1
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Li E, van der Heyden MAG. The network of cardiac K IR2.1: its function, cellular regulation, electrical signaling, diseases and new drug avenues. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03116-5. [PMID: 38683369 DOI: 10.1007/s00210-024-03116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
The functioning of the human heart relies on complex electrical and communication systems that coordinate cardiac contractions and sustain rhythmicity. One of the key players contributing to this intricate system is the KIR2.1 potassium ion channel, which is encoded by the KCNJ2 gene. KIR2.1 channels exhibit abundant expression in both ventricular myocytes and Purkinje fibers, exerting an important role in maintaining the balance of intracellular potassium ion levels within the heart. And by stabilizing the resting membrane potential and contributing to action potential repolarization, these channels have an important role in cardiac excitability also. Either gain- or loss-of-function mutations, but also acquired impairments of their function, are implicated in the pathogenesis of diverse types of cardiac arrhythmias. In this review, we aim to elucidate the system functions of KIR2.1 channels related to cellular electrical signaling, communication, and their contributions to cardiovascular disease. Based on this knowledge, we will discuss existing and new pharmacological avenues to modulate their function.
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Affiliation(s)
- Encan Li
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM, Utrecht, Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM, Utrecht, Netherlands.
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2
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Matthews E, Palace J, Ramdas S, Sansone V, Tristani-Firouzi M, Vicart S, Willis T. Care Recommendations for the Investigation and Management of Children With Skeletal Muscle Channelopathies. Pediatr Neurol 2023; 145:102-111. [PMID: 37315339 DOI: 10.1016/j.pediatrneurol.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 06/16/2023]
Abstract
The field of pediatric skeletal muscle channelopathies has seen major new advances in terms of a wider understanding of clinical presentations and new phenotypes. Skeletal muscle channelopathies cause significant disability and even death in some of the newly described phenotypes. Despite this, there are virtually no data on the epidemiology and longitudinal natural history of these conditions or randomized controlled trial evidence of efficacy or tolerability of any treatment in children, and thus best practice care recommendations do not exist. Clinical history, and to a lesser extent examination, is key to eliciting symptoms and signs that indicate a differential diagnosis of muscle channelopathy. Normal routine investigations should not deter one from the diagnosis. Specialist neurophysiologic investigations have an additional role, but their availability should not delay genetic testing. New phenotypes are increasingly likely to be identified by next-generation sequencing panels. Many treatments or interventions for symptomatic patients are available, with anecdotal data to support their benefit, but we lack trial data on efficacy, safety, or superiority. This lack of trial data in turn can lead to hesitancy in prescribing among doctors or in accepting medication by parents. Holistic management addressing work, education, activity, and additional symptoms of pain and fatigue provides significant benefit. Preventable morbidity and sometimes mortality occurs if the diagnosis and therefore treatment is delayed. Advances in genetic sequencing technology and greater access to testing may help to refine recently identified phenotypes, including histology, as more cases are described. Randomized controlled treatment trials are required to inform best practice care recommendations. A holistic approach to management is essential and should not be overlooked. Good quality data on prevalence, health burden, and optimal treatment are urgently needed.
