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Brlek P, Pavelić ES, Mešić J, Vrdoljak K, Skelin A, Manola Š, Pavlović N, Ćatić J, Matijević G, Brugada J, Primorac D. Case report: State-of-the-art risk-modifying treatment of sudden cardiac death in an asymptomatic patient with a mutation in the SCN5A gene and a review of the literature. Front Cardiovasc Med 2023; 10:1193878. [PMID: 37745129 PMCID: PMC10512029 DOI: 10.3389/fcvm.2023.1193878] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 08/21/2023] [Indexed: 09/26/2023] Open
Abstract
Brugada syndrome is a rare hereditary disorder characterized by distinct ECG findings, complex genetics, and a high risk of sudden cardiac death. Recognition of the syndrome is crucial as it represents a paradigm of sudden death tragedy in individuals at the peak of their lives. Notably, Brugada syndrome accounts for more than 20% of sudden cardiac deaths in individuals with structurally normal hearts. Although this syndrome follows an autosomal dominant inheritance pattern, it is more prevalent and severe in males. Diagnosis is primarily based on the characteristic ECG pattern observed in the right precordial leads. Mutations in the SCN5A gene, resulting in loss of function, are the most common genetic cause. We presented a 36-year-old proband with a family history of sudden cardiac death. Although the patient was asymptomatic for Brugada syndrome, his father had experienced sudden death at the age of 36. The proband was admitted to St. Catherine's Specialty Hospital where blood was taken and subjected to next-generation sequencing (NGS) using a "Sudden cardiac death" panel. The analysis identified a pathogenic variant in the SCN5A gene [c.4222G > A(p.Gly1408Arg)], which is associated with autosomal dominant Brugada syndrome. Based on the positive genetic test result, the patient was referred for further examination. ECG with modified precordial lead positioning confirmed the presence of the Brugada phenotype, displaying the type-2 and type-1 ECG patterns. Therefore, we made the diagnosis and decided to implant an implantable cardioverter-defibrillator (ICD) based on the results of broad genetic NGS testing, diagnostic criteria (ECG), and considering the high burden of sudden cardiac death in the patient's family, as well as his concerns that limited his everyday activities. This case shows that genetics and personalized medicine hold immense potential in the primary prevention, diagnosis, and treatment of Brugada syndrome and sudden cardiac death.
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Affiliation(s)
- Petar Brlek
- St. Catherine Specialty Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | | | - Jana Mešić
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | | | | | - Šime Manola
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Nikola Pavlović
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | - Jasmina Ćatić
- St. Catherine Specialty Hospital, Zagreb, Croatia
- Department for Cardiovascular Diseases, University Hospital Dubrava, Zagreb, Croatia
| | | | - Josep Brugada
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Dragan Primorac
- St. Catherine Specialty Hospital, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Medical School, University of Rijeka, Rijeka, Croatia
- Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
- Medical School, University of Split, Split, Croatia
- Department of Biochemistry & Molecular Biology, The Pennsylvania State University, State College, PA, United States
- The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States
- Medical School REGIOMED, Coburg, Germany
- National Forensic Sciences University, Gujarat, India
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Primorac D, Odak L, Perić V, Ćatić J, Šikić J, Radeljić V, Manola Š, Nussbaum R, Vatta M, Aradhya S, Sofrenović T, Matišić V, Molnar V, Skelin A, Mirat J, Brachmann J. Sudden Cardiac Death-A New Insight Into Potentially Fatal Genetic Markers. Front Med (Lausanne) 2021; 8:647412. [PMID: 33829027 PMCID: PMC8019733 DOI: 10.3389/fmed.2021.647412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/01/2021] [Indexed: 01/13/2023] Open
Abstract
Sudden cardiac death (SCD) is an unexpected and dramatic event. It draws special attention especially in young, seemingly healthy athletes. Our scientific paper is based on the death of a young, 23-year-old professional footballer, who died on the football field after a two-year history of cardiac symptoms. In this study we analyzed clinical, ECG and laboratory data, as well as results of genetic testing analysis in family members. To elucidate potential genetic etiology of SCD in this family, our analysis included 294 genes related to various cardiac conditions.
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Affiliation(s)
- Dragan Primorac
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Eberly College of Science, The Pennsylvania State University, University Park, State College, Philadelphia, PA, United States.,The Henry C. Lee College of Criminal Justice and Forensic Sciences, University of New Haven, West Haven, CT, United States.,Medical School, University of Split, Split, Croatia.,Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia.,Medical School, University of Rijeka, Rijeka, Croatia.,Medical School REGIOMED, Coburg, Germany.,Medical School, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Ljubica Odak
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Children's Hospital Zagreb, Zagreb, Croatia
| | | | - Jasmina Ćatić
- St. Catherine Specialty Hospital, Zagreb, Croatia.,Department of Cardiology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Jozica Šikić
- Department of Cardiology, Clinical Hospital Sveti Duh, Zagreb, Croatia
| | - Vjekoslav Radeljić
- Department of Cardiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Šime Manola
- Department of Cardiology, Clinical Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | | | | | | | | | - Vid Matišić
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | - Vilim Molnar
- St. Catherine Specialty Hospital, Zagreb, Croatia
| | | | - Jure Mirat
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Johannes Brachmann
- Medical School, University of Split, Split, Croatia.,Medical School REGIOMED, Coburg, Germany
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Primorac D, Bach-Rojecky L, Vađunec D, Juginović A, Žunić K, Matišić V, Skelin A, Arsov B, Boban L, Erceg D, Ivkošić IE, Molnar V, Ćatić J, Mikula I, Boban L, Primorac L, Esquivel B, Donaldson M. Pharmacogenomics at the center of precision medicine: challenges and perspective in an era of Big Data. Pharmacogenomics 2020; 21:141-156. [PMID: 31950879 DOI: 10.2217/pgs-2019-0134] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 12/12/2022] Open
Abstract
Pharmacogenomics (PGx) is one of the core elements of personalized medicine. PGx information reduces the likelihood of adverse drug reactions and optimizes therapeutic efficacy. St Catherine Specialty Hospital in Zagreb/Zabok, Croatia has implemented a personalized patient approach using the RightMed® Comprehensive PGx panel of 25 pharmacogenes plus Facor V Leiden, Factor II and MTHFR genes, which is interpreted by a special counseling team to offer the best quality of care. With the advent of significant technological advances comes another challenge: how can we harness the data to inform clinically actionable measures and how can we use it to develop better predictive risk models? We propose to apply the principles artificial intelligence to develop a medication optimization platform to prevent, manage and treat different diseases.
