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Zhang J, Zou Y, Chen X, Pan J, Yu H, Wang Y, Wu Y, Zou H. Extremely dangerous hypopituitarism related long QT syndrome and transient ST-segment elevation: A case report. SAGE Open Med Case Rep 2023; 11:2050313X221147194. [PMID: 36636098 PMCID: PMC9829875 DOI: 10.1177/2050313x221147194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 12/07/2022] [Indexed: 01/14/2023] Open
Abstract
Acquired long QT syndrome caused by hypopituitarism and transient ST-segment elevation has not been reported in cardiac arrest patients. We report a case of extremely dangerous acquired long QT syndrome and transient ST-segment elevation. A 44-year-old Chinese woman with renal failure experienced sudden cardiac arrest in the haemodialysis room. Subsequent electrocardiogram showed QT prolongation and transient ST-segment elevation. This patient's medical history, subsequent laboratory results and pituitary magnetic resonance imaging suggested hypopituitarism. Transient ST-segment elevation on the electrocardiogram was considered to be caused by repeated direct current shocks. The patient was diagnosed with acquired long QT syndrome and was not taking any antiarrhythmic drugs. Her corrected QT interval normalized after hormone replacement therapy. This case highlights the importance of the awareness of hypopituitarism; early identification and intervention can prevent the occurrence of this life-threatening arrhythmia. ST-segment elevation is not always due to acute myocardial infarction, and a variety of other causes, especially electrical cardioversion, should be considered.
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Affiliation(s)
- Jia Zhang
- Department of Inspection Medical, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yingying Zou
- Digestive System Department, The Third Affiliated Hospital of Qiqihar Medical College, Qiqihar, China
| | - Xiaoshu Chen
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Jingye Pan
- Department of General and Intensive Care Medical, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Haizhu Yu
- Department of General Practice, Zhejiang Hospital, Hangzhou, China
| | - Yi Wang
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - Yanran Wu
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China
| | - He Zou
- Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou, China,He Zou, Department of Cardiovascular Medicine, Wenzhou People’s Hospital, The Wenzhou Third Clinical Institute Affiliated with Wenzhou Medical University, Wenzhou 325035, Zhejiang, China.
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Harvey A, Curnier D, Dodin P, Abadir S, Jacquemet V, Caru M. OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1633-1677. [PMID: 35537006 DOI: 10.1093/eurjpc/zwac081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/13/2022]
Abstract
Current exercise recommendations make it difficult for long QT syndrome (LQTS) patients to adopt a physically active and/or athletic lifestyle. The purpose of this review is to summarize the current evidence, identify knowledge gaps, and discuss research perspectives in the field of exercise and LQTS. The first aim is to document the influence of exercise training, exercise stress, and postural change interventions on ventricular repolarization in LQTS patients, while the second aim is to describe electrophysiological measurements used to study the above. Studies examining the effects of exercise on congenital or acquired LQTS in human subjects of all ages were included. Systematic searches were performed on 1 October 2021, through PubMed (NLM), Ovid Medline, Ovid All EBM Reviews, Ovid Embase, and ISI Web of Science, and limited to articles written in English or French. A total of 1986 LQTS patients and 2560 controls were included in the 49 studies. Studies were mainly case-control studies (n = 41) and examined exercise stress and/or postural change interventions (n = 48). One study used a 3-month exercise training program. Results suggest that LQTS patients have subtype-specific repolarization responses to sympathetic stress. Measurement methods and quality were found to be very heterogeneous, which makes inter-study comparisons difficult. In the absence of randomized controlled trials, the current recommendations may have long-term risks for LQTS patients who are discouraged from performing physical activity, rendering its associated health benefits out of range. Future research should focus on discovering the most appropriate levels of exercise training that promote ventricular repolarization normalization in LQTS.
