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Mascarenhas L, Downey M, Schwartz G, Adabag S. Antiarrhythmic effects of metformin. Heart Rhythm O2 2024; 5:310-320. [PMID: 38840768 PMCID: PMC11148504 DOI: 10.1016/j.hroo.2024.04.003] [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: 06/07/2024] Open
Abstract
Atrial fibrillation/flutter (AF) is a major public health problem and is associated with stroke, heart failure, dementia, and death. It is estimated that 20%-30% of Americans will develop AF at some point in their life. Current medications to prevent AF have limited efficacy and significant adverse effects. Newer and safer therapies to prevent AF are needed. Ventricular arrhythmias are less prevalent than AF but may have significant consequences including sudden cardiac death. Metformin is the most prescribed, first-line medication for treatment of diabetes mellitus (DM). It decreases hepatic glucose production but also reduces inflammation and oxidative stress. Experimental studies have shown that metformin improves metabolic, electrical, and histologic risk factors associated with AF and ventricular arrhythmias. Furthermore, in large clinical observational studies, metformin has been associated with a reduced risk of AF in people with DM. These data suggest that metformin may have antiarrhythmic properties and may be a candidate to be repurposed as a medication to prevent cardiac arrhythmias. In this article, we review the clinical observational and experimental evidence for the association between metformin and cardiac arrhythmias. We also discuss the potential antiarrhythmic mechanisms underlying this association. Repurposing a well-tolerated, safe, and inexpensive medication to prevent cardiac arrhythmias has significant positive public health implications.
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Affiliation(s)
- Lorraine Mascarenhas
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Michael Downey
- Department of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Gregory Schwartz
- Cardiology Section, Rocky Mountain Regional VA Medical Center and University of Colorado School of Medicine, Aurora, Colorado
| | - Selcuk Adabag
- Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Department of Cardiology, Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota
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Loureiro Fialho G, Miotto R, Tatsch Cavagnollo M, Murilo Melo H, Wolf P, Walz R, Lin K. The epileptic heart: Cardiac comorbidities and complications of epilepsy. Atrial and ventricular structure and function by echocardiography in individuals with epilepsy - From clinical implications to individualized assessment. Epilepsy Behav Rep 2024; 26:100668. [PMID: 38699061 PMCID: PMC11063386 DOI: 10.1016/j.ebr.2024.100668] [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: 03/06/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/05/2024] Open
Abstract
Epilepsy is an increasing global neurological health issue. Recently, epidemiological and mechanistic studies have raised concern about cardiac involvement in individuals with epilepsy. This has resulted in the "epileptic heart" concept. Epidemiological data linking epilepsy to cardiovascular disease indicate an increased risk for ventricular and atrial arrhythmias, myocardial infarction, heart failure, and sudden death among individuals with epilepsy. Pathways of this interaction comprise increased prevalence of traditional cardiac risk factors, genetic abnormalities, altered brain circuitry with autonomic imbalance, and antiseizure medications with enzyme-inducing and ionic channel-blocking proprieties. Pathophysiological findings in the atria and ventricles of patients with epilepsy are discussed. Echocardiographic findings and future applications of this tool are reviewed. A risk stratification model and future studies on cardiac risk assessment in individuals with epilepsy are proposed.
