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Marchand M, Erickson AC, Gillman L, Haywood R, Morrison J, Jaworsky D, Drouin O, Laksman Z, Krahn AD, Arbour L. The Impact of Chronic Disease on the Corrected QT (QTc) Value in Women in a British Columbia First Nations Population. Can J Cardiol 2024; 40:89-97. [PMID: 37852605 DOI: 10.1016/j.cjca.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 09/27/2023] [Accepted: 10/12/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Indigenous women have higher rates of chronic disease than Indigenous men and non-Indigenous women. Long QT syndrome (LQTS) can be inherited or acquired; the latter may occur with chronic disease. A prolonged corrected QT value (QTc) is an independent risk factor for ventricular arrhythmias and sudden death, but few studies have quantified the impact of chronic disease on the QTc. We assessed the association between chronic disease and QTc prolongation in a population of First Nations women previously ascertained to study a high rate of inherited LQTS due to a unique genetic (founder) variant in their community. METHODS This substudy focusing on women expands on the original research where patients with clinical features of LQTS and their relatives were assessed for genetic variants discovered to affect the QTc. Medical records were retrospectively reviewed and chronic diseases documented. Using multivariate linear regression, adjusting for the effect of genetic variants, age, and QTc-prolonging medications, we evaluated the association between chronic disease and the QTc. RESULTS In total, 275 women were included. After adjustments, a prolonged QTc was associated with coronary artery disease (26.5 ms, 95% confidence interval [CI] 9.0-44.1 ms; P = 0.003), conduction system disease (26.8 ms, 95% CI 2.2-51.4 ms; P = 0.033), rheumatoid arthritis (28.9 ms, 95% CI 12.7-45.1 ms; P = 0.001), and type 2 diabetes mellitus (17.9 ms, 95% CI 3.6-32.3 ms; P = 0.015). CONCLUSIONS This quantification of the association between chronic disease and QTc prolongation in an Indigenous cohort provides insight into the nongenetic determinants of QTc prolongation. Corroboration in other populations will provide evidence for generalisability of these results.
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Affiliation(s)
- Miles Marchand
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Syilx Okanagan Nation, British Columbia, Canada
| | - Anders C Erickson
- Population and Public Health Division, British Columbia Ministry of Health, Victoria, British Columbia, Canada(‡)
| | - Lawrence Gillman
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada; Community Genetics Research Program, University of British Columbia, Island Medical Program, Victoria, British Columbia, Canada
| | - Rachel Haywood
- Community Genetics Research Program, University of British Columbia, Island Medical Program, Victoria, British Columbia, Canada
| | - Julie Morrison
- Community Member, Gitxsan Nation, British Columbia, Canada
| | - Denise Jaworsky
- Northern Health Authority, Terrace, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Olivier Drouin
- Northern Health Authority, Terrace, British Columbia, Canada
| | - Zachary Laksman
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada; Community Genetics Research Program, University of British Columbia, Island Medical Program, Victoria, British Columbia, Canada.
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Saramet EE, Pomȋrleanu C, Maştaleru A, Oancea A, Cojocaru DC, Russu M, Negru RD, Ancuța C. Autonomic Dysfunction and Cardiovascular Risk in Patients with Rheumatoid Arthritis: Can Heart Rate Variability Analysis Contribute to a Better Evaluation of the Cardiovascular Profile of a Patient? J Clin Med 2023; 12:7736. [PMID: 38137805 PMCID: PMC10743610 DOI: 10.3390/jcm12247736] [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: 11/16/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease of autoimmune etiology. Increased scientific evidence suggests that immune-mediated inflammatory dis-eases are associated with autonomic nervous system (ANS) dysfunction. Studies proved that autonomic imbalance is correlated with RA evolution and may explain augmented cardiovascular pathology and mortality not attributable to classical risk factors. (2) Methods: 75 patients (25 males, 50 females) with RA were submitted to standard ECG recording and 24 h Holter monitoring. Twenty-five healthy patients were used as controls. Both time (SDNN, SDANN, SDANN Index, RRmed, rMSSD, and pNN50) and frequency domain (TP, VLF, HF, LF and LF/HF) heart rate variability (HRV) parameters were obtained. Parameters were compared to controls, and correlations with the QTc-interval and inflammatory status expressed through the C-reactive protein (CRP) were evaluated. (3) Results: In patients with a CRP > 5 mg/L, HRV parameters were lower compared to controls and to patients with a CRP ≤ 5 mg/L. All HRV parameters generated by Holter monitoring are negatively correlated with CRP levels and QTc values. The number of premature ventricular contractions (PVC) recorded is correlated with SDNN, SDANN, and LF/HF values. (4) Conclusions: Our study supports recent data suggesting that in RA there is an autonomic system dysfunction strongly connected with the inflammatory status of the patient. The autonomic dysfunction can contribute to the increased risk of cardiovascular death observed in patients with RA.
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Affiliation(s)
- Elena Esmeralda Saramet
- “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania; (E.E.S.); (M.R.)
| | - Cristina Pomȋrleanu
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.P.); (C.A.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
| | - Alexandra Maştaleru
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Andra Oancea
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Doina-Clementina Cojocaru
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Mara Russu
- “Grigore T. Popa” University of Medicine and Pharmacy, 16 Universitatii Str., 700115 Iași, Romania; (E.E.S.); (M.R.)
| | - Robert Daniel Negru
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Codrina Ancuța
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania; (C.P.); (C.A.)
- Clinical Rehabilitation Hospital, 700661 Iasi, Romania; (A.M.); (A.O.); (D.-C.C.)
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3
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Mojón-Álvarez D, Izquierdo A, Cubero-Gallego H, Calvo-Fernández A, Marrugat J, Pérez-Fernández S, Cabero P, Solà-Richarte C, Soler C, Farré N, Vaquerizo B. The natural history of QTc interval and its clinical impact in coronavirus disease 2019 survivors after 1 year. Front Cardiovasc Med 2023; 10:1140276. [PMID: 37089886 PMCID: PMC10117953 DOI: 10.3389/fcvm.2023.1140276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
Background and objectiveProlonged QTc interval on admission and a higher risk of death in SARS-CoV-2 patients have been reported. The long-term clinical impact of prolonged QTc interval is unknown. This study examined the relationship in COVID-19 survivors of a prolonged QTc on admission with long-term adverse events, changes in QTc duration and its impact on 1-year prognosis, and factors associated with a prolonged QTc at follow-up.MethodsWe conducted a single-center prospective cohort study of 523 SARS-CoV-2-positive patients who were alive on discharge. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval and repeated in 421 patients 7 months after discharge. Mortality, hospital readmission, and new arrhythmia rates 1 year after discharge were reviewed.ResultsThirty-one (6.3%) survivors had a baseline prolonged QTc. They were older, had more cardiovascular risk factors, cardiac disease, and comorbidities, and higher levels of terminal pro-brain natriuretic peptide. There was no relationship between prolonged QTc on admission and the 1-year endpoint (9.8% vs. 5.5%, p = 0.212). In 84% of survivors with prolonged baseline QTc, it normalized at 7.9 ± 2.2 months. Of the survivors, 2.4% had prolonged QTc at follow-up, and this was independently associated with obesity, ischemic cardiomyopathy, chronic obstructive pulmonary disease, and cancer. Prolonged baseline QTc was not independently associated with the composite adverse event at 1 year.ConclusionsProlonged QTc in the acute phase normalized in most COVID-19 survivors and had no clinical long-term impact. Prolonged QTc at follow-up was related to the presence of obesity and previously acquired chronic diseases and was not related to 1-year prognosis.
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Affiliation(s)
- Diana Mojón-Álvarez
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Andrea Izquierdo
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
| | - Héctor Cubero-Gallego
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
| | - Alicia Calvo-Fernández
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
| | - Jaume Marrugat
- CIBER Group in Epidemiology and Public Heath (CIBERCV), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- REGICOR (Registre Gironí del Cor) Study Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Pérez-Fernández
- Scientific Coordination Facility, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Paula Cabero
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Cristina Soler
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Núria Farré
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
| | - Beatriz Vaquerizo
- Cardiology Department, Hospital del Mar, Barcelona, Spain
- Medicine Department, Autonomous University of Barcelona, Barcelona, Spain
- IMIM, Heart Disease Biomedical Research Group, Barcelona, Spain
- Medicine Department, Pompeu Fabra University, Barcelona, Spain
- CIBER Group in Epidemiology and Public Heath (CIBERCV), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Correspondence: Beatriz Vaquerizo
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Motawea KR, El-Sakka AA, Kandil OA, Ahmed N, Abdelnaem M, Zaki B, Elhalag RH, Varney J, Swed S, Nashwan AJ, Sawaf B, Seijari M, Farwati A, Battikh N, Rakab A. Relation Between Familial Mediterranean Fever and QT Markers (QTc, QTd, and QTcd): A Systematic Review and Meta-Analysis. Cureus 2022; 14:e30585. [DOI: 10.7759/cureus.30585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2022] [Indexed: 11/05/2022] Open
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Yuniadi Y, Yugo D, Fajri M, Tejo BA, Widowati DR, Hanafy DA, Raharjo SB. ECG
characteristics of
COVID
‐19 patient with arrhythmias: Referral hospitals data from Indonesia. J Arrhythm 2022; 38:432-438. [PMID: 35785388 PMCID: PMC9237289 DOI: 10.1002/joa3.12718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/17/2022] [Accepted: 03/27/2022] [Indexed: 12/12/2022] Open
Abstract
Background Arrhythmia is a significant clinical modifier in COVID‐19 patient outcomes. Currently, data on arrhythmia and ECG characteristics in COVID‐19 from lower middle‐income countries are limited. Methods COVID‐19 was confirmed by polymerase chain reaction testing of a nasopharyngeal sample. All clinical records were systematically evaluated to obtain demographic characteristics and medical comorbidities. The ECG was recorded on admission, in‐hospital, and at discharge. Results Total documented arrhythmia events account for 22% of patients, comprising 6% of new‐onset arrhythmia and 16% of existing arrhythmia. Atrial fibrillation is the most common arrhythmia. The ECG changes were a decrease in heart rate (91 ± 22 vs. 83 ± 20, p < .001) and an increase in the QT interval (354.7 ± 53.70 vs. 371.4 ± 59.48 msec, p < .001) from hospital admission to hospital discharge, respectively. The in‐hospital HR of 85 bpm or higher increases the risk of death (OR = 2.69, p = .019). Conclusion The incidence of arrhythmias in COVID‐19 patients at COVID‐19 referral hospitals in Indonesia is 22%. Atrial fibrillation is the most common arrhythmia in COVID‐19 patients. Prolongation of QRS duration from admission to discharge was related to the occurrence of new‐onset arrhythmia. The in‐hospital HR of 85 bpm or higher increased the risk of death.
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Affiliation(s)
- Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Dony Yugo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | | | | | | | - Dicky Armen Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
| | - Sunu Budhi Raharjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia, and National Cardiovascular Center Harapan Kita Jakarta Indonesia
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Svorc P, Svorc P. General anesthesia and electrocardiographic parameters in in vivo experiments involving rats. Physiol Res 2022; 71:177-192. [PMID: 35275702 PMCID: PMC9150551 DOI: 10.33549/physiolres.934848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/18/2022] [Indexed: 11/25/2022] Open
Abstract
In in vivo cardiovascular or toxicological studies involving rat models, changes in selected electrocardiographic (ECG) parameters are monitored after various interventions to assess the origin and development of heart rhythm disorders. Each ECG parameter has diagnostic significance; as such, commonly evaluated ECG parameters, including heart rate, PR interval, P wave duration, P wave amplitude, QRS complex, QT and QTc interval duration, R wave and T wave amplitude, of rats under various types of general anesthesia were the focus of this study. Studies that performed in vivo cardiovascular or toxicological experiments in rats were retrieved from a search of the Web of Science database for articles published mainly between 2000 and 2021. In total, the search retrieved 123 articles. ECG parameters that were reported as baseline or control values were summarized and averages with ranges were calculated. It is important to be cautious when interpreting results and, in discussions addressing the mechanisms underlying a given type of arrhythmia, acknowledge that initial ECG parameters may already be affected to some extent by the general anesthesia as well as by sex and the time of day the experiments were performed.
