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Boleti OD, Roussos S, Norrish G, Field E, Oates S, Tollit J, Nepali G, Bhole V, Uzun O, Daubeney PEF, Stuart GA, Fernandes P, McLeod K, Ilina M, Liaqath MNA, Bharucha T, Delle Donne G, Brown E, Linter K, Khodaghalian B, Jones C, Searle J, Mathur S, Boyd N, Reindhardt Z, Duignan S, Prendiville T, Adwani S, Zenker M, Wolf CM, Kaski JP. Sudden cardiac death in childhood RASopathy-associated hypertrophic cardiomyopathy: Validation of the HCM risk-kids model and predictors of events. Int J Cardiol 2023; 393:131405. [PMID: 37777071 DOI: 10.1016/j.ijcard.2023.131405] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND RASopathies account for nearly 20% of cases of childhood hypertrophic cardiomyopathy (HCM). Sudden cardiac death (SCD) occurs in patients with RASopathy-associated HCM, but the risk factors for SCD have not been systematically evaluated. AIM To validate the HCM Risk-Kids SCD risk prediction model in children with RASopathy-associated HCM and investigate potential specific SCD predictors in this population. METHODS Validation of HCM Risk-Kids was performed in a retrospective cohort of 169 patients with a RASopathy-associated HCM from 15 international paediatric cardiology centres. Multiple imputation by chained equations was used for missing values related to the HCM Risk-Kids parameters. RESULTS Eleven patients (6.5%) experienced a SCD or equivalent event at a median age of 12.5 months (IQR 7.7-28.64). The calculated SCD/equivalent event incidence was 0.78 (95% CI 0.43-1.41) per 100 patient years. Six patients (54.54%) with an event were in the low-risk category according to the HCM Risk-Kids model. Harrell's C index was 0.60, with a sensitivity of 9.09%, specificity of 63.92%, positive predictive value of 1.72%, and negative predictive value of 91%; with a poor distinction between the different risk groups. Unexplained syncope (HR 42.17, 95% CI 10.49-169.56, p < 0.001) and non-sustained ventricular tachycardia (HR 5.48, 95% CI 1.58-19.03, p < 0.007) were predictors of SCD on univariate analysis. CONCLUSION Unexplained syncope and the presence of NSVT emerge as predictors for SCD in children with RASopathy-associated HCM. The HCM Risk-Kids model may not be appropriate to use in this population, but larger multicentre collaborative studies are required to investigate this further.
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Affiliation(s)
- Olga D Boleti
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Sotirios Roussos
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gabrielle Norrish
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Ella Field
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Stephanie Oates
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Jennifer Tollit
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK
| | - Gauri Nepali
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Vinay Bhole
- The Heart Unit, Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Orhan Uzun
- Children's Heart Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Piers E F Daubeney
- Department of Paediatric Cardiology, Royal Brompton and Harefield NHS Trust, London, United Kingdom
| | - Graham A Stuart
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Precylia Fernandes
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Karen McLeod
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Maria Ilina
- Department of Paediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, Southampton General Hospital, Southampton, United Kingdom
| | - Grazia Delle Donne
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Elspeth Brown
- Department of Paediatric Cardiology, Leeds General Infirmary, Leeds, United Kingdom
| | - Katie Linter
- Department of Paediatric Cardiology, Glenfield Hospital, Leicester, United Kingdom
| | - Bernadette Khodaghalian
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Caroline Jones
- Department of Paediatric Cardiology, Alder Hey Children's Hospital, Liverpool, United Kingdom
| | - Jonathan Searle
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK; Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom; Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Sujeev Mathur
- Children's Heart Service, Evelina Children's Hospital, London, United Kingdom
| | - Nicola Boyd
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Zdenka Reindhardt
- Department of Paediatric Cardiology, The Freeman Hospital, Newcastle, United Kingdom
| | - Sophie Duignan
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Terence Prendiville
- The Children's Heart Centre, Our Lady's Children's Hospital, Dublin, Ireland
| | - Satish Adwani
- Department of Paediatric Cardiology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Martin Zenker
- Institute of Human Genetics, University Hospital, Magdeburg, Germany
| | - Cordula Maria Wolf
- Department of Congenital Heart Defects and Pediatric Cardiology, German Heart Center Munich, Technical University of Munich, DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Juan Pablo Kaski
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom; Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, UK.