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Affiliation(s)
- Guilherme Loureiro Fialho
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Ramsés Miotto
- Cardiology Division, Department of Internal Medicine, University Hospital (HU) Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Márcia Tatsch Cavagnollo
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Hiago Murilo Melo
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Peter Wolf
- Danish Epilepsy Centre, Dianalund, Denmark
| | - Roger Walz
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
| | - Katia Lin
- Postgraduate Program in Medical Sciences, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Applied Neuroscience, University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Neurology Division, Department of Internal Medicine, University Hospital, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
- Center for Epilepsy Surgery of Santa Catarina (CEPESC), University Hospital (HU), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil
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Li Y, Liu Z, Liu T, Li J, Mei Z, Fan H, Cao C. Risk Prediction for Sudden Cardiac Death in the General Population: A Systematic Review and Meta-Analysis. Int J Public Health 2024; 69:1606913. [PMID: 38572495 PMCID: PMC10988292 DOI: 10.3389/ijph.2024.1606913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/01/2024] [Indexed: 04/05/2024] Open
Abstract
Objective: Identification of SCD risk is important in the general population from a public health perspective. The objective is to summarize and appraise the available prediction models for the risk of SCD among the general population. Methods: Data were obtained searching six electronic databases and reporting prediction models of SCD risk in the general population. Studies with duplicate cohorts and missing information were excluded from the meta-analysis. Results: Out of 8,407 studies identified, fifteen studies were included in the systematic review, while five studies were included in the meta-analysis. The Cox proportional hazards model was used in thirteen studies (96.67%). Study locations were limited to Europe and the United States. Our pooled meta-analyses included four predictors: diabetes mellitus (ES = 2.69, 95%CI: 1.93, 3.76), QRS duration (ES = 1.16, 95%CI: 1.06, 1.26), spatial QRS-T angle (ES = 1.46, 95%CI: 1.27, 1.69) and factional shortening (ES = 1.37, 95%CI: 1.15, 1.64). Conclusion: Risk prediction model may be useful as an adjunct for risk stratification strategies for SCD in the general population. Further studies among people except for white participants and more accessible factors are necessary to explore.
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Affiliation(s)
- Yue Li
- College of Management and Economics, Tianjin University, Tianjin, China
| | - Zhengkun Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Tao Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Ji Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Zihan Mei
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Chunxia Cao
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
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Adabag S, Gravely A, Kattel S, Buelt-Gebhardt M, Westanmo A. QT prolongation predicts all-cause mortality above and beyond a validated risk score. J Electrocardiol 2024; 83:1-3. [PMID: 38160528 DOI: 10.1016/j.jelectrocard.2023.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/12/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION QT prolongation is a risk factor for life-threatening arrhythmias and sudden cardiac death. In large cohorts, QT interval was associated with all-cause mortality, but these analyses may contain residual confounding. Whether the QT interval provides prognostic information above and beyond a validated mortality risk score is unknown. We hypothesized that QT interval on ECG will independently predict mortality after adjustment for the Care Assessment Needs (CAN) score, which was validated to predict mortality nationwide at the Veterans Administration (VA) (c-index 0.86). METHODS Outpatients with an ECG at the Minneapolis VA from 2012 to 2016 were included in this retrospective cohort study. ECGs with ventricular rate < 50 or > 100 beats/min and those with QRS > 120 ms were excluded. QT intervals were corrected (QTc) using the Bazett's formula. CAN score, calculated within 1-week of the ECG, was obtained from the VA Corporate Data Warehouse. RESULTS Of the 31,201 patients, 427 (1.4%) had QTc ≥ 500 ms, 1799 (5.8%) had QTc 470-500 ms and 28,975 (92.9%) had QTc < 470 ms. Compared to those with QTc < 470 ms, CAN-adjusted odds ratios (OR) for 1-year mortality (1.76 for QTc 470-500 and 2.70 for QTc > 500 ms; p < 0.0001 for both) and for 5-year mortality (1.75 for QTc 470-500 and 2.48 for QTc > 500 ms; p < 0.0001 for both) were significantly higher in those with longer QTc. C-index for CAN score and QTc predicting 1-year mortality was 0.837. CONCLUSIONS QT prolongation predicts all-cause mortality independently of a validated mortality risk prediction score.
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Affiliation(s)
- Selçuk Adabag
- Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America.
