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Zhang X, Xiao J, Yang F, Qu H, Ye C, Chen S, Guo Y. Identification of sudden cardiac death from human blood using ATR-FTIR spectroscopy and machine learning. Int J Legal Med 2024; 138:1139-1148. [PMID: 38047927 DOI: 10.1007/s00414-023-03118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/25/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The aim of this study is to identify a rapid, sensitive, and non-destructive auxiliary approach for postmortem diagnosis of SCD, addressing the challenges faced in forensic practice. METHODS ATR-FTIR spectroscopy was employed to collect spectral features of blood samples from different cases, combined with pathological changes. Mixed datasets were analyzed using ANN, KNN, RF, and SVM algorithms. Evaluation metrics such as accuracy, precision, recall, F1-score and confusion matrix were used to select the optimal algorithm and construct the postmortem diagnosis model for SCD. RESULTS A total of 77 cases were collected, including 43 cases in the SCD group and 34 cases in the non-SCD group. A total of 693 spectrogram were obtained. Compared to other algorithms, the SVM algorithm demonstrated the highest accuracy, reaching 95.83% based on spectral biomarkers. Furthermore, by combing spectral biomarkers with age, gender, and cardiac histopathological changes, the accuracy of the SVM model could get 100%. CONCLUSION Integrating artificial intelligence technology, pathology, and physical chemistry analysis of blood components can serve as an effective auxiliary method for postmortem diagnosis of SCD.
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Affiliation(s)
- Xiangyan Zhang
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Jiao Xiao
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Fengqin Yang
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Hongke Qu
- Key Laboratory of Carcinogenesis and Cancer Invasion of the Chinese Ministry of Education, Cancer Research Institute and School of Basic Medicine Sciences, Central South University, Changsha, Hunan, China
| | - Chengxin Ye
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Sile Chen
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Yadong Guo
- Department of Forensic Science, School of Basic Medical Sciences, Central South University, Changsha, China.
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Improta-Caria AC, Rodrigues LF, Joaquim VHA, De Sousa RAL, Fernandes T, Oliveira EM. MicroRNAs regulating signaling pathways in cardiac fibrosis: potential role of the exercise training. Am J Physiol Heart Circ Physiol 2024; 326:H497-H510. [PMID: 38063810 DOI: 10.1152/ajpheart.00410.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024]
Abstract
Cardiovascular and metabolic diseases such as hypertension, type 2 diabetes, and obesity develop long-term fibrotic processes in the heart, promoting pathological cardiac remodeling, including after myocardial infarction, reparative fibrotic processes also occur. These processes are regulated by many intracellular signaling pathways that have not yet been completely elucidated, including those associated with microRNA (miRNA) expression. miRNAs are small RNA transcripts (18-25 nucleotides in length) that act as posttranscriptionally regulators of gene expression, inhibiting or degrading one or more target messenger RNAs (mRNAs), and proven to be involved in many biological processes such as cell cycle, differentiation, proliferation, migration, and apoptosis, directly affecting the pathophysiology of several diseases, including cardiac fibrosis. Exercise training can modulate the expression of miRNAs and it is known to be beneficial in various cardiovascular diseases, attenuating cardiac fibrosis processes. However, the signaling pathways modulated by the exercise associated with miRNAs in cardiac fibrosis were not fully understood. Thus, this review aims to analyze the expression of miRNAs that modulate signaling pathways in cardiac fibrosis processes that can be regulated by exercise training.
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Affiliation(s)
- Alex Cleber Improta-Caria
- Laboratory of Biochemistry and Molecular Biology of the Exercise, Physical Education and Sport School, University of São Paulo, São Paulo, Brazil
| | - Luis Felipe Rodrigues
- Laboratory of Biochemistry and Molecular Biology of the Exercise, Physical Education and Sport School, University of São Paulo, São Paulo, Brazil
| | - Victor Hugo Antonio Joaquim
- Laboratory of Biochemistry and Molecular Biology of the Exercise, Physical Education and Sport School, University of São Paulo, São Paulo, Brazil
| | | | - Tiago Fernandes
- Laboratory of Biochemistry and Molecular Biology of the Exercise, Physical Education and Sport School, University of São Paulo, São Paulo, Brazil
| | - Edilamar Menezes Oliveira
- Laboratory of Biochemistry and Molecular Biology of the Exercise, Physical Education and Sport School, University of São Paulo, São Paulo, Brazil
- Departments of Internal Medicine, Center for Regenerative Medicine, USF Health Heart Institute, Morsani College of Medicine, University of South Florida, Tampa, Florida, United States
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Coulibaly I, N'Djessan JJ, Adoubi A, Yao H, Gbetchedji S, Soya E, Ncho-Mottoh MP, Angoran I, Kouamé S, Tro G, Touré C, Anzouan-Kacou JB. [Acute heart failure with altered ejection fraction : Electrocardiographic signs with mortality at the Abidjan cardiology institute]. Ann Cardiol Angeiol (Paris) 2024; 73:101628. [PMID: 37984237 DOI: 10.1016/j.ancard.2023.101628] [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: 03/07/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Heart failure with impaired ejection fraction (HFIEF) represents the end-stage of most cardiac diseases, and is responsible for a high mortality rate. In order to identify patients at risk, numerous clinical and paraclinical prognostic factors have been proposed. The electrocardiogram (ECG), easy to perform and inexpensive, retains a powerful role in the prognostic evaluation of heart failure patients. The aim was to evaluate ECG signs associated with mortality in a retrospective cohort of patients with ICFEA. METHODOLOGY The study was observational and analytical based on retrospective data collected from patients benefiting from a primary hospitalization for ICFEA at the Abidjan Heart Institute from January 2018 to July 2020. RESULTS Of the 370 patients included, 197 had died by August 1, 2020, representing an overall mortality of 53%. Mortality progressed gradually up to one year, then remained unchanged up to 30 months. In multivariate Cox regression including ECG variables only, the presence of intra-ventricular conduction disorders (OR: 1.80; 95% CI [1.01-3.25]), microvoltage (OR: 1.82; 95% CI [1.05-16]), and pathological Q waves (OR: 1.70; 95% CI [1.02-2.83]), were significantly associated with overall mortality. When ECG variables and clinical, paraclinical and therapeutic demographic variables were included, only the presence of pathological Q waves (OR:1.74; 95% CI [1.01-3.01]) persisted as a risk factor for mortality. Hypertension and treatment of heart failure, in particular ACEI/ARII, beta-blockers and ARM, were protective factors. The presence of Q waves was associated with a significant reduction in survival, based on curves obtained using the Kaplan-Meier model. CONCLUSION ICFEA is responsible for high mortality, mainly in the year following the 1st hospitalization for cardiac decompensation. The presence of pathological Q waves is the only electrocardiographic sign that remains statistically associated with a poor prognosis, after adjustment.