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Norrish G, Kadirrajah V, Field E, Dady K, Tollit J, McLeod K, McGowan R, Cervi E, Kaski JP. Childhood Hypertrophic Cardiomyopathy Caused by Beta-Myosin Heavy Chain Variants Is Associated With a More Obstructive but Less Arrhythmogenic Phenotype Than Myosin-Binding Protein C Disease. Circ Genom Precis Med 2023; 16:483-485. [PMID: 37387224 DOI: 10.1161/circgen.123.004118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
| | - Vidthya Kadirrajah
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
| | - Kathleen Dady
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
| | - Jennifer Tollit
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
| | - Karen McLeod
- Department of Pediatric Cardiology, Royal Hospital for Children, Glasgow, United Kingdom (KML)
| | - Ruth McGowan
- West of Scotland Centre for Genomic Medicine, Glasgow, United Kingdom (R.M.G.)
| | - Elena Cervi
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom (G.N., E.F., K.D., J.T., E.C., J.P.K.)
- Institute of Cardiovascular Science, University College London, United Kingdom (G.N., V.K., E.F., J.T., E.C., J.P.K.)
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Bueno-Beti C, Tafuni A, Chelko SP, Sheppard MN, Field E, Tollit J, Heenan IK, Barnes A, Taylor MR, Mestroni L, Kaski JP, Saffitz JE, Asimaki A. Innate immune signaling in hearts and buccal mucosa cells of patients with arrhythmogenic cardiomyopathy. Heart Rhythm O2 2023; 4:650-659. [PMID: 37936669 PMCID: PMC10626188 DOI: 10.1016/j.hroo.2023.09.006] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Nuclear factor κB (NF-κB) signaling in cardiac myocytes causes disease in a mouse model of arrhythmogenic cardiomyopathy (ACM) by mobilizing CCR2-expressing macrophages that promote myocardial injury and arrhythmias. Buccal mucosa cells exhibit pathologic features similar to those seen in cardiac myocytes in patients with ACM. Objectives We sought to determine if persistent innate immune signaling via NF-κB occurs in cardiac myocytes in patients with ACM and if this is associated with myocardial infiltration of proinflammatory cells expressing CCR2. We also determined if buccal mucosa cells from young subjects with inherited disease alleles exhibit NF-κB signaling. Methods We analyzed myocardium from ACM patients who died suddenly or required cardiac transplantation. We also analyzed buccal mucosa cells from young subjects with inherited disease alleles. The presence of immunoreactive signal for RelA/p65 in nuclei of cardiac myocytes and buccal cells was used as a reliable indicator of active NF-κB signaling. We also counted myocardial CCR2-expressing cells. Results RelA/p65 signal was seen in numerous cardiac myocyte nuclei in 34 of 36 cases of ACM but not in 19 age-matched control individuals. Cells expressing CCR2 were increased in patient hearts in numbers directly correlated with the number of cardiac myocytes showing NF-κB signaling. NF-κB signaling was observed in buccal cells in young subjects with active disease. Conclusions Patients with clinically active ACM exhibit persistent innate immune responses in cardiac myocytes and buccal mucosa cells, reflecting a local and systemic inflammatory process. Such individuals may benefit from anti-inflammatory therapy.
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Affiliation(s)
- Carlos Bueno-Beti
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
| | | | - Stephen P. Chelko
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, Florida
| | - Mary N. Sheppard
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Jennifer Tollit
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Imogen K. Heenan
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Annabelle Barnes
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Matthew R. Taylor
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Luisa Mestroni
- Cardiovascular Institute and Adult Medical Genetics Program, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London, United Kingdom
| | - Jeffrey E. Saffitz
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Angeliki Asimaki
- Cardiovascular Academic and Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Group, St. George’s, University of London, United Kingdom
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Bueto-Beni C, Tafuni A, Chelko SP, Sheppard MN, Field E, Tollit J, Heenan IK, Barnes A, Taylor MR, Mestroni L, Kaski JP, Saffitz JE, Asimaki A. Innate Immune Signaling in Hearts and Buccal Mucosa Cells of Patients with Arrhythmogenic Cardiomyopathy. bioRxiv 2023:2023.07.25.550526. [PMID: 37649905 PMCID: PMC10465021 DOI: 10.1101/2023.07.25.550526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Objectives We sought to determine if persistent innate immune signaling via NFκB occurs in cardiac myocytes in patients with arrhythmogenic cardiomyopathy and if this is associated with myocardial infiltration of pro-inflammatory cells expressing CCR2. We also determined if buccal mucosa cells from young subjects with inherited disease alleles exhibit NFκB signaling. Background NFκB signaling in cardiac myocytes causes disease in a mouse model of arrhythmogenic cardiomyopathy by mobilizing CCR2-expressing macrophages which promote myocardial injury and arrhythmias. Buccal mucosa cells exhibit pathologic features similar to those seen in cardiac myocytes in patients with arrhythmogenic cardiomyopathy. Methods We analyzed myocardium from arrhythmogenic cardiomyopathy patients who died suddenly or required cardiac transplantation. We also analyzed buccal mucosa cells from young subjects with inherited disease alleles. The