| | - Amy Gravely
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Sharma Kattel
- Division of Cardiology, Minneapolis VA Health Care System, Minneapolis, MN, United States of America; Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, United States of America
| | - Melissa Buelt-Gebhardt
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
| | - Anders Westanmo
- Research Service, Minneapolis VA Health Care System, Minneapolis, MN, United States of America
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Westaby J. Society for Cardiovascular Pathology Journal Club: Obesity-related heart disease. Cardiovasc Pathol 2024; 68:107582. [PMID: 37844675 DOI: 10.1016/j.carpath.2023.107582] [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: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Affiliation(s)
- Joseph Westaby
- CRY Centre for Cardiovascular Pathology, Cardiovascular Clinical Academic Group and Cardiology Research Section, Molecular and Clinical Sciences Research Institute, St. George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
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Ardissino M, Patel KHK, Rayes B, Reddy RK, Mellor GJ, Ng FS. Multiple anthropometric measures and proarrhythmic 12-lead ECG indices: A mendelian randomization study. PLoS Med 2023; 20:e1004275. [PMID: 37552661 PMCID: PMC10443852 DOI: 10.1371/journal.pmed.1004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 08/22/2023] [Accepted: 07/10/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Observational studies suggest that electrocardiogram (ECG) indices might be influenced by obesity and other anthropometric measures, though it is difficult to infer causal relationships based on observational data due to risk of residual confounding. We utilized mendelian randomization (MR) to explore causal relevance of multiple anthropometric measures on P-wave duration (PWD), PR interval, QRS duration, and corrected QT interval (QTc). METHODS AND FINDINGS Uncorrelated (r2 < 0.001) genome-wide significant (p < 5 × 10-8) single nucleotide polymorphisms (SNPs) were extracted from genome-wide association studies (GWAS) on body mass index (BMI, n = 806,834), waist:hip ratio adjusted for BMI (aWHR, n = 697,734), height (n = 709,594), weight (n = 360,116), fat mass (n = 354,224), and fat-free mass (n = 354,808). Genetic association estimates for the outcomes were extracted from GWAS on PR interval and QRS duration (n = 180,574), PWD (n = 44,456), and QTc (n = 84,630). Data source GWAS studies were performed between 2018 and 2022 in predominantly European ancestry individuals. Inverse-variance weighted MR was used for primary analysis; weighted median MR and MR-Egger were used as sensitivity analyses. Higher genetically predicted BMI was associated with longer PWD (β 5.58; 95%CI [3.66,7.50]; p = < 0.001), as was higher fat mass (β 6.62; 95%CI [4.63,8.62]; p < 0.001), fat-free mass (β 9.16; 95%CI [6.85,11.47]; p < 0.001) height (β 4.23; 95%CI [3.16, 5.31]; p < 0.001), and weight (β 8.08; 95%CI [6.19,9.96]; p < 0.001). Finally, genetically predicted BMI was associated with longer QTc (β 3.53; 95%CI [2.63,4.43]; p < 0.001), driven by both fat mass (β 3.65; 95%CI [2.73,4.57]; p < 0.001) and fat-free mass (β 2.08; 95%CI [0.85,3.31]; p = 0.001). Additionally, genetically predicted height (β 0.98; 95%CI [0.46,1.50]; p < 0.001), weight (β 3.45; 95%CI [2.54,4.36]; p < 0.001), and aWHR (β 1.92; 95%CI [0.87,2.97]; p = < 0.001) were all associated with longer QTc. The key limitation is that due to insufficient power, we were not able to explore whether a single anthropometric measure is the primary driver of the associations observed. CONCLUSIONS The results of this study support a causal role of BMI on multiple ECG indices that have previously been associated with atrial and ventricular arrhythmic risk. Importantly, the results identify a role of both fat mass, fat-free mass, and height in this association.