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Affiliation(s)
- I Coulibaly
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - J J N'Djessan
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire.
| | - A Adoubi
- Service d'hospitalisation de médecine, Centre Hospitalier Universitaire de Bouaké, Côte d'Ivoire
| | - H Yao
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Gbetchedji
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - E Soya
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - M P Ncho-Mottoh
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - I Angoran
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - S Kouamé
- Unité de Soins Intensifs Cardiologiques, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - G Tro
- Service d'hospitalisation de médecine, Centre Hospitalier Universitaire de Bouaké, Côte d'Ivoire
| | - C Touré
- Service d'hospitalisation de médecine, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
| | - J B Anzouan-Kacou
- Service des explorations externes, Institut de Cardiologie d'Abidjan, Côte d'Ivoire
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Kamimura D, Hall ME. Can Any Electrocardiographic Indicators Reflect Myocardial Fibrosis? Am J Cardiol 2023; 206:372-374. [PMID: 37689495 DOI: 10.1016/j.amjcard.2023.08.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 09/11/2023]
Affiliation(s)
- Daisuke Kamimura
- Department of Clinical Laboratory, Yokohama City University Hospital, Yokohama, Japan; Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.
| | - Michael E Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Yousaf A, Ahmad S, Peltz J, Ahsan MJ, Abbas KS, Muhammad S, Watson C, Asad ZUA, Kim MH. Left bundle branch area pacing vs biventricular pacing for cardiac resynchronization: A systematic review and meta-analysis. Heart Rhythm O2 2023; 4:671-680. [PMID: 38034886 PMCID: PMC10685169 DOI: 10.1016/j.hroo.2023.06.011] [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] [Indexed: 12/02/2023] Open
Abstract
Background Left bundle branch area pacing (LBBAP) may offer greater physiological benefits than traditional biventricular pacing (BiVP). However, there are limited data comparing the efficacy of LBBAP vs BiVP in patients with systolic heart failure (HF). Objective The purpose of this meta-analysis was to compare the feasibility and electromechanical and clinical outcomes of both LBBAP and BiVP. Methods We conducted a systematic review of studies retrieved from various databases including PubMed, Embase, Google Scholar, Scopus, and Cochrane Central Register of Control Trials (CENTRAL) published up to May 22, 2023. The risk ratio (RR) and standardized mean difference (SMD) with corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. Results We included 12 studies with a total of 3004 patients (LBBAP = 1242, BiVP = 1762). Pooled results showed that LBBAP resulted in a significant increase in left ventricular ejection fraction (SMD 0.40, 95% CI 0.25, 0.54, P < .00001), echocardiographic response (RR 1.19, 95% CI 1.10 to 1.29, P < .0001), improvement in New York Heart Association functional class (SMD -0.44, 95% CI -0.65 to -0.23, P < .0001), QRS duration reduction (SMD -0.90, 95% CI -1.14 to -0.66, P < .00001), left ventricular end-diastolic diameter reduction (SMD -0.31, 95% CI -0.57 to -0.05, P = .02), fewer HF hospitalizations (RR 0.72, 95% CI 0.62, 0.85, P < .0001), and improved survival (RR 0.73, 95% CI 0.58, 0.92, P = .007). In addition, LBBAP was associated with shorter fluoroscopy time (SMD -0.94, 95% CI -1.42 to -0.47, P < .0001) and lower pacing threshold at implantation (SMD -1.03, 95% CI -1.32 to -0.74, P < .00001) and at 6 months (SMD -1.44, 95% CI -2.11 to -0.77, P < .0001) as compared with BiVP. Conclusion Compared with BiVP, LBBAP was associated with better electromechanical and clinical outcomes, including left ventricular ejection fraction, QRS duration, echocardiographic response, New York Heart Association functional class, HF hospitalization, and all-cause mortality in patients with systolic HF.
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Affiliation(s)
- Amman Yousaf
- Department of Medicine, McLaren Flint-Michigan State University, Flint, Michigan
| | - Soban Ahmad
- Department of Medicine, East Carolina University, Greenville, North Carolina
| | - Joshua Peltz
- Department of Medicine, East Carolina University, Greenville, North Carolina
| | | | | | - Shoaib Muhammad
- Department of Medicine, Gulab Devi Hospital, Lahore, Pakistan
| | - Christopher Watson
- Department of Medicine, East Carolina University, Greenville, North Carolina
| | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael H. Kim
- Department of Medicine, Creighton University and CHI Health, Omaha, Nebraska
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Li T, Xiong X, Wang Y, Li Y, Liu Y, Zhang M, Li C, Yu T, Cao W, Chen S, Zhang H, Wang X, Lv L, Zhou Y, Liang H, Li X, Shan H. Neuroepithelial cell-transforming 1 promotes cardiac fibrosis via the Wnt/β-catenin signaling pathway. iScience 2023; 26:107888. [PMID: 37766986 PMCID: PMC10520536 DOI: 10.1016/j.isci.2023.107888] [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: 01/18/2023] [Revised: 07/15/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
This study found that the level of neuroepithelial cell-transforming gene 1 protein (NET1) was significantly increased in a mouse cardiac fibrosis model. Moreover, the expression level of NET1 was increased in cardiac fibrosis induced by TGF-β1, suggesting that NET1 was involved in the pathological process of cardiac fibrosis. Overexpression of NET1 promoted β-catenin expression in the nucleus and significantly increased the proliferation and migration of cardiac fibroblasts. NET1 may form a complex with β-catenin through GSK3β. Knockdown of β-catenin alleviated the effects of NET1 overexpression on collagen production and cell migration. In the heart of NET1 knockout mice, NET1 knockout can reduce the expression of β-catenin, α-SMA, and collagen content induced by MI. In conclusion, NET1 may regulate the activation of Wnt/β-catenin and TGF/Smads signaling pathway, promote collagen synthesis in fibroblasts, and participate in cardiac fibrosis. Thus, NET1 may be a potential therapeutic target in cardiac fibrosis.