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Affiliation(s)
- Pavol Svorc
- Department of Physiology, Medical Faculty, Safarik University, Kosice, Slovak Republic
- Department of Physiology and Patophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Pavol Svorc
- Department of Physiology and Patophysiology, Medical Faculty, Ostrava University, Ostrava, Czech Republic
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Saramet EE, Negru RD, Oancea A, Constantin MML, Ancuta C. 24 h Holter ECG Monitoring of Patients with Rheumatoid Arthritis-A Potential Role for a Precise Evaluation of QT Interval Duration and Associated Arrhythmic Complications. Diagnostics (Basel) 2022; 12:diagnostics12030638. [PMID: 35328191 PMCID: PMC8946977 DOI: 10.3390/diagnostics12030638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/22/2022] [Accepted: 03/01/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Patients with rheumatoid arthritis (RA) have increased systemic inflammatory burden associated with elevated cardiovascular mortality. Prolonged ventricular repolarisation evaluated by QT interval duration is a risk factor for cardiovascular and total mortality. In RA, mortality risk is correlated with dynamics and cumulative incidence of QTc prolongation rather than QTc value. The aim is to evaluate if QT parameters evaluated with 24 h Holter ECG are a better option to complete the cardiovascular profile of RA patients than parameters from short ECG recordings. Materials and methods: A total of 58 patients (22 males, 36 females) with RA were submitted to short ECG recordings at admission and to 24 h Holter ECG. QT interval parameters and ventricular ectopy generated from both types of recordings were analyzed. Results: QTc interval values obtained from Holter ECG were significantly higher than the values from short term ECG and were correlated with severity of inflammatory process. The number of QRS complexes with QTc > 450 ms recorded during 24 h Holter was strongly correlated with the number of ventricular events and severity of the inflammatory process. Conclusions: In patients with RA, the Holter ECG recordings could realize a more precise evaluation of the extent and dynamics of QTc interval duration and of ventricular ectopic events with potential risk of sudden death.
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Cubeddu LX, de la Rosa D, Ameruoso M. Antiviral and anti-inflammatory drugs to combat COVID-19: Effects on cardiac ion channels and risk of ventricular arrhythmias. BIOIMPACTS : BI 2022; 12:9-20. [PMID: 35087712 PMCID: PMC8783084 DOI: 10.34172/bi.2021.23630] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 12/27/2022]
Abstract
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Introduction: Drugs with no indication for the treatment of cardiovascular diseases (e.g., drugs employed to treat COVID-19) can increase the risk of arrhythmias. Of interest, a six-fold increase in the number of arrhythmic events was reported in patients with severe COVID-19. In this study, we reviewed (i) the pro-arrhythmic action of drugs given to patients with COVID-19 infection, and (ii) the effects of inflammatory cytokines on cardiac ion channels and possible generation of arrhythmias.
Methods: We conducted a literature search on the drugs with purported or demonstrated efficacy against COVID-19 disease, emphasizing the mechanisms by which anti-COVID-19 drugs and inflammatory cytokines interfere with cardiac ion channels.
Results:Antibiotics (azithromycin), antimalarials (hydroxychloroquine, chloroquine), antivirals (ritonavir/lopinavir, atazanavir), and some of the tyrosine kinase inhibitors (vandetanib) could induce long QT and increase risk for ventricular arrhythmias. The pro-arrhythmic action results from drug-induced inhibition of Kv11.1 (hERG) channels interfering with the repolarizing potassium IKr currents, leading to long QT and increased risk of triggered arrhythmias. At higher concentrations, these drugs may interfere with IKs, IK1, and/or Ito potassium currents, and even inhibit sodium (INa) and calcium (ICa) currents, inducing additional cardiac toxicity. Ibrutinib, an inhibitor of Bruton’s TK, increased the incidence of atrial fibrillation and ventricular tachycardia associated with a short QT interval. Inflammatory cytokines IL-6 and TNF-α inhibit IKr and Ito repolarizing potassium currents. High levels of inflammatory cytokines could contribute to the arrhythmic events. For remdesivir, favipiravir, dexamethasone, tocilizumab, anakinra, baricitinib, and monoclonal antibodies (bamlanivimab, etesevimab, and casirivimab), no evidence supports significant effects on cardiac ion channels, changes in the QT interval, and increased risk for ventricular arrhythmias.
Conclusion: This study supports the concept of hERG channel promiscuity. Different drug classes given to COVID-19 patients might delay repolarization, and increase the risk of ventricular arrhythmias. The presence of comorbid pro-arrhythmic disease states, and elevated levels of pro-arrhythmic cytokines, could increase the risk of ventricular arrhythmias. Discontinuation of nonessential drugs and correction of electrolyte abnormalities could prevent severe ventricular arrhythmias. Altogether, the most effective therapies against COVID-19 (remdesivir, dexamethasone, monoclonal antibodies) lack pro-arrhythmic activity.
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Affiliation(s)
- Luigi X Cubeddu
- Nova SE University, Health Professions Division, 3200 S, University Drive, Davie, FL 33328, USA
| | - Daisy de la Rosa
- Nova SE University, Health Professions Division, 3200 S, University Drive, Davie, FL 33328, USA
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Saad S, Delouya G, Lambert C, Barkati M, Dariane C, Laskine M, Taussky D. Prevalence and risk factors of QTc prolongation in prostate cancer patients undergoing brachytherapy. Cancer Invest 2022; 40:219-227. [PMID: 35000504 DOI: 10.1080/07357907.2022.2027435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
QTc prolongation is linked to Torsade de Pointes, sudden cardiac death, and overall cardiovascular mortality. 754 prostate cancer patients undergoing brachytherapy were analyzed, prolonged QTc was defined as ≥450ms. A prolonged QTc was more frequent (10.1% vs 5.1%, p = 0.040) in patients with high-risk cancer than in low to intermediate risk patients. The absolute QTc-time was correlated with age (r = 0.125), neutrophil count (r = 0.130) and negatively correlated with the testosterone level (r=-0.205). Treating physicians should be aware of this and monitor the QTc during ADT to possibly decrease cardiac morbidity/mortality in these patients who are more likely to require ADT.
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Affiliation(s)
- Simon Saad
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada
| | - Guila Delouya
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Carole Lambert
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Charles Dariane
- Department of Urology, University of Montreal Health Center, Montreal, Canada.,Department of Urology, Hôpital européen Georges-Pompidou, Paris University, Paris, France
| | - Mikhael Laskine
- CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada.,Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, University of Montreal Health Center, Montreal, Canada.,CRCHUM-Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
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Park E, Giles JT, Perez-Recio T, Pina P, Depender C, Gartshteyn Y, Askanase AD, Bathon J, Geraldino-Pardilla L. Hydroxychloroquine use is not associated with QTc length in a large cohort of SLE and RA patients. Arthritis Res Ther 2021; 23:271. [PMID: 34715924 PMCID: PMC8554185 DOI: 10.1186/s13075-021-02646-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hydroxychloroquine (HCQ) is a cornerstone therapy for systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). However, reports of its use and subsequent fatal arrhythmias in patients with coronavirus disease 19 (COVID-19) have raised concern regarding its cardiovascular (CV) safety. Therefore, we examined the relationship between HCQ use and corrected QT (QTc) length in SLE and RA patients without clinical CV disease (CVD). Methods SLE patients from the Columbia University Lupus Cohort registry (n = 352) and two RA cohorts (n = 178; ESCAPE-RA and RHYTHM-RA) with electrocardiograms (ECGs) collected as part of study data were analyzed. RA cohort participants were recruited from tertiary referral centers with additional referrals from community rheumatologists, while SLE subjects originated from the Columbia University Lupus Cohort. All patients met American College of Rheumatology (ACR) classification criteria for SLE or RA and lacked known CVD. The exposure of interest was HCQ use and main outcome measure was QTc length [continuous or categorical (≥ 440 ms and ≥ 500 ms)]. Results Of the combined SLE and RA cohorts (n = 530), 70% were HCQ users and 44% had a QTc ≥ 440 ms. The adjusted mean QTc length was comparable between HCQ users vs non-users (438 ms vs 437 ms). In multivariable logistic models, HCQ use was not a significant predictor of a QTc ≥ 440 ms for the entire cohort (OR 0.77; 95% CI 0.48–1.23; p = 0.27). Importantly, a QTc ≥ 500 ms was inversely associated with HCQ use and not associated with arrhythmias or deaths. A significant interaction was found between HCQ use and use of anti-psychotics. Ultimately, the use of HCQ combined with any QTc prolonging medication as a group was associated with a QTc length (434 ms; 95% CI 430, 439) which was comparable to that of use of HCQ alone (433 ms; 95% CI 429-437). Conclusion In a combined cohort of SLE and RA patients without clinical CVD, adjusted QTc length was comparable between HCQ and non-HCQ users, supporting its CV safety in patients with rheumatic diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02646-0.
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Affiliation(s)
- Elizabeth Park
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA.
| | - Jon T Giles
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Thania Perez-Recio
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Paloma Pina
- Cardiac Electrophysiology, Northwestern Medicine, Chicago, IL, USA
| | - Christopher Depender
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Yevgeniya Gartshteyn
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Anca D Askanase
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Joan Bathon
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Columbia University Vagelos College of Physicians and Surgeons and New York Presbyterian Hospital, 630 W 168th St, P&S 3-450, New York, NY, 10032, USA
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Kusmiati T, Mertaniasih NM, Eko Putranto JN, Suprapti B, Soedarsono, Luthfah N, Koesoemoprodjo W, Sari AP. The role of C-Reactive protein as an inflammatory marker to predict prolonged QTc interval in rifampicin-resistant tuberculosis patients: A case-control study. Ann Med Surg (Lond) 2021; 70:102899. [PMID: 34691435 PMCID: PMC8519798 DOI: 10.1016/j.amsu.2021.102899] [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: 08/13/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 01/08/2023] Open
Abstract
Background long-term use of anti-tuberculosis drugs (ATD) increases the risk of QTc prolongation, while C-reactive protein (CRP) can be used as an inflammatory marker of Mycobacterium tuberculosis infection. Objective: correlation of CRP on the QTc interval in Rifampicin-resistant tuberculosis (RR-TB) patients with the short regimen. Methods An observational study was conducted in Rifampicin-resistant tuberculosis (RR-TB) patients from 2 groups, patients on intensive phase and patients on continuation phase. CRP levels were measured from blood samples and measured automatically using the immunoturbidimetric assay. QTc interval was calculated using electrocardiography. Levels of CRP levels and QTc interval between the 2 groups were analyzed. The statistical analysis used includes the independent t-test, Mann Whitney test, and Rank Spearman test with p = 0.05. Results Forty-five eligible RR-TB patients were included in this study. CRP levels and QTc intervals between 2 groups (intensive and continuation phase) showed significant difference with p < 0.001 but found no significant correlation of CRP levels and QTc interval in both intensive and continuation phase with p = 0.226 and 0.805, respectively. A higher level of CRP strongly indicated the inflammation caused by RR-TB infection at the early phase of the disease, but not correlated with QTc interval in RR-TB patients. Conclusion Levels of CRP and QTc interval do not correlate in RR-TB patients and can not be used to be the marker of QTc prolongation in RR-TB Patients. CRP levels are markers used for diagnosis and monitoring in RR-TB patients. Decrease CRP levels in RR-TB patients are don't a marker of QTc prolongation. The significant between intensive and continuation phase of CRP and QTc interval in RR-TB patients.
