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Vereckei A, Katona G, Szénási G, Vidács LD, Földeák D, Takács H, Nagy V, Sepp R. Novel electrocardiographic criteria may render possible the more accurate recognition of cardiac amyloidosis. ESC Heart Fail 2024; 11:1030-1038. [PMID: 38243379 DOI: 10.1002/ehf2.14655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 10/04/2023] [Accepted: 12/12/2023] [Indexed: 01/21/2024] Open
Abstract
AIMS The early diagnosis of cardiac amyloidosis (CA) is paramount, since there are effective therapies that improve patient survival. The diagnostic accuracy of classical electrocardiographic (ECG) signs, such as low voltage, pseudoinfarct pattern, and conduction disturbances in the diagnosis of CA, is inferior to that of the echocardiographic myocardial deformation criteria; therefore, our aim was to find more accurate novel ECG criteria for this purpose. METHODS We tested the diagnostic value of five novel ECG criteria, two of them devised by us, in 34 patients with confirmed CA (20 transthyretin amyloidosis and 14 AL amyloidosis) and 45 control patients with left ventricular hypertrophy on echocardiography due to hypertension, valvular aortic stenosis and hypertrophic cardiomyopathy. The following novel ECG criteria, that suggested CA, were tested: QRS amplitude in lead I < 0.55 mV (I < 0.55); QRS amplitude in lead aVR < 0.5 mV (aVR < 0.5); average QRS amplitude of leads I + aVR < 0.575 mV [(I + aVR) < 0.575]; average QRS amplitude of leads I + aVR/average QRS amplitude of leads V1-4 < 0.375 [(I + aVR)/(V1-4) < 0.375]; average QRS amplitude of leads I + aVR/longest intrinsicoid deflection in leads I,aVL,V1-6 < 0.0115 [(I + aVR)/I,aVL,V1-6ID < 0.0115]. RESULTS The I < 0.55, aVR < 0.5, (I + aVR) < 0.575, (I + aVR)/(V1-4) < 0.375, (I + aVR)/I,aVL,V1-6ID < 0.0115 test accuracy (TA) were 81%, 84.8%, 82.3%, 84.8%, and 83.3%, respectively; the sensitivity (SE): 76.5%, 82.4%, 85.3%, 82.4%, and 76.9%; specificity (SP): 84.4%, 86.7%, 80%, 86.7%, and 87.5%; positive predictive values (PPV): 78.8%, 82.4%, 76.3%, 82.4%, and 80%; negative predictive values (NPV): 82.6%, 86.7%, 87.8%, 86.7%, and 85.4%; area under curve (AUC) values: 0.8922, 0.8794, 09016, 0.8824, and 0.8462 were respectively. These parameters of the novel ECG criteria were at least as good as those reported by other authors in the literature of the qualitative (TA: 67%, SE: 80%, SP: 34%, PPV: 75%, NPV: 42%, AUC: 0.57) and quantitative apical sparing (TA: 64-80%, SE: 66-81.3%, SP: 55-78.3%, PPV: 33-83.9%, NPV: 41-75%, AUC: 0.62-0.68) and left ventricular ejection fraction/global longitudinal strain >4.1 (TA: 77%, SE: 93%, SP: 38%, PPV: 79%, NPV: 69%, AUC: 0.65) echocardiographic criteria. Among the classical criteria, the low voltage in limb leads criterion was present most frequently (in 73.5%) in patients with CA, with slightly worse diagnostic value than the novel ECG criteria (TA: 78.5%, SE: 73.5%, SP: 82.2%, PPV: 75.8%, NPV: 80.4%). CONCLUSIONS The novel ECG criteria [mostly the aVR < 0.5, (I + aVR)/(V1-4) < 0.375] seem at least as reliable in the diagnosis of CA as the best echocardiographic myocardial deformation criteria and might be used either together with the echocardiographic criteria or as stand-alone criteria to diagnose CA in the future.