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Affiliation(s)
- Tianyu Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
- Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, P.R. China
| | - Xue Xiong
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yujing Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yue Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yao Liu
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Mingxiu Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Chao Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Tong Yu
- Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Noncoding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai 201620, P.R. China
| | - Wei Cao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150086, P.R. China
| | - Shuangshuang Chen
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Huizhen Zhang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Xiaona Wang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Lifang Lv
- The Centre of Functional Experiment Teaching, School of Basic Medicine, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Yuhong Zhou
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Haihai Liang
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
- Research Unit of Noninfectious Chronic Diseases in Frigid Zone (2019RU070), Chinese Academy of Medical Sciences, Harbin 150081, P.R. China
| | - Xuelian Li
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
| | - Hongli Shan
- Department of Pharmacology (State-Province Key Laboratories of Biomedicine-Pharmaceutics of China, Key Laboratory of Cardiovascular Research, Ministry of Education), College of Pharmacy, Harbin Medical University, Harbin, Heilongjiang 150081, P.R. China
- Shanghai Frontiers Science Research Center for Druggability of Cardiovascular Noncoding RNA, Institute for Frontier Medical Technology, Shanghai University of Engineering Science, Shanghai 201620, P.R. China
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Konagai N, Asaumi Y, Murata S, Noda T, Takeuchi S, Fujino M, Honda S, Yoneda S, Kataoka Y, Otsuka F, Nishimura K, Tsujita K, Kusano K, Noguchi T, Yasuda S. In-hospital predictors for primary prevention of sudden death after acute myocardial infarction with cardiac dysfunction. J Cardiol 2023; 82:186-193. [PMID: 37187290 DOI: 10.1016/j.jjcc.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/24/2023] [Accepted: 05/10/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Current guidelines recommend prophylactic defibrillator implantation in patients with acute myocardial infarction (AMI) and left ventricular ejection fraction (LVEF) ≤40 % or LVEF ≤35 % plus heart failure symptoms or inducible ventricular tachyarrhythmias during an electrophysiology study at 40 days after AMI or 90 days after revascularization. In-hospital predictors of sudden cardiac death (SCD) after AMI during the index hospitalization remain unsettled. We sought to examine in-hospital predictors of SCD in patients with AMI and LVEF ≤40 % evaluated during the index hospitalization. METHODS We retrospectively evaluated 441 consecutive patients with AMI and LVEF ≤40 % admitted to our hospital between 2001 and 2014 (77 % male gender; median age: 70 years; median hospitalization length: 23 days). The primary endpoint was a composite of SCD or aborted SCD at ≥30 days after AMI onset (composite arrhythmic event). LVEF and QRS duration (QRSd) on electrocardiography were measured at a median of 12 days and 18 days, respectively. RESULTS During a median follow-up of 7.6 years, the incidence of composite arrhythmic events was 7.3 % (32 of 441 patients). In multivariable analysis, QRSd ≥100 msec (beta-coefficient = 1.54, p = 0.003), LVEF ≤23 % (beta-coefficient = 1.14, p = 0.007), and onset-reperfusion time > 5.5 h (beta-coefficient = 1.16, p = 0.035) were independent predictors of composite arrhythmic events. The combination of these 3 factors was associated with the highest rate of composite arrhythmic events compared with 0-2 factors (p < 0.001). CONCLUSIONS The combination of QRSd ≥100 msec, LVEF ≤23 %, and onset-reperfusion time > 5.5 h during the index hospitalization provides precise risk stratification for SCD in patients early after AMI.
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Affiliation(s)
- Nao Konagai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Shunsuke Murata
- Department of Preventative Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Satoshi Takeuchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Cardiovascular Medicine, Tohoku University School of Medicine, Sendai, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kunihiro Nishimura
- Department of Preventative Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenichi Tsujita
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan; Department of Cardiovascular Medicine, Tohoku University School of Medicine, Sendai, Japan
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Calò L, Lanza O, Crescenzi C, Parisi C, Panattoni G, Martino A, Rebecchi M, Tarzia P, Ciampi P, Romeo F, Canestrelli S, Silvetti E, De Ruvo E. The value of the 12-lead electrocardiogram in the prediction of sudden cardiac death. Eur Heart J Suppl 2023; 25:C218-C226. [PMID: 37125292 PMCID: PMC10132628 DOI: 10.1093/eurheartjsupp/suad023] [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] [Indexed: 05/02/2023]
Abstract
Sudden cardiac death (SCD) can be caused by several clinical conditions, overt or misconceived, which recognize different pathophysiologies determining the development of fatal arrhythmic events. In the various forms of structural heart disease such as ischaemic heart disease, cardiomyopathies (e.g. hypertrophic cardiomyopathy, dilated cardiomyopathy, and arrhythmogenic cardiomyopathy), channelopathies (e.g. long-QT syndrome, congenital short QT, Brugada syndrome, early repolarization (ER) syndrome, and idiopathic ventricular fibrillation) but also in the apparently healthy subject, the 12-lead electrocardiogram (ECG) has proved, over the years, to be a reliable and readily available method for stratifying the risk of adverse arrhythmic events and consequently SCD. Several electrocardiographic markers have been shown to be associated with adverse outcomes in different types of patients. Although with different sensitivity and specificity in each clinical condition, depolarization abnormalities, such as QRS fragmentation, Q waves, QRS duration, left posterior fascicular block, low QRS voltage, and left ventricular hypertrophy and similarly repolarization abnormalities as ER pattern, T wave alternans, QT interval, and QT dispersion, have shown significant efficacy in predicting SCD. Despite the advancement of techniques especially in the field of imaging, the correct interpretation of the 12-lead ECG remains, therefore, an effective tool for assessing the possible prognostic outcome in terms of arrhythmic risk and SCD in different types of patients.
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Affiliation(s)
- Leonardo Calò
- Corresponding author. Tel: +39 06 23188406, Fax: +39 06 23188410,
| | - Oreste Lanza
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Cinzia Crescenzi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Cristian Parisi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Germana Panattoni
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Annamaria Martino
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Pierpaolo Tarzia
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Pellegrino Ciampi
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Fabiana Romeo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Stefano Canestrelli
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Elisa Silvetti
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
| | - Ermenegildo De Ruvo
- Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy
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Hekkanen JJ, Kenttä TV, Holmström L, Tulppo MP, Ukkola OH, Pakanen L, Junttila MJ, Huikuri HV, Perkiömäki JS. Association of electrocardiographic spatial heterogeneity of repolarization and spatial heterogeneity of atrial depolarization with left ventricular fibrosis. Europace 2023; 25:820-827. [PMID: 36635858 PMCID: PMC10062366 DOI: 10.1093/europace/euac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/14/2022] [Indexed: 01/14/2023] Open
Abstract
AIMS To evaluate the relationship between spatial heterogeneity of electrocardiographic repolarization and spatial heterogeneity of atrial depolarization with arrhythmic substrate represented by left ventricular fibrosis. METHODS AND RESULTS We assessed the associations of T- and P-wave morphology parameters analysed from the standard 12-lead electrocardiograms with left ventricular fibrosis in 378 victims of unexpected sudden cardiac death (SCD) who underwent medico-legal autopsy. Based on autopsy findings, the SCD victims were categorized into four different groups according to different stages of severity of left ventricular fibrosis (substantial fibrosis, moderate patchy fibrosis, scattered mild fibrosis, no fibrosis). T-wave and P-wave area dispersion (TWAd: 0.0841 ± 0.496, 0.170 ± 0.492, 0.302 ± 404, 0.296 ± 0.476, P = 0.008; PWAd: 0.574 ± 0.384, 0.561 ± 0.367, 0.654 ± 0.281, 0.717 ± 0.257, P = 0.011, respectively; low values abnormal), non-dipolar components of T-wave and P-wave morphology (T_NonDipolarABS: 0.0496 ± 0.0377, 0.0571 ± 0.0487, 0.0432 ± 0.0476, 0.0380 ± 0.0377, P = 0.027; P_NonDipolarABS: 0.0132 ± 0.0164, 0.0130 ± 0.0135, 0.0092 ± 0.0117, 0.0069 ± 0.00472, P = 0.005, respectively, high values abnormal), T-wave morphology dispersion (TMD: 45.9 ± 28.3, 40.5 ± 25.8, 35.5 ± 24.9, 33.0 ± 24.6, P = 0.030, respectively, high values abnormal), and P-wave heterogeneity (PWH: 20.0 ± 9.44, 19.7 ± 8.87, 17.9 ± 9.78, 15.4 ± 4.60, P = 0.019, respectively, high values abnormal) differed significantly between the groups with different stages of left ventricular fibrosis. After adjustment with heart weight, T_NonDipolarABS [standardized β (sβ) = 0.131, P = 0.014], PWAd (sβ = -0.161, P = 0.003), P_NonDipolarABS (sβ = 0.174, P = 0.001), and PWH (sβ = 0.128, P = 0.015) retained independent association, and TWAd (sβ = -0.091, P = 0.074) and TMD (sβ = 0.097, P = 0.063) tended to retain their association with the degree of myocardial fibrosis. CONCLUSION Our findings suggest that abnormal values of T- and P-wave morphology are associated with arrhythmic substrate represented by ventricular fibrosis partly explaining the mechanism behind their prognostic significance.