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Affiliation(s)
- Tutik Kusmiati
- Doctoral Program of Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.,Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Ni Made Mertaniasih
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Johanes Nugroho Eko Putranto
- Department of Vascular and Cardiology Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Budi Suprapti
- Faculty of Pharmacy, Universitas Airlangga - Universitas Airlangga Teaching Hospital, Surabaya, Indonesia
| | - Soedarsono
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Nadya Luthfah
- Department of Vascular and Cardiology Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Winariani Koesoemoprodjo
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
| | - Aryani Prawita Sari
- Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, Indonesia
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12
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Mantri N, Lu M, Zaroff JG, Risch N, Hoffmann T, Oni-Orisan A, Lee C, Jorgenson E, Iribarren C. QT Interval Dynamics and Cardiovascular Outcomes: A Cohort Study in an Integrated Health Care Delivery System. J Am Heart Assoc 2021; 10:e018513. [PMID: 34581201 PMCID: PMC8649135 DOI: 10.1161/jaha.120.018513] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Long QT has been associated with ventricular dysrhythmias, cardiovascular disease (CVD) mortality, and sudden cardiac death. However, no studies to date have investigated the dynamics of within‐person QT change over time in relation to risk of incident CVD and all‐cause mortality in a real‐world setting. Methods and Results A cohort study among members of an integrated health care delivery system in Northern California including 61 455 people (mean age, 62 years; 60% women, 42% non‐White) with 3 or more ECGs (baseline in 2005–2009; mean±SD follow‐up time, 7.6±2.6 years). In fully adjusted models, tertile 3 versus tertile 1 of average QT corrected (using the Fridericia correction) was associated with cardiac arrest (hazard ratio [HR], 1.66), heart failure (HR, 1.62), ventricular dysrhythmias (HR, 1.56), all CVD (HR, 1.31), ischemic heart disease (HR, 1.28), total stroke (HR, 1.18), and all‐cause mortality (HR, 1.24). Tertile 3 versus tertile 2 of the QT corrected linear slope was associated with cardiac arrest (HR, 1.22), ventricular dysrhythmias (HR, 1.12), and all‐cause mortality (HR, 1.09). Tertile 3 versus tertile 1 of the QT corrected root mean squared error was associated with ventricular dysrhythmias (HR, 1.34), heart failure (HR, 1.28), all‐cause mortality (HR, 1.20), all CVD (HR, 1.14), total stroke (HR, 1.08), and ischemic heart disease (HR, 1.07). Conclusions Our results demonstrate improved predictive ability for CVD outcomes using longitudinal information from serial ECGs. Long‐term average QT corrected was more strongly associated with CVD outcomes than the linear slope or the root mean squared error. This new evidence is clinically relevant because ECGs are frequently used, noninvasive, and inexpensive.
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Affiliation(s)
- Neha Mantri
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Meng Lu
- Division of Research Kaiser Permanente Oakland CA
| | - Jonathan G Zaroff
- Department of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA
| | - Neil Risch
- Institute for Human Genetics University of California, San Francisco CA
| | - Thomas Hoffmann
- Institute for Human Genetics University of California, San Francisco CA
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13
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Schiavone M, Gasperetti A, Gherbesi E, Bergamaschi L, Arosio R, Mitacchione G, Viecca M, Forleo GB. Arrhythmogenic Risk and Mechanisms of QT-Prolonging Drugs to Treat COVID-19. Card Electrophysiol Clin 2021; 14:95-104. [PMID: 35221089 PMCID: PMC8556572 DOI: 10.1016/j.ccep.2021.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Marco Schiavone
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy.
| | - Alessio Gasperetti
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy; Division of Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - Elisa Gherbesi
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Roberto Arosio
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
| | | | - Maurizio Viecca
- Cardiology Unit, Luigi Sacco University Hospital, Milan, Italy
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14
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Yalta K, Yetkin E, Yalta T. Systemic inflammation in patients with Takotsubo syndrome: a review of mechanistic and clinical implications. Monaldi Arch Chest Dis 2021; 91. [PMID: 33728882 DOI: 10.4081/monaldi.2021.1718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
Over recent decades, systemic inflammation as quantified with inflammation markers or indices has been extensively investigated in the setting of various cardiovascular conditions including heart failure (HF), acute coronary syndromes (ACS). In contrast, systemic inflammation in patients with takotsubo syndrome (TTS) has been an underrated phenomenon in clinical practice. On the other hand, experimental and clinical data have been rapidly accumulating in the recent years regarding pathogenetic, prognostic as well as therapeutic implications of systemic inflammation in TTS. Accordingly, the present article aims to provide a general perspective on mechanistic and clinical aspects of systemic inflammation in the setting of TTS.
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Affiliation(s)
- Kenan Yalta
- CardiologyDepartment, Trakya University, Edirne.
| | - Ertan Yetkin
- Cardiology Department, Derindere Hospital, Istanbul.
| | - Tulin Yalta
- Pathology Department, Trakya University, Edirne.
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15
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Ingegnoli F, Buoli M, Antonucci F, Coletto LA, Esposito CM, Caporali R. The Link Between Autonomic Nervous System and Rheumatoid Arthritis: From Bench to Bedside. Front Med (Lausanne) 2020; 7:589079. [PMID: 33365319 PMCID: PMC7750536 DOI: 10.3389/fmed.2020.589079] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/30/2020] [Indexed: 12/25/2022] Open
Abstract
Neuronal stimulation is an emerging field of research focused on the management and treatment of various diseases through the reestablishment of physiological homeostasis. Electrical vagus nerve stimulation has recently been proposed as a revolutionary therapeutic option for rheumatoid arthritis (RA) in combination with or even as a replacement for conventional and biological drugs. In the past few years, disruption of the autonomic system has been linked to RA onset and activity. Novel research on the link between the autonomic nervous system and the immune system (immune-autonomics) has paved the way for the development of innovative RA management strategies. Clinical evidence supports this approach. Cardiovascular involvement, in terms of reduced baroreflex sensitivity and heart rate variability-derived indices, and mood disorders, common comorbidities in patients with RA, have been linked to autonomic nervous system dysfunction, which in turn is influenced by increased levels of circulating pro-inflammatory cytokines. This narrative review provides an overview of the autonomic nervous system and RA connection, discussing most of the common cardiac and mental health-related RA comorbidities and their potential relationships to systemic and joint inflammation.
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Affiliation(s)
- Francesca Ingegnoli
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Flavia Antonucci
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), Università degli Studi di Milano, Milan, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, Gaetano Pini Hospital, Milan, Italy.,Department of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
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16
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Bogh SB, Kellett J, Ekelund U, Brabrand M. Relation of QRS Voltage and Prolonged QTc Interval to One-Year Mortality. Am J Cardiol 2020; 134:138-142. [PMID: 32892990 DOI: 10.1016/j.amjcard.2020.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/07/2020] [Accepted: 08/07/2020] [Indexed: 12/26/2022]
Abstract
The association between QRS voltage and QTc interval prolongation with mortality for up to 1 year after recording an ECG on patients attending emergency departments (EDs) was examined in a retrospective register-based observational study on 37,473 patients attending 2 Danish EDs. Of 37,473 patients who had an ECG performed on their first ED presentation 2,164 (5.8%) died within 30 days of presentation and 6,395 (17.1%) died within a year. Compared with survivors, patients who died had significantly longer QRS intervals and lower QRS voltages. A combined lead I and II QRS voltage <=1.4 mV was consistently associated with approximately twice the risk of mortality for up to at least 1 year after the ECG recording and this risk was not influenced by the length of the QTc interval. The increased mortality risk of a low QRS voltage remained even after adjustment for age, gender, Charlson co-morbidity index, and abnormal sodium and urea levels. In conclusion, low QRS voltage is a simple measurement that could potentially be used as an objective prognostic marker.
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Affiliation(s)
- Søren Bie Bogh
- Odense Patient data Explorative Network, University of Southern Denmark and Odense University Hospital, Odense, Denmark
| | - John Kellett
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark.
| | - Ulf Ekelund
- Department of Emergency and Internal Medicine, Skåne University Hospital at Lund, Lund, Sweden
| | - Mikkel Brabrand
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark; Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
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17
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Patel KHK, Jones TN, Sattler S, Mason JC, Ng FS. Proarrhythmic electrophysiological and structural remodeling in rheumatoid arthritis. Am J Physiol Heart Circ Physiol 2020; 319:H1008-H1020. [PMID: 32946265 DOI: 10.1152/ajpheart.00401.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Chronic inflammatory disorders, including rheumatoid arthritis (RA), are associated with a twofold increase in the incidence of sudden cardiac death (SCD) compared with the healthy population. Although this is partly explained by an increased prevalence of coronary artery disease, growing evidence suggests that ischemia alone cannot completely account for the increased risk. The present review explores the mechanisms of cardiac electrophysiological remodeling in response to chronic inflammation in RA. In particular, it focuses on the roles of nonischemic structural remodeling, altered cardiac ionic currents, and autonomic nervous system dysfunction in ventricular arrhythmogenesis and SCD. It also explores whether common genetic elements predispose to both RA and SCD. Finally, it evaluates the potential dual effects of disease-modifying therapy in both diminishing and promoting the risk of ventricular arrhythmias and SCD.
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Affiliation(s)
| | | | - Susanne Sattler
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Justin C Mason
- National Heart and Lung Institute, Imperial College London, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, United Kingdom
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18
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Farré N, Mojón D, Llagostera M, Belarte-Tornero LC, Calvo-Fernández A, Vallés E, Negrete A, García-Guimaraes M, Bartolomé Y, Fernández C, García-Duran AB, Marrugat J, Vaquerizo B. Prolonged QT Interval in SARS-CoV-2 Infection: Prevalence and Prognosis. J Clin Med 2020; 9:E2712. [PMID: 32839385 PMCID: PMC7563186 DOI: 10.3390/jcm9092712] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The prognostic value of a prolonged QT interval in SARS-Cov2 infection is not well known. OBJECTIVE To determine whether the presence of a prolonged QT on admission is an independent factor for mortality in SARS-Cov2 hospitalized patients. METHODS Single-center cohort of 623 consecutive patients with positive polymerase-chain-reaction test (PCR) to SARS Cov2, recruited from 27 February to 7 April 2020. An electrocardiogram was taken on these patients within the first 48 h after diagnosis and before the administration of any medication with a known effect on QT interval. A prolonged QT interval was defined as a corrected QT (QTc) interval >480 milliseconds. Patients were followed up with until 10 May 2020. RESULTS Sixty-one patients (9.8%) had prolonged QTc and only 3.2% had a baseline QTc > 500 milliseconds. Patients with prolonged QTc were older, had more comorbidities, and higher levels of immune-inflammatory markers. There were no episodes of ventricular tachycardia or ventricular fibrillation during hospitalization. All-cause death was higher in patients with prolonged QTc (41.0% vs. 8.7%, p < 0.001, multivariable HR 2.68 (1.58-4.55), p < 0.001). CONCLUSIONS Almost 10% of patients with COVID-19 infection have a prolonged QTc interval on admission. A prolonged QTc was independently associated with a higher mortality even after adjustment for age, comorbidities, and treatment with hydroxychloroquine and azithromycin. An electrocardiogram should be included on admission to identify high-risk SARS-CoV-2 patients.
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Affiliation(s)
- Núria Farré
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
- Department of Medicine, School of Medicine, Univ Autonoma de Barcelona, 08003 Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Diana Mojón
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Marc Llagostera
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Laia C. Belarte-Tornero
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
- Department of Medicine, School of Medicine, Univ Autonoma de Barcelona, 08003 Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Alicia Calvo-Fernández
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
- Department of Medicine, School of Medicine, Univ Autonoma de Barcelona, 08003 Barcelona, Spain
| | - Ermengol Vallés
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
- Department of Medicine, School of Medicine, Univ Autonoma de Barcelona, 08003 Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
| | - Alejandro Negrete
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Marcos García-Guimaraes
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Yolanda Bartolomé
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Camino Fernández
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Ana B. García-Duran
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
| | - Jaume Marrugat
- REGICOR (Registre Gironí del Cor) Study Group, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
- CIBER (Centro de Investigación Biomédica en Red) of Cardiovascular Diseases (CIBERCV), Instituto de Salud Carlos III (ISCIII), 08003 Barcelona, Spain
| | - Beatriz Vaquerizo
- Department of Cardiology, Hospital del Mar, 08003 Barcelona, Spain; (D.M.); (M.L.); (L.C.B.-T.); (A.C.-F.); (E.V.); (A.N.); (M.G.-G.); (Y.B.); (C.F.); (A.B.G.-D.); (B.V.)
