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Inno A, Tarantini L, Parrini I, Spallarossa P, Maurea N, Bisceglia I, Silvestris N, Russo A, Gori S. Cardiovascular Effects of Immune Checkpoint Inhibitors: More Than Just Myocarditis. Curr Oncol Rep 2023; 25:743-751. [PMID: 37017825 DOI: 10.1007/s11912-023-01411-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitors have reshaped the treatment of cancer, but they are characterized by peculiar toxicity consisting of immune-related adverse events that may potentially affect any organ or system. In this review, we summarize data on clinical presentation, diagnosis, pathogenesis, and management of the main immune-related cardiovascular toxicities of immune checkpoint inhibitors. RECENT FINDINGS The most relevant immune-related cardiovascular toxicity is myocarditis, but other non-negligible reported events include non-inflammatory heart failure, conduction abnormalities, pericardial disease, and vasculitis. More recently, growing evidence suggests a role for immune checkpoint inhibitors in accelerating atherosclerosis and promoting plaque inflammation, thus leading to myocardial infarction. Immune checkpoint inhibitors are associated with several forms of cardiovascular toxicity; thus, an accurate cardiovascular baseline evaluation and periodical monitoring are required. Furthermore, the optimization of cardiovascular risk factors before, during, and after treatment may contribute to mitigating both short-term and long-term cardiovascular toxicity of these drugs.
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Affiliation(s)
- Alessandro Inno
- Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A Sempreboni 5, 37024, Negrar Di Valpolicella, VR, Italy.
| | - Luigi Tarantini
- Cardiologia Ospedaliera, AUSL - IRCCS in Tecnologie Avanzate E Modelli Assistenziali in Oncologia, Reggio Emilia, Italy
| | - Iris Parrini
- Dipartimento Di Cardiologia, Ospedale Mauriziano, Turin, Italy
| | - Paolo Spallarossa
- Clinica Di Malattie Dell'Apparato Cardiovascolare, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola Maurea
- Struttura Complessa Cardiologia, Istituto Nazionale Tumori Di Napoli IRCCS Fondazione G. Pascale, Naples, Italy
| | - Irma Bisceglia
- Servizi Cardiologici Integrati, Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Nicola Silvestris
- Oncologia Medica, Dipartimento Di Patologia Umana "G. Barresi", Università Di Messina, Messina, Italy
| | - Antonio Russo
- Dipartimento Di Discipline Chirurgiche, Oncologiche E Stomatologiche, Università Di Palermo, Palermo, Italy
| | - Stefania Gori
- Oncologia Medica, IRCCS Ospedale Sacro Cuore Don Calabria, Via Don A Sempreboni 5, 37024, Negrar Di Valpolicella, VR, Italy
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Frimodt-Møller EK, Soliman EZ, Kizer JR, Vittinghoff E, Psaty BM, Biering-Sørensen T, Gottdiener JS, Marcus GM. Lifestyle habits associated with cardiac conduction disease. Eur Heart J 2023; 44:1058-1066. [PMID: 36660815 PMCID: PMC10226753 DOI: 10.1093/eurheartj/ehac799] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 11/25/2022] [Accepted: 12/19/2022] [Indexed: 01/21/2023] Open
Abstract
AIMS Cardiac conduction disease can lead to syncope, heart failure, and death. The only available therapy is pacemaker implantation, with no established prevention strategies. Research to identify modifiable risk factors has been scant. METHODS AND RESULTS Data from the Cardiovascular Health Study, a population-based cohort study of adults ≥ 65 years with annual 12-lead electrocardiograms obtained over 10 years, were utilized to examine relationships between baseline characteristics, including lifestyle habits, and conduction disease. Of 5050 participants (mean age 73 ± 6 years; 52% women), prevalent conduction disease included 257 with first-degree atrioventricular block, 99 with left anterior fascicular block, 9 with left posterior fascicular block, 193 with right bundle branch block (BBB), 76 with left BBB, and 102 with intraventricular block at baseline. After multivariable adjustment, older age, male sex, a larger body mass index, hypertension, and coronary heart disease were associated with a higher prevalence of conduction disease, whereas White race and more physical activity were associated with a lower prevalence. Over a median follow-up on 7 (interquartile range 1-9) years, 1036 developed incident conduction disease. Older age, male sex, a larger BMI, and diabetes were each associated with incident conduction disease. Of lifestyle habits, more physical activity (hazard ratio 0.91, 95% confidence interval 0.84-0.98, P = 0.017) was associated with a reduced risk, while smoking and alcohol did not exhibit a significant association. CONCLUSION While some difficult to control comorbidities were associated with conduction disease as expected, a readily modifiable lifestyle factor, physical activity, was associated with a lower risk.
