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Anastasakis A, Papatheodorou E, Ritsatos K, Protonotarios N, Rentoumi V, Gatzoulis K, Antoniades L, Agapitos E, Koutsaftis P, Spiliopoulou C, Tousoulis D. Sudden unexplained death in the young: epidemiology, aetiology and value of the clinically guided genetic screening. Europace 2018; 20:472-480. [PMID: 28177452 DOI: 10.1093/europace/euw362] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/26/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To determine the incidence and the causes of sudden death (SD) in persons aged 1-35 years old and the diagnostic yield of clinically guided genetic screening in the sudden arrhythmic death syndrome (SADS) victims' families. Methods and results Incidence and causes of SD in the Attica region of Greece in 2002-10 were determined using death certificates and autopsy reports. We evaluated clinically consecutive families of SADS victims and if a clinical diagnosis was established, we proceeded to targeted genetic analysis. Out of 6030 deaths, 56% were due to traumatic or violent causes, 40.5% were natural deaths, and 3.3% were of undetermined cause. There were 349 SD cases. Cardiovascular causes accounted for 65%, non-cardiovascular causes for 17%, and SADS for 18%. Clinical evaluation identified an inherited heart disease in 5/20 SADS families (25%). Targeted genetic analysis identified a causative mutation in all of the five screened families and reconfirmed the diagnosis in three of five proband victims. Clinical and genetic evaluation of 28 family members identified eight affected carriers and eight non-affected carriers. Molecular autopsy failed to identify any of these families. Conclusion Sudden death in the young is of cardiovascular origin in the majority of cases. A considerable rate of SD cases remains of unknown cause on post-mortem. Apart from channelopathies, subclinical forms of inherited structural heart diseases would appear to be implicated in SADS. Clinically guided genetic screening has a significant diagnostic yield and identifies affected families that would have been missed by the current suggested molecular autopsy panel.
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Affiliation(s)
- Aris Anastasakis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Efstathios Papatheodorou
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece.,Cardiovascular and Cell Sciences Research Institute, Jenner Wing, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Konstantinos Ritsatos
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Nikos Protonotarios
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Vasiliki Rentoumi
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Konstantinos Gatzoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | | | - Emmanuel Agapitos
- Department of Pathology, Medical School, University of Athens, Athens, Greece
| | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
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Corrado D, Wichter T, Link MS, Hauer R, Marchlinski F, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NAM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of arrhythmogenic right ventricular cardiomyopathy/dysplasia: an international task force consensus statement. Eur Heart J 2015. [PMID: 26216920 PMCID: PMC4670964 DOI: 10.1093/eurheartj/ehv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Thomas Wichter
- Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany
| | - Mark S Link
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | - Richard Hauer
- ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
| | | | - Aris Anastasakis
- First Cardiology Department, University of Athens, Medical School, Athens, Greece
| | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
| | | | | | | | | | - Christian Schmied
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Firat Duru
- Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland
| | | | - N A Mark Estes
- New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA, USA
| | | | - Gaetano Thiene
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Via N. Giustiniani 2, Padova 35121, Italy
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Corrado D, Wichter T, Link MS, Hauer RNW, Marchlinski FE, Anastasakis A, Bauce B, Basso C, Brunckhorst C, Tsatsopoulou A, Tandri H, Paul M, Schmied C, Pelliccia A, Duru F, Protonotarios N, Estes NM, McKenna WJ, Thiene G, Marcus FI, Calkins H. Treatment of Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia: An International Task Force Consensus Statement. Circulation 2015. [PMID: 26216213 PMCID: PMC4521905 DOI: 10.1161/circulationaha.115.017944] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Domenico Corrado
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.).
| | - Thomas Wichter
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Mark S Link
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Richard N W Hauer
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank E Marchlinski
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Aris Anastasakis
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Barbara Bauce
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Cristina Basso
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Corinna Brunckhorst
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Adalena Tsatsopoulou
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Harikrishna Tandri
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Matthias Paul
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Christian Schmied
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Antonio Pelliccia
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Firat Duru
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Nikos Protonotarios
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Na Mark Estes
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - William J McKenna
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Gaetano Thiene
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Frank I Marcus
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
| | - Hugh Calkins
- From the Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical School, Padova, Italy (D.C., B.B., C.Basso, G.T.); Heart Center Osnabrück-Bad Rothenfelde, Marienhospital Osnabrück, Osnabrück, Germany (T.W.); New England Cardiac Arrhythmia Center, Tufts University School of Medicine, Boston, MA (M.S.L., N.A.M.E.); ICIN-Netherlands Heart Institute, Utrecht, The Netherlands (R.N.W.H.); University of Pennsylvania Health System, Philadelphia, PA (F.M.); First Cardiology Department, University of Athens, Medical School, Athens, Greece (A.A.); Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland (C. Brunckhorst, C.S., F.D.); Yannis Protonotarios Medical Centre, Hora Naxos, Greece (A.T., N.P.); Johns Hopkins Hospital, Baltimore, MD (H.T., H.C.); University Hospital of Münster, Münster, Germany (M.P.); Center of Sports Sciences, Rome, Italy (A.P.); The Heart Hospital, London, UK (W.J.M.); and University of Arizona, Tucson (F.I.M.)
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Protonotarios A, Anastasakis A, Panagiotakos DB, Antoniades L, Syrris P, Vouliotis A, Stefanadis C, Tsatsopoulou A, McKenna WJ, Protonotarios N. Arrhythmic risk assessment in genotyped families with arrhythmogenic right ventricular cardiomyopathy. Europace 2015; 18:610-6. [PMID: 25825460 DOI: 10.1093/europace/euv061] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [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: 11/29/2014] [Accepted: 02/23/2015] [Indexed: 12/16/2022] Open
Abstract
AIMS Arrhythmogenic right-ventricular cardiomyopathy (ARVC) is a genetically determined disorder, mostly caused by mutations in genes encoding desmosomal proteins. We evaluated phenotype/genotype characteristics to predict the risk for the first major arrhythmic event in desmosomal-mutation-associated ARVC families. METHODS AND RESULTS A cohort of 105 desmosomal-mutation carriers belonging to 39 consecutive ARVC families was evaluated. Serial clinical work-up consisting of history, physical examination, 12-lead/signal-averaged/24 h ambulatory ECG, and two-dimensional echocardiography was performed every 6-12 months. The predictive value of gender and genotype for the first major arrhythmic event was investigated within the cohort using time-to-event analysis. ECG/echocardiographic features were evaluated at the time of event and associated with the outcome using an age-matched nested case-control study within the cohort. Forty-three (41%) participants experienced the primary arrhythmic outcome at median age of 29 (21-46) years. The first event was sustained ventricular tachycardia in 31 and sudden cardiac death in 12. Definite diagnosis according to the 2010 Task Force criteria, showed 57% positive and 100% negative predictive value for the occurrence of arrhythmic outcome. Male gender (hazard ratio = 3.26, 95%CI, 1.63-6.51), predicted the first major arrhythmic event, independently of genotype, on multivariable analysis. Repolarization abnormalities and left-ventricular dysfunction independently associated with clinical disease profile at the time of event. CONCLUSION Male gender, independently of genotype is an arrhythmic risk predictor in ARVC-associated desmosomal-mutation carriers. Repolarization abnormalities and left-ventricular dysfunction are important components of the first event-associated clinical disease profile.