- Department of Medicine, School of Medicine, Univ Autonoma de Barcelona, 08003 Barcelona, Spain
- Heart Diseases Biomedical Research Group (GREC), IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain
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19
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Sciaccaluga C, Cameli M, Menci D, Mandoli GE, Sisti N, Cameli P, Franchi F, Mondillo S, Valente S. COVID-19 and the burning issue of drug interaction: never forget the ECG. Postgrad Med J 2020; 97:180-184. [PMID: 32820084 DOI: 10.1136/postgradmedj-2020-138093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023]
Abstract
The coronavirus disease of 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), has been rapidly escalating, becoming a relevant threat to global health. Being a recent virus outbreak, there are still no available therapeutic regimens that have been approved in large randomised trials and so patients are currently being treated with multiple drugs. This raises concerns regarding drug interaction and their implication in arrhythmic burden. In fact, two of the actually used drugs against SARS-CoV2, such as chloroquine and the combination lopinavir/ritonavir, might determine a QT (the time from the start of the Q wave to the end of the T wave) interval prolongation and they show several interactions with antiarrhythmic drugs and antipsychotic medications, making them prone to an increased risk of developing arrhythmias. This brief review focuses the attention on the most relevant drug interactions involving the currently used COVID-19 medications and their possible association with cardiac rhythm disorders, taking into account also pre-existing condition and precipitating factors that might additionally increase this risk. Furthermore, based on the available evidence and based on the knowledge of drug interaction, we propose a quick and simple algorithm that might help both cardiologists and non-cardiologists in the management of the arrhythmic risk before and during the treatment with the specific drugs used against SARS-CoV2.
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Affiliation(s)
- Carlotta Sciaccaluga
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Daniele Menci
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Paolo Cameli
- Respiratory Diseases and Lung Transplantation, Department of Medicine, Surgery and Neurosciences, Siena University Hospital, Siena, Italy
| | - Federico Franchi
- Department of Medicine, Surgery and Neuroscience, Anesthesia and Intensive Care Unit, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Section of Cardiology, University of Siena, Siena, Italy
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20
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Morin DP, Chong-Yik R, Thihalolipavan S, Krauthammer YS, Bernard ML, Khatib S, Polin GM, Rogers PA. Utility of serial measurement of biomarkers of cardiovascular stress and inflammation in systolic dysfunction. Europace 2020; 22:1044-1053. [PMID: 32357207 DOI: 10.1093/europace/euaa075] [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: 12/15/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Evidence links markers of systemic inflammation and heart failure (HF) with ventricular arrhythmias (VA) and/or death. Biomarker levels, and the risk they indicate, may vary over time. We evaluated the utility of serial laboratory measurements of inflammatory biomarkers and HF, using time-dependent analysis. METHODS AND RESULTS We prospectively enrolled ambulatory patients with left ventricular ejection fraction (LVEF) ≤35% and a primary-prevention implanted cardioverter-defibrillator (ICD). Levels of established inflammatory biomarkers [C-reactive protein, erythrocyte sedimentation rate (ESR), suppression of tumourigenicity 2 (ST2), tumour necrosis factor alpha (TNF-α)] and brain natriuretic peptide (BNP) were assessed at 3-month intervals for 1 year. We assessed relationships between biomarkers modelled as time-dependent variables, VA, and death. Among 196 patients (66±14 years, LVEF 23±8%), 33 experienced VA, and 18 died. Using only baseline values, BNP predicted VA, and both BNP and ST2 predicted death. Using serial measurements at 3-month intervals, time-varying BNP independently predicted VA, and time-varying ST2 independently predicted death. C-statistic analysis revealed no significant benefit to repeated testing compared with baseline-only measurement. C-reactive protein, ESR, and TNF-α, either at baseline or over time, did not predict either endpoint. CONCLUSION In stable ambulatory patients with systolic cardiomyopathy and an ICD, BNP predicts ventricular tachyarrhythmia, and ST2 predicts death. Repeated laboratory measurements over a year's time do not improve risk stratification beyond baseline measurement alone. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01892462 (https://clinicaltrials.gov/ct2/show/NCT01892462).
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Affiliation(s)
- Daniel P Morin
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA.,Division of Electrophysiology, Department of Cardiology, Ochsner Clinical School, University of Queensland School of Medicine, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Ronald Chong-Yik
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Sudarone Thihalolipavan
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Yoaav S Krauthammer
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Michael L Bernard
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Sammy Khatib
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Glenn M Polin
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
| | - Paul A Rogers
- Division of Electrophysiology, Department of Cardiology, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70118, USA
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Toma L, Stanciu AM, Zgura A, Bacalbasa N, Diaconu C, Iliescu L. Electrocardiographic Changes in Liver Cirrhosis-Clues for Cirrhotic Cardiomyopathy. ACTA ACUST UNITED AC 2020; 56:medicina56020068. [PMID: 32050594 PMCID: PMC7073951 DOI: 10.3390/medicina56020068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/02/2020] [Accepted: 02/03/2020] [Indexed: 12/15/2022]
Abstract
Background and Objectives: Cirrhotic cardiomyopathy is a chronic cardiac dysfunction associated with liver cirrhosis, in patients without previous heart disease, irrespective of the etiology of cirrhosis. Electrocardiography (ECG) is an important way to evaluate patients with cirrhosis and may reveal significant changes associated with liver disease. Our study aimed to evaluate ECG changes in patients with diagnosed liver cirrhosis and compare them to patients with chronic hepatitis. Materials and Methods: We evaluated laboratory findings and ECG tracings in 63 patients with cirrhosis and 54 patients with chronic hepatitis of viral etiology. The end points of the study were prolonged QT interval, QRS hypovoltage and T-peak-to-T-end decrease. We confirmed the diagnosis of cirrhotic cardiomyopathy using echocardiography data. Results: Advanced liver disease was associated with prolonged QT intervals. Also, QRS amplitude was lower in patients with decompensated cirrhosis than in patients with compensated liver disease. We found an accentuated deceleration of the T wave in patients with cirrhosis. These findings correlated to serum levels of albumin, cholesterol and ammonia. Conclusions: ECG changes in liver cirrhosis are frequently encountered and are important noninvasive markers for the presence of cirrhotic cardiomyopathy.
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Affiliation(s)
- Letitia Toma
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Adriana Mercan Stanciu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
| | - Anca Zgura
- Chemotherapy Department, OncoFort Hospital, 022328 Bucharest, Romania;
| | - Nicolae Bacalbasa
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
| | - Camelia Diaconu
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 022328 Bucharest, Romania;
| | - Laura Iliescu
- Department of Internal Medicine II, Fundeni Clinical Institute, 022328 Bucharest, Romania; (L.T.); (A.M.S.)
- Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 022328 Bucharest, Romania;
- Correspondence: ; Tel.: +407-22-235-695
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Abstract
The term inflammatory joint disease (IJD) encompasses a group of chronic conditions with predominant joint involvement. They share an increased risk of cardiovascular (CV) complications. However, the implication of the sex in the risk of CV disease in IJD has not been specifically addressed. The aim of this work is to assess the influence of sex on the clinical expression of CV manifestations associated to IJD. With this objective, an update of the current knowledge of the sex influence on CV disease in patients with IJD was conducted. A PubMed database search of the most relevant literature on this topic was performed mainly based on studies published in English over the last 10 years. Although most studies on IJD were not specifically designed to address sex differences regarding CV complications, it seems that men with rheumatoid arthritis (RA) are at higher risk of pericarditis, ischemic heart disease, heart failure (HF) with reduced ejection fraction (EF), and CV mortality than women with RA. In contrast, HF with preserved EF and diastolic dysfunction is more frequent in women with RA. Men with ankylosing spondylitis present more frequently disorders of the conduction system and aortic valvulopathy than women. A limited number of studies addressed CV differences according to sex in psoriatic arthritis. Although there are some differences according to sex in the clinical expression of CV complications in patients with IJD, much research is still needed to better identify the implication of sex in the risk of CV disease in these patients.
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Neef M, Berndt K, Spies C, Laufs U, Metze M. [Cardiac arrhythmias in patients with chronic autoimmune diseases]. Herzschrittmacherther Elektrophysiol 2019; 30:240-244. [PMID: 31444570 DOI: 10.1007/s00399-019-00636-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
Chronic inflammation due to autoimmune diseases is associated with a higher rate of supraventricular and ventricular arrhythmias leading to an increased risk for cardiovascular morbidity and mortality. Involvement of the cardiac conduction system is common in patients with chronic autoimmune diseases, although the penetrance of clinical signs and symptoms is variable and complete heart block with need for therapy is rare. The combination of the increased prevalence of structural cardiovascular disease and the direct impact of inflammatory mechanisms on cardiac electrophysiology seems to be responsible for the higher rate of tachyarrhythmias. In particular, fibroblast activation, gap junction impairment via changes in connexin composition and abnormalities in intracellular calcium-handling are mentioned. Electrocardiographic markers of an increased arrhythmogenic potential in patients with chronic autoimmune disorders may include prolonged P‑wave duration as well as abnormal QTc interval and reduced heart rate variability. Thus, minimizing the inflammatory burden through tight control of disease activity may help reduce the arrhythmic load.
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Affiliation(s)
- Martin Neef
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Katharina Berndt
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Christian Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
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Alarcon MML, Trentin-Sonoda M, Panico K, Schleier Y, Duque T, Moreno-Loaiza O, de Yurre AR, Ferreira F, Caio-Silva W, Coury PR, Paiva CN, Medei E, Carneiro-Ramos MS. Cardiac arrhythmias after renal I/R depend on IL-1β. J Mol Cell Cardiol 2019; 131:101-111. [PMID: 31029578 DOI: 10.1016/j.yjmcc.2019.04.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 01/10/2023]
Abstract
AIMS Cardiac arrhythmias are one of the most important remote complications after kidney injury. Renal ischemia reperfusion (I/R) is a major cause of acute renal injury predisposing to several remote dysfunctions, including cardiac electrical disturbance. Since IL-1β production dependent on NLRP3 represents a link between tissue malfunctioning and cardiac arrhythmias, here we tested the hypothesis that longer ventricular repolarization and arrhythmias after renal I/R depend on this innate immunity sensor. METHODS AND RESULTS Nlrp3-/- and Casp1-/- mice reacted to renal I/R with no increase in plasma IL-1β, different from WT (wild-type) I/R. A prolonged QJ interval and an increased susceptibility to ventricular arrhythmias were found after I/R compared to Sham controls in wild-type mice at 15 days post-perfusion, but not in Nlrp3-/- or CASP1-/- I/R, indicating that the absence of NLRP3 or CASP1 totally prevented longer QJ interval after renal I/R. In contrast with WT mice, we found no renal atrophy and no renal dysfunction in Nlrp3-/- and Casp1-/- mice after renal I/R. Depletion of macrophages in vivo after I/R and a day before IL-1β peak (at 7 days post-perfusion) totally prevented prolongation of QJ interval, suggesting that macrophages might participate as sensors of tissue injury. Moreover, treatment of I/R-WT mice with IL-1r antagonist (IL-1ra) from 8 to 15 days post perfusion did not interfere with renal function, but reversed QJ prolongation, prevented the increase in susceptibility to ventricular arrhythmias and rescued a close to normal duration and amplitude of calcium transient. CONCLUSION Taken together, these results corroborate the hypothesis that IL-1β is produced after sensing renal injury through NRLP3-CASP1, and IL-1β on its turn triggers longer ventricular repolarization and increase susceptibility to cardiac arrhythmias. Still, they offer a therapeutic approach to treat cardiac arrhythmias that arise after renal I/R.