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Affiliation(s)
- Dragan Primorac
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,University of Split School of Medicine, 21 000 Split, Croatia.,Eberly College of Science, 517 Thomas St, State College, Penn State University, PA 16803, USA.,The Henry C Lee College of Criminal Justice & Forensic Sciences, University of New Haven, West Haven, CT 06516, USA.,University of Osijek School of Medicine, 31000 Osijek, Croatia.,University of Rijeka School of Medicine, 51000 Rijeka, Croatia.,Srebrnjak Children's Hospital, 10000 Zagreb, Croatia.,University of Osijek Faculty of Dental Medicine & Health, 31000 Osijek, Croatia
| | - Lidija Bach-Rojecky
- University of Zagreb Faculty of Pharmacy & Biochemistry, 10000 Zagreb, Croatia
| | - Dalia Vađunec
- University of Zagreb Faculty of Pharmacy & Biochemistry, 10000 Zagreb, Croatia
| | - Alen Juginović
- University of Split School of Medicine, 21 000 Split, Croatia
| | | | - Vid Matišić
- University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Andrea Skelin
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,Genos Glycoscience Research Laboratory, 10000 Zagreb, Croatia
| | - Borna Arsov
- University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Luka Boban
- University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Damir Erceg
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,Srebrnjak Children's Hospital, 10000 Zagreb, Croatia.,University of Osijek Faculty of Dental Medicine & Health, 31000 Osijek, Croatia.,Croatian Catholic University, 10000 Zagreb, Croatia
| | - Ivana Erceg Ivkošić
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,University of Osijek Faculty of Dental Medicine & Health, 31000 Osijek, Croatia
| | - Vilim Molnar
- University of Zagreb School of Medicine, 10000 Zagreb, Croatia
| | - Jasmina Ćatić
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,University of Osijek School of Medicine, 31000 Osijek, Croatia.,Clinical Hospital Dubrava, Department of Cardiology, 10000 Zagreb, Croatia
| | - Ivan Mikula
- St Catherine Specialty Hospital, 10000 Zagreb & 49210 Zabok, Croatia.,University North, Nursing Department, 42000 Varaždin, Croatia
| | | | - Lara Primorac
- Wharton Business School, University of Pennsylvania, Philadelphia, PA 19104, USA
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Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore) 2018; 97:e0601. [PMID: 29718862 PMCID: PMC6393031 DOI: 10.1097/md.0000000000010601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
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Affiliation(s)
- Jasmina Ćatić
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
| | - Ivana Jurin
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
| | | | - Helena Jerkić
- Department of Cardiology, Clinical Hospital “Merkur”
| | - Robert Blažeković
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
- Department of Cardiac and Transplant Surgery, Clinical Hospital “Dubrava”, Zagreb, Croatia
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Sušić L, Baraban V, Vincelj J, Maričić L, Ćatić J, Blažeković R, Manojlović S. Dilemma in clinical diagnosis of right ventricular masses. J Clin Ultrasound 2017; 45:362-369. [PMID: 27753105 DOI: 10.1002/jcu.22414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/24/2016] [Accepted: 09/03/2016] [Indexed: 06/06/2023]
Abstract
Detection of an intracardiac mass always represents a clinical challenge. We present a 61-year-old female patient with symptoms of New York Heart Association class III. Two-dimensional transthoracic echocardiography revealed a hypoechogenic mass in the cavity of the dilated right ventricle (RV). Cardiac MRI described a pathologic structure of the RV free wall with pedunculated tumor in its cavity. Three months later, on a repeated echocardiography, there were three individual masses. The patient underwent surgery and the pathohistologic report demonstrated thrombotic masses. During the postoperative period, after reviewing all medical records, the conclusion was arrhythmogenic RV cardiomyopathy. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:362-369, 2017.
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Affiliation(s)
- Livija Sušić
- Health Centre Osijek, Croatia
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
| | - Vedrana Baraban
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
- University Hospital Centre Osijek, Croatia
| | - Josip Vincelj
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
- University Hospital Dubrava, Zagreb, Croatia
| | - Lana Maričić
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
- University Hospital Centre Osijek, Croatia
| | - Jasmina Ćatić
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
- University Hospital Dubrava, Zagreb, Croatia
| | - Robert Blažeković
- J.J. Strossmayer University, Faculty of Medicine Osijek, Croatia
- University Hospital Dubrava, Zagreb, Croatia
| | - Spomenka Manojlović
- University Hospital Dubrava, Zagreb, Croatia
- University of Zagreb, Faculty of Medicine, Croatia
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