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Affiliation(s)
- Emma Matthews
- Department of Neurology, Atkinson-Morley Neuromuscular Centre, St George's University Hospitals NHS Foundation Trust, and Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Jacqueline Palace
- Clinical Neurology, John Radcliffe Hospital, Oxford University Foundation Trust, Oxford, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sithara Ramdas
- Department of Paediatrics, MDUK Neuromuscular Centre, University of Oxford, Oxford, UK; Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Valeria Sansone
- Neurorehabilitation Unit, Neuromuscular Omnicentre Clinical Center, Niguarda Hospital, University of Milan, Milan, Italy
| | - Martin Tristani-Firouzi
- Nora Eccles Harrison Cardiovascular Research and Training Institute and the Division of Paediatric Cardiology, University of Utah, Salt Lake City, Utah
| | - Savine Vicart
- Reference Centre for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Tracey Willis
- Robert Jones and Agnes Hunt Orthopaedic Hospital, NHS Foundation Trust, Oswestry, England
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3
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Beverley KM, Pattnaik BR. Inward rectifier potassium (Kir) channels in the retina: living our vision. Am J Physiol Cell Physiol 2022; 323:C772-C782. [PMID: 35912989 PMCID: PMC9448332 DOI: 10.1152/ajpcell.00112.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022]
Abstract
Channel proteins are vital for conducting ions throughout the body and are especially relevant to retina physiology. Inward rectifier potassium (Kir) channels are a class of K+ channels responsible for maintaining membrane potential and extracellular K+ concentrations. Studies of the KCNJ gene (that encodes Kir protein) expression identified the presence of all of the subclasses (Kir 1-7) of Kir channels in the retina or retinal-pigmented epithelium (RPE). However, functional studies have established the involvement of the Kir4.1 homotetramer and Kir4.1/5.1 heterotetramer in Müller glial cells, Kir2.1 in bipolar cells, and Kir7.1 in the RPE cell physiology. Here, we propose the potential roles of Kir channels in the retina based on the physiological contributions to the brain, pancreatic, and cardiac tissue functions. There are several open questions regarding the expressed KCNJ genes in the retina and RPE. For example, why does not the Kir channel subtype gene expression correspond with protein expression? Catching up with multiomics or functional "omics" approaches might shed light on posttranscriptional changes that might influence Kir subunit mRNA translation within the retina that guides our vision.
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Affiliation(s)
- Katie M Beverley
- Endocrinology and Reproductive Physiology Graduate Program, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin, Madison, Wisconsin
| | - Bikash R Pattnaik
- Endocrinology and Reproductive Physiology Graduate Program, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin, Madison, Wisconsin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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4
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Manuel AIM, Gutiérrez LK, Pedrosa MLV, Uréndez FMC, Jiménez FJB, Carrascoso IM, Pérez PS, Macías Á, Jalife J. Molecular stratification of arrhythmogenic mechanisms in the Andersen Tawil Syndrome. Cardiovasc Res 2022; 119:919-932. [PMID: 35892314 PMCID: PMC10153646 DOI: 10.1093/cvr/cvac118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Andersen Tawil Syndrome (ATS) is a rare inheritable disease associated with loss-of-function mutations in KCNJ2, the gene coding the strong inward rectifier potassium channel Kir2.1, which forms an essential membrane protein controlling cardiac excitability. ATS is usually marked by a triad of periodic paralysis, life-threatening cardiac arrhythmias and dysmorphic features, but its expression is variable and not all patients with a phenotype linked to ATS have a known genetic alteration. The mechanisms underlying this arrhythmogenic syndrome are poorly understood. Knowing such mechanisms would be essential to distinguish ATS from other channelopathies with overlapping phenotypes and to develop individualized therapies. For example, the recently suggested role of Kir2.1 as a countercurrent to sarcoplasmic calcium reuptake might explain the arrhythmogenic mechanisms of ATS and its overlap with catecholaminergic polymorphic ventricular tachycardia (CPVT). Here we summarize current knowledge on the mechanisms of arrhythmias leading to sudden cardiac death in ATS. We first provide an overview of the syndrome and its pathophysiology, from the patient´s bedside to the protein, and discuss the role of essential regulators and interactors that could play a role in cases of ATS. The review highlights novel ideas related to some post-translational channel interactions with partner proteins that might help define the molecular bases of the arrhythmia phenotype. We then propose a new all-embracing classification of the currently known ATS loss-of-function mutations according to their position in the Kir2.1 channel structure and their functional implications. We also discuss specific ATS pathogenic variants, their clinical manifestations and treatment stratification. The goal is to provide a deeper mechanistic understanding of the syndrome toward the development of novel targets and personalized treatment strategies.