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Affiliation(s)
| | - Aris Anastasakis
- 1st Department of Cardiology, University of Athens Medical School, Athens, Greece
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | | | - Petros Syrris
- Institute of Cardiovascular Science, University College London and The Heart Hospital, University College London Hospitals Trust, London, UK
| | - Apostolos Vouliotis
- 1st Department of Cardiology, University of Athens Medical School, Athens, Greece
| | | | | | - William J McKenna
- Institute of Cardiovascular Science, University College London and The Heart Hospital, University College London Hospitals Trust, London, UK
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Efremidis M, Prappa E, Charalampous C, Protonotarios N, Letsas KP, Sideris A. Endocardial late potentials during sinus rhythm define the re-entry circuit of ventricular tachycardia in arrhythmogenic right ventricular cardiomyopathy. Hellenic J Cardiol 2013; 54:394-396. [PMID: 24100184] [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: 06/02/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is an inherited cardiomyopathy characterized by progressive fibro-fatty replacement of the right ventricular myocardium. We report a case where mapping of endocardial potentials during sinus rhythm identified the re-entry circuit of a recurrent ventricular tachycardia in a patient with ARVC. The tachycardia was subsequently ablated successfully.
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Affiliation(s)
- Michalis Efremidis
- Second Department of Cardiology, Evangelismos General Hospital, Athens, Greece
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6
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Mavrogeni S, Protonotarios N, Tsatsopoulou A, Papachristou P, Sfendouraki E, Papadopoulos G. Naxos disease evolution mimicking acute myocarditis: The role of cardiovascular magnetic resonance imaging. Int J Cardiol 2013; 166:e14-5. [DOI: 10.1016/j.ijcard.2012.12.078] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 12/25/2012] [Indexed: 01/04/2023]
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Iliuta L, Uno K, Ebihara A, Hayashi N, Chigira M, Yoshikawa T, Kimura K, Yamagata H, Yatomi Y, Takenaka K, Neves A, Mathias L, Leshko J, Linask K, Henriques-Coelho T, Areias J, Huhta J, Barbier P, Castiglioni L, Colazzo F, Fontana L, Nobili E, Franzosi M, Li Causi T, Sironi L, Tremoli E, Guerrini U, Stankovic I, Claus P, Jasaityte R, Putnikovic B, Neskovic A, Voigt J, Kutty S, Attebery J, Yeager E, Truemper E, Li L, Hammel J, Danford D, Tumasyan L, Adamyan K, Chilingaryan A, Mjolstad O, Andersen G, Dalen H, Graven T, Kleinau J, Skjetne K, Haugen B, Sucu M, Uku O, Sari I, Ercan S, Davutoglu V, Ozer O, Kim S, Na JO, Im S, Choi C, Lim H, Kim J, Han S, Seo H, Park C, Oh D, Hammoudi N, Duprey M, Regnier P, Vignalou J, Boubrit L, Pousset F, Jobard O, Isnard R, Shin SH, Woo S, Kim D, Park K, Kwan J, Andersen G, Mjolstad O, Graven T, Kleinau J, Skjetne K, Haugen B, Dalen H, Grigoryan S, Tunyan L, Hazarapetyan L, Shkolnik E, Vasyuk Y, Nesvetov V, Ruddox V, Edvardsen T, Otterstad J, Patrianakos A, Zacharaki A, Kalogerakis A, Nyktari E, Psathakis E, Parthenakis F, Vardas P, Yodwut C, Weinert L, Lang R, Mor-Avi V, Bandera F, Arena R, Labate V, Castelvecchio S, Menicanti L, Guazzi M, Nedeljkovic I, Ostojic M, Stepanovic J, Giga V, Beleslin B, Popovic D, Djordjevic-Dikic A, Petrovic M, Nedeljkovic M, Seferovic P, Popovic D, Ostojic M, Popovic B, Petrovic M, Vujisic-Tesic B, Nedeljkovic I, Arandjelovic A, Banovic M, Seferovic P, Damjanovic S, Horovitz A, Iriart X, De Guillebon D, Reant P, Lafitte S, Thambo J, Venkatesh A, Shahgaldi K, Johnson J, Brodin L, Winter R, Sahlen A, Manouras A, Szulik M, Streb W, Kalarus Z, Kukulski T, Lesniak-Sobelga AM, Kostkiewicz M, Tomkiewicz-Pajak L, Olszowska M, Hlawaty M, Rubis P, Podolec P, Spinelli L, Di Panzillo EA, Morisco C, Crispo S, Trimarco B, Lutay Y, Parkhomenko A, Stepura A, Zamfir D, Tautu O, Nestoruc A, Onut R, Comanescu I, Scafa Udriste A, Dorobantu M, Guseva O, Zhuravskaya N, Bartosh-Zelenaya S, Zagatina A, Kekovic P, Isailovic-Kekovic M, Squeri A, Macri' G, Anglano F, Censi S, Conti R, Pizzarelli M, Trecroci U, Bosi S, Le Tourneau T, Probst V, Kyndt F, Duval D, Trochu J, Bernstein J, Hagege A, Levine R, Le Marec H, Schott J, Enache R, Muraru D, Popescu B, Mateescu A, Purcarea F, Calin A, Beladan C, Rosca M, Ginghina C, Urdaniz MM, Rodriguez Palomares JF, Rius JB, Acosta Velez JG, Garcia-Moreno LG, Tura GT, Alujas MTG, Mas PT, Masip AE, Dorado DG, Zito C, Cusma-Piccione M, Miceli M, Di Bella G, Mohammed M, Oreto L, Di Matteo I, Crea P, Alongi G, Carerj S, Mizariene V, Zaliaduonyte-Peksiene D, Vaskelyte J, Jonkaitiene R, Jurkevicius R, D'auria F, Stinziani V, Grego S, Polisca P, Chiariello L, Cardoso M, Almeida A, David C, Marques J, Jorge C, Silva D, Magalhaes A, Goncalves S, Diogo A, Shiran A, Adawi S, Sachner R, Asmer I, Ganaeem M, Rubinshtein R, Gaspar T, Necas J, Kovalova S, Bombardini T, Sicari R, Ciampi Q, Gherardi S, Costantino M, Picano E, Casartelli M, Bombardini T, Simion D, Gaspari M, Procaccio F, Tsatsopoulou A, Prappa E, Kalantzi M, Patrianakos A, Anastasakis A, Protonotarios N, Monteforte N, Bloise R, Napolitano C, Priori S, Davos C, Varela A, Tsilafakis C, Kostavassili I, Mavroidis M, Di Molfetta A, Musca F, Fresiello L, Santini L, Forleo G, Lunati M, Ferrari G, Romeo F, Moreo A, Lourenco M, Azevedo O, Machado I, Nogueira I, Fernandes M, Pereira V, Quelhas I, Lourenco A, Estensen M, Langesaeter E, Gullestad L, Aakhus S, Skulstad H, Gronlund C, Gustavsson S, Morner S, Suhr O, Lindqvist P, Sunbul M, Kepez A, Durmus E, Ozben B, Mutlu B, Esposito R, Santoro A, Ippolito R, Schiano Lomoriello V, De Palma D, Santoro C, Muscariello R, Ierano P, Galderisi M, Mohammed M, Zito C, Cusma-Piccione M, Di Bella G, Antonini-Canterin F, Taha N, Di Bello