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Affiliation(s)
- Jenni J Hekkanen
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Lauri Holmström
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare, Hoitajanrinne 1, P.O. Box 310, FI-90101 Oulu, Finland
- Department of Forensic Medicine, Medical Research Center Oulu, Research Unit of Internal Medicine, University of Oulu, Aapistie 5B, P.O. Box 5000, FI-90014 Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Internal Medicine, Division of Cardiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, P.O. Box 5000, Kajaanintie 50, 90014 Oulu, Finland
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10
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Arceluz MR, Thind M, Garcia FC, Guandalini GS, Santangeli P, Hyman M, Deo R, Frankel DS, Supple GE, Schaller RD, Callans DJ, Nazarian S, Dixit S, Kumareswaran R, Zado ES, Marchlinski FE. Sinus Rhythm Electrocardiographic Abnormalities, Sites of Origin, and Ablation Outcomes of Ventricular Premature Depolarizations Initiating Ventricular Fibrillation. Heart Rhythm 2023; 20:844-852. [PMID: 36958413 DOI: 10.1016/j.hrthm.2023.03.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/13/2023] [Accepted: 03/15/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Ventricular fibrillation (VF) can be initiated by ventricular premature depolarizations (VPDs) in the absence of obvious structural abnormalities. OBJECTIVE To determine the prevalence of 12-lead ECG sinus rhythm reduced QRS amplitude, QRS fractionation (QRSf) and early repolarization (ER) pattern, and the outcome of catheter ablation and VPD anatomic distribution in patients with VPDs initiating VF. METHODS We compared a cohort with no apparent structural heart disease and VPDs initiating VF (Group 1, n=42) to a reference cohort (Group 2, n=61) of patients with no structural heart disease and symptomatic unifocal VPDs. RESULTS A reduced QRS amplitude (<.55 mV) in aVF (59 % vs 10%, p<0.001), QRSf in ≥2 contiguous leads (50% vs 16%, p<0.001) and early repolarization pattern (21.4% vs 1.6%, p=0.01) were more common in Group 1 vs Group 2. At least one abnormal ECG finding was present in 34 (81%) Group 1 vs 17 (28%) Group 2 patients, (p<0.001). VPD origin included RV and LV distal Purkinje system and moderator band/ papillary muscles, in 83% Group 1 vs 18% Group 2 patients, p<0.001. VF was eliminated with single ablation procedure in 77% of Group 1 patients with at least 2 years of follow-up. CONCLUSIONS A reduced QRS amplitude (<.55 mV) in aVF, QRS fractionation in ≥2 contiguous leads and/or an early repolarization pattern are frequently observed in patients with VPDs initiating VF. VPDs initiating VF typically originate from the distal Purkinje system and papillary muscles and can be successfully eliminated with catheter ablation.
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Affiliation(s)
- Martín R Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Munveer Thind
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Matthew Hyman
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sanjay Dixit
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ramanan Kumareswaran
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Erica S Zado
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
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11
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ECG criteria to distinguish hypertrophic cardiomyopathy featured with "Pseudo-STEMI" from acute ST-elevation myocardial infarction. J Electrocardiol 2023; 77:10-16. [PMID: 36527914 DOI: 10.1016/j.jelectrocard.2022.11.009] [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: 08/28/2022] [Revised: 11/24/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUD The ECG profile of Hypertrophic Cardiomyopathy (HCM) includes ST-segment elevation (STE) that may lead to misdiagnosis of acute ST-segment elevation myocardial infarction (STEMI). This pseudo-STEMI may bring non-essential treatment. We aimed to confirm the ECG differences between HCM featured with pseudo-STEMI and acute STEMI. MATERIAL AND METHODS We retrospectively enrolled 59 HCM cases (Group A) and 56 acute STEMI cases (Group B). Based on the locations of STE, all the patients were divided into four subgroups, including HCM with STE in anterior leads (Group A1), anterior STEMI (Group B1), HCM with STE in inferior leads (Group A2) and inferior STEMI (Group B2). Several ECG parameters were compared between these subgroups. RESULTS ECG parameters significantly differed between these groups, especially the number of leads with TWI. We evaluated the diagnostic value of ECG profiles for those groups. ROC analysis showed that for Group A vs. Group B, number of leads with TWI showed the highest AUC value of 0.805 and its cutoff of 2.5, with 76.3% sensitivity and 76.8% specificity. For Group A1 vs. Group B1, it showed the highest AUC value of 0.801 and its cut-off point was 2.5, with 77.1% sensitivity and 79.1% specificity. For Group A2 vs. Group B2, it showed the highest AUC value of 0.822 and the cut-off value was 4.5, with 54.5% sensitivity and 92.3% specificity. CONCLUSION ECG plays a valid tool to distinguish "Pseudo-STEMI" HCM from acute STEMI, especially number of leads with TWI.