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Affiliation(s)
- András Vereckei
- Department of Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Gábor Katona
- Department of Medicine and Hematology, Semmelweis University, Budapest, Hungary
| | - Gábor Szénási
- Institute of Translational Medicine, Semmelweis University, Budapest, Hungary
| | - László Dániel Vidács
- Department of Internal Medicine, Division of Non-Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Dóra Földeák
- Department of Internal Medicine, Division of Non-Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Hedvig Takács
- Department of Internal Medicine, Division of Non-Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Viktória Nagy
- Department of Internal Medicine, Division of Non-Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Róbert Sepp
- Department of Internal Medicine, Division of Non-Invasive Cardiology, University of Szeged, Szeged, Hungary
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Rácz G, Takács H, Kormányos Á, Polestyuk B, Borbás J, Gyenes N, Schvartz N, Németh G, Kincses ZT, Sepp R, Nagy V. Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities. Diagnostics (Basel) 2022; 12:diagnostics12081941. [PMID: 36010290 PMCID: PMC9406902 DOI: 10.3390/diagnostics12081941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/01/2022] [Accepted: 08/06/2022] [Indexed: 01/08/2023] Open
Abstract
Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer data available in non-hospitalized, mildly symptomatic COVID-19 patients. In our work, we aimed to investigate subclinical cardiac alterations characterized by parameters provided by advanced echocardiographic techniques following mild SARS-CoV-2 viral infection. A total of 86 patients (30 males, age: 39.5 ± 13.0 yrs) were assessed 59 ± 33 days after mild SARS-CoV-2 viral infection (requiring no hospital or <5 days in-hospital treatment) by advanced echocardiographic examination including 2-dimensional (2D) speckle tracking echocardiography and non-invasive myocardial work analysis, and were compared to an age-and sex-matched control group. Altogether, variables from eleven echocardiographic categories representing morphological or functional echocardiographic parameters showed statistical difference between the post-COVID patient group and the control group. The magnitude of change was subtle or mild in the case of these parameters, ranging from 1−11.7% of relative change. Among the parameters, global longitudinal strain [−20.3 (−21.1−−19.0) vs. −19.1 (−20.4−−17.6) %; p = 0.0007], global myocardial work index [1975 (1789−2105) vs. 1829 (1656−2057) Hgmm%; p = 0.007] and right ventricular free wall strain values (−26.6 ± 3.80 vs. −23.8 ± 4.0%; p = 0.0003) showed the most significant differences between the two groups. Subclinical cardiac alterations are present following even mild SARS-CoV-2 viral infection. These more subtle alterations are difficult to detect by routine echocardiography. Extended protocols, involving speckle-tracking echocardiography, non-invasive measurement of cardiac hemodynamics, and possibly myocardial work are necessary for detection and adequate follow-up.