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Affiliation(s)
- Emilie K Frimodt-Møller
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elsayed Z Soliman
- Department of Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jorge R Kizer
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
| | - Eric Vittinghoff
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Departments of Medicine, Epidemiology, and Health Systems and Population Health, University of Washington, Washington, WA 98195-9458, USA
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - John S Gottdiener
- Division of Cardiology, University of Maryland, Baltimore, MD 21201, USA
| | - Gregory M Marcus
- Division of Cardiology, University of California San Francisco, 505 Parnassus Ave, M1180B, San Francisco, CA 94143, USA
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Parker LE, Kramer RJ, Kaplan S, Landstrom AP. One gene, two modes of inheritance, four diseases: A systematic review of the cardiac manifestation of pathogenic variants in JPH2-encoded junctophilin-2. Trends Cardiovasc Med 2023; 33:1-10. [PMID: 34861382 PMCID: PMC9156715 DOI: 10.1016/j.tcm.2021.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/22/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 02/01/2023]
Abstract
Rare variants in JPH2 have been associated with a range of cardiac disease, including hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM), arrhythmias, and sudden cardiac death (SCD); however, our understanding of how variants in JPH2 correspond to specific modes of inheritance and correlate clinical phenotypes has not been comprehensively explored. In this systematic review, we assess current case reports and series that describe patients with JPH2 variants and cardiac disease. We identified a total of 61 variant-positive individuals, approximately 80% of whom had some form of cardiac disease, including 47% HCM, 18% DCM, and 14% arrhythmia/SCD. In analyzing the 24 probands described in the studies, we found that autosomal recessive, loss-of-function variants are associated with severe, early onset DCM, while autosomal dominant missense variants are associated with a wider range of cardiac disease, including HCM, arrhythmia, SCD, and cardiac conduction disease.
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Affiliation(s)
- Lauren E Parker
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - Ryan J Kramer
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States
| | - Samantha Kaplan
- Medical Center Library and Archives, Duke University, Durham, NC, United States
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Cardiology, Duke University School of Medicine, Durham, NC, United States; Department of Cell Biology, Duke University School of Medicine, Durham, NC, United States.
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Abstract
Cardiac amyloidosis (CA) results in symptoms of heart failure, atrial and ventricular arrhythmias, conduction disturbances, and profound autonomic dysfunction. These symptoms present unique management challenges as compared with patients without CA, and can be very debilitating. Thus, management of the cardiovascular symptoms of these patients plays a central role in their care. This review presents an overview of the typical cardiovascular manifestations encountered in patients with CA and highlights the key management considerations for each.
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Gossios TD, Providencia R, Creta A, Segal OR, Nikolenko N, Turner C, Lopes LR, Wahbi K, Savvatis K. An overview of heart rhythm disorders and management in myotonic dystrophy type 1. Heart Rhythm 2021; 19:497-504. [PMID: 34843968 DOI: 10.1016/j.hrthm.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/07/2021] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
Myotonic dystrophy type 1 (DM1) is the most common adult form of muscular dystrophy, presenting with a constellation of systemic findings secondary to a CTG triplet expansion of the noncoding region of the DMPK gene. Cardiac involvement is frequent, with conduction disease and supraventricular and ventricular arrhythmias being the most prevalent cardiac manifestations, often developing from a young age. The development of cardiac arrhythmias has been linked to increased morbidity and mortality, with sudden cardiac death well described. Strategies to mitigate risk of arrhythmic death have been developed. In this review, we outline the current knowledge on the pathophysiology of rhythm abnormalities in patients with myotonic dystrophy and summarize available knowledge on arrhythmic risk stratification. We also review management strategies from an electrophysiological perspective, attempting to underline the substantial unmet need to address residual arrhythmic risks for this population.