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12
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Berger M, Kumowski N, Straw S, Verket M, Marx N, Witte KK, Schütt K. Clinical implications and risk factors for QRS prolongation over time in heart failure patients. Clin Res Cardiol 2023; 112:312-322. [PMID: 36378295 PMCID: PMC9898415 DOI: 10.1007/s00392-022-02122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND QRS prolongation is an established prognostic marker in heart failure (HF). In contrast, the role of QRS width progression over time has been incompletely explored. The current study investigates the role of QRS width progression over time on clinical status and identifies underlying predictors. METHODS Datasets of ≥ 2 consecutive visits from 100 attendees to our HF clinic between April and August 2021 were analysed for changes in QRS complex duration. RESULTS In total 240 datasets were stratified into tertiles based on change in QRS duration (mm/month) (1st tertile: - 1.65 [1.50] 'regression'; 2nd tertile 0.03 [0.19] 'stable', 3rd tertile 3.57 [10.11] 'progression'). The incidence of the combined endpoint HF hospitalisation and worsening of symptomatic heart failure was significantly higher in the group with QRS width progression (3rd tertile) compared with the stable group (2nd tertile; log-rank test: p = 0.013). These patients were characterised by higher plasma NT-pro-BNP levels (p = 0.008) and higher heart rate (p = 0.007). A spline-based prediction model identified patients at risk of QRS width progression when NT-pro-BNP and heartrate were > 837 pg/ml and > 83/bpm, respectively. These markers were independent of guideline-directed medical HF therapy. Patients beyond both thresholds had a 14-fold increased risk of QRS width progression compared to those with neither or either alone (HR: 14.2 [95% 6.9 - 53.6]; p < 0.0001, p for interaction = 0.016). CONCLUSIONS This pilot study demonstrates that QRS width progression is associated with clinical deterioration of HF. NTproBNP plasma levels and heart rate indicate patients at risk QRS width progression, independently of HF therapy.
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Affiliation(s)
- Martin Berger
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nina Kumowski
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Sam Straw
- grid.9909.90000 0004 1936 8403Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Marlo Verket
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Nikolaus Marx
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Klaus K. Witte
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
| | - Katharina Schütt
- grid.412301.50000 0000 8653 1507Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Aachen, Germany
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13
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Chen YY, Chung FP, Lin YJ, Chien KL, Chang WT. Exploring the Risk Factors of Sudden Cardiac Death Using an Electrocardiography and Medical Ultrasonography for the General Population Without a History of Coronary Artery Disease or Left Ventricular Ejection Fraction <35% and Aged >35 Years - A Novel Point-Based Prediction Model Based on the Chin-Shan Community Cardiovascular Cohort. Circ J 2022; 87:139-149. [PMID: 36047166 DOI: 10.1253/circj.cj-22-0322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Most of the factors and prediction models of sudden cardiac death (SCD) have been developed without considering the Asia population. The purpose of this study is to construct a point-based prediction model for the general population in Asia.Methods and Results: Chin-Shan Community Cardiovascular Cohort (CCCC) is a community-based longitudinal cohort initiated between 1990 and 1991, enrolling participants aged ≥35 years and following them up until 2005. Participants with coronary artery disease (CAD) or a left ventricular ejection fraction (LVEF) of 35% were excluded from this study. The Framingham risk score function was used to derive a simple point-based prediction model. Based on bootstrapping, a novel model (CCCC-SCD-Score) was validated. A total of 2,105 participants were analyzed. The incidence rate of SCD was 0.406 per 1,000 person-years. The CCCC-SCD-Score score was calculated using age groups (maximal points=4), left ventricular hypertrophy, hypertension, left ventricular ejection fraction <40%, aortic flow rate >190 cm/s, and carotid plaque scores ≥5 (point=1 for each risk factor). The C-index of the CCCC-SCD-Score in predicting SCD risks was 0.888 (95% confidence interval: 0.807-0.969). CONCLUSIONS For the general Asian population without a history of CAD or a LVEF <35% and who are aged >35 years, the novel model-based scoring system effectively identifies the risk for SCD using the clinical factors, electrocardiographic and echocardiographic data.
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Affiliation(s)
- Yun-Yu Chen
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University.,Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital
| | - Fa-Po Chung
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming Chiao Tung University
| | - Yenn-Jiang Lin
- Heart Rhythm Center and Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital.,Department of Internal Medicine, Faculty of Medicine, Institute of Clinical Medicine, Cardiovascular Research Center, School of Medicine, National Yang Ming Chiao Tung University
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine College of Public Health, National Taiwan University
| | - Wei-Tien Chang
- Department of Emergency Medicine, National Taiwan University Hospital
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14
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An autopsy case of sudden unexpected death of a young adult with progressive intraventricular conduction delay. Pathol Res Pract 2022; 240:154226. [DOI: 10.1016/j.prp.2022.154226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/12/2022] [Indexed: 11/15/2022]
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15
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Holmström L, Juntunen S, Vähätalo J, Pakanen L, Kaikkonen K, Haukilahti A, Kenttä T, Tikkanen J, Viitasalo V, Perkiömäki J, Huikuri H, Myerburg RJ, Junttila J. Plaque histology and myocardial disease in sudden coronary death: the Fingesture study. Eur Heart J 2022; 43:4923-4930. [PMID: 36172703 PMCID: PMC9748531 DOI: 10.1093/eurheartj/ehac533] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/18/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS At least 50% of deaths due to coronary artery disease (CAD) are sudden cardiac deaths (SCDs), but the role of acute plaque complications on the incidence of sudden death in CAD is somewhat unclear. The present study aimed to investigate plaque histology and concomitant myocardial disease in sudden coronary death. METHODS AND RESULTS The study population is derived from the Fingesture study, which has collected data from 5869 consecutive autopsy-verified SCD victims in Northern Finland (population ≈600 000) between 1998 and 2017. In this substudy, histological examination of culprit lesions was performed in 600 SCD victims whose death was due to CAD. Determination of the cause of death was based on the combination of medical records, police reports, and autopsy data. Plaque histology was classified as either (i) plaque rupture or erosion, (ii) intraplaque haemorrhage, or (iii) stable plaque. The mean age of the study subjects was 64.9 ± 11.2 years, and 82% were male. Twenty-four per cent had plaque rupture or plaque erosion, 24% had an intraplaque haemorrhage, and 52% had a stable plaque. Myocardial hypertrophy was present in 78% and myocardial fibrosis in 93% of victims. The presence of myocardial hypertrophy or fibrosis was not associated with specific plaque histology. CONCLUSION Less than half of sudden deaths due to CAD had evidence of acute plaque complication, an observation which is contrary to historical perceptions. The prevalence of concomitant myocardial disease was high and independent of associated plaque morphology.