V, Vriz O, Pugliatti P, Carerj S, Beladan C, Popescu B, Calin A, Rosca M, Matei F, Enache E, Gurzun M, Ginghina C, Stanescu C, Manoliu V, Branidou K, Daha I, Baicus C, Adam C, Ene I, Dan G, Von Bibra H, Wulf G, Schuster T, Pfuetzner A, Heilmeyer P, Dobson G, Smith B, Grapsa J, Nihoyannopoulos P, Montoro Lopez M, Alonso Ladreda A, Florez Gomez R, Itziar Soto C, Rios Blanco J, Gemma D, Iniesta Manjavacas A, Moreno Yanguela M, Lopez Sendon J, Guzman Martinez G, O'driscoll J, Marciniak A, Perez-Lopez M, Sharma R, Bombardini T, Cini D, Gherardi S, Del Bene R, Serra W, Moreo A, Sicari R, Picano E, Fernandez Cimadevilla O, De La Hera Galarza J, Pasanisi E, Alvarez Pichel I, Diaz Molina B, Martin Fernandez M, Corros C, Lambert Rodriguez J, Sicari R, Jedrzychowska-Baraniak J, Jarosz K, Jozwa R, Kasprzak J, Mohty D, Petitalot V, El Hamel C, Damy T, Lavergne D, Echahidi N, Virot P, Cogne M, Jaccard A, Weng KP, Hsieh KS, Yang YY, Wutthachusin T, Kaier T, Grapsa J, Morgan D, Hakky S, Purkayastha S, Connolly S, Fox K, Ahmed A, Cousins J, Nihoyannopoulos P, Sveric K, Richter U, Wunderlich C, Strasser R, Spethmann S, Dreger H, Baldenhofer G, Mueller E, Stuuer K, Stangl V, Laule M, Baumann G, Stangl K, Knebel F, Ruiz Ortiz M, Mesa D, Delgado M, Romo E, Castillo F, Morenate M, Baeza F, Toledano F, Leon C, De Lezo JS, Ishizu T, Seo Y, Kameda Y, Enomoto M, Atsumi A, Yamamoto M, Nogami Y, Aonuma K, Theodosis-Georgilas A, Tountas H, Fousteris E, Tsaoussis G, Margetis P, Deligiorgis A, Katidis Z, Melidonis A, Beldekos D, Foussas S, Butz T, Faber L, Piper C, Reckefuss N, Wirdeier S, Van Bracht M, Prull M, Plehn G, Horstkotte D, Trappe HJ, Winter S, Martinek M, Ebner C, Nesser H, Kilickiran Avci B, Yurdakul S, Sahin S, Tanrikulu A, Ermis E, Aytekin S, Cefalu C, Barbier P, Santoro A, Ippolito R, Esposito R, Schiano Lomoriello V, De Palma D, Muscariello R, Galderisi M, Karamanou A, Hamodraka E, Vrakas S, Paraskevaides I, Lekakis I, Kremastinos D, Enache R, Piazza R, Muraru D, Mateescu A, Popescu B, Calin A, Beladan C, Rosca M, Nicolosi G, Ginghina C, Erdogan E, Bacaksiz A, Akkaya M, Tasal A, Vatankulu M, Turfan M, Sonmez O, Ertas G, Uyarel H, Goktekin O, Singelton J, Petraco R, Shaikh R, Cole G, Francis D, Manisty C, Almeida A, Cortez-Dias N, Sousa J, Carpinteiro L, Marques J, Silva D, Jorge C, Carrilho-Ferreira P, Pinto F, Diogo A, Kleczynski P, Legutko J, Rakowski T, Dziewierz A, Siudak Z, Zdzienicka J, Brzozowska-Czarnek A, Dubiel J, Dudek D, Carvalho MS, De Araujo Goncalves P, Dores H, Sousa P, Marques H, Pereira Machado F, Gaspar A, Aleixo A, Mota Carmo M, Roquette J, Obase K, Sakakura T, Matsushita S, Takeuchi M, Tamai S, Komeda M, Yoshida K, Jimenez Rubio C, Isasti Aizpurua G, Miralles Ibarra J, Gianstefani S, Catibog N, Whittaker A, Wathen P, Kogoj P, Reiken J, Monaghan M, Salvetti M, Muiesan M, Paini A, Agabiti Rosei C, Aggiusti C, Bertacchini F, Stassaldi D, Rubagotti G, Comaglio A, Agabiti Rosei E, Soldati E, Corciu A, Zucchelli G, Di Cori A, Segreti L, De Lucia R, Paperini L, Viani S, Vannozzi A, Bongiorni M, Kablak-Ziembicka A, Przewlocki T, Stepien E, Wrotniak L, Karch I, Podolec P, Kleczynski P, Rakowski T, Dziewierz A, Jakala J, Legutko J, Dubiel J, Dudek D. Poster session Friday 7 December - PM: Effect of systemic illnesses on the heart. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes266] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Patrianakos A, Protonotarios N, Nyktari E, Pagonidis K, Tsatsopoulou A, Parthenakis F, Vardas P. Arrhythmogenic right ventricular cardiomyopathy/dysplasia and troponin release. Myocarditis or the “hot phase” of the disease? Int J Cardiol 2012; 157:e26-8. [DOI: 10.1016/j.ijcard.2011.09.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 09/06/2011] [Indexed: 11/26/2022]
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Anastasakis A, Vouliotis AI, Protonotarios N, Stefanadis C. Arrhythmogenic Right Ventricular Cardiomyopathy: The Challenge of Genetic Interpretation in Clinically Suspected Cases. Cardiology 2012; 123:190-4. [DOI: 10.1159/000342274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 11/19/2022]
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Mavrogeni S, Bratis K, Protonotarios N, Tsatsopoulou A, Papadopoulos G. Cardiac magnetic resonance can early assess the presence and severity of heart involvement in Naxos disease. Int J Cardiol 2012; 154:e19-20. [DOI: 10.1016/j.ijcard.2011.05.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2011] [Accepted: 05/13/2011] [Indexed: 10/18/2022]
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Avramides D, Protonotarios N, Asimaki A, Matsakas E. Arrhythmogenic right ventricular cardiomyopathy/dysplasia. Hellenic J Cardiol 2011; 52:452-461. [PMID: 21940295] [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: 05/31/2023] Open
Abstract
We describe the case of a 51-year-old woman with a 10-year history of dyspnoea and fatigue on slight effort, presyncopal episodes, and ventricular extrasystolic arrhythmia. Tests were negative for coronary artery disease, valvular disease, or left ventricular dysfunction. The patient fulfilled the clinical criteria for arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and the diagnosis was confirmed histologically with an endomyocardial biopsy. During 5-year follow up she also exhibited significant structural progression to the left ventricle. This is a rare case of ARVC/D manifested in middle age, with a negative family history, negative test for desmosome mutations, and negative myocardial immunohistochemical analysis, evidence that tends to suggest an acquired form of the disease. We also present a brief review of the clinical, electrocardiographic, structural, pathological/anatomical and genetic characteristics of the disease, the diagnostic criteria, prognosis, management, and sudden death prevention, as well as the way we have managed our patient until the present day.