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Affiliation(s)
- Maddalena Ardissino
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | | | - Bilal Rayes
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Rohin K. Reddy
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Greg J. Mellor
- Royal Papworth Hospital, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
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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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Goel H, Shah K, Kothari J, Daly T, Saraiya P, Taha I, Le M, Shirani J. Premorbid echocardiography and risk of hospitalization in COVID-19. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1733-1739. [PMID: 37726514 PMCID: PMC8982906 DOI: 10.1007/s10554-022-02565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 has caused a global pandemic unprecedented in a century. Though primarily a respiratory illness, cardiovascular risk factors predict adverse outcomes. We aimed to investigate the role of baseline echocardiographic abnormalities in further refining risk in addition to clinical risk factors. METHODS Adults with COVID-19 positive RT-PCR test across St Luke's University Health Network between March 1st 2020-October 31st 2020 were identified. Those with trans-thoracic echocardiography (TTE) within 15-180 days preceding COVID-19 positivity were selected, excluding severe valvular disease, acute cardiac event between TTE and COVID-19, or asymptomatic patients positive on screening. Demographic, clinical, and echocardiographic variables were manually extracted from patients' EHR and compared between groups stratified by disease severity. Logistic regression was used to identify independent predictors of hospitalization. RESULTS 192 patients met inclusion criteria. 87 (45.3%) required hospitalization, 34 (17.7%) suffered severe disease (need for ICU care/mechanical ventilation/in-hospital death). Age, co-morbidities, and several echocardiographic abnormalities were more prevalent in those with moderate-severe disease than in mild disease, with notable exceptions of systolic/diastolic dysfunction. On multivariate analysis, age (OR 1.039, 95% CI 1.011-1.067), coronary artery disease (OR 4.184, 95% CI 1.451-12.063), COPD (OR 6.886, 95% CI 1.396-33.959) and left atrial diameter ≥ 4.0 cm (OR 2.379, 95% CI 1.031-5.493) predicted need for hospitalization. Model showed excellent discrimination (ROC AUC 0.809, 95% CI 0.746-0.873). CONCLUSIONS Baseline left atrial enlargement is an independent risk factor for risk of hospitalization among patients with COVID-19. When available, baseline LA enlargement may identify patients for (1) closer outpatient follow up, and (2) counseling vaccine-hesitancy.
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Affiliation(s)
- Harsh Goel
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA, 19140
| | - Kashyap Shah
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015.
| | - Janish Kothari
- Division of Cardiovascular Medicine, St. Luke's University Hospital, Bethlehem, PA, USA, 18015
| | - Timothy Daly
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015
| | - Pooja Saraiya
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015
| | - Israa Taha
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015
| | - Marjolein Le
- Department of Medicine, St. Luke's University Hospital, 801 Ostrum Street, Bethlehem, PA, USA, 18015
| | - Jamshid Shirani
- Division of Cardiovascular Medicine, St. Luke's University Hospital, Bethlehem, PA, USA, 18015
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA, 19140
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Wu SJ, Hsieh YC. Sudden cardiac death in heart failure with preserved ejection fraction: an updated review. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-021-00059-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
AbstractDespite the advances in medical and device therapies for heart failure (HF), sudden cardiac death (SCD) remains a tremendous global burden in patients with HF. Among the risk factors for SCD, HF has the greatest impact. Previous studies focusing on patients with systolic dysfunction have found several predictive factors associated with SCD, leading to the subsequent development of strategies of primary prevention, like placement of implantable cardioverter-defibrillator (ICD) in high-risk patients. Although patients with HF with preserved ejection fraction (HFpEF) were less prone to SCD compared to patients with HF with reduced ejection fraction (HFrEF), patients with HFpEF did account for a significant proportion of all HF patients who encountered SCD. The cutoff value of left ventricular ejection fraction (LVEF) to define the subset of HF did not reach consensus until 2016 when the European Society of Cardiology proposed a new classification system by LVEF. There is a great unmet need in the field of SCD in HFpEF regarding risk stratification and appropriate device therapy with ICD implantation. In this article, we will approach SCD in HFpEF from HFrEF subsets. We also aim at clarifying the mechanisms, risk factors, and prevention of SCD in HFpEF.