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Affiliation(s)
- Lauri Holmström
- Corresponding author. Tel: +358 8 3154464, Fax: +358 8 3155599,
| | | | - Juha Vähätalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Lasse Pakanen
- Forensic Medicine Unit, Finnish Institute for Health and Welfare (THL), PO Box 310, 90101 Oulu, Finland,Department of Forensic Medicine, Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu, PO Box 5000, 90014 Oulu, Finland
| | - Kari Kaikkonen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Anette Haukilahti
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Tuomas Kenttä
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Jani Tikkanen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Ville Viitasalo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Juha Perkiömäki
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014 Oulu, Finland
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16
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Yi H, Liu C, Shi J, Wang S, Zhang H, He Y, Tao J, Li S, Zhang R. EGCG Alleviates Obesity-Induced Myocardial Fibrosis in Rats by Enhancing Expression of SCN5A. Front Cardiovasc Med 2022; 9:869279. [PMID: 35571212 PMCID: PMC9098820 DOI: 10.3389/fcvm.2022.869279] [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: 02/04/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022] Open
Abstract
Object Obesity is an increase in body weight beyond the limitation of skeletal and physical requirement, as the result of an excessive accumulation of fat in the body. Obesity could increase the risk of myocardial fibrosis. (-)-Epigallocatechin-3-gallate (EGCG) is the most abundant substance in green tea and has been reported to have multiple pharmacological activities. However, there is not enough evidence to show that EGCG has a therapeutic effect on obesity-induced myocardial fibrosis. This study aims to investigate whether EGCG is a potential drug for obesity-induced myocardial fibrosis. Methods Obesity-induced myocardial fibrosis rat model was established by HFD feeding for 36 weeks. EGCG was intragastrically administered at 160 mg/kg/d for the last 4 weeks. The pathological changes of myocardial fibrosis were evaluated by tissue pathological staining and collagen quantification. Furthermore, total RNA was extracted from the heart for RNA-seq to identify the changes in the transcript profile, and the relevant hub genes were verified by quantitative real-time PCR and western blot. Results EGCG significantly relieved HFD diet-induced obesity and alleviated the pathology of myocardial fibrosis. Biochemical analysis showed that EGCG could relieve the burden of lipid metabolism and injury to the myocardium and transcript profile analysis showed that EGCG could alleviate obesity-induced myocardial fibrosis by increasing the level of Scn5a in the heart. Furthermore, quantitative real-time PCR and western blot analysis for SCN5A also confirmed this finding. Conclusion Taken together, these results suggest that EGCG could protect against the obesity-induced myocardial fibrosis. EGCG plays an anti-myocardial fibrosis role by regulating the expression of SCN5A in the heart.
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Affiliation(s)
- Haoan Yi
- Department of Cell Biology and Medical Genetics, School of Basic Medicine, Kunming Medical University, Kunming, China
| | - Cong Liu
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Orthopedics, Tangdu Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jing Shi
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Kunming Medical University, Kunming, China
| | - Shuo Wang
- Department of Pharmacology, School of Basic Medicine, Kunming Medical University, Kunming, China
| | - Haoxin Zhang
- Department of Orthopaedics, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yongshu He
- Department of Cell Biology and Medical Genetics, School of Basic Medicine, Kunming Medical University, Kunming, China
| | - Jianping Tao
- Department of Anesthesiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shude Li
- Department of Biochemistry and Molecular Biology, School of Basic Medicine, Kunming Medical University, Kunming, China
- Pharmaceutical Science and Yunnan Key Laboratory of Pharmacology for Natural Products, Kunming Medical University, Kunming, China
- *Correspondence: Shude Li
| | - Renfa Zhang
- Department of Physical Education, Kunming Medical University, Kunming, China
- Renfa Zhang
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17
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van der Voorn SM, Bourfiss M, te Riele ASJM, Taha K, Vos MA, de Brouwer R, Verstraelen TE, de Boer RA, Remme CA, van Veen TAB. Exploring the Correlation Between Fibrosis Biomarkers and Clinical Disease Severity in PLN p.Arg14del Patients. Front Cardiovasc Med 2022; 8:802998. [PMID: 35097021 PMCID: PMC8793805 DOI: 10.3389/fcvm.2021.802998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Pathogenic variants in phospholamban (PLN, like p. Arg14del), are found in patients diagnosed with arrhythmogenic (ACM) and dilated cardiomyopathy (DCM). Fibrosis formation in the heart is one of the hallmarks in PLN p.Arg14del carriers. During collagen synthesis and breakdown, propeptides are released into the circulation, such as procollagen type I carboxy-terminal propeptide (PICP) and C-terminal telopeptide collagen type I (ICTP).Aim: To investigate if PICP/ICTP levels in blood are correlative biomarkers for clinical disease severity and outcome in PLN p.Arg14del variant carriers.Methods: Serum and EDTA blood samples were collected from 72 PLN p.Arg14del carriers (age 50.5 years, 63% female) diagnosed with ACM (n = 12), DCM (n = 14), and preclinical variant carriers (n = 46). PICP levels were measured with an enzyme-linked immune sorbent assay and ICTP with a radio immuno-assay. Increased PICP/ICTP ratios suggest a higher collagen deposition. Clinical data including electrocardiographic, and imaging results were adjudicated from medical records.Results: No correlation between PICP/ICTP ratios and late gadolinium enhancement (LGE) was found. Moderate correlations were found between the PICP/ICTP ratio and end-diastolic/systolic volume (both rs = 0.40, n = 23, p = 0.06). PICP/ICTP ratio was significantly higher in patients with T wave inversion (TWI), especially in leads V4–V6, II, III, and aVF (p < 0.022) and in patients with premature ventricular contractions (PVCs) during an exercise tolerance test (p = 0.007).Conclusion: High PICP/ICTP ratios correlated with clinical parameters, such as TWI and PVCs. Given the limited size and heterogeneity of the patient group, additional studies are required to substantiate the incremental prognostic value of these fibrosis biomarkers in PLN p.Arg14del patients.
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Affiliation(s)
- Stephanie M. van der Voorn
- Division Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mimount Bourfiss
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Anneline S. J. M. te Riele
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Karim Taha
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marc A. Vos
- Division Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Remco de Brouwer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Tom E. Verstraelen
- Heart Center, Department of Cardiology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, Netherlands
| | - Rudolf A. de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Carol Ann Remme
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Univeristy Medical Center, Location Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Toon A. B. van Veen
- Division Heart and Lungs, Department of Medical Physiology, University Medical Center Utrecht, Utrecht, Netherlands
- *Correspondence: Toon A. B. van Veen
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18
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Holkeri A, Eranti A, Haukilahti MAE, Kerola T, Kenttä TV, Noponen K, Seppänen T, Rissanen H, Heliövaara M, Knekt P, Junttila MJ, Huikuri HV, Aro AL. Prognostic significance of flat T-waves in the lateral leads in general population. J Electrocardiol 2021; 69:105-110. [PMID: 34656915 DOI: 10.1016/j.jelectrocard.2021.10.001] [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: 05/21/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Negative T-waves are associated with sudden cardiac death (SCD) risk in the general population. Whether flat T-waves also predict SCD is not known. The aim of the study was to examine the clinical characteristics and risk of SCD in general population subjects with flat T-waves. METHODS We examined the electrocardiograms of 6750 Finnish general population adults aged ≥30 years and classified the subjects into 3 groups: 1) negative T-waves with an amplitude ≥0.1 mV in ≥2 of the leads I, II, aVL, V4-V6, 2) negative or positive low amplitude T-waves with an amplitude <0.1 mV and the ratio of T-wave and R-wave <10% in ≥2 of the leads I, II, aVL, V4-V6, and 3) normal positive T-waves (not meeting the aforesaid criteria). The association between T-wave classification and SCD was assessed during a 10-year follow-up. RESULTS A total of 215 (3.2%) subjects had negative T-waves, 856 (12.7%) flat T-waves, and 5679 (84.1%) normal T-waves. Flat T-wave subjects were older and had more often cardiovascular morbidities compared to normal T-wave subjects, while negative T-wave subjects were the oldest and had most often cardiovascular morbidities. After adjusting for multiple factors, both flat T-waves (hazard ratio [HR] 1.81; 95% confidence interval [CI] 1.13-2.91) and negative T-waves (HR 3.27; 95% CI 1.85-5.78) associated with SCD. CONCLUSIONS Cardiovascular risk factors and disease are common among subjects with flat T-waves, but these minor T-wave abnormalities are also independently associated with increased SCD risk.