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Affiliation(s)
- Thomas D Gossios
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom.
| | - Rui Providencia
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Antonio Creta
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Oliver R Segal
- Department of Cardiology, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
| | - Nikoletta Nikolenko
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - Chris Turner
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, United Kingdom
| | - Luis R Lopes
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom; Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London Hospital, London, United Kingdom
| | - Karim Wahbi
- APHP, Cochin Hospital, Cardiology Department, FILNEMUS, Paris-Descartes, Sorbonne Paris Cité University, Paris, France
| | - Konstantinos Savvatis
- Inherited Cardiac Conditions Unit, Barts Heart Centre, St. Bartholomew's Hospital, London, United Kingdom
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Cheung CC, Sarcon A, Belhassen B, Scheinman M. Twirling around the block-A complex case of cardiac sarcoidosis. Heart Rhythm 2021; 18:151-153. [PMID: 33413950 DOI: 10.1016/j.hrthm.2020.08.012] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Christopher C Cheung
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Annahita Sarcon
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Bernard Belhassen
- Division of Cardiology, University of California, San Francisco, San Francisco, California
| | - Melvin Scheinman
- Division of Cardiology, University of California, San Francisco, San Francisco, California.
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Prashar A, Chen D, Youssef G, Ramsay D. Case report: third-degree atrioventricular block secondary to septic coronary artery embolism following infective endocarditis. Eur Heart J Case Rep 2020; 4:1-4. [PMID: 33204940 PMCID: PMC7649438 DOI: 10.1093/ehjcr/ytaa193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/24/2020] [Accepted: 06/05/2020] [Indexed: 11/14/2022]
Abstract
Background Coronary artery emboli can occur from a number of rare causes such as arterial thrombo-embolus or septic embolus. This diagnosis generally requires multi-modal imaging including echocardiography, computed tomography, or invasive coronary angiography. Septic coronary emboli is an extremely rare consequence of infective endocarditis (IE), having been reported in <1% of all cases. Case summary A 54-year-old previously healthy Tibetan monk presented feeling generally unwell and lethargic. Electrocardiogram demonstrated sinus rhythm, third-degree atrioventricular block with a left bundle branch escape. Initial transthoracic and transoesophageal echocardiography demonstrated vegetations on the aortic and tricuspid valve as well as intra-myocardial abscess. Coronary angiography revealed septic embolus involving the septal perforator coronary artery. He underwent surgical replacement of the infected valves and debridement and repair of a ventricular septal defect. Discussion Infective endocarditis can predispose to a range of cardiac pathology. This case demonstrates that patients can present with cardiac conduction disease from a septic embolus involving a coronary artery as a complication of IE.
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Affiliation(s)
- Abhisheik Prashar
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
| | - Daniel Chen
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
| | - George Youssef
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
| | - David Ramsay
- Department of Cardiology, St George Hospital, Sydney, NSW 2217, Australia
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Phan DQ, Goitia J, Lee MS, Gupta N, Aharonian V, Mansukhani P, Moore N, Brar SS, Zadegan R. Predictors of conduction recovery after permanent pacemaker implantation following transcatheter aortic valve replacement. J Interv Card Electrophysiol 2020; 61:365-374. [PMID: 32671716 DOI: 10.1007/s10840-020-00813-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Conduction disturbances after transcatheter aortic valve replacement (TAVR) requiring pacemaker (PPM) implantation are a known complication and may be reversible. Therefore, we sought to evaluate the incidence and predictors for atrioventricular (AV) conduction recovery after TAVR. METHODS A single-center, retrospective study of patients undergoing PPM implantation for conduction disorders after TAVR between June 2011 and March 2019. Conduction recovery was defined as ≤ 1% ventricular pacing (VP) on follow-up PPM interrogation. RESULTS A total of 110 patients (mean age 83.6 ± 6.6 years, 46.8% female) were included. At a median follow-up of 438 days (interquartile range [IQR] 111-760 days), 35 patients (32%) had conduction recovery, with 50% of these occurring within the first 6 months. On multivariate analysis, predictors of conduction recovery include female sex (hazard ratio [HR] 2.5, 95% confidence interval [CI] 1.01-6.4, p = 0.048), non-VP/non-complete heart block rhythm immediately post-TAVR (HR 5.2, 95% CI 1.5-18.1, p = 0.011), normal sinus rhythm 7 days post-TAVR (HR 3.9, 95% CI 1.7-9.2, p = 0.002), and smaller valve size (mm) (HR 0.81, 95% CI 0.7-0.996, p = 0.045). Significant narrowing of the QRS and resolution of new-onset left bundle branch block within 1 month post-TAVR occurred in those with conduction recovery on PPM interrogation. CONCLUSIONS One-third of patients receiving new PPM implantation have conduction recovery after TAVR, with 50% occurring within the first 6 months. Patient gender, valve size, and rhythm on serial ECGs after TAVR can help identify patients that may recover AV conduction. A conservative approach rather than immediate PPM implantation may be considered in these patients.