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Affiliation(s)
| | - Mayra Trentin-Sonoda
- Center of Natural and Human Sciences (CCNH), Universidade Federal do ABC, Santo André, SP, Brazil
| | - Karine Panico
- Center of Natural and Human Sciences (CCNH), Universidade Federal do ABC, Santo André, SP, Brazil
| | - Ygor Schleier
- Laboratory of Cardioimmunology, Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Thabata Duque
- Laboratory of Cardioimmunology, Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Oscar Moreno-Loaiza
- Laboratory of Cardioimmunology, Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Ainhoa Rodriguez de Yurre
- Laboratory of Cardioimmunology, Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Fabianno Ferreira
- Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Wellington Caio-Silva
- Center of Natural and Human Sciences (CCNH), Universidade Federal do ABC, Santo André, SP, Brazil
| | - Pedrosa Roberto Coury
- Clementino Fraga Filho Hospital - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia N Paiva
- Institute of Microbiology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Emiliano Medei
- Laboratory of Cardioimmunology, Federal University of Rio de Janeiro, Institute of Biophysics Carlos Chagas Filho, Rio de Janeiro, Brazil; National Center for Structural Biology and Bioimaging - CENABIO/UFRJ, Rio de Janeiro, Brazil.
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Huang X, Li Z, Hu J, Yang Z, Liu Z, Zhang T, Zhang C, Yuan B. Knockout of Wdr1 results in cardiac hypertrophy and impaired cardiac function in adult mouse heart. Gene 2019; 697:40-47. [PMID: 30794912 DOI: 10.1016/j.gene.2019.02.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 01/23/2019] [Accepted: 02/01/2019] [Indexed: 12/12/2022]
Abstract
WDR1 is a major cofactor of the actin depolymerizing factor (ADF)/cofilin, accelerating ADF/cofilin-mediated actin disassembly. We had previously showed that WDR1-mediated actin dynamics is required for postnatal myocardial growth and adult myocardial maintenance in mice, in which the detailed phenotypes of adult cardiomyocyte-specific Wdr1 deletion mice had not been analyzed. In this study, we systematically analyzed the role of Wdr1 in adult mouse heart. Adult cardiomyocyte-specific Wdr1 deletion mice (cKO) exhibited cardiac hypertrophy and myocardial fibrosis. Echocardiographic study and electrocardiography revealed impaired contractile function, prolonged QT interval and Tpeak-Tend interval, and abnormal T-wave amplitude in cKO mice. Increased levels of sarcomeric proteins, adherens junction proteins and cofilin, and severe actin filament (F-actin) accumulations were observed in cKO mice heart. Taken together, this finding demonstrates that WDR1 is a critical factor for normal structure and function of adult mouse heart.
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Affiliation(s)
- Xia Huang
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China
| | - Ziyi Li
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China
| | - Jisheng Hu
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China
| | - Zihao Yang
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China
| | - Zhongying Liu
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China
| | - Tongcun Zhang
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China.
| | - Chenxi Zhang
- Central Laboratory, Affiliated Nanjing Brain Hospital, Nanjing Medical University, Nanjing, Jiangsu Province 210029, PR China.
| | - Baiyin Yuan
- Biomedical Research Institute, College of Life Science and Health, Wuhan University of Science and Technology, Wuhan, Hubei Province 430081, PR China.
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Aromolaran AS, Srivastava U, Alí A, Chahine M, Lazaro D, El-Sherif N, Capecchi PL, Laghi-Pasini F, Lazzerini PE, Boutjdir M. Interleukin-6 inhibition of hERG underlies risk for acquired long QT in cardiac and systemic inflammation. PLoS One 2018; 13:e0208321. [PMID: 30521586 PMCID: PMC6283635 DOI: 10.1371/journal.pone.0208321] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
Increased proinflammatory interleukin-6 (IL-6) levels are associated with acquired long QT-syndrome (LQTS) in patients with systemic inflammation, leading to higher risks for life-threatening polymorphic ventricular tachycardia such as Torsades de Pointes. However, the functional and molecular mechanisms of this association are not known. In most cases of acquired LQTS, the target ion channel is the human ether-á-go-go-related gene (hERG) encoding the rapid component of the delayed rectifier K current, IKr, which plays a critical role in cardiac repolarization. Here, we tested the hypothesis that IL-6 may cause QT prolongation by suppressing IKr. Electrophysiological and biochemical assays were used to assess the impact of IL-6 on the functional expression of IKr in HEK293 cells and adult guinea-pig ventricular myocytes (AGPVM). In HEK293 cells, IL-6 alone or in combination with the soluble IL-6 receptor (IL-6R), produced a significant depression of IKr peak and tail current densities. Block of IL-6R or Janus kinase (JAK) reversed the inhibitory effects of IL-6 on IKr. In AGPVM, IL-6 prolonged action potential duration (APD) which was further prolonged in the presence of IL-6R. Similar to heterologous cells, IL-6 reduced endogenous guinea pig ERG channel mRNA and protein expression. The data are first to demonstrate that IL-6 inhibition of IKr and the resulting prolongation of APD is mediated via IL-6R and JAK pathway activation and forms the basis for the observed clinical QT interval prolongation. These novel findings may guide the development of targeted anti-arrhythmic therapeutic interventions in patients with LQTS and inflammatory disorders.
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Affiliation(s)
- Ademuyiwa S. Aromolaran
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
- Department of Cell Biology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
| | - Ujala Srivastava
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
- Department of Cell Biology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
| | - Alessandra Alí
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Mohamed Chahine
- Centre de Recherche, Institut Universitaire en Santé Mentale de Québec, Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Deana Lazaro
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
| | - Nabil El-Sherif
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Mohamed Boutjdir
- Cardiovascular Research Program, VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
- Department of Cell Biology and Pharmacology, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
- Departments of Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America
- Department of Medicine, New York University School of Medicine, New York, United States of America
- * E-mail:
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ADLAN AHMEDM. Inflammation and Heart Rate–corrected QT Interval: Evidence for a Potentially Reversible Cause of Sudden Death in Patients with Rheumatoid Arthritis? J Rheumatol 2018; 45:1609-1610. [DOI: 10.3899/jrheum.180921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kobayashi H, Kobayashi Y, Yokoe I, Kitamura N, Nishiwaki A, Takei M, Giles JT. Heart Rate–corrected QT Interval Duration in Rheumatoid Arthritis and Its Reduction with Treatment with the Interleukin 6 Inhibitor Tocilizumab. J Rheumatol 2018; 45:1620-1627. [DOI: 10.3899/jrheum.180065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2018] [Indexed: 01/08/2023]
Abstract
Objective.Individuals with rheumatoid arthritis (RA) are at a heightened risk of sudden cardiac death, an outcome increased in those with prolongation of the corrected electrocardiographic QT interval (QTc). We compared QTc between patients with RA and demographically matched controls and studied the change in QTc after treatment with the interleukin 6 inhibitor tocilizumab (TCZ).Methods.Standard 12-lead electrocardiograms were obtained and QTc was measured in patients with RA at baseline and after 24 weeks of TCZ treatment, then compared with non-RA controls who were frequency-matched on age and sex. Indicators of the baseline QTc and predictors of change in QTc were studied using multivariable linear regression.Results.A total of 94 RA and 42 non-RA controls were studied. The average baseline QTc was 10 ms longer in the RA group vs controls (422 vs 412 ms, respectively; p < 0.001) and decreased to an average of 406 ms with treatment (p < 0.001). Baseline QTc was significantly and independently higher among those with anticyclic citrullinated peptide antibodies seropositivity, higher swollen joint counts, and higher levels of C-reactive protein (CRP) and matrix metalloproteinase 3. Each log unit decrease in CRP with treatment was associated with an average reduction in QTc of 2.9 ms (p = 0.002) after adjusting for age and baseline QTc. Clinical response measures were not associated with the change in QTc.Conclusion.The marked normalization of QTc observed with TCZ treatment, and its close parallel with CRP reduction, support the premise that systemic inflammation contributes to cardiac repolarization abnormalities in RA that may be amenable to treatment.
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Schade Hansen C, Pottegård A, Ekelund U, Kildegaard Jensen H, Lundager Forberg J, Brabrand M, Lassen AT. Association between QTc prolongation and mortality in patients with suspected poisoning in the emergency department: a transnational propensity score matched cohort study. BMJ Open 2018; 8:e020036. [PMID: 29982199 PMCID: PMC6042584 DOI: 10.1136/bmjopen-2017-020036] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Poisoning is a frequent cause of admission to the emergency department (ED) and may involve drugs known to prolong the QT interval. This study aims to describe the prevalence of QTc prolongation among ED patients with suspected poisoning and to calculate the absolute and relative risk of mortality or cardiac arrest associated with a prolonged QTc interval. METHODS We performed a register-based cohort study, including all adult first-time contacts with suspected poisoning to the ED of two Swedish hospitals (January 2010-December 2014) and two Danish hospitals (March 2013-April 2014). We used propensity score matching to calculate HRs for all-cause mortality or cardiac arrest (combined endpoint) within 30 days after contact comparing patients with a prolonged QTc interval (≥450 ms men, ≥460 ms women) with patients with a QTc interval of <440 ms. RESULTS Among all first-time contacts with suspected poisoning that had an ECG recorded within 4 hours after arrival (n=3869), QTc prolongation occurred in 6.5%. The overall mortality after a 30-day follow-up period was 0.8% (95% CI 0.6 to 1.2), with an absolute risk of mortality or cardiac arrest in patients with QTc prolongation of 3.2% (95% CI 1.4 to 6.1). A prolonged QTc interval on arrival was associated with a HR of 3.6 (95% CI 1.0 to 12.2). CONCLUSION In the ED, a prolonged QTc interval in patients arriving with suspected poisoning seems to be associated with a threefold increased risk of 30-day all-cause mortality or cardiac arrest.
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Affiliation(s)
| | - Anton Pottegård
- Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ulf Ekelund
- Department of Emergency Medicine, Skåne University Hospital, Lund, Sweden
| | | | | | - Mikkel Brabrand
- Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
- Department of Emergency Medicine, Hospital of South West Jutland, Esbjerg, Denmark
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Cerşit S, Cerşit HP. Impact of cardiac rehabilitation on ventricular repolarization indexes in patients with rheumatid arthritis. J Electrocardiol 2018; 51:787-791. [PMID: 30177313 DOI: 10.1016/j.jelectrocard.2018.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/03/2018] [Accepted: 06/16/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Abnormalities in ventricular repolarization (VR) parameters have been associated with sudden cardiac death (SCD) in patients with rheumatoid arthritis (RA). The benefits of cardiac rehabilitation (CR) in patients with RA are well recognized. We aimed to assess its impact on VR indexes in patients with RA. METHODS This study included 45 patients with RA (36 female, age 58 ± 5.5 years) and 50 age- and sex-matched otherwise healthy controls. Baseline electrocardiogram (ECG) recordings were used to compare VR parameters such as maximum and minimum QT intervals, and corrected, and dispersion (QTmax, QTmin, cQTmax, cQTmin, QTd, cQTd, respectively), JT and cJT intervals, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios in patients with RA and healthy individuals. The effects of 6-week CR in patients with RA were also evaluated by comparing pre- and post-CR ECGs, exercise tolerance test (MET and VO2max) and RA characteristics (C-reactive protein (CRP), Disease Activity Score 28 (DAS28) and Health Assessment Questionnaire(HAQ)). RESULTS In comparison with the healthy individuals, the patients with RA had significantly higher cQTmax and QTmin intervals, QTd, cQTd, Tp-e and cTp-e intervals, and Tp-e/QT and Tp-e/cQT ratios. At the end of CR, all VR indexes (p < 005), except QTd, were significantly decreased as did the results for CRP, DAS28, and HAQ (all p < 0.05), and MET and VO2max (p < 0.05 for both) were significantly increased in patients with RA. CONCLUSIONS CR may provide an improvement in the majority of VR indexes which are related with ventricular arrhythmia and SCD in patients with RA. Changes in ETT parameters and RA characteristics may contribute to improvement of several VR indexes such as cQTd, cJT and Tp-e intervals at the end of CR.