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Affiliation(s)
- Arttu Holkeri
- Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland.
| | - Antti Eranti
- Heart Center, Central Hospital of North Karelia, Tikkamäentie 16, 80210 Joensuu, Finland
| | - M Anette E Haukilahti
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Faculty of Medicine, PO Box 5000, FI-90014 Oulu, Finland
| | - Tuomas Kerola
- Department of Internal Medicine, Päijät-Häme Central Hospital, Keskussairaalankatu 7, 15850 Lahti, Finland
| | - Tuomas V Kenttä
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Faculty of Medicine, PO Box 5000, FI-90014 Oulu, Finland
| | - Kai Noponen
- Center for Machine Vision and Signal Analysis, University of Oulu, PO Box 4500, Oulu FI-90014, Finland
| | - Tapio Seppänen
- Center for Machine Vision and Signal Analysis, University of Oulu, PO Box 4500, Oulu FI-90014, Finland
| | - Harri Rissanen
- Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
| | - Markku Heliövaara
- Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
| | - Paul Knekt
- Finnish Institute for Health and Welfare, PO Box 30, FI-00271 Helsinki, Finland
| | - M Juhani Junttila
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Faculty of Medicine, PO Box 5000, FI-90014 Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital and University of Oulu, Faculty of Medicine, PO Box 5000, FI-90014 Oulu, Finland
| | - Aapo L Aro
- Division of Cardiology, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Meilahti Tower Hospital, PL 340, 00029 HUS Helsinki, Finland
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19
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Arceluz MR, Liuba I, Tschabrunn CM, Frankel DS, Santangeli P, Supple GE, Schaller RD, Garcia FC, Callans DJ, Guandalini GS, Walsh K, Nazarian S, Zado ES, Marchlinski FE. Sinus rhythm QRS amplitude and fractionation in patients with nonischemic cardiomyopathy to identify ventricular tachycardia substrate and location. Heart Rhythm 2021; 19:187-194. [PMID: 34601127 DOI: 10.1016/j.hrthm.2021.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ventricular tachycardia (VT) substrate in left ventricular (LV) nonischemic cardiomyopathy (NICM) consists of fibrosis with surviving myocardium. OBJECTIVE The purpose of this study was to determine whether, in patients with LV NICM and sustained VT, reduced QRS amplitude and QRSf during sinus rhythm can identify the presence and location of abnormal septal (S-NICM) and/or free-wall (FW-NICM) VT substrate. METHODS We compared patients with NICM and VT (group 1) with electroanatomic mapping septal (S-NICM; n = 21) or free-wall (FW-NICM; n = 20) VT substrate to a 38-patient reference cohort (group 2) with cardiac magnetic resonance imaging (cMRI) and NICM but no VT referred for primary prevention implantable cardioverter-defibrillator (26 [68.4%] with late gadolinium enhancement). RESULTS Group 1 had lower QRS amplitude in leads II (0.60 ± 0.22 vs 0.86 ± 0.35, P <.001), aVR (0.60 ± 0.24 vs 0.75 ± 0.31, P = .002), aVF (0.48 ± 0.20 vs 0.70 ± 0.28, P <.001), and V2 (1.09 ± 0.52 vs 1.38 ± 0.55, P = .001) than group 2. QRS <0.55 mV in lead aVF identified VT and accompanying substrate with sensitivity 70% and specificity 71%. Most group 1 and group 2 patients had 12-lead ECG QRS fractionation (QRSf) in ≥2 contiguous leads (78% vs 63.2%, P = .14). Sensitivity and specificity for ≥2 QRSf leads identifying respective regional electroanatomic or cMRI abnormalities were 76% and 50% for inferior, 44% and 87% for lateral, and 21% and 89% for anterior leads. CONCLUSION In LV NICM, low frontal plane QRS (<0.55 mV in aVF) is associated with VT substrate. Although multilead QRS fractionation is associated with the presence and location of VT substrate, it is frequently identified in patients without VT with cMRI abnormalities.
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Affiliation(s)
- Martín R Arceluz
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ioan Liuba
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cory M Tschabrunn
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David S Frankel
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Pasquale Santangeli
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gregory E Supple
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert D Schaller
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fermin C Garcia
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David J Callans
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Katie Walsh
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Saman Nazarian
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica S Zado
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Francis E Marchlinski
- Section of Cardiac Electrophysiology, Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
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20
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Noordman ABP, Maass AH, Groenveld H, Mulder BA, Rienstra M, Blaauw Y. Myocardial Scar Characterization and Future Ventricular Arrhythmia in Patients With Ischemic Cardiomyopathy and an Implantable Cardioverter-Defibrillator. Front Cardiovasc Med 2021; 8:708406. [PMID: 34485409 PMCID: PMC8415981 DOI: 10.3389/fcvm.2021.708406] [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: 05/11/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Implantable cardioverter-defibrillator (ICD) therapy is associated with several deleterious effects, which can be reduced by antiarrhythmic drugs or catheter ablation. However, it is largely unknown which patients might benefit from these therapies. Therefore, this study aimed to investigate whether myocardial scar characterization improves risk stratification for ventricular arrhythmia (VA) occurrence in patients with ischemic cardiomyopathy and an ICD. Methods: In this study, 82 patients with ischemic cardiomyopathy who received an ICD were enrolled retrospectively. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) images were analyzed using an investigational software tool to obtain quantitative data regarding the total scar, core, and border zone (BZ). Data regarding the QRS complex was obtained from electrocardiography (ECG). The primary endpoint was appropriate ICD therapy. Results: During a median follow-up duration of 3.98 years [interquartile range (IQR) 2.89–5.14 years], appropriate therapy occurred in 24 (29.3%) patients. Patients with appropriate ICD therapy had a significantly larger total scar mass [60.0 (IQR 41.2–73.4) vs. 43.3 (IQR 31.2–61.2) g; P = 0.009] and BZ mass [32.9 (IQR 26.9–42.4) vs. 24.5 (IQR 18.8–32.5) g; P = 0.001] than those without appropriate therapy. In multivariable Cox regression analyses, total scar mass [hazard ratio (HR) 1.02 [95% confidence interval (CI) 1.00–1.04]; P = 0.014] and BZ mass (HR 1.04 [95% CI 1.01–1.07]; P = 0.009) independently predicted appropriate ICD therapy. Core mass and the QRS complex, however, were not significantly associated with the primary endpoint. Conclusion: LGE-CMR-based, but not ECG-based myocardial scar characterization improves risk stratification for VA occurrence in patients with ischemic cardiomyopathy who received an ICD.