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Affiliation(s)
| | - Lilian K Gutiérrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | | | | | - Francisco José Bermúdez Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain.,Departamento de Cardiología, Hospital Virgen de las Nieves, GranadaSpain
| | | | - Patricia Sánchez Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - Álvaro Macías
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Departments of Medicine and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
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5
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Villar-Quiles RN, Sternberg D, Tredez G, Beatriz Romero N, Evangelista T, Lafôret P, Cintas P, Sole G, Sacconi S, Bendahhou S, Franques J, Cances C, Noury JB, Delmont E, Blondy P, Perrin L, Hezode M, Fournier E, Fontaine B, Stojkovic T, Vicart S. Phenotypical variability and atypical presentations in a French cohort of Andersen-Tawil syndrome. Eur J Neurol 2022; 29:2398-2411. [PMID: 35460302 DOI: 10.1111/ene.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Andersen-Tawil syndrome (ATS) is a skeletal muscle channelopathy caused by KCNJ2 mutations, characterized by a clinical triad of periodic paralysis, cardiac arrhythmias and dysmorphism. The muscle phenotype, particularly the atypical forms with prominent permanent weakness or predominantly painful symptoms, remains incompletely characterized. METHODS A retrospective clinical, histological, electroneuromyography (ENMG) and genetic analysis of molecularly confirmed ATS patients, diagnosed and followed up at neuromuscular reference centers in France, was conducted. RESULTS Thirty-five patients from 27 unrelated families carrying 17 different missense KCNJ2 mutations (four novel mutations) and a heterozygous KCNJ2 duplication are reported. The typical triad was observed in 42.9% of patients. Cardiac abnormalities were observed in 65.7%: 56.5% asymptomatic and 39.1% requiring antiarrhythmic drugs. 71.4% of patients exhibited dysmorphic features. Muscle symptoms were reported in 85.7%, amongst whom 13.3% had no cardiopathy and 33.3% no dysmorphic features. Periodic paralysis was present in 80% and was significantly more frequent in men. Common triggers were exercise, immobility and carbohydrate-rich diet. Ictal serum potassium concentrations were low in 53.6%. Of the 35 patients, 45.7% had permanent weakness affecting proximal muscles, which was mild and stable or slowly progressive over several decades. Four patients presented with exercise-induced pain and myalgia attacks. Diagnostic delay was 14.4 ± 9.5 years. ENMG long-exercise test performed in 25 patients (71.4%) showed in all a decremental response up to 40%. Muscle biopsy performed in 12 patients revealed tubular aggregates in six patients (associated in two of them with vacuolar lesions), dystrophic features in one patient and non-specific myopathic features in one patient; it was normal in four patients. DISCUSSION Recognition of atypical features (exercise-induced pain or myalgia and permanent weakness) along with any of the elements of the triad should arouse suspicion. The ENMG long-exercise test has a high diagnostic yield and should be performed. Early diagnosis is of utmost importance to improve disease prognosis.
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Affiliation(s)
- Rocio Nur Villar-Quiles
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Damien Sternberg
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Grégoire Tredez
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Norma Beatriz Romero
- Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Teresinha Evangelista
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascal Lafôret
- Reference Center for Neuromuscular Disorders, APHP, Raymond-Poincaré Hospital, Paris, France
| | - Pascal Cintas
- Neurology Department, Pierre-Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - Guilhem Sole
- Reference Centre for Neuromuscular Disorders, Pellegrin Hospital CHU Bordeaux, Bordeaux, France
| | - Sabrina Sacconi
- Neuromuscular Diseases and ALS Specialized Center, University of Nice-Sophia Antipolis, Nice, France
| | - Said Bendahhou
- UMR7370 CNRS, LP2M, Labex ICST, Faculty of Medicine, University of Nice-Sophia Antipolis, Nice, France
| | - Jérôme Franques
- Assistance Publique-Hôpitaux de Marseille, Department of Neurology and Neuromuscular Diseases, La Timone Hospital, Marseille, France
| | - Claude Cances
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropediatric Department, Toulouse University Hospital, Toulouse, France
| | - J B Noury