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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Ibrahim SH, Bilchick KC, Miller MS, Blazek OJ, Strickling JE, Elumogo C, Wharton RC, Patel P, Ondigi O, Brady WJ, Kwon Y, Mazimba S. Increased left and right atrial volume indices are associated with decreased survival times post-cardiac arrest. Resuscitation 2021; 170:306-313. [PMID: 34695443 DOI: 10.1016/j.resuscitation.2021.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/14/2021] [Accepted: 10/13/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left and right atrial volume indices (LAVI and RAVI) are markers of cardiac remodeling. LAVI and RAVI are associated with worse outcomes in other cardiac conditions. This study aimed to determine the associations of these atrial volume indices with survival time post-cardiac arrest. METHODS This was a single center, retrospective study of patients with a sudden cardiac arrest event during index hospitalization from 2014-2018 based on pre-arrest parameters. The analysis was stratified based on whether a pulseless ventricular tachycardia/ventricular fibrillation (pVT/VF) event or a pulseless electrical activity (PEA)/asystole event occurred. Cox proportional hazards regression and model selection with best subsets approach evaluated the association of atrial volume parameters with survival times in the context of other covariates. RESULTS Of 305 patients studied (64 ± 14 years, 37% female), the mean LAVI was 34.0 ± 15.8 mL/m2 (based on 162 reliable measurements), and mean RAVI was 25.0 ± 15.6 mL/m2 (based on 163 measurements). Increased atrial volume indices were most strongly associated with survival in patients who had sustained pVT/VF (LAVI HR 0.47, 95% CI 0.25-0.90, p = 0.020; RAVI HR 0.57, 95% CI 0.30-1.05, p = 0.074). In multivariable best subsets Cox regression with LAVI, RAVI, and 13 other scaled covariates, LAVI < 34 ml/m2 was by far the best single predictor of survival (p < 0.0001), and the next best predictor was the absence of pulmonary hypertension. CONCLUSION Among patients with cardiac arrest from ventricular arrhythmias, those with no more than mild left atrial enlargement pre-arrest by LAVI measurement had the best prognosis. Additional studies are indicated to validate the importance of this finding for clinical management decisions. CONDENSED ABSTRACT In patients with sudden cardiac arrest associated with ventricular arrhythmias, a left atrial volume index (LAVI) < 34 mL/m2 prior to the arrest had the strongest association with survival among fifteen candidate predictors. Pulmonary hypertension was more common in patients with an elevated right atrial volume index (RAVI), and the absence of pulmonary hypertension was the next best pre-arrest parameter predictive of survival. Larger studies are indicated to validate the use of LAVI for clinical management decisions in this condition.
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Affiliation(s)
- Sami H Ibrahim
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Matthew S Miller
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Olivia J Blazek
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Jarred E Strickling
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Comfort Elumogo
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Robert C Wharton
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Paras Patel
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Olivia Ondigi
- Department of Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - William J Brady
- Department of Emergency Medicine, University of Virginia Health System, Charlottesville, VA, United States.
| | - Younghoon Kwon
- Division of Cardiovascular Medicine, University of Washington, Seattle, WA, United States.
| | - Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, United States.
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12
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Giamouzis G, Dimos A, Xanthopoulos A, Skoularigis J, Triposkiadis F. Left ventricular hypertrophy and sudden cardiac death. Heart Fail Rev 2021; 27:711-724. [PMID: 34184173 DOI: 10.1007/s10741-021-10134-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 12/31/2022]
Abstract
Sudden cardiac death (SCD) is among the leading causes of death worldwide, and it remains a public health problem, as it involves young subjects. Current guideline-directed risk stratification for primary prevention is largely based on left ventricular (LV) ejection fraction (LVEF), and preventive strategies such as implantation of a cardiac defibrillator (ICD) are justified only for documented low LVEF (i.e., ≤ 35%). Unfortunately, only a small percentage of primary prevention ICDs, implanted on the basis of a low LVEF, will deliver life-saving therapies on an annual basis. On the other hand, the vast majority of patients that experience SCD have LVEF > 35%, which is clamoring for better understanding of the underlying mechanisms. It is mandatory that additional variables be considered, both independently and in combination with the EF, to improve SCD risk prediction. LV hypertrophy (LVH) is a strong independent risk factor for SCD regardless of the etiology and the severity of symptoms. Concentric and eccentric LV hypertrophy, and even earlier concentric remodeling without hypertrophy, are all associated with increased risk of SCD. In this paper, we summarize the physiology and physiopathology of LVH, review the epidemiological evidence supporting the association between LVH and SCD, briefly discuss the mechanisms linking LVH with SCD, and emphasize the need to evaluate LV geometry as a potential risk stratification tool regardless of the LVEF.