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Asimaki A, Tandri H, Duffy ER, Winterfield JR, Mackey-Bojack S, Picken MM, Cooper LT, Wilber DJ, Marcus FI, Basso C, Thiene G, Tsatsopoulou A, Protonotarios N, Stevenson WG, McKenna WJ, Gautam S, Remick DG, Calkins H, Saffitz JE. Altered desmosomal proteins in granulomatous myocarditis and potential pathogenic links to arrhythmogenic right ventricular cardiomyopathy. Circ Arrhythm Electrophysiol 2011; 4:743-52. [PMID: 21859801 DOI: 10.1161/circep.111.964890] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [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: 01/24/2023]
Abstract
BACKGROUND Immunoreactive signal for the desmosomal protein plakoglobin (γ-catenin) is reduced at cardiac intercalated disks in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC), a highly arrhythmogenic condition caused by mutations in genes encoding desmosomal proteins. Previously, we observed a false-positive case in which plakoglobin signal was reduced in a patient initially believed to have ARVC but who actually had cardiac sarcoidosis. Sarcoidosis can masquerade clinically as ARVC but has not been previously associated with altered desmosomal proteins. METHODS AND RESULTS We observed marked reduction in immunoreactive signal for plakoglobin at cardiac myocyte junctions in patients with sarcoidosis and giant cell myocarditis, both highly arrhythmogenic forms of myocarditis associated with granulomatous inflammation. In contrast, plakoglobin signal was not depressed in lymphocytic (nongranulomatous) myocarditis. To determine whether cytokines might promote dislocation of plakoglobin from desmosomes, we incubated cultures of neonatal rat ventricular myocytes with selected inflammatory mediators. Brief exposure to low concentrations of interleukin (IL)-17, tumor necrosis factor-α (TNF-α), and IL-6 (cytokines implicated in granulomatous myocarditis) caused translocation of plakoglobin from cell-cell junctions to intracellular sites, whereas other potent cytokines implicated in nongranulomatous myocarditis had no effect, even at much higher concentrations. We also observed myocardial expression of IL-17 and TNF-α and elevated levels of serum inflammatory mediators, including IL-6R, IL-8, monocyte chemoattractant protein 1, and macrophage inflammatory protein 1β, in patients with ARVC (all P<0.0001 compared with controls). CONCLUSIONS The results suggest novel disease mechanisms involving desmosomal proteins in granulomatous myocarditis and implicate cytokines, perhaps derived in part from the myocardium, in disruption of desmosomal proteins and arrhythmogenesis in ARVC.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Letsas KP, Efremidis M, Weber R, Korantzopoulos P, Protonotarios N, Prappa E, Kounas SP, Evagelidou EN, Xydonas S, Kalusche D, Sideris A, Arentz T. Epsilon-like waves and ventricular conduction abnormalities in subjects with type 1 ECG pattern of Brugada syndrome. Heart Rhythm 2011; 8:874-8. [PMID: 21315837 DOI: 10.1016/j.hrthm.2011.01.043] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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] [Received: 12/27/2010] [Accepted: 01/27/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Previous studies have demonstrated an overlap between the arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) and Brugada syndrome (BS). Conduction delay in the right ventricle has been demonstrated in both entities. OBJECTIVE This study investigated specific ARVC/D electrocardiographic (ECG) markers in subjects with spontaneous or drug-induced type 1 ECG pattern of BS. METHODS The study population consisted of 47 apparently healthy individuals (38 men, mean age 44.1 ± 13.3 years) with spontaneous (n = 17) or drug-induced (n = 30) type 1 ECG phenotype of BS. The clinical records of these individuals were retrospectively analyzed. RESULTS Fifteen subjects (31.9%) were symptomatic, with a history of syncope. A family history of BS or sudden cardiac death was reported in 10 (21.3%) and 8 (17.0%) cases, respectively. Epsilon-like waves in leads V1-V3 were observed in 6 subjects (12.7%). Epsilon-like waves were seen in spontaneous type 1 ECGs in 2 cases and after sodium channel blocking test in 4 cases. In baseline ECGs, localized prolongation (>110 ms) of the QRS complex in leads V1-V3, QRS duration ratio in (V1+V2+V3)/(V4+V5+V6) ≥ 1.2, and prolonged S wave upstroke (>55 ms) in leads V1-V3 were seen in 48.8%, 29.8%, and 40.4% of subjects, respectively. Epsilon-like waves and delayed S wave upstroke were more commonly observed in subjects with family history of BS (P = .014 and P = .038, respectively). CONCLUSION Specific ECG markers that reflect ventricular conduction delay in ARVC/D are commonly observed in subjects with spontaneous or drug-induced type 1 ECG pattern of BS as well. These depolarization abnormalities may be related to subtle underlying structural abnormalities.
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Protonotarios N, Anastasakis A, Antoniades L, Chlouverakis G, Syrris P, Basso C, Asimaki A, Theopistou A, Stefanadis C, Thiene G, McKenna WJ, Tsatsopoulou A. Arrhythmogenic right ventricular cardiomyopathy/dysplasia on the basis of the revised diagnostic criteria in affected families with desmosomal mutations. Eur Heart J 2011; 32:1097-104. [PMID: 21345848 PMCID: PMC3086899 DOI: 10.1093/eurheartj/ehr043] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aims To evaluate arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) in affected families with desmosome mutations on the basis of the recently revised Task Force Criteria (TFC). Methods and results One hundred and three consecutive carriers of pathogenic desmosome mutations and 102 mutation-negative relatives belonging to 22 families with dominant and 14 families with recessive ARVC/D were evaluated according to the original and revised TFC. Serial cardiac assessment with 12-lead, signal-averaged, and 24 h ambulatory ECG and two-dimensional echocardiography was performed. Clinical events and outcome were prospectively analysed up to 24 years (median 4 years). With the revised criteria, 16 carriers were newly diagnosed on the basis of ECG abnormalities in 100%, ventricular arrhythmias in 79%, and functional/structural alterations in 31%, increasing diagnostic sensitivity from 57 to 71% (P = 0.001). Task Force Criteria specificity improved from 92 to 99% (P = 0.016). In dominant mutation carriers, penetrance changed significantly (61 vs. 42%, P = 0.001); no changes were observed in recessive homozygous carriers (97 vs. 97%, P = 1.00). Affected carriers according to the revised TFC (n = 73) had 12-lead ECG abnormalities in 96%, ventricular arrhythmias in 91%, and functional/structural alterations fulfilling echocardiographic criteria in 76%. Cumulative and event-free survival did not differ significantly between dominant and recessive affected carriers, being at 78.6 vs. 76 and 51.7 vs. 55.4%, respectively, by the age of 40 years. Conclusion Revised TFC increased diagnostic sensitivity particularly in dominant ARVC/D. Serial family evaluation may rely on electrocardiography which seems to have the best diagnostic utility particularly in early disease that is not detectable by two-dimensional echocardiography.