- Neurology Department, Neuromuscular Center, CHRU Cavale Blanche, Brest, France
| | - Emilien Delmont
- Department of Neurology, University Hospital Timone, Marseille, France
| | - Patricia Blondy
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurence Perrin
- Pediatrics Department, APHP, Robert-Débré Hospital, Paris, France
| | - Marianne Hezode
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Fournier
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Fontaine
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Tanya Stojkovic
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Savine Vicart
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
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6
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Awuah DO, Hussain MS, Ponnapalli A, Deliwala SS, Seedahmed EM, Bachuwa G. Refractory familial hypokalaemic periodic paralysis leading to cardiovascular compromise. BMJ Case Rep 2022; 15:e246674. [PMID: 35131788 PMCID: PMC8823031 DOI: 10.1136/bcr-2021-246674] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/03/2022] Open
Abstract
Familial hypokalaemic periodic paralysis (FHPP) is a rare neuromuscular disorder that is classified under periodic paralysis (PP), which is characterised by episodes of muscle weakness. Common triggers include intense exercise, fasting or consumption of carbohydrate-rich meals. Hypokalaemic PP has an incidence of 1 in 100 000; despite the temporal association, cardiac manifestations are exceedingly rare. We present a case of FHPP, a channelopathy presenting with severe refractory hypokalaemia. The challenges with our patient were maintaining potassium levels within normal ranges and initiating a close follow-up plan. Due to the lack of clinical guidance in our case, many aspects of care, including surveillance, medications and genetic testing, remain unaddressed. Medical management includes aggressive correction with supplements, potassium-sparing diuretics and carbonic anhydrase inhibitors. Severe cases of dysrhythmias, especially ventricular fibrillation, require electrophysiology evaluation and possible implantation of a defibrillator to prevent sudden cardiac death.
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Affiliation(s)
- Dominic O Awuah
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
| | | | | | | | | | - Ghassan Bachuwa
- Internal Medicine, Hurley Medical Center, Flint, Michigan, USA
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7
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Yim J, Kim KB, Kim M, Lee GD, Kim M. Andersen-Tawil Syndrome With Novel Mutation in KCNJ2: Case Report. Front Pediatr 2021; 9:790075. [PMID: 35174115 PMCID: PMC8842678 DOI: 10.3389/fped.2021.790075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/22/2021] [Indexed: 11/17/2022] Open
Abstract
Andersen-Tawil syndrome (ATS) is a rare autosomal dominant disorder characterized by a classic symptom triad: periodic paralysis, ventricular arrhythmias associated with prolonged QT interval, and dysmorphic skeletal and facial features. Pathogenic variants of the inwardly rectifying potassium channel subfamily J member 2 (KCNJ2) gene have been linked to the ATS. Herein, we report a novel KCNJ2 causative variant in a proband and her father showing different ATS-associated symptoms. A 15-year-old girl was referred because of episodic weakness and periodic paralysis in both legs for 2-3 months. The symptoms occurred either when she was tired or after strenuous exercise. These attacks made walking or climbing stairs difficult and lasted from one to several days. She had a short stature (142 cm, <3rd percentile) and weighed 40 kg. The proband also showed orbital hypertelorism, dental crowding, mandibular hypoplasia, fifth-digit clinodactyly, and small hands. Scoliosis in the thoracolumbar region was detected by chest X-ray. Since she was 7 years old, she had been treated for arrhythmia-associated long QT interval and underwent periodic echocardiography. Brain MRI revealed cerebrovascular abnormalities indicating absence or hypoplasia of bilateral internal carotid arteries, and compensation of other collateral vessels was observed. There were no specific findings related to intellectual development. The proband's father also had a history of periodic paralysis similar to the proband. He did not show any cardiac symptoms. Interestingly, he was diagnosed with hyperthyroidism during an evaluation for paralytic symptoms. Clinical exome sequencing revealed a novel heterozygous missense variant: Chr17(GRCh37):g.68171593A>T, NM_000891.2:c.413A>T, p.(Glu138Val) in KCNJ2 in the proband and the proband's father.