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Affiliation(s)
- Derek Q Phan
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Jesse Goitia
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Nigel Gupta
- Division of Cardiac Electrophysiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA
| | - Vicken Aharonian
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA
| | - Prakash Mansukhani
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA
| | - Naing Moore
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA
| | - Somjot S Brar
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA
| | - Ray Zadegan
- Regional Cardiac Catheterization Lab, Kaiser Permanente, Los Angeles Medical Center, 4867 Sunset Boulevard, Cardiac Cath Lab, Room 3755, Los Angeles, CA, 90027, USA.
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López-Sainz Á, Climent V, Ripoll-Vera T, Espinosa MA, Barriales-Villa R, Navarro M, Limeres J, Domingo D, Kasper DC, Garcia-Pavia P. Negative screening of Fabry disease in patients with conduction disorders requiring a pacemaker. Orphanet J Rare Dis 2019; 14:170. [PMID: 31286959 PMCID: PMC6615152 DOI: 10.1186/s13023-019-1140-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 06/25/2019] [Indexed: 12/16/2022] Open
Abstract
Identification of Fabry disease (FD) in cardiac patients has been restricted so far to patients with left ventricular hypertrophy. Conduction problems are frequent in FD and could precede other manifestations, offering a possible earlier diagnosis. We studied the prevalence of FD in 188 patients < 70 years with conduction problems requiring pacemaker implantation. Although classical manifestations of FD were not rare, no patient with FD was identified. Screening efforts should not be conducted in this population.
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Affiliation(s)
- Ángela López-Sainz
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 2. Majadahonda, 28222, Madrid, Spain.,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | - Vicente Climent
- Cardiology Department, Hospital General Universitario de Alicante, ISABIAL - FISABIO, Alicante, Spain
| | - Tomas Ripoll-Vera
- Cardiology Department, Hospital Universitario Son Llatzer, IdISBa, Mallorca, Spain
| | - Maria Angeles Espinosa
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Roberto Barriales-Villa
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Inherited Cardiovascular Diseases Unit, Cardiology Service, Complexo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC) ServizoGalego de Saúde (SERGAS), Universidade da Coruña, A Coruña, Spain
| | - Marina Navarro
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Department of Cardiology, Hospital Universitario Virgen de Arrixaca, El Palmar, Spain
| | - Javier Limeres
- CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain.,Inherited Cardiovascular Diseases Unit, Department of Cardiology, Valld'Hebron University Hospital, Barcelona, Spain
| | - Diana Domingo
- Department of Cardiology, Hospital UniversitarioLa Fe, Valencia, Spain
| | - David C Kasper
- ARCHIMED Life Science, Leberstrasse 20, 1110, Vienna, Austria
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Manuel de Falla, 2. Majadahonda, 28222, Madrid, Spain. .,CIBER in Cardiovascular Diseases (CIBERCV), Madrid, Spain. .,University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Madrid, Spain.