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Gehmlich K, Syrris P, Peskett E, Evans A, Ehler E, Asimaki A, Anastasakis A, Tsatsopoulou A, Vouliotis AI, Stefanadis C, Saffitz JE, Protonotarios N, McKenna WJ. Mechanistic insights into arrhythmogenic right ventricular cardiomyopathy caused by desmocollin-2 mutations. Cardiovasc Res 2010; 90:77-87. [PMID: 21062920 PMCID: PMC3058729 DOI: 10.1093/cvr/cvq353] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Aims Recent immunohistochemical studies observed the loss of plakoglobin (PG) from the intercalated disc (ID) as a hallmark of arrhythmogenic right ventricular cardiomyopathy (ARVC), suggesting a final common pathway for this disease. However, the underlying molecular processes are poorly understood. Methods and results We have identified novel mutations in the desmosomal cadherin desmocollin 2 (DSC2 R203C, L229X, T275M, and G371fsX378). The two missense mutations (DSC2 R203C and T275M) have been functionally characterized, together with a previously reported frameshift variant (DSC2 A897fsX900), to examine their pathogenic potential towards PG's functions at the ID. The three mutant proteins were transiently expressed in various cellular systems and assayed for expression, processing, localization, and binding to other desmosomal components in comparison to wild-type DSC2a protein. The two missense mutations showed defects in proteolytic cleavage, a process which is required for the functional activation of mature cadherins. In both cases, this is thought to cause a reduction of functional DSC2 at the desmosomes in cardiac cells. In contrast, the frameshift variant was incorporated into cardiac desmosomes; however, it showed reduced binding to PG. Conclusion Despite different modes of action, for all three variants, the reduced ability to provide a ligand for PG at the desmosomes was observed. This is in agreement with the reduced intensity of PG at these structures observed in ARVC patients.
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Affiliation(s)
- Katja Gehmlich
- Institute of Cardiovascular Science, University College London, London, UK.
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Patrianakos AP, Protonotarios N, Zacharaki A, Tsatsopoulou A, Parthenakis FI, Vardas PE. Isolated left ventricular apical hypoplasia: a newly recognized unclassified cardiomyopathy. J Am Soc Echocardiogr 2010; 23:1336.e1-4. [PMID: 20591617 DOI: 10.1016/j.echo.2010.05.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [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] [Received: 02/28/2010] [Indexed: 10/19/2022]
Abstract
We describe two relatively asymptomatic cases diagnosed with the newly recognized unclassified cardiomyopathy, isolated left ventricular apical hypoplasia. The disease has been described mainly in cardiac magnetic resonance, whereas this study presents the echocardiographic characteristics of this new cardiomyopathy.
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17
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Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MGPJ, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DMY, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation 2010; 121:1533-41. [PMID: 20172911 PMCID: PMC2860804 DOI: 10.1161/circulationaha.108.840827] [Citation(s) in RCA: 1350] [Impact Index Per Article: 96.4] [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] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features of ARVC/D. This enabled confirmatory clinical diagnosis in index cases through exclusion of phenocopies and provided a standard on which clinical research and genetic studies could be based. Structural, histological, electrocardiographic, arrhythmic, and familial features of the disease were incorporated into the criteria, subdivided into major and minor categories according to the specificity of their association with ARVC/D. At that time, clinical experience with ARVC/D was dominated by symptomatic index cases and sudden cardiac death victims-the overt or severe end of the disease spectrum. Consequently, the 1994 criteria were highly specific but lacked sensitivity for early and familial disease. METHODS AND RESULTS Revision of the diagnostic criteria provides guidance on the role of emerging diagnostic modalities and advances in the genetics of ARVC/D. The criteria have been modified to incorporate new knowledge and technology to improve diagnostic sensitivity, but with the important requisite of maintaining diagnostic specificity. The approach of classifying structural, histological, electrocardiographic, arrhythmic, and genetic features of the disease as major and minor criteria has been maintained. In this modification of the Task Force criteria, quantitative criteria are proposed and abnormalities are defined on the basis of comparison with normal subject data. CONCLUSIONS The present modifications of the Task Force Criteria represent a working framework to improve the diagnosis and management of this condition. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00024505.
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18
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Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MGPJ, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DMY, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. Eur Heart J 2010; 31:806-14. [PMID: 20172912 PMCID: PMC2848326 DOI: 10.1093/eurheartj/ehq025] [Citation(s) in RCA: 917] [Impact Index Per Article: 65.5] [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] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In 1994, an International Task Force proposed criteria for the clinical diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) that facilitated recognition and interpretation of the frequently nonspecific clinical features of ARVC/D. This enabled confirmatory clinical diagnosis in index cases through exclusion of phenocopies and provided a standard on which clinical research and genetic studies could be based. Structural, histological, electrocardiographic, arrhythmic, and familial features of the disease were incorporated into the criteria, subdivided into major and minor categories according to the specificity of their association with ARVC/D. At that time, clinical experience with ARVC/D was dominated by symptomatic index cases and sudden cardiac death victims-the overt or severe end of the disease spectrum. Consequently, the 1994 criteria were highly specific but lacked sensitivity for early and familial disease. METHODS AND RESULTS Revision of the diagnostic criteria provides guidance on the role of emerging diagnostic modalities and advances in the genetics of ARVC/D. The criteria have been modified to incorporate new knowledge and technology to improve diagnostic sensitivity, but with the important requisite of maintaining diagnostic specificity. The approach of classifying structural, histological, electrocardiographic, arrhythmic, and genetic features of the disease as major and minor criteria has been maintained. In this modification of the Task Force criteria, quantitative criteria are proposed and abnormalities are defined on the basis of comparison with normal subject data. CONCLUSIONS The present modifications of the Task Force Criteria represent a working framework to improve the diagnosis and management of this condition. Clinical Trial Registration clinicaltrials.gov Identifier: NCT00024505.