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Affiliation(s)
- Sinan Cerşit
- Koşuyolu Kartal Heart Training and Research Hospital, Department of Cardiology, İstanbul, Turkey.
| | - Hülya Peynirci Cerşit
- Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, İstanbul, Turkey
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Lazzerini PE, Laghi Pasini F, Acampa M, Capecchi PL. Inflammatory cytokines, life-threatening arrhythmias and premature mortality in chronic inflammatory arthritis: time to focus on. Ann Rheum Dis 2018; 78:e98. [DOI: 10.1136/annrheumdis-2018-213789] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 02/02/2023]
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Biskup M, Biskup W, Majdan M, Targońska-Stępniak B. Cardiovascular system changes in rheumatoid arthritis patients with continued low disease activity. Rheumatol Int 2018; 38:1207-1215. [PMID: 29774373 PMCID: PMC6006198 DOI: 10.1007/s00296-018-4053-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
Systemic inflammation and disease activity seem to contribute to excessive prevalence of cardiovascular (CV) diseases (CVDs) in patients with rheumatoid arthritis (RA). The objective of the study was to assess chosen CV parameters in RA patients who have continuous low disease activity. The study group consisted of 70 RA patients without known CVD and 33 healthy controls, of a comparable age. All RA patients had continued low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. The groups were assessed for: blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography (ECG), ejection fraction (EJ) and diastolic dysfunction (E/A ratio) in echocardiography. In RA patients in comparison with controls, significantly greater values of cIMT [0.83 (0.21) vs 0.62 (0.1) mm, p < 0.001] were found, as well as higher incidence of atherosclerotic plaques [43 (61.4%) vs 10 (30.3%), p = 0.003], prolonged QTc interval [439.6 (23.7) vs 414.0 (27.9) ms, p < 0.001]. High or very high Systemic Coronary Risk Evaluation (SCORE) was found in 32.9% of patients with RA and increased serum NT-proBNP in 71.4%. The mean values of CV parameters (cIMT, E/A, NT-proBNP, SCORE) were associated with age, disease duration, rheumatoid factor (RF-IgM), erythrocyte sedimentation rate (ESR). The results of our study indicate, that RA with continued low disease activity is associated with atherosclerosis and heart dysfunction. Strong relationships were found between CV parameters and patients' age, disease duration. Deterioration of CV parameters was associated with higher DAS28, ESR, RF-IgM concentration and bone erosions.
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Affiliation(s)
| | | | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J 2018; 38:1717-1727. [PMID: 27252448 DOI: 10.1093/eurheartj/ehw208] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic immuno-mediated disease primarily affecting the joints, characterized by persistent high-grade systemic inflammation. Cardiovascular morbidity and mortality are significantly increased in RA, with >50% of premature deaths attributable to cardiovascular disease. In particular, RA patients were twice as likely to experience sudden cardiac death compared with non-RA subjects, pointing to an increased propensity to develop malignant ventricular arrhythmias. Indeed, ventricular repolarization (QT interval) abnormalities and cardiovascular autonomic nervous system dysfunction, representing two well-recognized risk factors for life-threatening ventricular arrhythmias in the general population, are commonly observed in RA. Moreover, large population-based studies seem to indicate that also the prevalence of atrial fibrillation is significantly higher in RA subjects than in the general population, thus suggesting that these patients are characterized by an abnormal diffuse myocardial electrical instability. Although the underlying mechanisms accounting for the pro-arrhythmogenic substrate in RA are probably intricate, the leading role seems to be played by chronic systemic inflammatory activation, able to promote arrhythmias both indirectly, by accelerating the development of ischaemic heart disease and congestive heart failure, and directly, by affecting cardiac electrophysiology. In this integrated mechanistic view, lowering the inflammatory burden through an increasingly tight control of disease activity may represent the most effective intervention to reduce arrhythmic risk in these patients. Intriguingly, these considerations could be more generally applicable to all the diseases characterized by chronic systemic inflammation, and could help elucidate the link between low-grade chronic inflammation and arrhythmic risk in the general population.
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Cardiovascular involvement in systemic rheumatic diseases: An integrated view for the treating physicians. Autoimmun Rev 2018; 17:201-214. [DOI: 10.1016/j.autrev.2017.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 10/12/2017] [Indexed: 02/07/2023]
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Lazzerini PE, Capecchi PL, Galeazzi M, Laghi-Pasini F. Biologic drugs and arrhythmic risk in chronic inflammatory arthritis: the good and the bad. Immunol Res 2018; 65:262-275. [PMID: 27423435 DOI: 10.1007/s12026-016-8833-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Increasing evidence indicates that patients with chronic inflammatory arthritis (CIA), including rheumatoid arthritis and spondyloarthropathies, have an increased risk of arrhythmic events, significantly contributing to the higher cardiovascular disease (CVD) morbidity and mortality observed in these subjects compared to the general population. Although the mechanisms accounting for such an arrhythmogenic substrate are not fully understood, the main role is probably played by chronic systemic inflammation, able to accelerate the development of structural CVD, as well as to directly affect cardiac electrophysiology. In the past decade, biologic therapies have revolutionized the treatment of CIA by highly enhancing the probability to effectively control disease activity and its systemic consequences, including cardiovascular involvement. Accordingly, accumulating data demonstrated that by potently inhibiting systemic inflammation, biologic drugs can reduce CVD progression and ameliorate arrhythmic risk parameters, with a putative beneficial impact on arrhythmia incidence. Nevertheless, a significant number of reports from clinical trials and postmarketing experience suggest that some of these medications, particularly TNF inhibitor monoclonal antibodies and rituximab, may in some circumstances precipitate arrhythmia occurrence, probably by acutely amplifying myocardial electric instability intrinsically associated with these diseases. In this review, we analyze the intricate link between biologic drugs and arrhythmias in CIA in the effort to identify which factors are involved in the fine-tuning of antiarrhythmic/pro-arrhythmic balance, and understand how this knowledge should be translated in the clinical practice to obtain the most favorable benefit-to-risk profile when biologic drugs are used in these patients.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy.
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Mauro Galeazzi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
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A molecular pathway analysis informs the genetic risk for arrhythmias during antipsychotic treatment. Int Clin Psychopharmacol 2018; 33:1-14. [PMID: 29064910 DOI: 10.1097/yic.0000000000000198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Arrhythmias are a frequent and potentially fatal side effect of antipsychotic treatment. Strict ECG monitoring and clinical interviews are the standards used to prevent arrhythmias. A biologic predictive tool is missing. The identification of a genetic makeup at risk of antipsychotic-induced arrhythmias is the aim of the present investigation. The aim of this study was to identify a molecular pathway enriched in single nucleotide polymorphisms associated with antipsychotic-induced QTc modifications. In total, 661 schizophrenic individuals from the CATIE study, M=486 (73.52%), mean age=40.92±11.02, were included. QTc variation was measured as a phase-specific change-created variable. A nested mixed regression for a repeated-measures model served in R for the analysis of the clinical and treatment-related covariates and molecular pathway analysis. Plink was used for the genetic genome-wide analysis. Quality checking was the standard (genotype call rate>0.95; minor allele frequency>0.01; Hardy-Weinberg equilibrium<0.0001) and the inflation factor was controlled by λ values. Quetiapine and perphenazine were associated with QTc variation during phase 1. No other significant association was detected. No significant inflation was detected. A number of molecular pathways were associated with QT variation at a conservative (adjusted) P value less than 0.05, including pathways related to neuronal wiring and collagen biosynthesis, along with pathways related to K+ currents and cardiac contraction. Pathways related to neuronal wiring, collagen biosynthesis, and ion currents were identified as possibly involved in QTc modifications during antispsychotic treatment in SKZ patients.
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Masoud S, Lim PB, Kitas GD, Panoulas V. Sudden cardiac death in patients with rheumatoid arthritis. World J Cardiol 2017; 9:562-573. [PMID: 28824786 PMCID: PMC5545140 DOI: 10.4330/wjc.v9.i7.562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death (SCD), has been shown in patients with rheumatoid arthritis (RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.
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Li Z, Guo X, Sun G, Zheng L, Sun Y, Liu Y, Abraham MR. Plasma homocysteine levels associated with a corrected QT interval. BMC Cardiovasc Disord 2017; 17:182. [PMID: 28693429 PMCID: PMC5504627 DOI: 10.1186/s12872-017-0617-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 06/27/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Little is known about the relationship between homocysteine (Hcy) levels and the QT interval. We examined the association of different Hcy levels with corrected QT (QTc) intervals in a general population. METHODS Plasma levels of Hcy were assessed in a population-based study of 7002 participants 35 years of age and older from 2012 to 2013. Twelve-lead ECGs were performed on all participants and analyzed automatically. RESULTS The distribution of Hcy levels was determined for an entire population after the data were grouped into quartiles (Q1: <=11.1umol/L; Q2: 11.1-13.8umol/L; Q3: 13.8-18.2 umol/L; Q4 > 18.2 umol/L). The mean value of the QTc interval in each quartile was 433.2 ± 23.8 ms, 430.0 ± 24.6 ms, 429.2 ± 24.5 ms and 430.6 ± 25.7 ms. Multiple logistic regression analyses showed that, compared with the second quartile, and after fully adjusting for potential confounding factors, the odds for QTc > 440 ms in the first and fourth quartile increased (P < 0.05), (OR: 1.23, 95% CI: 1.05-1.43 for Q1; OR: 1.40, 95% CI: 1.19-1.65 for Q4). CONCLUSIONS QTc interval was associated with the Hcy level in this general population.
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Affiliation(s)
- Zhao Li
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Xiaofan Guo
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Guozhe Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Library, Shengjing Hospital of China Medical University, Shenyang, Liaoning People’s Republic of China
| | - Yingxian Sun
- Department of Cardiology, the First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001 People’s Republic of China
| | - Yamin Liu
- Department of Cardiology, Johns Hopkins University, Baltimore, MD USA
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Yalta T, Yalta K. Systemic Inflammation and Arrhythmogenesis: A Review of Mechanistic and Clinical Perspectives. Angiology 2017; 69:288-296. [DOI: 10.1177/0003319717709380] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the recent decades, systemic inflammation, as a clinical phenomenon, has been the focus of extensive research particularly with regard to its potential association with a variety of cardiovascular diseases including atherogenesis and acute coronary syndromes. Within this context, there also exists a potential link between systemic inflammation and cardiac arrhythmogenesis in various aspects. Accordingly, systemic inflammation response as measured with inflammation markers (cytokines, etc) has been investigated in the setting of well-known cardiac arrhythmias including atrial fibrillation and ventricular tachycardia. Based on current literature, clinical utility of these markers might potentially yield important prognostic implications in the setting of certain arrhythmogenic conditions. On the other hand, there exists limited data regarding therapeutic implications including clinical benefit of primary anti-inflammatory agents (corticosteroids, colchicine, etc) in the setting of arrhythmia management. The present review primarily aims to discuss potential triggers and fundamental mechanisms of inflammation-related arrhythmias along with a particular emphasis on clinical implications of systemic inflammation in the setting of cardiac arrhythmogenesis.
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Affiliation(s)
- Tulin Yalta
- Pathology Department, Trakya Üniversity, Edirne, Turkey
| | - Kenan Yalta
- Cardiology Department, Trakya Üniversity, Edirne, Turkey
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Turk SA, Heslinga SC, Dekker J, Britsemmer L, van der Lugt V, Lems WF, van Schaardenburg D, Nurmohamed MT. The Relationship Between Cardiac Conduction Times, Cardiovascular Risk Factors, and Inflammation in Patients with Early Arthritis. J Rheumatol 2017; 44:580-586. [DOI: 10.3899/jrheum.161184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2017] [Indexed: 02/07/2023]
Abstract
Objective.To investigate the prevalence of conduction disorders in patients with early arthritis and the relationship with inflammation and traditional cardiovascular (CV) risk factors.Methods.Patients with rheumatoid arthritis (RA) have a 2-fold higher risk of sudden cardiac death, possibly owing to conduction disorders. This increased risk might already be present at the clinical onset of arthritis. Therefore, we assessed electrocardiography, blood pressure, 28-joint Disease Activity Score (DAS28), lipid profile, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level in 480 patients with early arthritis at baseline and after 1 year.Results.The prevalence of conduction disorders was 12.5%. Conduction times at baseline were not associated with DAS28, ESR, or CRP levels and did not change during antirheumatic treatment. Baseline and the improvement in DAS28 (European League Against Rheumatism response), ESR, and CRP were significantly associated with heart rate, lipid profile, and blood pressure. Elevated total cholesterol and blood pressure were associated with an increased QRS time. The change in heart rate differed 7.3 bpm between patients with the least versus largest DAS improvement.Conclusion.The prevalence of conduction disorders in patients with early arthritis was 12.5%, which is similar to the general population and was not associated with changes in inflammation markers. However, a high cholesterol was associated with a prolonged QRS time. Therefore, the emphasis of CV risk management in arthritis should not be only on treatment of disease activity but also on traditional CV risk factors. The relationship between the improvement in disease activity and heart rate is remarkable because this could imply a 10-year CV mortality risk difference of 24%.