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Affiliation(s)
- Gergely Rácz
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Hedvig Takács
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Árpád Kormányos
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Bianka Polestyuk
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - János Borbás
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Nándor Gyenes
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Noémi Schvartz
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | - Gergely Németh
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
| | | | - Róbert Sepp
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
- Correspondence: ; Tel.: +36-30-267-5845; Fax: +36-62-545-820
| | - Viktória Nagy
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
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Sepp R, Hategan L, Csányi B, Borbás J, Tringer A, Pálinkás ED, Nagy V, Takács H, Latinovics D, Nyolczas N, Pálinkás A, Faludi R, Rábai M, Szabó GT, Czuriga D, Balogh L, Halmosi R, Borbély A, Habon T, Hegedűs Z, Nagy I. The Genetic Architecture of Hypertrophic Cardiomyopathy in Hungary: Analysis of 242 Patients with a Panel of 98 Genes. Diagnostics (Basel) 2022; 12:diagnostics12051132. [PMID: 35626289 PMCID: PMC9139509 DOI: 10.3390/diagnostics12051132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 04/24/2022] [Accepted: 04/29/2022] [Indexed: 12/03/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary disease of the myocardium most commonly caused by mutations in sarcomeric genes. We aimed to perform a nationwide large-scale genetic analysis of a previously unreported, representative HCM cohort in Hungary. A total of 242 consecutive HCM index patients (127 men, 44 ± 11 years) were studied with next generation sequencing using a custom-designed gene-panel comprising 98 cardiomyopathy-related genes. A total of 90 patients (37%) carried pathogenic/likely pathogenic (P/LP) variants. The percentage of patients with P/LP variants in genes with definitive evidence for HCM association was 93%. Most of the patients with P/LP variants had mutations in MYBPC3 (55 pts, 61%) and in MYH7 (21 pts, 23%). Double P/LP variants were present in four patients (1.7%). P/LP variants in other genes could be detected in ≤3% of patients. Of the patients without P/LP variants, 46 patients (19%) carried a variant of unknown significance. Non-HCM P/LP variants were identified in six patients (2.5%), with two in RAF1 (p.Leu633Val, p.Ser257Leu) and one in DES (p.Arg406Trp), FHL1 (p.Glu96Ter), TTN (p.Lys23480fs), and in the mitochondrial genome (m.3243A>G). Frameshift, nonsense, and splice-variants made up 82% of all P/LP MYBPC3 variants. In all the other genes, missense mutations were the dominant form of variants. The MYBPC3 p.Gln1233Ter, the MYBPC3 p.Pro955ArgfsTer95, and the MYBPC3 p.Ser593ProfsTer11 variants were identified in 12, 7, and 13 patients, respectively. These three variants made up 36% of all patients with identified P/LP variants, raising the possibility of a possible founder effect for these mutations. Similar to other HCM populations, the MYBPC3 and the MYH7 genes seemed to be the most frequently affected genes in Hungarian HCM patients. The high prevalence of three MYBPC3 mutations raises the possibility of a founder effect in our HCM cohort.
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Affiliation(s)
- Róbert Sepp
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
- Correspondence: ; Tel.: +36-30-267-5845; Fax: +36-62-545-820
| | - Lidia Hategan
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Beáta Csányi
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - János Borbás
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Annamária Tringer
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Eszter Dalma Pálinkás
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Viktória Nagy
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Hedvig Takács
- Division of Non-Invasive Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Szeged, Semmelweis u. 8, H-6725 Szeged, Hungary; (L.H.); (B.C.); (J.B.); (A.T.); (E.D.P.); (V.N.); (H.T.)
| | - Dóra Latinovics
- SeqOmics Biotechnology Ltd., Vállalkozók útja 7, H-6782 Mórahalom, Hungary; (D.L.); (I.N.)
| | - Noémi Nyolczas
- Gottsegen National Cardiovascular Center, Haller u. 29, H-1096 Budapest, Hungary;
- Military Hospital-State Health Center, Róbert Károly körút 44, H-1134 Budapest, Hungary
| | - Attila Pálinkás
- Elisabeth Hospital, Dr. Imre József u. 9, H-6800 Hódmezővásárhely, Hungary;
| | - Réka Faludi
- Heart Institute, Medical School, University of Pécs, Ifjúság útja 13, H-7624 Pécs, Hungary;
| | - Miklós Rábai
- Division of Cardiology, First Department of Medicine, Medical School, University of Pécs, Ifjúság útja 13, H-7624 Pécs, Hungary; (M.R.); (R.H.); (T.H.)
| | - Gábor Tamás Szabó
- Division of Cardiology and Division of Clinical Physiology, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, H-4032 Debrecen, Hungary; (G.T.S.); (D.C.); (L.B.); (A.B.)
| | - Dániel Czuriga
- Division of Cardiology and Division of Clinical Physiology, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, H-4032 Debrecen, Hungary; (G.T.S.); (D.C.); (L.B.); (A.B.)
| | - László Balogh
- Division of Cardiology and Division of Clinical Physiology, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, H-4032 Debrecen, Hungary; (G.T.S.); (D.C.); (L.B.); (A.B.)
| | - Róbert Halmosi
- Division of Cardiology, First Department of Medicine, Medical School, University of Pécs, Ifjúság útja 13, H-7624 Pécs, Hungary; (M.R.); (R.H.); (T.H.)