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10
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Nikhanj A, Sivakumaran S, Miskew-Nichols B, Siddiqi ZA, Oudit GY. Ventricular tachycardia in patients with type 1 myotonic dystrophy: a case series. Eur Heart J Case Rep 2019; 3:5513091. [PMID: 31449640 PMCID: PMC6601193 DOI: 10.1093/ehjcr/ytz095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/05/2019] [Accepted: 05/18/2019] [Indexed: 11/28/2022]
Abstract
Background Type 1 myotonic dystrophy (DM1) is associated with a variety of cardiac conduction abnormalities and the frequent need for permanent pacing. However, the role of ventricular tachycardia (VT) and the implied risk of sudden cardiac death (SCD) is poorly understood. Case summary This study examined a 56-patient DM1 cohort of men and women, and identified five patients (two females and three males) with ventricular arrhythmias (8.9%). Patients were reviewed on a case-by-case basis, with their clinical presentation and management of VT and the associated cardiomyopathy indicated. Patient cardiac function was determined by 12-lead electrocardiogram, 48-h Holter monitor, and transthoracic echocardiography. These patients were therefore suitable candidates for implantable cardioverter-defibrillator implantation and received these devices; four of the five patients also received cardiac resynchronization therapy. Medical therapies included angiotensin converting enzyme inhibition, mineralocorticoid receptor antagonist, and following device implantation, beta-blocker therapy was initiated. Discussion Our case series demonstrates the prevalence of VT in patients with DM1 highlighting the associated risks of SCD in this patient population. The burden of ventricular arrhythmias, advanced conduction disease, and cardiomyopathy are best treated with a combination of device and medical therapies.
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Affiliation(s)
- Anish Nikhanj
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Soori Sivakumaran
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Bailey Miskew-Nichols
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
| | - Zaeem A Siddiqi
- Division of Neurology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada
| | - Gavin Y Oudit
- Division of Cardiology, Department of Medicine, University of Alberta, 8440 112 Street NW, Edmonton, Alberta, Canada.,Mazankowski Alberta Heart Institute, University of Alberta, 11220 83 Avenue NW, Edmonton, Alberta, Canada
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11
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Gessner G, Runge S, Koenen M, Heinemann SH, Koenen M, Haas J, Meder B, Thomas D, Katus HA, Schweizer PA. ANK2 functionally interacts with KCNH2 aggravating long QT syndrome in a double mutation carrier. Biochem Biophys Res Commun 2019; 512:845-851. [PMID: 30929919 DOI: 10.1016/j.bbrc.2019.03.162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 03/12/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
Pathogenic long QT mutations often comprise high phenotypic variability and particularly variants in ANK2 (long QT syndrome 4) frequently lack QT prolongation. We sought to elucidate the genetic and functional background underlying the clinical diversity in a 3-generation family with different cardiac arrhythmias. Next-generation sequencing-based screening of patients with QT prolongation identified the index patient of the family carrying an ANK2-E1813K variant and a previously uncharacterized KCNH2-H562R mutation in a double heterozygous conformation. The patient presented with a severe clinical phenotype including a markedly prolonged QTc interval (544 ms), recurrent syncope due to Torsade de Pointes tachycardias, survived cardiopulmonary resuscitation, progressive cardiac conduction defect, and atrial fibrillation. Evaluation of other family members identified a sister and a niece solely carrying the ANK2-E1813K variant, who showed age-related conduction disease. An asymptomatic second sister solely carried the KCNH2-H562R mutation. Voltage-clamp recordings in Xenopus oocytes revealed that KCNH2-H562R subunits were non-functional but did not exert dominant-negative effects on wild-type subunits. Expression of KCNH2-H562R in HEK293 cells showed a trafficking deficiency. Co-expression of the C-terminal regulatory domain of ANK2 in Xenopus oocytes revealed that ANK2-E1813K diminished currents mediated by the combination of wild-type and H562R KCNH2 subunits. Our data suggest that ANK2 functionally interacts with KCNH2 leading to a stronger current suppression and marked aggravation of long QT syndrome in the patient carrying variants in both proteins.