presence of immunoreactive signal for RelA/p65 in nuclei of cardiac myocytes and buccal cells was used as a reliable indicator of active NFκB signaling. We also counted myocardial CCR2-expressing cells. Results NFκB signaling was seen in cardiac myocytes in 34 of 36 cases of arrhythmogenic cardiomyopathy but in none of 19 age-matched controls. Cells expressing CCR2 were increased in patient hearts in numbers directly correlated with the number of cardiac myocytes showing NFκB signaling. NFκB signaling also occurred in buccal cells in young subjects with active disease. Conclusions Patients with clinically active arrhythmogenic cardiomyopathy exhibit persistent innate immune responses in cardiac myocytes and buccal mucosa cells reflecting an inflammatory process that fails to resolve. Such individuals may benefit from anti-inflammatory therapy. CONDENSED ABSTRACT NFκB signaling in cardiac myocytes causes arrhythmias and myocardial injury in a mouse model of arrhythmogenic cardiomyopathy by mobilizing pro-inflammatory CCR2-expressing macrophages to the heart. Based on these new mechanistic insights, we analyzed hearts of arrhythmogenic cardiomyopathy patients who died suddenly or required cardiac transplantation. We observed active NFκB signaling in cardiac myocytes associated with marked infiltration of CCR2-expressing cells. We also observed NFκB signaling in buccal mucosa cells obtained from young subjects with active disease. Thus, anti-inflammatory therapy may be effective in arrhythmogenic cardiomyopathy. Screening buccal cells may be a reliable way to identify patients most likely to benefit. HIGHLIGHTS Inflammation likely contributes to the pathogenesis of arrhythmogenic cardiomyopathy but the responsible mechanisms and the roles of specific classes of immune cells remain undefined.NFκB signaling in cardiac myocytes is sufficient to cause disease in a mouse model of arrhythmogenic cardiomyopathy by mobilizing injurious myeloid cells expressing CCR2 to the heart.Here, we provide evidence of persistent NFκB signaling in cardiac myocytes and increased CCR2-expressing cells in hearts of patients with arrhythmogenic cardiomyopathy. We observed a close correlation between the number of cardiac myocytes with active NFκB signaling and the number of CCR2-expressing cells in patient hearts.We also provide evidence of active NFκB signaling in buccal mucosa cells associated with initial onset of disease and/or disease progression in young subjects with arrhythmogenic cardiomyopathy alleles.
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Lopez-Blazquez M, Field E, Tollit J, Walsh H, Addis A, French N, Starling L, Kaski JP. Clinical significance of inferolateral early repolarisation and late potentials in children with Brugada Syndrome. J Electrocardiol 2021; 66:79-83. [PMID: 33831794 DOI: 10.1016/j.jelectrocard.2021.03.011] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The clinical utility of inferolateral early repolarisation (ER) and late potentials (LP) in children with Brugada Syndrome (BrS) has not been previously evaluated. The aim of this study was to determine the prevalence of electrocardiographic (ECG) abnormalities in children with BrS, and to investigate their relationship with clinical outcomes. METHODS 43 patients with BrS and 47 controls aged ≤18 undergoing systematic clinical and ECG evaluation, including signal-averaged ECG (SAECG) and pharmacological provocation testing, between 2003 and 2019 were included. RESULTS Four patients with BrS (9%) presented with a spontaneous type 1 Brugada pattern; the remaining 39 (91%) were diagnosed following ajmaline provocation testing. Twelve BrS patients (28%) had late potentials (LP) on SAECG compared to 1 (2%) in controls (p = 0.001). LP were more common in 5 patients with a high-risk phenotype (60% vs 24%) but this was not statistically significant. Twelve patients with BrS (28%) had inferolateral early repolarisation (ER) and 2 (5%) had fractionated QRS (f-QRS), but there were no statistically-significant differences with controls in these parameters. A significant arrhythmia (non-sustained ventricular tachycardia or atrial fibrillation) was seen in 4 patients (9%). CONCLUSIONS This study shows a high prevalence of SAECG abnormalities in children with BrS compared with controls, but this was not significantly associated with a high-risk phenotype.
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Affiliation(s)
- Maria Lopez-Blazquez
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Gregorio Marañon Children Hospital, Madrid, Spain
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jennifer Tollit
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Helen Walsh
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Amy Addis
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Nichola French
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Luke Starling
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; UCL Institute of Cardiovascular Science, London, United Kingdom.
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Lane A, Tollit J, Lewis R, Murray P. P197 Efficacy of a Local Domiciliary Non-invasive Ventilation (NIV) Service for Motor Neurone Disease (MND): Patient Survival, Safety and Satisfaction: Abstract P197 Table 1. Thorax 2015. [DOI: 10.1136/thoraxjnl-2015-207770.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Harlow S, Tollit J, Irvin-Sellers M. P31 Intelligence Based Information System (ibis) Reduces Respiratory Patients' Use Of Secondary Health Care Resources. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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