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Asimaki A, Tandri H, Huang H, Halushka MK, Gautam S, Basso C, Thiene G, Tsatsopoulou A, Protonotarios N, McKenna WJ, Calkins H, Saffitz JE. A new diagnostic test for arrhythmogenic right ventricular cardiomyopathy. N Engl J Med 2009; 360:1075-84. [PMID: 19279339 DOI: 10.1056/nejmoa0808138] [Citation(s) in RCA: 367] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The diagnosis of arrhythmogenic right ventricular cardiomyopathy (ARVC) can be challenging because the clinical presentation is highly variable and genetic penetrance is often low. METHODS To determine whether a change in the distribution of desmosomal proteins can be used as a sensitive and specific diagnostic test for ARVC, we performed immunohistochemical analysis of human myocardial samples. RESULTS We first tested myocardium from 11 subjects with ARVC; of these samples, 8 had desmosomal gene mutations. We also tested myocardium obtained at autopsy from 10 subjects with no clinical or pathological evidence of heart disease as control samples. All ARVC samples but no control samples showed a marked reduction in immunoreactive signal levels for plakoglobin (also known as gamma-catenin), a protein that links adhesion molecules at the intercalated disk to the cytoskeleton. Other desmosomal proteins showed variable changes, but signal levels for the nondesmosomal adhesion molecule N-cadherin were normal in all subjects with ARVC. To determine whether a diminished plakoglobin signal level was specific for ARVC, we analyzed myocardium from 15 subjects with hypertrophic, dilated, or ischemic cardiomyopathies. In every sample, levels of N-cadherin and plakoglobin signals at junctions were indistinguishable from those in control samples. Finally, we performed blinded immunohistochemical analysis of heart-biopsy samples from the Johns Hopkins ARVC registry. We made the correct diagnosis in 10 of 11 subjects with definite ARVC on the basis of clinical criteria and correctly ruled out ARVC in 10 of 11 subjects without ARVC, for a sensitivity of 91%, a specificity of 82%, a positive predictive value of 83%, and a negative predictive value of 90%. The plakoglobin signal level was reduced diffusely in ARVC samples, including those obtained in the left ventricle and the interventricular septum. CONCLUSIONS Routine immunohistochemical analysis of a conventional endomyocardial-biopsy sample appears to be a highly sensitive and specific diagnostic test for ARVC.
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Affiliation(s)
- Angeliki Asimaki
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA
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Lazaros G, Anastasakis A, Tsiachris D, Dilaveris P, Protonotarios N, Stefanadis C. Naxos disease presenting with ventricular tachycardia and troponin elevation. Heart Vessels 2009; 24:63-5. [DOI: 10.1007/s00380-008-1082-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 06/13/2008] [Indexed: 11/29/2022]
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Antoniades L, Tsatsopoulou A, Anastasakis A, Syrris P, Asimaki A, Panagiotakos D, Zambartas C, Stefanadis C, McKenna WJ, Protonotarios N. Arrhythmogenic right ventricular cardiomyopathy caused by deletions in plakophilin-2 and plakoglobin (Naxos disease) in families from Greece and Cyprus: genotype-phenotype relations, diagnostic features and prognosis. Eur Heart J 2006; 27:2208-16. [PMID: 16893920 DOI: 10.1093/eurheartj/ehl184] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [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: 11/14/2022] Open
Abstract
AIMS To evaluate clinical disease expression, non-invasive diagnosis, and prognosis in families with dominant vs. recessive arrhythmogenic right ventricular cardiomyopathy (ARVC) due to mutations in related desmosomal proteins plakophilin-2 (PKP2) and plakoglobin (JUP), respectively. METHODS AND RESULTS One hundred and eighty-seven individuals belonging to ARVC families, four with dominant PKP2 mutations and 12 with recessive JUP mutation underwent serial non-invasive cardiac assessment. Survival and arrhythmic events were evaluated prospectively up to 21 years (median 8.5 years). Sixteen of 22 PKP2 carriers and all 26 homozygous JUP carriers fulfilled the diagnostic criteria for ARVC, the youngest by the age of 13 years. Clinical disease expression did not differ significantly between PKP2 and JUP carriers. T-wave inversion in leads V1-V3, right ventricular wall motion abnormalities, and frequent ventricular extrasystoles were the most sensitive/specific markers for identification of mutation carriers. QRS dispersion > or =40 ms was an independent predictor of syncope but not of sudden death. CONCLUSION Mutations in PKP2 and JUP express similar cardiac phenotype. Non-invasive family screening may largely be based on T-wave inversion, right ventricular wall motion abnormalities, and frequent ventricular extrasystoles to identify mutation carriers.
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Abstract
Naxos disease is a recessively inherited condition with arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) and a cutaneous phenotype, characterised by peculiar woolly hair and palmoplantar keratoderma. The disease was first described in families originating from the Greek island of Naxos. Moreover, affected families have been identified in other Aegean islands, Turkey, Israel and Saudi Arabia. A syndrome with the same cutaneous phenotype and predominantly left ventricular involvement has been described in families from India and Ecuador (Carvajal syndrome). Woolly hair appears from birth, palmoplantar keratoderma develop during the first year of life and cardiomyopathy is clinically manifested by adolescence with 100% penetrance. Patients present with syncope, sustained ventricular tachycardia or sudden death. Symptoms of right heart failure appear during the end stages of the disease. In the Carvajal variant the cardiomyopathy is clinically manifested during childhood leading more frequently to heart failure. Mutations in the genes encoding the desmosomal proteins plakoglobin and desmoplakin have been identified as the cause of Naxos disease. Defects in the linking sites of these proteins can interrupt the contiguous chain of cell adhesion, particularly under conditions of increased mechanical stress or stretch, leading to cell death, progressive loss of myocardium and fibro-fatty replacement. Implantation of an automatic cardioverter defibrillator is indicated for prevention of sudden cardiac death. Antiarrhythmic drugs are used for preventing recurrences of episodes of sustained ventricular tachycardia and classical pharmacological treatment for congestive heart failure, while heart transplantation is considered at the end stages.
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Affiliation(s)
- Nikos Protonotarios
- Yannis Protonotarios Foundation, Medical Center of Naxos, Naxos 84300, Greece
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Anastasakis A, Kotsiopoulou C, Rigopoulos A, Theopistou A, Protonotarios N, Panagiotakos D, Mammalis N, Stefanadis C. Similarities in the profile of cardiopulmonary exercise testing between patients with hypertrophic cardiomyopathy and strength athletes. Heart 2005; 91:1477-8. [PMID: 16230452 PMCID: PMC1769161 DOI: 10.1136/hrt.2004.055053] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2005] [Indexed: 11/03/2022] Open
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Kaplan SR, Gard JJ, Protonotarios N, Tsatsopoulou A, Spiliopoulou C, Anastasakis A, Squarcioni CP, McKenna WJ, Thiene G, Basso C, Brousse N, Fontaine G, Saffitz JE. Remodeling of myocyte gap junctions in arrhythmogenic right ventricular cardiomyopathy due to a deletion in plakoglobin (Naxos disease). Heart Rhythm 2005; 1:3-11. [PMID: 15851108 DOI: 10.1016/j.hrthm.2004.01.001] [Citation(s) in RCA: 249] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2003] [Accepted: 01/24/2004] [Indexed: 01/09/2023]
Abstract
OBJECTIVES We tested the hypothesis that defective interactions between adhesion junctions and the cytoskeleton caused by the plakoglobin mutation in Naxos disease lead to remodeling of gap junctions and altered expression of the major gap junction protein, connexin43. BACKGROUND Naxos disease, a recessive form of arrhythmogenic right ventricular cardiomyopathy, is associated with a high incidence of arrhythmias and sudden cardiac death. Naxos disease is caused by a mutation in plakoglobin, a protein that links cell-cell adhesion molecules to the cytoskeleton. METHODS Myocardial expression of connexin43 and other intercellular junction proteins was characterized in 4 patients with Naxos disease. Immunohistochemistry was performed in all 4 patients, and immunoblotting and electron microscopy were performed in 1 patient who died in childhood before overt arrhythmogenic right ventricular cardiomyopathy had developed. RESULTS Connexin43 expression at intercellular junctions was reduced significantly in both right and left ventricles in all patients with Naxos disease. Electron microscopy revealed smaller and fewer gap junctions interconnecting ventricular myocytes. Mutant plakoglobin was expressed but failed to localize normally at intercellular junctions. Localization of N-cadherin, alpha- and beta-catenins, plakophilin-2, desmoplakin-1, and desmocollin-2 at intercalated disks appeared normal. CONCLUSIONS Remodeling of gap junctions occurs early in Naxos disease, presumably because of abnormal linkage between mechanical junctions and the cytoskeleton. Gap junction remodeling may produce a coupling defect which, combined with the subsequent development of pathologic changes in myocardium, could contribute to a highly arrhythmogenic substrate and enhance the risk of sudden death in Naxos disease.
