation(s)
| | - Trine Skov Nielsen
- Department of Forensic Medicine, Section of Forensic Pathology, Aarhus University, Aarhus, Denmark
| | | | - Jacob Tfelt-Hansen
- Department of Cardiology, Rigshospitalet, Denmark.,Department of Forensic Medicine, Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
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Lynge TH, Jeppesen AG, Winkel BG, Glinge C, Schmidt MR, Søndergaard L, Risgaard B, Tfelt-Hansen J. Nationwide Study of Sudden Cardiac Death in People With Congenital Heart Defects Aged 0 to 35 Years. Circ Arrhythm Electrophysiol 2019; 11:e005757. [PMID: 29858381 DOI: 10.1161/circep.117.005757] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 03/27/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital heart defects (CHD) are among the leading causes of sudden cardiac death (SCD) in the young. Nationwide incidence of SCD in people with CHD (SCD-CHD) has not been established in the young general population. The aims of this study were to investigate incidence of SCD-CHD and whether incidence of SCD-CHD in infants declined after implementation of nationwide fetal ultrasound screening in Denmark. METHODS All deaths (n=11 451) among people aged 0 to 35 years in Denmark in 2000 to 2009 (24.4 million person-years) were included. Danish death certificates, autopsy reports, records from hospitals and general practitioners, and data from nationwide Danish registries were used to identify SCD-CHD cases. RESULTS We identified 90 (11%) cases of SCD-CHD from 809 SCD. The incidence rate of SCD-CHD was 0.4 per 100 000 person-years among people aged 0 to 35 years. In total, 53 (59%) were diagnosed with CHD before death. Incidence of SCD was 9.6× higher among patients with CHD compared with people without CHD (P<0.01). Annual incidence of physical activity-related SCD-CHD among patients aged 2 to 35 years diagnosed with CHD was 0.9 per 100 000. The annual incidence rate of SCD-CHD in infants declined after implementation of nationwide fetal ultrasound screening (incidence rate ratio, 3.8; P<0.01). CONCLUSIONS The proportion of SCD-CHD in the young was 11%, which is higher than previously reported. Physical activity-related SCD-CHD was a rare event among patients with CHD. We observed an ≈4-fold lower incidence of SCD-CHD among infants born after implementation of nationwide screening.
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Affiliation(s)
- Thomas Hadberg Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.).
| | - Alexander Gade Jeppesen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.)
| | - Bo Gregers Winkel
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.)
| | - Charlotte Glinge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.)
| | | | - Lars Søndergaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.).,Department of Medicine and Surgery, University of Copenhagen, Denmark (L.S., J.T.-H.)
| | - Bjarke Risgaard
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.)
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (T.H.L., A.G.J., B.G.W., C.G., L.S., B.R., J.T.-H.).,Department of Medicine and Surgery, University of Copenhagen, Denmark (L.S., J.T.-H.)
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Raju H, Ware JS, Skinner JR, Hedley PL, Arno G, Love DR, van der Werf C, Tfelt-Hansen J, Winkel BG, Cohen MC, Li X, John S, Sharma S, Jeffery S, Wilde AAM, Christiansen M, Sheppard MN, Behr ER. Next-generation sequencing using microfluidic PCR enrichment for molecular autopsy. BMC Cardiovasc Disord 2019; 19:174. [PMID: 31337358 PMCID: PMC6651896 DOI: 10.1186/s12872-019-1154-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/10/2019] [Indexed: 01/11/2023] Open
Abstract
Background We aimed to determine the mutation yield and clinical applicability of “molecular autopsy” following sudden arrhythmic death syndrome (SADS) by validating and utilizing low-cost high-throughput technologies: Fluidigm Access Array PCR-enrichment with Illumina HiSeq 2000 next generation sequencing (NGS). Methods We validated and optimized the NGS platform with a subset of 46 patients by comparison with Sanger sequencing of coding exons of major arrhythmia risk-genes (KCNQ1, KCNH2, SCN5A, KCNE1, KCNE2, RYR2). A combined large multi-ethnic international SADS cohort was sequenced utilizing the NGS platform to determine overall molecular yield; rare variants identified by NGS were subsequently reconfirmed by Sanger sequencing. Results The NGS platform demonstrated 100% sensitivity for pathogenic variants as well as 87.20% sensitivity and 99.99% specificity for all substitutions (optimization subset, n = 46). The positive predictive value (PPV) for NGS for rare substitutions was 16.0% (27 confirmed rare variants of 169 positive NGS calls in 151 additional cases). The overall molecular yield in 197 multi-ethnic SADS cases (mean age 22.6 ± 14.4 years, 68% male) was 5.1% (95% confidence interval 2.0–8.1%), representing 10 cases carrying pathogenic or likely pathogenic risk-mutations. Conclusions Molecular autopsy with Fluidigm Access Array and Illumina HiSeq NGS utilizing a selected panel of LQTS/BrS and CPVT risk-genes offers moderate diagnostic yield, albeit requiring confirmatory Sanger-sequencing of mutational variants. Electronic supplementary material The online version of this article (10.1186/s12872-019-1154-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hariharan Raju
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK. .,Health Cardiology, Faculty of Medicine & Health Sciences, Macquarie University, Suite 203, 2 Technology Place, Sydney, NSW, 2109, Australia.
| | - James S Ware
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Jonathan R Skinner
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
| | - Paula L Hedley
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark
| | - Gavin Arno
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Donald R Love
- Diagnostic Genetics, Auckland City Hospital, Auckland, New Zealand
| | - Christian van der Werf
- Amsterdam UMC, Heart Centre, and Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Forensic Medicine, University of Copenhagen, København, Denmark.,ERN-GUARD Heart (European Union), Brussels, Belgium
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,ERN-GUARD Heart (European Union), Brussels, Belgium
| | - Marta C Cohen
- Histopathology Department, Sheffield Children's Hospital, Sheffield, UK
| | - Xinzhong Li
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK.,School of Science, Engineering and Design, Teesside University, Middlesbrough, UK
| | - Shibu John
- NIHR Royal Brompton Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Sanjay Sharma
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Steve Jeffery
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK
| | - Arthur A M Wilde
- Amsterdam UMC, Heart Centre, and Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, Netherlands.,ERN-GUARD Heart (European Union), Brussels, Belgium
| | - Michael Christiansen
- Department for Congenital Disorders, Statens Serum Institut, Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Mary N Sheppard
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK.,ERN-GUARD Heart (European Union), Brussels, Belgium
| | - Elijah R Behr
- Cardiovascular Sciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, SW17 0RE, UK. .,ERN-GUARD Heart (European Union), Brussels, Belgium.
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