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Affiliation(s)
- Alwin B P Noordman
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Alexander H Maass
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Hessel Groenveld
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Bart A Mulder
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Heart Center, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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21
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Ge H, Liu G, Yamawaki TM, Tao C, Alexander ST, Ly K, Fordstrom P, Shkumatov AA, Li CM, Rajamani S, Zhou M, Ason B. Phytosterol accumulation results in ventricular arrhythmia, impaired cardiac function and death in mice. Sci Rep 2021; 11:17449. [PMID: 34465831 PMCID: PMC8408133 DOI: 10.1038/s41598-021-96936-x] [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: 04/28/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Heart failure (HF) and cardiac arrhythmias share overlapping pathological mechanisms that act cooperatively to accelerate disease pathogenesis. Cardiac fibrosis is associated with both pathological conditions. Our previous work identified a link between phytosterol accumulation and cardiac injury in a mouse model of phytosterolemia, a rare disorder characterized by elevated circulating phytosterols and increased cardiovascular disease risk. Here, we uncover a previously unknown pathological link between phytosterols and cardiac arrhythmias in the same animal model. Phytosterolemia resulted in inflammatory pathway induction, premature ventricular contractions (PVC) and ventricular tachycardia (VT). Blockade of phytosterol absorption either by therapeutic inhibition or by genetic inactivation of NPC1L1 prevented the induction of inflammation and arrhythmogenesis. Inhibition of phytosterol absorption reduced inflammation and cardiac fibrosis, improved cardiac function, reduced the incidence of arrhythmias and increased survival in a mouse model of phytosterolemia. Collectively, this work identified a pathological mechanism whereby elevated phytosterols result in inflammation and cardiac fibrosis leading to impaired cardiac function, arrhythmias and sudden death. These comorbidities provide insight into the underlying pathophysiological mechanism for phytosterolemia-associated risk of sudden cardiac death.
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Affiliation(s)
- Hongfei Ge
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Gongxin Liu
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Tracy M Yamawaki
- Genomic Analysis Unit, Amgen Research, South San Francisco, CA, USA
| | - Caroline Tao
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Shawn T Alexander
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Kimberly Ly
- Translational Safety and Bioanalytical Sciences, Amgen Research, South San Francisco, CA, USA
| | - Preston Fordstrom
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Artem A Shkumatov
- Translational Safety and Bioanalytical Sciences, Amgen Research, South San Francisco, CA, USA
| | - Chi-Ming Li
- Genomic Analysis Unit, Amgen Research, South San Francisco, CA, USA
| | - Sridharan Rajamani
- Translational Safety and Bioanalytical Sciences, Amgen Research, South San Francisco, CA, USA
| | - Mingyue Zhou
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA
| | - Brandon Ason
- Cardiometabolic Disorders Therapeutic Area, Amgen Research, Amgen, Inc, 1120 Veterans Blvd, South San Francisco, CA, 94080, USA.
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22
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Shao Q, Huang Y, Zhang C, Gao X, Gao S. Emerging landscape of circHIPK3 and its role in cancer and other diseases (Review). Mol Med Rep 2021; 23:409. [PMID: 33786629 PMCID: PMC8025471 DOI: 10.3892/mmr.2021.12048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 02/19/2021] [Indexed: 12/25/2022] Open
Abstract
Circular RNAs (circRNAs) are a special class of recently re‑discovered RNAs, which are covalently closed ring RNA molecules. circRNAs have been reported to possess multiple functions and are considered crucial regulators of several processes, and are therefore gaining increasing attention. In recent years, increasing evidence has shown that circRNAs are implicated in several crucial biological processes via regulation of gene expression, and their dysregulation is also associated with the development of numerous diseases, particularly acting as oncogenic or tumor‑suppressor molecules in cancer. Furthermore, circRNAs are involved in cell proliferation, differentiation, apoptosis, invasion and metastasis. In the present review, the biogenesis and functions of circRNAs are described, with a focus on the most recent research advances and the emerging roles of circular homeodomain‑interacting protein kinase 3 (circHIPK3) in human diseases. The present review may provide novel avenues for research on the roles of circHIPK3 as a clinical diagnostic and prognostic biomarker, as well as highlighting promising therapeutic targets for certain diseases and cancer.
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Affiliation(s)
- Qi Shao
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471023, P.R. China
| | - Yong Huang
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471023, P.R. China
| | - Cai Zhang
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471023, P.R. China
| | - Xiaochan Gao
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471023, P.R. China
| | - Shiyang Gao
- College of Animal Science and Technology, Henan University of Science and Technology, Luoyang, Henan 471023, P.R. China
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23
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Akyüz AR, Şahin S, Çırakoğlu ÖF, Kul S, Turan T, Erkan H. Relation between fragmented QRS complex and cardio-ankle vascular index in asymptomatic subjects. Clin Exp Hypertens 2021; 43:368-372. [PMID: 33626982 DOI: 10.1080/10641963.2021.1890764] [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: 10/22/2022]
Abstract
OBJECTIVES Stiffness of large arteries has been related to cardiovascular mortality. Cardio-ankle vascular index (CAVI) is a novel marker of arterial stiffness. Herein, we aimed to study the relationship between fragmented QRS (fQRS) in electrocardiogram and CAVI. METHODS Asymptomatic patients with fQRS and without fQRS were enrolled in the study consecutively. The fQRS complexes were analyzed in the 12-lead electrocardiogram. Arterial stiffness was assessed by using cardio ankle vascular index (CAVI). It was measured by a VaSera VS-1000 CAVI instrument. RESULTS CAVI values of the patients with fQRS was significantly higher compared to those without fQRS (8.625 (7.9-9.2) versus 6.65 (6.7-8.4) p < .001). In a univariate analysis, it was revealed that there was a significant correlation between increased CAVI and fQRS, age, and epicardial fat thickness. Multiple binary logistic regression analysis revealed that age [95% confidence interval (CI): 1,068-1.214, p < .001] and fQRS [95% (CI): 1.766-23.117, p: 0.005] were the independent determinants of increased CAVI values. CONCLUSIONS ECG is a widely and readily available, inexpensive, reproducible technique that can be examined by almost every physician. fQRS values in electrocardiogram may provide a significant predictive value for arterial stiffness in asymptomatic subjects.
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Affiliation(s)
- Ali Rıza Akyüz
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Sinan Şahin
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ömer Faruk Çırakoğlu
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Selim Kul
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
| | - Hakan Erkan
- Department of Cardiology, University of Health Sciences, Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Trabzon, Turkey
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24
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Aro AL. Will electrocardiographic detection of myocardial fibrosis work? Heart 2020; 106:958-959. [PMID: 32229506 DOI: 10.1136/heartjnl-2020-316646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Aapo L Aro
- Heart and Lung Center, Helsinki University Hospital, Helsinki 00290, Finland
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