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Affiliation(s)
- Starr R Kaplan
- Department of Pathology and Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, Missouri 63100, USA
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Protonotarios N, Tsatsopoulou A. Naxos disease. Indian Pacing Electrophysiol J 2005; 5:76-80. [PMID: 16943947 PMCID: PMC1502077] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Since 1995, according to the World Health Organisation's classification of cardiomyopathies, Naxos disease has been considered as the recessive form of arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C). It is a stereotype association of ARVD/C with a cutaneous phenotype, characterised by woolly hair and palmoplantar keratoderma.
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Protonotarios N, Tsatsopoulou A. Naxos disease and Carvajal syndrome: cardiocutaneous disorders that highlight the pathogenesis and broaden the spectrum of arrhythmogenic right ventricular cardiomyopathy. Cardiovasc Pathol 2005; 13:185-94. [PMID: 15210133 DOI: 10.1016/j.carpath.2004.03.609] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.1] [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: 02/06/2004] [Revised: 03/24/2004] [Accepted: 03/30/2004] [Indexed: 11/22/2022] Open
Abstract
Naxos disease is a recessive association of arrhythmogenic right ventricular cardiomyopathy (ARVC) with wooly hair and palmoplantar keratoderma or similar skin disorder. The clinical and histopathological spectrum of heart disease, molecular genetics and genotype-phenotype correlation are reviewed in 22 affected families with this cardiocutaneous syndrome reported in the literature from Greece, Italy, India, Ecuador, Israel and Turkey. All patients had the hair and skin phenotype from infancy and developed ARVC by adolescence. Mutations in genes encoding the cell adhesion proteins piakoglobin and desmoplakin that truncate the proteins at the C-terminal domains were identified to underlie this syndrome. A particular mutation in Ecuadorian families that truncates the intermediate filament-binding site of desmoplakin results in a variant of Naxos disease with predominantly left ventricular involvement, early morbidity and clinical overlapping with dilated cardiomyopathy (Carvajal syndrome). A lethal autosomal recessive cardiocutaneous syndrome of Poll Hereford calves has been reported in Australia sharing similarities with the human syndrome reviewed here with respect to hair and cardiac phenotype. The cardiomyopathy in Naxos cardiocutaneous syndromes presents with increased arrhythmogenicity and variable left ventricular involovement and is characterized histologically by myocardial loss with fibrofatty or fibrous replacement at subepicardial and mediomural layers. The clinical heterogeneity and tissue characteristics in this cell-adhesion cardiomyopathy might be mutation specific and leads to consideration that the spectrum of ARVC should be broadened.
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Basso C, Wichter T, Danieli GA, Corrado D, Czarnowska E, Fontaine G, McKenna WJ, Nava A, Protonotarios N, Antoniades L, Wlodarska K, D'Alessi F, Thiene G. Arrhythmogenic right ventricular cardiomyopathy: clinical registry and database, evaluation of therapies, pathology registry, DNA banking. Eur Heart J 2004; 25:531-4. [PMID: 15039134 DOI: 10.1016/j.ehj.2003.12.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Cristina Basso
- Institute of Pathological Anatomy, University of Padua, Italy
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Anastasakis A, Theopistou A, Rigopoulos A, Karvouni E, Protonotarios N, Markou D, Sevdalis E, Mamalis N, Stefanadis C, Toutouzas P. Inherited cardiovascular diseases: identification of silent/subclinical forms by screening target groups. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)82015-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Protonotarios N, Tsatsopoulou A, Anastasakis A, Sevdalis E, Theopistou A, Miliou A, Rigopoulos A, Karvouni E, Stefanadis C, Toutouzas P. Clinical markers for the identification of gene carriers in naxos disease families. J Am Coll Cardiol 2002. [DOI: 10.1016/s0735-1097(02)80691-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Basso C, Tsatsopoulou A, Thiene G, Anastasakis A, Valente M, Protonotarios N. "Petrified" right ventricle in long-standing naxos arrhythmogenic right ventricular cardiomyopathy. Circulation 2001; 104:E132-3. [PMID: 11733410 DOI: 10.1161/hc4701.098570] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- C Basso
- Institute of Pathology, University of Padua, Italy
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Protonotarios N, Tsatsopoulou A, Anastasakis A, Sevdalis E, McKoy G, Stratos K, Gatzoulis K, Tentolouris K, Spiliopoulou C, Panagiotakos D, McKenna W, Toutouzas P. Genotype-phenotype assessment in autosomal recessive arrhythmogenic right ventricular cardiomyopathy (Naxos disease) caused by a deletion in plakoglobin. J Am Coll Cardiol 2001; 38:1477-84. [PMID: 11691526 DOI: 10.1016/s0735-1097(01)01568-6] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [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: 12/12/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the genotype-phenotype relation with respect to penetrance, age and severity of expression, disease progression and prognosis in a recessively inherited arrhythmogenic right ventricular cardiomyopathy (ARVC). BACKGROUND Naxos disease is a recessively inherited ARVC caused by a mutation in the gene encoding plakoglobin (cell adhesion protein) in which the cardiac phenotype is associated with palmoplantar keratoderma and woolly hair. METHODS Twelve families with Naxos disease underwent cardiac and molecular genetic investigation. Serial cardiac assessment with annual resting 12-lead and 24-h ambulatory electrocardiogram (ECG) and two-dimensional echocardiography was performed during 1 to 16 years, median 7 +/- 6 years in all 78 surviving members. RESULTS Twenty-eight surviving members were homozygous and 40 were heterozygous for the mutation. All adults who were homozygous (n = 26) fulfilled the diagnostic criteria for ARVC, the youngest by the age of 13 years. In eight who were heterozygous, minor ECG or echocardiographic abnormalities were observed. Of the 26 subjects who were affected homozygotes, 92% showed ECG abnormalities, 92% ventricular arrhythmias, 100% right ventricular structural alterations and 27% left ventricular involvement. During follow-up (10 +/- 6 years), 16 (62%) developed structural progression, 12 (46%) arrhythmic events and 7 (27%) heart failure. The annual disease-related and sudden death mortality was 3% and 2.3%, respectively. CONCLUSIONS Autosomal recessive ARVC caused by a mutation in plakoglobin was 100% penetrant by adolescence. Affected subjects who were homozygous experienced progressive disease with adverse prognosis. A minority of subjects who were heterozygous showed minor ECG/echocardiographic changes, but clinically significant disease did not develop.