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Affiliation(s)
- Jisook Yim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Kyoung Bo Kim
- Department of Laboratory Medicine, Keimyung University School of Medicine, Daegu, South Korea
| | - Minsun Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Gun Dong Lee
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Myungshin Kim
- Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea.,Catholic Genetic Laboratory Center, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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8
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Arbustini E, Di Toro A, Giuliani L, Favalli V, Narula N, Grasso M. Cardiac Phenotypes in Hereditary Muscle Disorders: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 72:2485-2506. [PMID: 30442292 DOI: 10.1016/j.jacc.2018.08.2182] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/20/2018] [Accepted: 08/10/2018] [Indexed: 01/05/2023]
Abstract
Hereditary muscular diseases commonly involve the heart. Cardiac manifestations encompass a spectrum of phenotypes, including both cardiomyopathies and rhythm disorders. Common biomarkers suggesting cardiomuscular diseases include increased circulating creatine kinase and/or lactic acid levels or disease-specific metabolic indicators. Cardiac and extra-cardiac traits, imaging tests, family studies, and genetic testing provide precise diagnoses. Cardiac phenotypes are mainly dilated and hypokinetic in dystrophinopathies, Emery-Dreifuss muscular dystrophies, and limb girdle muscular dystrophies; hypertrophic in Friedreich ataxia, mitochondrial diseases, glycogen storage diseases, and fatty acid oxidation disorders; and restrictive in myofibrillar myopathies. Left ventricular noncompaction is variably associated with the different myopathies. Conduction defects and arrhythmias constitute a major phenotype in myotonic dystrophies and skeletal muscle channelopathies. Although the actual cardiac management is rarely based on the cause, the cardiac phenotypes need precise characterization because they are often the only or the predominant manifestations and the prognostic determinants of many hereditary muscle disorders.
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Affiliation(s)
- Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy.
| | - Alessandro Di Toro
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Giuliani
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Nupoor Narula
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy; Division of Cardiology, Department of Medicine, New York Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Maurizia Grasso
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation, University Hospital Policlinico San Matteo, Pavia, Italy
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9
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Alrashed NA, Al-Manea WM, Tulbah SA, Al-Hassnan ZN. Phenotypic variability in a series of four pediatric patients with Andersen-Tawil syndrome: A Saudi experience. Int J Pediatr Adolesc Med 2019; 6:158-164. [PMID: 31890843 PMCID: PMC6926230 DOI: 10.1016/j.ijpam.2019.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 06/13/2019] [Indexed: 11/30/2022]
Abstract
Andersen-Tawil syndrome (ATS) is a rare genetic disorder characterized by periodic paralysis, ventricular arrhythmia, and dysmorphic features. However, the classical features are not always seen in the syndrome; therefore, the diagnosis can be challenging. We describe our experience with ATS in Riyadh, Saudi Arabia, by presenting a case series involving four patients in the pediatric cardiology clinic confirmed to have ATS. Despite the diversity in phenotypes and clinical course among the four cases, all patients had bidirectional ventricular tachycardia and were confirmed to have ATS by performing genetic testing. In this case series, we identified one novel and three previously described KCNJ2 mutations. We also confirmed the beneficial effect of AAI pacing in one of our patients, together with medical therapy with β-blockers and flecainide. In Saudi Arabia, there is a distinct genetic pool and a high incidence of inherited diseases. Raising awareness about these diseases is crucial, especially in a country such as Saudi Arabia, wherein consanguinity remains a significant factor leading to an increased incidence of inherited diseases. Furthermore, because of the limited information available regarding this rare syndrome, we believe that this case series would offer an opportunity to provide a better understanding of ATS in our local region and worldwide.