- Szentágothai Research Centre, University of Pécs, Ifjúság útja 20, H-7624 Pécs, Hungary
| | - Attila Borbély
- Division of Cardiology and Division of Clinical Physiology, Department of Cardiology, University of Debrecen, Móricz Zsigmond körút 22, H-4032 Debrecen, Hungary; (G.T.S.); (D.C.); (L.B.); (A.B.)
| | - Tamás Habon
- Division of Cardiology, First Department of Medicine, Medical School, University of Pécs, Ifjúság útja 13, H-7624 Pécs, Hungary; (M.R.); (R.H.); (T.H.)
| | - Zoltán Hegedűs
- Institute of Biophysics, Biological Research Centre, Eötvös Loránd Research Network, Temesvári krt. 62, H-6726 Szeged, Hungary;
- Department of Biochemistry and Medical Chemistry, Medical School, University of Pécs, Szigeti út 12, H-7624 Pécs, Hungary
| | - István Nagy
- SeqOmics Biotechnology Ltd., Vállalkozók útja 7, H-6782 Mórahalom, Hungary; (D.L.); (I.N.)
- Institute of Biochemistry, Biological Research Center, Eötvös Loránd Research Network, Temesvári krt. 62, H-6726 Szeged, Hungary
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Kui P, Polyák A, Morvay N, Tiszlavicz L, Nagy N, Ördög B, Takács H, Leprán I, Farkas A, Papp JG, Jost N, Varró A, Baczkó I, Farkas AS. Long-Term Endurance Exercise Training Alters Repolarization in a New Rabbit Athlete’s Heart Model. Front Physiol 2022; 12:741317. [PMID: 35237176 PMCID: PMC8882986 DOI: 10.3389/fphys.2021.741317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
In the present study, the effect of long-term exercise training was investigated on myocardial morphological and functional remodeling and on proarrhythmic sensitivity in a rabbit athlete’s heart model. New-Zealand white rabbits were trained during a 12-week long treadmill running protocol and compared with their sedentary controls. At the end of the training protocol, echocardiography, in vivo and in vitro ECG recordings, proarrhythmic sensitivity with dofetilide (nM) were performed in isolated hearts, and action potential duration (APD) measurements at different potassium concentrations (4.5 and 2 mM) were made in the isolated papillary muscles. Expression levels of the slow component of delayed rectifier potassium current and fibrosis synthesis and degradation biomarkers were quantified. Echocardiography showed a significantly dilated left ventricle in the running rabbits. ECG PQ and RR intervals were significantly longer in the exercised group (79 ± 2 vs. 69 ± 2 ms and 325 ± 11 vs. 265 ± 6 ms, p < 0.05, respectively). The in vivo heart rate variability (HRV) (SD of root mean square: 5.2 ± 1.4 ms vs. 1.4 ± 0.2 ms, p < 0.05) and Tpeak-Tend variability were higher in the running rabbits. Bradycardia disappeared in the exercised group in vitro. Dofetilide tended to increase the QTc interval in a greater extent, and significantly increased the number of arrhythmic beats in the trained animals in vitro. APD was longer in the exercised group at a low potassium level. Real-time quantitative PCR (RT-qPCR) showed significantly greater messenger RNA expression of fibrotic biomarkers in the exercised group. Increased repolarization variability and higher arrhythmia incidences, lengthened APD at a low potassium level, increased fibrotic biomarker gene expressions may indicate higher sensitivity of the rabbit “athlete’s heart” to life-threatening arrhythmias.