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MESH Headings
- Abnormalities, Multiple/diagnosis
- Abnormalities, Multiple/epidemiology
- Abnormalities, Multiple/genetics
- Adolescent
- Adult
- Age Distribution
- Age of Onset
- Aged
- Analysis of Variance
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/genetics
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/epidemiology
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Child
- Child, Preschool
- Cytoskeletal Proteins/genetics
- Death, Sudden, Cardiac/etiology
- Desmoplakins
- Disease Progression
- Echocardiography
- Electrocardiography
- Female
- Gene Deletion
- Genes, Recessive/genetics
- Genetic Testing
- Genotype
- Hair/abnormalities
- Heterozygote
- Homozygote
- Humans
- Infant
- Keratoderma, Palmoplantar/diagnosis
- Keratoderma, Palmoplantar/epidemiology
- Keratoderma, Palmoplantar/genetics
- Male
- Mediterranean Islands/epidemiology
- Middle Aged
- Pedigree
- Penetrance
- Phenotype
- Predictive Value of Tests
- Prognosis
- Severity of Illness Index
- Survival Analysis
- Syncope/etiology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/epidemiology
- Ventricular Dysfunction, Right/genetics
- gamma Catenin
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Abstract
Naxos disease is a unique form of right ventricular cardiomyopathy with a high prevalence of malignant ventricular arrhythmias, including sudden cardiac death. As a hereditary systemic disease confined to a small island, it has been closely studied over the last 15 years. The implantation of an automatic defibrillator provides an alternative form of antiarrhythmic management to improve life expectancy in these high risk cardiac patients. We present the first two Naxos disease patients with malignant ventricular arrhythmias who had defibrillator implantation.
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Affiliation(s)
- K Gatzoulis
- University Cardiac Department, Hippokration General Hospital, Athens, Greece
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McKoy G, Protonotarios N, Crosby A, Tsatsopoulou A, Anastasakis A, Coonar A, Norman M, Baboonian C, Jeffery S, McKenna WJ. Identification of a deletion in plakoglobin in arrhythmogenic right ventricular cardiomyopathy with palmoplantar keratoderma and woolly hair (Naxos disease). Lancet 2000; 355:2119-24. [PMID: 10902626 DOI: 10.1016/s0140-6736(00)02379-5] [Citation(s) in RCA: 703] [Impact Index Per Article: 29.3] [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: 01/14/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an autosomal dominant heart muscle disorder that causes arrhythmia, heart failure, and sudden death. Previously we mapped the genetic locus for the triad of autosomal recessive ARVC, palmoplantar keratoderma, and woolly hair (Naxos disease) to chromosome 17q21, in which the gene for plakoglobin is encoded. This protein is a key component of desmosomes and adherens junctions, and is important for the tight adhesion of many cell types, including those in the heart and skin. METHODS We studied 19 individuals with Naxos disease, as well as unaffected family members and unrelated individuals from the neighbouring Greek islands of Naxos and Milos. Gene sequence was determined by reverse transcriptase PCR from RNA isolated from the skin of an affected individual and mutations in other cases were confirmed by restriction-enzyme analysis. FINDINGS A homozygous 2 base pair deletion in the plakoglobin gene was identified only in the 19 affected individuals. This deletion caused a frameshift and premature termination of the protein, which was shown by western blot analysis. 29 clinically unaffected family members were heterozygous for the mutation; 20 unrelated individuals from Naxos and 43 autosomal dominant ARVC probands were homozygous for the normal allele. INTERPRETATION The finding of a deletion in plakoglobin in ARVC suggests that the proteins involved in cell-cell adhesion play an important part in maintaining myocyte integrity, and when junctions are disrupted, cell death, and fibrofatty replacement occur. Therefore, the discovery of a mutation in a protein with functions in maintaining cell junction integrity has important implications for other dominant forms of ARVC, related cardiomyopathies, and other cutaneous diseases.
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Affiliation(s)
- G McKoy
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK
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Coonar AS, Protonotarios N, Tsatsopoulou A, Needham EW, Houlston RS, Cliff S, Otter MI, Murday VA, Mattu RK, McKenna WJ. Gene for arrhythmogenic right ventricular cardiomyopathy with diffuse nonepidermolytic palmoplantar keratoderma and woolly hair (Naxos disease) maps to 17q21. Circulation 1998; 97:2049-58. [PMID: 9610536 DOI: 10.1161/01.cir.97.20.2049] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.1] [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: 02/07/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disease of unknown etiology that causes arrhythmias, heart failure, and sudden death. Diagnosis can be difficult, and this hampers investigation of its molecular basis. Forms of ARVC in which gene penetrance and disease expression are greater should facilitate genetic study. We undertook a clinical and genetic investigation of Naxos disease, originally described by Protonotarios in 1986. This disease constitutes the triad of ARVC, diffuse nonepidermolytic palmoplantar keratoderma, and woolly hair. METHODS AND RESULTS We evaluated the population of Naxos, Greece, to identify probands, which was followed by family screening. Twenty-one affected persons from 9 families of 150 persons were identified. Linkage analysis was performed with microsatellite markers. The disease locus mapped to 17q21. A peak 2-point LOD score of 3.62 at theta=0.0 was found with a marker within intron 4 of the keratin 9 gene, a member of the type I (acidic) keratin family. A preserved homozygous disease haplotype was identified. Haplotype analysis delimited the disease interval. CONCLUSIONS Hair and skin abnormalities were found to be reliable markers of subsequent heart disease. This suggests the presence of a single mutant gene with novel cardiac, skin, and hair function or two or more tightly linked disease genes. Recessive inheritance of Naxos disease and a founder effect were demonstrated. Identification of a fully informative genetic marker linked to the disease and uncommon in the background population may be of use as a test to identify disease gene carriers.
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Affiliation(s)
- A S Coonar
- Department of Cardiological Sciences, St George's Hospital Medical School, London, UK.
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Protonotarios N, Tsatsopoulou A, Patsourakos P, Alexopoulos D, Gezerlis P, Simitsis S, Scampardonis G. Cardiac abnormalities in familial palmoplantar keratosis. Heart 1986; 56:321-6. [PMID: 2945574 PMCID: PMC1236865 DOI: 10.1136/hrt.56.4.321] [Citation(s) in RCA: 208] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Cardiac abnormalities were identified in patients with familial palmoplantar keratosis. All of them were descended from families on the Greek island of Naxos. Four families were studied and nine cases of palmoplantar keratosis were identified; seven of them showed symptoms and signs of heart disease. Cardiomegaly on chest x ray and electrocardiographic abnormalities were common findings. Three cases had episodes of ventricular tachycardia and a fourth patient died suddenly. All patients with cardiac signs and symptoms showed echocardiographic enlargement of the right ventricle and a right ventricular band; in three the left ventricle was also affected.
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