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Affiliation(s)
- Norah A Alrashed
- Princess Nourah Bint Abdulrahman University - College of Medicine, Riyadh, Saudi Arabia
| | - Waleed M Al-Manea
- Division of Pediatric Cardiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Sahar A Tulbah
- Cardiovascular Genetics Program, Department of Medical Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Zuhair N Al-Hassnan
- Cardiovascular Genetics Program, Department of Medical Genetics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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10
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Gélinas R, El Khoury N, Chaix MA, Beauchamp C, Alikashani A, Ethier N, Boucher G, Villeneuve L, Robb L, Latour F, Mondesert B, Rivard L, Goyette P, Talajic M, Fiset C, Rioux JD. Characterization of a Human Induced Pluripotent Stem Cell-Derived Cardiomyocyte Model for the Study of Variant Pathogenicity: Validation of a KCNJ2 Mutation. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.117.001755. [PMID: 29021306 DOI: 10.1161/circgenetics.117.001755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/10/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Long-QT syndrome is a potentially fatal condition for which 30% of patients are without a genetically confirmed diagnosis. Rapid identification of causal mutations is thus a priority to avoid at-risk situations that can lead to fatal cardiac events. Massively parallel sequencing technologies are useful for the identification of sequence variants; however, electrophysiological testing of newly identified variants is crucial to demonstrate causality. Long-QT syndrome could, therefore, benefit from having a standardized platform for functional characterization of candidate variants in the physiological context of human cardiomyocytes. METHODS AND RESULTS Using a variant in Kir2.1 (Gly52Val) revealed by whole-exome sequencing in a patient presenting with symptoms of long-QT syndrome as a proof of principle, we demonstrated that commercially available human induced pluripotent stem cell-derived cardiomyocytes are a powerful model for screening variants involved in genetic cardiac diseases. Immunohistochemistry experiments and whole-cell current recordings in human embryonic kidney cells expressing the wild-type or the mutant Kir2.1 demonstrated that Kir2.1-52V alters channel cellular trafficking and fails to form a functional channel. Using human induced pluripotent stem cell-derived cardiomyocytes, we not only confirmed these results but also further demonstrated that Kir2.1-52V is associated with a dramatic prolongation of action potential duration with evidence of arrhythmic activity, parameters which could not have been studied using human embryonic kidney cells. CONCLUSIONS Our study confirms the pathogenicity of Kir2.1-52V in 1 patient with long-QT syndrome and also supports the use of isogenic human induced pluripotent stem cell-derived cardiomyocytes as a physiologically relevant model for the screening of variants of unknown function.
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Affiliation(s)
- Roselle Gélinas
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Nabil El Khoury
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Marie-A Chaix
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Claudine Beauchamp
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Azadeh Alikashani
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Nathalie Ethier
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Gabrielle Boucher
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Louis Villeneuve
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Laura Robb
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Frédéric Latour
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Blandine Mondesert
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Lena Rivard
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Philippe Goyette
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Mario Talajic
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada
| | - Céline Fiset
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada.
| | - John David Rioux
- From the Research Center (R.G., N.E.K., M.-A.C., C.B., A.A., N.E., G.B., L.V., L.R., F.L., B.M., L.R., P.G., M.T., C.F., J.D.R.) and Cardiovascular Genetics Center (L. Robb, L. Rivard, M.T.), Montreal Heart Institute, Quebec, Canada; and Department of Medicine (R.G., M.-A.C., B.M., L.R., M.T., J.D.R.) and Faculty of Pharmacy (N.E.K., C.F.), Université de Montréal, Quebec, Canada.