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Affiliation(s)
- Péter Kui
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Alexandra Polyák
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Nikolett Morvay
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - László Tiszlavicz
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Norbert Nagy
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Balázs Ördög
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Hedvig Takács
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - István Leprán
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - András Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Julius Gy. Papp
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - Norbert Jost
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- ELKH-SZTE Working Group of Cardiovascular Pharmacology, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- *Correspondence: András Varró,
| | - István Baczkó
- Department of Pharmacology and Pharmacotherapy, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Attila S. Farkas
- Department of Internal Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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Pozsonyi Z, Peskó G, Takács H, Csuka D, Nagy V, Szilágyi Á, Hategan L, Muk B, Csányi B, Nyolczas N, Dézsi L, Molnár JM, Csillik A, Révész K, Iványi B, Szabó F, Birtalan K, Masszi T, Arányi Z, Sepp R. Variant Transthyretin Amyloidosis (ATTRv) in Hungary: First Data on Epidemiology and Clinical Features. Genes (Basel) 2021; 12:genes12081152. [PMID: 34440326 PMCID: PMC8392019 DOI: 10.3390/genes12081152] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 12/28/2022] Open
Abstract
Background: Variant transthyretin amyloidosis (ATTRv) is an autosomal dominant inherited disease, where the mutation of the transthyretin gene (TTR) results in the deposition of pathogenic protein fibrils in various tissues. The mutation type influences the clinical course. Until now, no data were available on the genotype, phenotype, and prevalence of Hungarian ATTRv patients. The aim of our study was to assess the prevalence, regional distribution, genotypes, and phenotypes of Hungarian patients with ATTRv. Methods: With the collaboration of Hungarian regional and university centers, we identified patients diagnosed with ATTRv. We also searched prior publications for case studies of Hungarian ATTRv patients. Results: 40 individuals in 23 families with ATTRv were identified within the borders of Hungary. At the time of the diagnosis, 24 of them were symptomatic. The two most common mutations were ATTRHis88Arg (nine families) and ATTRIle107Val (8 families). ATTRVal30Met was demonstrated in 2 families, and ATTRVal122del, ATTRPhe33Leu, ATTRIle84Ser, and ATTRAsp18Gly in one family each. The median age of the symptomatic patients at the time of clinical diagnosis was 65 years. The most common clinically significant organ involvement was restrictive cardiomyopathy, found in 24 patients. Polyneuropathy was diagnosed in 20 patients. A total of 19 patients showed a mixed phenotype. The leading symptom was heart failure in 8 cases (3 of them had only cardiac symptoms), polyneuropathy in 11 cases (all of them also had cardiac symptoms), and equally severe cardiac and neuropathy symptoms were present in 3 cases. Out of 24 symptomatic patients, 10 received targeted pharmacological therapy. The follow-up period ranged from 1 to 195 months. At the time of the retrospective analysis, 12 patients had already died, and 1 patient underwent heart transplantation. Conclusions: As TTR genotype influences the phenotype and clinical course of ATTRv, it is important to know the regional data. In Hungary, ATTRHis88Arg and ATTRIle107Val are the most common mutations in ATTRv, both presenting with mixed phenotype, but the median age at the time of the diagnosis is 9 years lower in patients with ATTRHis88Arg than in patients with ATTRIle107Val.
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Affiliation(s)
- Zoltán Pozsonyi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Gergely Peskó
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
- Correspondence:
| | - Hedvig Takács
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Dorottya Csuka
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Viktória Nagy
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Ágnes Szilágyi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Lidia Hategan
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Balázs Muk
- Military Hospital—State Health Centre, H-1134 Budapest, Hungary;
| | - Beáta Csányi
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Noémi Nyolczas
- Gottsegen National Cardiovascular Center, H-1096 Budapest, Hungary;
| | - Lívia Dézsi
- Department of Neurology, University of Szeged, H-6725 Szeged, Hungary;
| | - Judit Mária Molnár
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, H-1088 Budapest, Hungary; (J.M.M.); (F.S.)