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Affiliation(s)
- Audrey Harvey
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Daniel Curnier
- Laboratory of Pathophysiology of EXercise (LPEX), School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, Canada
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Philippe Dodin
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
| | - Sylvia Abadir
- Department of Pediatric Cardiology, Sainte-Justine University Health Center, Montreal, Canada
| | - Vincent Jacquemet
- Department of Pharmacology and Physiology, Faculty of Medicine, University of Montreal, Montreal, Canada
| | - Maxime Caru
- Sainte-Justine University Health Center, Research Center, Montreal, Canada
- Department of Pediatrics, Pennsylvania State University College of Medicine, Hershey, PA, USA
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA, USA
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Prifti E, Fall A, Davogustto G, Pulini A, Denjoy I, Funck-Brentano C, Khan Y, Durand-Salmon A, Badilini F, Wells QS, Leenhardt A, Zucker JD, Roden DM, Extramiana F, Salem JE. Deep learning analysis of electrocardiogram for risk prediction of drug-induced arrhythmias and diagnosis of long QT syndrome. Eur Heart J 2021; 42:3948-3961. [PMID: 34468739 DOI: 10.1093/eurheartj/ehab588] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS Congenital long-QT syndromes (cLQTS) or drug-induced long-QT syndromes (diLQTS) can cause torsade de pointes (TdP), a life-threatening ventricular arrhythmia. The current strategy for the identification of drugs at the high risk of TdP relies on measuring the QT interval corrected for heart rate (QTc) on the electrocardiogram (ECG). However, QTc has a low positive predictive value. METHODS AND RESULTS We used convolutional neural network (CNN) models to quantify ECG alterations induced by sotalol, an IKr blocker associated with TdP, aiming to provide new tools (CNN models) to enhance the prediction of drug-induced TdP (diTdP) and diagnosis of cLQTS. Tested CNN models used single or multiple 10-s recordings/patient using 8 leads or single leads in various cohorts: 1029 healthy subjects before and after sotalol intake (n = 14 135 ECGs); 487 cLQTS patients (n = 1083 ECGs: 560 type 1, 456 type 2, 67 type 3); and 48 patients with diTdP (n = 1105 ECGs, with 147 obtained within 48 h of a diTdP episode). CNN models outperformed models using QTc to identify exposure to sotalol [area under the receiver operating characteristic curve (ROC-AUC) = 0.98 vs. 0.72, P ≤ 0.001]. CNN models had higher ROC-AUC using multiple vs. single 10-s ECG (P ≤ 0.001). Performances were comparable for 8-lead vs. single-lead models. CNN models predicting sotalol exposure also accurately detected the presence and type of cLQTS vs. healthy controls, particularly for cLQT2 (AUC-ROC = 0.9) and were greatest shortly after a diTdP event and declining over time (P ≤ 0.001), after controlling for QTc and intake of culprit drugs. ECG segment analysis identified the J-Tpeak interval as the best discriminator of sotalol intake. CONCLUSION CNN models applied to ECGs outperform QTc measurements to identify exposure to drugs altering the QT interval, congenital LQTS, and are greatest shortly after a diTdP episode.
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Affiliation(s)
- Edi Prifti
- IRD, Sorbonne University, UMMISCO, 32 Avenue Henri Varagnat, Bondy 93143, France.,Sorbonne University, INSERM, NutriOmics, 91 Boulevard de l'Hopital, Paris 75013, France
| | - Ahmad Fall
- IRD, Sorbonne University, UMMISCO, 32 Avenue Henri Varagnat, Bondy 93143, France
| | - Giovanni Davogustto
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alfredo Pulini
- IRD, Sorbonne University, UMMISCO, 32 Avenue Henri Varagnat, Bondy 93143, France.,Faculty of Medicine, Université de Paris, Paris, France
| | - Isabelle Denjoy
- CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Christian Funck-Brentano
- Clinical Investigation Center Paris-Est, CIC-1901, INSERM, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology, Pitié-Salpêtrière University Hospital, Sorbonne Universite, 47 Boulevard de l'Hopital, Paris 7513, France
| | | | | | | | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Antoine Leenhardt
- CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Jean-Daniel Zucker
- IRD, Sorbonne University, UMMISCO, 32 Avenue Henri Varagnat, Bondy 93143, France.,Sorbonne University, INSERM, NutriOmics, 91 Boulevard de l'Hopital, Paris 75013, France
| | - Dan M Roden
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Fabrice Extramiana
- CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Joe-Elie Salem
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.,Clinical Investigation Center Paris-Est, CIC-1901, INSERM, UNICO-GRECO Cardio-Oncology Program, Department of Pharmacology, Pitié-Salpêtrière University Hospital, Sorbonne Universite, 47 Boulevard de l'Hopital, Paris 7513, France.,Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
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