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Dimitroulas T, Hodson J, Panoulas VF, Sandoo A, Smith J, Kitas G. Genetic variations in the alanine-glyoxylate aminotransferase 2 (AGXT2) gene and dimethylarginines levels in rheumatoid arthritis. Amino Acids 2017; 49:1133-1141. [PMID: 28357606 DOI: 10.1007/s00726-017-2413-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 03/22/2017] [Indexed: 12/20/2022]
Abstract
Rheumatoid arthritis (RA) is associated with high rates of cardiovascular events mainly due to coronary and cerebrovascular atherosclerotic disease. Asymmetric (ADMA) and symmetric (SDMA) dimethylarginines are endogenous inhibitors of nitric oxide synthase and have been repeatedly linked with adverse cardiovascular outcomes in the general population and various disease settings. Alanine-glyoxylate aminotransferase 2 (AGTX2) is considered an alternative metabolic pathway contributing to the clearance of dimethylarginines in humans. The aim of the current study was to investigate the effect of specific AGXT-2 gene polymorphisms on circulating levels of ADMA or SDMA in patients with RA. Serum ADMA and SDMA levels were measured in 201 individuals with RA [median age: 67 years (IQR: 59-73), 155 females]. Two single nucleotide polymorphisms (SNPs) in the AGXT-2 gene-rs37369 and rs28305-were genotyped. Distributions of SDMA and ADMA were skewed, hence comparisons across the gene polymorphisms were performed using Kruskal-Wallis tests, and summarized using medians and interquartile ranges. Univariable analysis did not demonstrate a significant difference in the levels of SDMA or ADMA amongst the different genotypic groups of either rs37369AGXT2 (p = 0.800, 0.977) or rs28305AGXT2 (p = 0.463, 0.634). In multivariable analyses, ADMA levels were found to be significantly associated with erythrocyte sedimentation rate and estimated glomerular filtration rate, whilst SDMA levels were significantly associated with estimated glomerular filtration rate and quantitative insulin sensitivity check index. After adjustments for these factors, the relationship between the AGXT2 gene variants and both ADMA and SDMA remained non-significant. Our study in a well-characterized RA population did not show an association between serum concentrations of dimethylarginines and genetic variants of the AGXT2 gene.
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Affiliation(s)
- Theodoros Dimitroulas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK. .,4th Department of Internal Medicine, School of Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
| | - James Hodson
- Institute of Translational Medicine, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2WB, UK
| | - Vasileios F Panoulas
- Cardiovascular Sciences, Imperial College London, National Heart and Lung Institute, London, UK
| | - Aamer Sandoo
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK.,School of Sport, Health and Exercise Sciences, Bangor University, George Building, Bangor, Gwynedd, LL57 2PZ, Wales, UK
| | - Jacqueline Smith
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, UK
| | - George Kitas
- Arthritis Research UK Epidemiology Unit, University of Manchester, Oxford Road, Manchester, UK
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Geraldino-Pardilla L, Gartshteyn Y, Piña P, Cerrone M, Giles JT, Zartoshti A, Bathon JM, Askanase AD. ECG non-specific ST-T and QTc abnormalities in patients with systemic lupus erythematosus compared with rheumatoid arthritis. Lupus Sci Med 2016; 3:e000168. [PMID: 28079193 PMCID: PMC5174789 DOI: 10.1136/lupus-2016-000168] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 10/29/2016] [Accepted: 09/03/2016] [Indexed: 12/29/2022]
Abstract
Objectives Cardiovascular disease (CVD) is a leading cause of death in systemic lupus erythematosus (SLE) and in rheumatoid arthritis (RA). Although only explored in one study, ECG non-specific ST-T abnormalities, in addition to corrected QT-interval (QTc) prolongation, were recently reported in an SLE inception cohort. Importantly, these ECG abnormalities are known predictors of CVD mortality in the general population, yet their prevalence in patients with established SLE has not been evaluated. Methods We cross-sectionally investigated the presence of non-specific ST-T and QTc abnormalities in 50 patients with SLE, predominantly Hispanic and black, without CVD or SLE-related cardiac involvement and compared them with 139 patients with RA without CVD. Demographics, disease-specific characteristics and CVD risk factors were ascertained and adjusted for. Results Patients with SLE (mean age 36±13 years, 92% women, 6 years median disease duration, 96% Hispanics and blacks) had a 3.3-fold higher adjusted prevalence of non-specific ST-T abnormalities (56% vs 17%; p <0.0001) compared with RA, despite the older age and higher percentage of men in the RA group. The QTc was 26 ms longer in SLE compared with RA (p=0.002) in the setting of a higher percentage of women, blacks, Hispanics and higher C reactive protein levels in the SLE group. Conclusions This study demonstrates a high prevalence of ECG abnormalities in predominantly Hispanic and black patients with SLE. Longitudinal evaluation of the progression to potentially life-threatening arrhythmias and/or cardiovascular events is warranted.
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Affiliation(s)
| | - Yevgeniya Gartshteyn
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Paloma Piña
- Northwestern University , Chicago, Illinois , USA
| | - Marina Cerrone
- New York University (NYU) School of Medicine , New York, New York , USA
| | - Jon T Giles
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Afshin Zartoshti
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Joan M Bathon
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
| | - Anca D Askanase
- Columbia University, College of Physicians & Surgeons , New York, New York , USA
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Assessing QT interval in patients with autoimmune chronic inflammatory diseases: perils and pitfalls. Lupus Sci Med 2016; 3:e000189. [PMID: 28074146 PMCID: PMC5174795 DOI: 10.1136/lupus-2016-000189] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences , University of Siena , Siena , Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences , University of Siena , Siena , Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences , University of Siena , Siena , Italy
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Adlan AM, Paton JFR, Lip GYH, Kitas GD, Fisher JP. Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in rheumatoid arthritis. J Physiol 2016; 595:967-981. [PMID: 27561790 PMCID: PMC5285627 DOI: 10.1113/jp272944] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/19/2016] [Indexed: 12/11/2022] Open
Abstract
KEY POINTS Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with an increased risk of cardiovascular mortality. Increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity heighten cardiovascular risk, althogh whether such autonomic dysfunction is present in RA is not known. In the present study, we observed an increased sympathetic nerve activity and reduced cardiac baroreflex sensitivity in patients with RA compared to matched controls. Pain was positively correlated with sympathetic nerve activity and negatively correlated with cardiac baroreflex sensitivity. The pattern of autonomic dysfunction that we describe may help to explain the increased cardiovascular risk in RA, and raises the possibility that optimizing pain management may resolve autonomic dysfunction in RA. ABSTRACT Rheumatoid arthritis (RA) is a chronic inflammatory condition associated with increased cardiovascular morbidity/mortality and an incompletely understood pathophysiology. In animal studies, central and blood borne inflammatory cytokines that can be elevated in RA evoke pathogenic increases in sympathetic activity and reductions in baroreflex sensitivity (BRS). We hypothesized that muscle sympathetic nerve activity (MSNA) was increased and BRS decreased in RA. MSNA, blood pressure and heart rate (HR) were recorded in age- and sex-matched RA-normotensive (n = 13), RA-hypertensive patients (RA-HTN; n = 17), normotensive (NC; n = 17) and hypertensive controls (HTN; n = 16). BRS was determined using the modified Oxford technique. Inflammation and pain were determined using serum high sensitivity C-reactive protein (hs-CRP) and a visual analogue scale (VAS), respectively. MSNA was elevated similarly in RA, RA-HTN and HTN patients (32 ± 9, 35 ± 14, 37 ± 8 bursts min-1 ) compared to NC (22 ± 9 bursts min-1 ; P = 0.004). Sympathetic BRS was similar between groups (P = 0.927), whereas cardiac BRS (cBRS) was reduced in RA, RA-HTN and HTN patients [5(3-8), 4 (2-7), 6 (4-9) ms mmHg-1 ] compared to NC [11 (8-15) ms mmHg-1 ; P = 0.002]. HR was independently associated with hs-CRP. Increased MSNA and reduced cBRS were associated with hs-CRP although confounded in multivariable analysis. VAS was independently associated with MSNA burst frequency, cBRS and HR. We provide the first evidence for heightened sympathetic outflow and reduced cBRS in RA that can be independent of hypertension. In RA patients, reported pain was positively correlated with MSNA and negatively correlated with cBRS. Future studies should assess whether therapies to ameliorate pain and inflammation in RA restores autonomic balance and reduces cardiovascular events.
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Affiliation(s)
- Ahmed M Adlan
- College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Julian F R Paton
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences, University of Bristol, Bristol, UK
| | - Gregory Y H Lip
- University of Birmingham Centre of Cardiovascular Sciences, City Hospital, Birmingham, UK
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK
| | - James P Fisher
- College of Life & Environmental Sciences, University of Birmingham, Birmingham, UK
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Lazzerini PE, Capecchi PL, Bertolozzi I, Morozzi G, Lorenzini S, Simpatico A, Selvi E, Bacarelli MR, Acampa M, Lazaro D, El-Sherif N, Boutjdir M, Laghi-Pasini F. Marked QTc Prolongation and Torsades de pointes in Patients with Chronic Inflammatory Arthritis. Front Cardiovasc Med 2016; 3:31. [PMID: 27703966 PMCID: PMC5029147 DOI: 10.3389/fcvm.2016.00031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 09/05/2016] [Indexed: 01/08/2023] Open
Abstract
Mounting evidence indicates that in chronic inflammatory arthritis (CIA), QTc prolongation is frequent and correlates with systemic inflammatory activation. Notably, basic studies demonstrated that inflammatory cytokines induce profound changes in potassium and calcium channels resulting in a prolonging effect on cardiomyocyte action potential duration, thus on the QT interval on the electrocardiogram. Moreover, it has been demonstrated that in rheumatoid arthritis (RA) patients, the risk of sudden cardiac death is significantly increased when compared to non-RA subjects. Conversely, to date no data are available about torsades de pointes (TdP) prevalence in CIA, and the few cases reported considered CIA only an incidental concomitant disease, not contributing factor to TdP development. We report three patients with active CIA developing marked QTc prolongation, in two cases complicated with TdP degenerating to cardiac arrest. In these patients, a blood sample was obtained within 24 h from TdP/marked QTc prolongation occurrence, and levels of IL-6, TNFα, and IL-1 were evaluated. In all three cases, IL-6 was markedly elevated, ~10 to 100 times more than reference values. Moreover, one patient also showed high circulating levels of TNFα and IL-1. In conclusion, active CIA may represent a currently overlooked QT-prolonging risk factor, potentially contributing in the presence of other “classical” risk factors to TdP occurrence. In particular, a relevant role may be played by elevated circulating IL-6 levels via direct electrophysiological effects on the heart. This fact should be carefully kept in mind, particularly when recognizable risk factors are already present and/or the addition of QT-prolonging drugs is required.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Iacopo Bertolozzi
- Cardiology Intensive Therapy Unit, Department of Internal Medicine, Hospital of Carrara , Carrara , Italy
| | - Gabriella Morozzi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Sauro Lorenzini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Antonella Simpatico
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Enrico Selvi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Maria Romana Bacarelli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Maurizio Acampa
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Deana Lazaro
- VA New York Harbor Healthcare System, SUNY Downstate Medical Center , New York, NY , USA
| | - Nabil El-Sherif
- VA New York Harbor Healthcare System, SUNY Downstate Medical Center , New York, NY , USA
| | - Mohamed Boutjdir
- VA New York Harbor Healthcare System, SUNY Downstate Medical Center, New York, NY, USA; NYU School of Medicine, New York, NY, USA
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
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Lee J, Jung SM, Ebert AD, Wu H, Diecke S, Kim Y, Yi H, Park SH, Ju JH. Generation of Functional Cardiomyocytes from the Synoviocytes of Patients with Rheumatoid Arthritis via Induced Pluripotent Stem Cells. Sci Rep 2016; 6:32669. [PMID: 27609119 PMCID: PMC5016736 DOI: 10.1038/srep32669] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 08/12/2016] [Indexed: 12/29/2022] Open
Abstract
Cardiovascular disease is a leading cause of morbidity in rheumatoid arthritis (RA) patients. This study aimed to generate and characterise cardiomyocytes from induced pluripotent stem cells (iPSCs) of RA patients. Fibroblast-like synoviocytes (FLSs) from patients with RA and osteoarthritis (OA) were successfully reprogrammed into RA-iPSCs and OA-iPSCs, respectively. The pluripotency of iPSCs was confirmed by quantitative reverse transcription-polymerase chain reaction and immunofluorescence staining. Established iPSCs were differentiated into cardiomyocytes using a small molecule-based monolayer differentiation protocol. Within 12 days of cardiac differentiation from patient-specific and control-iPSCs, spontaneously beating cardiomyocytes (iPSC-CMs) were observed. All iPSC-CMs exhibited a reliable sarcomeric structure stained with antibodies against cardiac markers and similar expression profiles of cardiac-specific genes. Intracellular calcium signalling was recorded to compare calcium-handling properties among cardiomyocytes differentiated from the three groups of iPSCs. RA-iPSC-CMs had a lower amplitude and a shorter duration of calcium transients than the control groups. Peak tangential stress and the maximum contractile rate were also decreased in RA-iPSC-CMs, suggesting that contractility was reduced. This study demonstrates the successful generation of functional cardiomyocytes from pathogenic synovial cells in RA patients through iPSC reprogramming. Research using RA-iPSC-CMs might provide an opportunity to investigate the pathophysiology of cardiac involvement in RA.