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Affiliation(s)
- Guido Gessner
- Center for Molecular Biomedicine, Department of Biophysics, Friedrich Schiller University Jena and Jena University Hospital, Hans-Knöll-St. 2, D-07745, Jena, Germany
| | - Sarah Runge
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany
| | - Michael Koenen
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; Department of Molecular Neurobiology, Max Planck Institute for Medical Research, Jahnstr. 29, D-69120, Heidelberg, Germany
| | - Stefan H Heinemann
- Center for Molecular Biomedicine, Department of Biophysics, Friedrich Schiller University Jena and Jena University Hospital, Hans-Knöll-St. 2, D-07745, Jena, Germany
| | - Mascha Koenen
- Institute for Comparative and Molecular Endocrinology, University of Ulm, Helmholtzstr. 8/1, D-89081, Ulm, Germany
| | - Jan Haas
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, INF 410, D-69120, Heidelberg, Germany
| | - Benjamin Meder
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, INF 410, D-69120, Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, INF 410, D-69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, INF 410, D-69120, Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital Heidelberg, INF 410, D-69120, Heidelberg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, University of Heidelberg, INF 410, D-69120, Heidelberg, Germany.
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12
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Podliesna S, Delanne J, Miller L, Tester DJ, Uzunyan M, Yano S, Klerk M, Cannon BC, Khongphatthanayothin A, Laurent G, Bertaux G, Falcon-Eicher S, Wu S, Yen HY, Gao H, Wilde AAM, Faivre L, Ackerman MJ, Lodder EM, Bezzina CR. Supraventricular tachycardias, conduction disease, and cardiomyopathy in 3 families with the same rare variant in TNNI3K (p.Glu768Lys). Heart Rhythm 2018; 16:98-105. [PMID: 30010057 DOI: 10.1016/j.hrthm.2018.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rare genetic variants in TNNI3K encoding troponin-I interacting kinase have been linked to a distinct syndrome consisting primarily of supraventricular tachycardias and variably expressed conduction disturbance and dilated cardiomyopathy in 2 families. OBJECTIVE The purpose of this study was to identify new genetic variants associated with inherited supraventricular tachycardias, cardiac conduction disease, and cardiomyopathy. METHODS We conducted next generation sequencing in 3 independent multigenerational families with atrial/junctional tachycardia with or without conduction disturbance, dilated cardiomyopathy, and sudden death. We also assessed the effect of identified variant on protein autophosphorylation. RESULTS In this study, we uncovered the same ultra-rare genetic variant in TNNI3K (c.2302G>A, p.Glu768Lys), which co-segregated with disease features in all affected individuals (n = 23) from all 3 families. TNNI3K harboring the TNNI3K-p.Glu768Lys variant displayed enhanced kinase activity, in line with expectations from previous mouse studies that demonstrated increased conduction indices and procardiomyopathic effects with increased levels of Tnni3k. CONCLUSION This study corroborates further the causal link between rare genetic variation in TNNI3K and this distinct complex phenotype, and points to enhanced kinase activity of TNNI3K as the underlying pathobiological mechanism.
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Affiliation(s)
- Svitlana Podliesna
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Lindsey Miller
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - David J Tester
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Merujan Uzunyan
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Shoji Yano
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California
| | - Mischa Klerk
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Bryan C Cannon
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Apichai Khongphatthanayothin
- USC Keck School of Medicine, LAC+USC Medical Center, Los Angeles, California; Bangkok General Hospital and Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Gabriel Laurent
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France; Service de rythmologie Centre Hospitalier Universitaire Le Bocage 2, Dijon, France
| | - Geraldine Bertaux
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France
| | - Sylvie Falcon-Eicher
- Centre de compétence pour les troubles du rythme cardiaque d'origine génétique, CHU Dijon-Bourgogne, Dijon, France
| | | | | | - Hanlin Gao
- Fulgent Genetics, Temple City, California
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Laurence Faivre
- Centre de Génétique, Hôpital d'Enfants, Dijon, France; Equipe GAD, UMR1231, FHU TRANSLAD et Institut GIMI, CHU Dijon-Bourgogne et Université de Bourgogne-Franche Comté, Dijon, France
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota
| | - Elisabeth M Lodder
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
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