| | - Anita Csillik
- Department of Neurology, Semmelweis University, H-1088 Budapest, Hungary; (A.C.); (Z.A.)
| | - Katalin Révész
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Béla Iványi
- Department of Pathology, University of Szeged, H-6725 Szeged, Hungary;
| | - Fruzsina Szabó
- Institute of Genomic Medicine and Rare Disorders, Semmelweis University, H-1088 Budapest, Hungary; (J.M.M.); (F.S.)
| | - Krisztián Birtalan
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
| | - Tamás Masszi
- Department of Internal Medicine and Haematology, Semmelweis University, H-1088 Budapest, Hungary; (Z.P.); (D.C.); (Á.S.); (K.R.); (T.M.)
| | - Zsuzsanna Arányi
- Department of Neurology, Semmelweis University, H-1088 Budapest, Hungary; (A.C.); (Z.A.)
| | - Róbert Sepp
- Division of Non-Invasive Cardiology, Department of Internal Medicine, University of Szeged, H-6725 Szeged, Hungary; (H.T.); (V.N.); (L.H.); (B.C.); (K.B.); (R.S.)
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Kui P, Orosz S, Takács H, Sarusi A, Csík N, Rárosi F, Csekő C, Varró A, Papp JG, Forster T, Farkas AS, Farkas A. New in vitro model for proarrhythmia safety screening: IKs inhibition potentiates the QTc prolonging effect of IKr inhibitors in isolated guinea pig hearts. J Pharmacol Toxicol Methods 2016; 80:26-34. [DOI: 10.1016/j.vascn.2016.04.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 04/01/2016] [Accepted: 04/04/2016] [Indexed: 01/25/2023]
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Takács H, Kui P, Farkas AS, Sarusi A, Forster T, Papp JG, Varró A, Curtis MJ, Shattock MJ, Farkas A. Ventricular cycle length irregularity affects the correlation between ventricular rate and coronary flow in isolated, Langendorff perfused guinea pig hearts. J Pharmacol Toxicol Methods 2015; 77:45-52. [PMID: 26455880 DOI: 10.1016/j.vascn.2015.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Heart rate affects coronary flow, but the mechanism is complex. The relationship between rhythm and flow is unclear, especially in experimental settings used for determining drug actions. The present study examined whether ventricular irregularity influences coronary flow independently of heart rate. METHODS Guinea pig hearts were perfused (Langendorff mode) at constant pressure. Hypokalemic Krebs solution facilitated spontaneous development of arrhythmias. The ECG, left ventricular and perfusion pressures were recorded, and the coronary flow was measured. Beat-to-beat ventricular cycle length variability was quantified. Hearts were retrospectively allocated to arbitrary 'Low' or 'High' RR variability groups. RESULTS A positive linear correlation was found between mean ventricular rate and coronary flow. The slope of the regression line was significantly greater in the 'High' versus 'Low' RR variability group, with greater coronary flow values in the 'High' RR variability group in the physiological heart rate range. During regular rhythm, left ventricular pressure exceeded perfusion pressure and prevented coronary perfusion at peak systole. However, ventricular irregularity significantly increased the number of beats in which left ventricular pressure remained below perfusion pressure, facilitating coronary perfusion. DISCUSSION In isolated hearts, cycle length irregularity increases the slope of the positive linear correlation between mean ventricular rate and coronary flow via producing beats in which left ventricular pressure remains below perfusion pressure. This means that changes in rhythm have the capacity to influence coronary flow independently of heart rate in isolated hearts perfused at constant pressure, which should be noted in drug studies on arrhythmias performed in Langendorff hearts.
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Affiliation(s)
- Hedvig Takács
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Péter Kui
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Attila S Farkas
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Annamária Sarusi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Forster
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Julius Gy Papp
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary; MTA-SZTE Research Group for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | | | | | - András Farkas
- Second Department of Medicine and Cardiology Centre, Faculty of Medicine, University of Szeged, Szeged, Hungary.
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