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Affiliation(s)
- Jaecheol Lee
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Seung Min Jung
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Antje D Ebert
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.,Department of Cardiology and Pneumonology, Göttingen University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Germany
| | - Haodi Wu
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sebastian Diecke
- Max Delbrück Center, Berlin, Germany Berlin Institute of Health, Berlin, Germany
| | - Youngkyun Kim
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Hyoju Yi
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA.,Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Sung-Hwan Park
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Ji Hyeon Ju
- Division of Rheumatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Rivera-López R, Jiménez-Jáimez J, Sabio JM, Zamora-Pasadas M, Vargas-Hitos JA, Martínez-Bordonado J, Navarrete-Navarrete N, Fernández RR, Sanchez-Cantalejo E, Jiménez-Alonso J. Relationship between QT Interval Length and Arterial Stiffness in Systemic Lupus Erythematosus (SLE): A Cross-Sectional Case-Control Study. PLoS One 2016; 11:e0152291. [PMID: 27064990 PMCID: PMC4827799 DOI: 10.1371/journal.pone.0152291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 03/12/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES The QT interval on the electrocardiogram has been shown to be longer in patients with systemic lupus erythematosus (SLE) compared to that of the general population. The clinical significance of this finding is unknown. The aim of this study was to assess the relationship between QT interval and subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. MATERIAL AND METHODS 93 patients with SLE and 109 healthy women with similar basal characteristics were studied. All patients underwent a 12- lead electrocardiogram, and corrected QT interval (QTc) was measured using the Bazett's formula. The presence of atherosclerosis was evaluated by carotid-femoral pulse-wave velocity. RESULTS Clinical basal characteristics were similar in both groups. QTc interval was 415 ± 21.4 milliseconds in all patients, and 407 ± 19.1 milliseconds in the control group (p = 0.007). There was a positive correlation between QTc interval and carotid-femoral pulse-wave velocity (r = 0.235; p = 0.02) in patients with SLE. This association was independent of hypertension and age in a multivariate analysis. CONCLUSION QTc interval measured by electrocardiogram is prolonged in SLE patients; it is related to subclinical atherosclerosis, measured by carotid-femoral pulse-wave velocity. This measure may help stratify risk in routine clinical practice and select the patients that might benefit from a more aggressive therapy in the prevention of cardiovascular events.
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Affiliation(s)
- Ricardo Rivera-López
- Cardiology Clinical Management Unit, Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
- * E-mail:
| | - Juan Jiménez-Jáimez
- Cardiology Clinical Management Unit, Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - José Mario Sabio
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Mónica Zamora-Pasadas
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - José Antonio Vargas-Hitos
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Josefina Martínez-Bordonado
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | - Nuria Navarrete-Navarrete
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
| | | | - E. Sanchez-Cantalejo
- Andalusian School of Public Health, Granada, Spain
- CIBER de Epidemiología y Salud Publica (CIBERESP), Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (Granada. ibs), Granada, Spain
| | - Juan Jiménez-Alonso
- Systemic Autoinmune Diseases Unit. Department of Internal Medicine. Granada University Hospitals; Granada Institute of Biohealth Research.Granada. Spain
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Szewieczek J, Gąsior Z, Duława J, Francuz T, Legierska K, Batko-Szwaczka A, Hornik B, Janusz-Jenczeń M, Włodarczyk I, Wilczyński K. ECG low QRS voltage and wide QRS complex predictive of centenarian 360-day mortality. AGE (DORDRECHT, NETHERLANDS) 2016; 38:44. [PMID: 27039197 PMCID: PMC5005906 DOI: 10.1007/s11357-016-9907-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/21/2016] [Indexed: 06/05/2023]
Abstract
We examined the electrocardiographic (ECG) findings of centenarians and associated them with >360-day survival. Physical and functional assessment, resting electrocardiogram and laboratory tests were performed on 86 study participants 101.9 ± 1.2 years old (mean ± SD) (70 women, 16 men) and followed for at least 360 days. Centenarian ECGs were assessed for left ventricular hypertrophy (LVH) according to the Romhilt-Estes score, Sokolow-Lyon criteria and Cornell voltage criteria which were positive for 12.8, 6.98, and 10.5 % of participants, respectively. Fifty-two study participants (60 %) survived ≥360 days. Multivariate logistic regression analysis revealed a negative relationship between 360-day survival and the following: R II <0.45 mV adjusted for CRP (odds ratio (OR) = 0.108, 95 % confidence interval (CI) = 0.034-0.341, P < .001), R aVF < 0.35 mV adjusted for CRP (OR = 0.151, 95 % CI = 0.039-0.584, P < .006), Sokolow-Lyon voltage <1.45 mV adjusted for CRP (OR = 0.178, 95 % CI = 0.064-0.492, P = .001), QRS ≥90 ms adjusted for CRP (OR = 0.375, 95 % CI = 0.144-0.975, P = .044), and Romhilt-Estes score ≥5 points adjusted for sex and Barthel Index (OR = 0.459, 95 % CI = 0.212-0.993, P = .048) in single variable ECG models. QRS voltage correlated positively with systolic and pulse pressure, serum vitamin B12 level, sodium, calcium, phosphorous, TIMP-1, and eGFR. QRS voltage correlated negatively with BMI, WHR, serum leptin, IL-6, TNF-α, and PAI-1 levels. QRS complex duration correlated positively with CRP; QTc correlated positively with TNF-α. Results suggest that Romhilt-Estes LVH criteria scores ≥5 points, low ECG QRS voltages (Sokolow-Lyon voltage <1.45 mV), and QRS complexes ≥90 ms are predictive of centenarian 360-day mortality.
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Affiliation(s)
- Jan Szewieczek
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland.
| | - Zbigniew Gąsior
- Department of Cardiology, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Duława
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Tomasz Francuz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Legierska
- Department of Internal Medicine and Metabolic Diseases, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Batko-Szwaczka
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Hornik
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Janusz-Jenczeń
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Iwona Włodarczyk
- Department of Internal Nursing, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Wilczyński
- Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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49
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Aulie HA, Estensen ME, Selvaag AM, Lilleby V, Murbraech K, Flatø B, Aakhus S. Cardiac Function in Adult Patients with Juvenile Idiopathic Arthritis. J Rheumatol 2015; 42:1716-23. [DOI: 10.3899/jrheum.141351] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/25/2022]
Abstract
Objective.To compare cardiac function in adults with longterm juvenile idiopathic arthritis (JIA) with that of healthy controls, and to investigate the influence of inflammation, disease severity, and use of antirheumatic medication on cardiac function.Methods.Eighty-five patients with JIA (median age 38.6 yrs) with active disease for at least 15 years were reexamined at a median of 29 years after disease onset and compared with 46 matched controls. Echocardiography, including tissue Doppler imaging and longitudinal peak-systolic global strain, was used to assess diastolic and systolic myocardial function, and 12-channel electrocardiography was performed.Results.The interventricular septum was thicker in patients than controls (mean ± SD 0.8 ± 0.2 cm vs 0.7 ± 0.1 cm, p = 0.036). Diastolic function in patients was altered compared with controls characterized by lower mitral E wave deceleration time (165 ± 36 ms vs 180 ± 40 ms, p = 0.029), higher surrogate marker of left ventricular (LV) filling pressure (median lateral E/e’ 5.3, interquartile range 4.6–6.3 vs 4.8, 3.9–5.7, p = 0.036), and larger left atrial area (16.4 ± 2.9 cm2vs 15.1 ± 2.8 cm2, p = 0.015). Systolic and diastolic blood pressures were higher in patients (120 ± 15 mmHg vs 114 ± 9 mmHg, p = 0.021 and 76 ± 10 mmHg vs 71 ± 8 mmHg, p = 0.009, respectively). QT corrected interval was similar in patients and controls. High high-sensitivity C-reactive protein (CRP), polyarticular disease course, and extended joint affection at 29-year followup, as well as duration of active disease, cumulative erythrocyte sedimentation rate, and CRP, and prednisolone use were associated with higher lateral E/e’.Conclusion.Adult patients with JIA did not differ from controls in LV systolic function, but had mildly thicker interventricular septum and indications for higher LV filling pressure, and most in patients with a higher disease burden.
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50
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Long QT Syndrome: An Emerging Role for Inflammation and Immunity. Front Cardiovasc Med 2015; 2:26. [PMID: 26798623 PMCID: PMC4712633 DOI: 10.3389/fcvm.2015.00026] [Citation(s) in RCA: 104] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/08/2015] [Indexed: 01/07/2023] Open
Abstract
The long QT syndrome (LQTS), classified as congenital or acquired, is a multi-factorial disorder of myocardial repolarization predisposing to life-threatening ventricular arrhythmias, particularly torsades de pointes. In the latest years, inflammation and immunity have been increasingly recognized as novel factors crucially involved in modulating ventricular repolarization. In the present paper, we critically review the available information on this topic, also analyzing putative mechanisms and potential interplays with the other etiologic factors, either acquired or inherited. Accumulating data indicate inflammatory activation as a potential cause of acquired LQTS. The putative underlying mechanisms are complex but essentially cytokine-mediated, including both direct actions on cardiomyocyte ion channels expression and function, and indirect effects resulting from an increased central nervous system sympathetic drive on the heart. Autoimmunity represents another recently arising cause of acquired LQTS. Indeed, increasing evidence demonstrates that autoantibodies may affect myocardial electric properties by directly cross-reacting with the cardiomyocyte and interfering with specific ion currents as a result of molecular mimicry mechanisms. Intriguingly, recent data suggest that inflammation and immunity may be also involved in modulating the clinical expression of congenital forms of LQTS, possibly triggering or enhancing electrical instability in patients who already are genetically predisposed to arrhythmias. In this view, targeting immuno-inflammatory pathways may in the future represent an attractive therapeutic approach in a number of LQTS patients, thus opening new exciting avenues in antiarrhythmic therapy.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena , Siena , Italy
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