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Bienias P, Kostera-Pruszczyk A, Miszczak-Knecht M, Ciurzyński M, Pruszczyk P. Propafenone is not effective for severe ventricular arrhythmias in Andersen-Tawil syndrome. Arch Med Sci 2018; 14:248-250. [PMID: 29379555 PMCID: PMC5778416 DOI: 10.5114/aoms.2016.61010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 11/03/2015] [Indexed: 11/20/2022] Open
Affiliation(s)
- Piotr Bienias
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Maria Miszczak-Knecht
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, Warsaw, Poland
- Department of Cardiology, Children’s Memorial Health Institute, Warsaw, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Krych M, Biernacka EK, Ponińska J, Kukla P, Filipecki A, Gajda R, Hasdemir C, Antzelevitch C, Kosiec A, Szperl M, Płoski R, Trusz-Gluza M, Mizia-Stec K, Hoffman P. Andersen-Tawil syndrome: Clinical presentation and predictors of symptomatic arrhythmias - Possible role of polymorphisms K897T in KCNH2 and H558R in SCN5A gene. J Cardiol 2017; 70:504-510. [PMID: 28336205 DOI: 10.1016/j.jjcc.2017.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/27/2016] [Accepted: 01/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Andersen-Tawil syndrome (ATS) is rare channelopathy caused by KCNJ2 mutation and probably KCNJ5. It is characterized by arrhythmias, neurological symptoms, and dysmorphic features. The present study retrospectively examined the characteristics of 11 unrelated families with ATS. METHODS This study consisted of 11 probands positive for KCNJ2 variants and 33 family members (mean age 30.0±17.3 years, female n=31). Additional genetic screening of 3 LQTS genes (KCNQ1, KCNH2, SCN5A) was performed in 9 families. Predictors of arrhythmias [premature ventricular beats>2000/24h, biventricular and polymorphic ventricular tachycardia (VT)], syncope, and/or cardiac arrest (CA) were evaluated. RESULTS In KCNJ2 mutation carriers vs non-carriers (n=25 vs n=19) significant differences were observed in U-wave manifestations in V2-V4, Tpeak-Tend duration, QTUc duration (p<0.0001), dysmorphic features, and neurological symptoms. Compared to asymptomatic carriers (n=9), in those with arrhythmias and/or syncope and/or CA (n=16) micrognathia (p=0.004), periodic paralysis (p=0.019), palpitation (p=0.005), U-wave n V2-V4 (p=0.049) were more frequent; QTU (p=0.045) and Tpeak-Tend (p=0.014) were also longer (n=9). In the subgroup of carriers with syncope and/or cardiac arrest (n=10, 90% women), K897T-KCNH2 polymorphism (p=0.02), periodic paralysis (p=0.004), muscle weakness (p=0.04), palpitations (p=0.04), arrhythmias (biventricular VT, p=0.003; polymorphic VT, p=0.009) were observed more frequently. Tpeak-Tend duration was longer (p=0.007) and the percentage of patients with premature ventricular contraction >2000/24h was higher (p=0.005). CONCLUSION A higher risk of arrhythmia, syncope, and/or CA is associated with the presence of micrognathia, periodic paralysis, and prolonged Tpeak-Tend time. Our findings suggest that K897T may contribute to the occurrence of syncope.
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Affiliation(s)
- Michalina Krych
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
| | | | - Joanna Ponińska
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Kukla
- Department of Cardiology and Internal Medicine, Specialistic Hospital, Gorlice, Poland
| | - Artur Filipecki
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | | | - Agnieszka Kosiec
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Małgorzata Szperl
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Warsaw Medical University, Poland
| | - Maria Trusz-Gluza
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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Intrafamilial phenotypic variability in Andersen–Tawil syndrome: A diagnostic challenge in a potentially treatable condition. Neuromuscul Disord 2017; 27:294-297. [DOI: 10.1016/j.nmd.2016.11.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 11/12/2016] [Indexed: 11/18/2022]
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Matthews E, Hanna MG. Dichlorphenamide efficacy in the primary periodic paralyses. Expert Opin Orphan Drugs 2017. [DOI: 10.1080/21678707.2017.1283216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Rai V, Agrawal DK. Role of risk stratification and genetics in sudden cardiac death. Can J Physiol Pharmacol 2016; 95:225-238. [PMID: 27875062 DOI: 10.1139/cjpp-2016-0457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.
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Affiliation(s)
- Vikrant Rai
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA.,Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
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Finsterer J, Stöllberger C, Maeztu C. Sudden cardiac death in neuromuscular disorders. Int J Cardiol 2016; 203:508-15. [DOI: 10.1016/j.ijcard.2015.10.176] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/25/2015] [Accepted: 10/24/2015] [Indexed: 12/31/2022]
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