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Affiliation(s)
- Grigorios Giamouzis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Apostolos Dimos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - Andrew Xanthopoulos
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece
| | - John Skoularigis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece.,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, University General Hospital of Larissa, Larissa, Greece. .,Department of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
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13
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Prognostic Significance of Echocardiographic Measures of Cardiac Remodeling in the Community. Curr Cardiol Rep 2021; 23:86. [PMID: 34081212 DOI: 10.1007/s11886-021-01512-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW Echocardiography is a noninvasive tool of choice for evaluating cardiac structure and function in numerous cardiac conditions ranging from congenital heart disease, myocardial diseases, coronary artery disease (CAD), valvulopathies, arrhythmias, and pericardial disorders. We review the prognostic significance of echocardiographic indices of cardiac remodeling in the general population. RECENT FINDINGS Recent meta-analyses have confirmed the prognostic significance of echocardiographic measurements (left ventricular mass/hypertrophy, systolic and diastolic dysfunction, left atrial dimensions and function, and strain rate measures) in asymptomatic people in the community for adverse clinical outcomes including CAD, stroke, heart failure, atrial fibrillation, sudden death, and all-cause mortality. The clinical utility of screening echocardiography has been examined comprehensively in hypertensive patients, where it is challenged by measurement variability. Echocardiographic measures predict cardiovascular disease outcomes consistently in multiple community-based epidemiological studies. However, the clinical utility of screening asymptomatic individuals with echocardiography in population-based settings is limited.
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14
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Fialho GL, Wolf P, Walz R, Lin K. Echocardiography in epilepsy: A tool to be explored. Epilepsia 2021; 62:1285-1286. [PMID: 33755989 DOI: 10.1111/epi.16879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Guilherme L Fialho
- Cardiology Division, Federal University of Santa Catarina, Florianópolis, Brazil.,Medical Sciences Postgraduate Program, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Peter Wolf
- Medical Sciences Postgraduate Program, Federal University of Santa Catarina, Florianópolis, Brazil.,Neurology Division, Federal University of Santa Catarina, Florianópolis, Brazil.,Danish Epilepsy Center, Dianalund, Denmark
| | - Roger Walz
- Medical Sciences Postgraduate Program, Federal University of Santa Catarina, Florianópolis, Brazil.,Neurology Division, Federal University of Santa Catarina, Florianópolis, Brazil.,Center for Applied Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
| | - Katia Lin
- Medical Sciences Postgraduate Program, Federal University of Santa Catarina, Florianópolis, Brazil.,Neurology Division, Federal University of Santa Catarina, Florianópolis, Brazil.,Center for Applied Neurosciences, Federal University of Santa Catarina, Florianópolis, Brazil
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15
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Scott Binder M, Roda RH, Corse AM, Sidhu S, Stewart S, Barth AS. Prevalence of heart disease in patients with mitochondrial abnormalities on skeletal muscle biopsy. Ann Clin Transl Neurol 2021; 8:825-830. [PMID: 33638621 PMCID: PMC8045917 DOI: 10.1002/acn3.51327] [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: 11/24/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Mitochondrial DNA mutations are associated with an increased risk of heart disease. Whether an increased prevalence of cardiovascular disease is present in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy remains unknown. This study was designed to determine the prevalence of cardiac conduction disease and structural heart disease in patients presenting with mitochondrial abnormalities on skeletal muscle biopsy. Methods This is a retrospective cohort study of 103 patients with mitochondrial abnormalities on skeletal muscle biopsy who were referred for evaluation of muscle weakness at a single tertiary care referral center from 2012 to 2018. Of these patients, 59 (57.3%) had an electrocardiogram available and were evaluated for the presence of conduction disease. An echocardiogram was available in 43 patients (42%) who were evaluated for the presence of structural heart disease. The prevalence of cardiac disease was compared to control cohort populations (Framingham and the Atherosclerosis Risk in Communities, ARIC cohorts). Results Mitochondrial abnormalities associated with cardiac conduction disease (defined as QRS duration ≥ 120 msec) were present in 8.9%, versus 2.0% (p < 0.001) in the Framingham population and 2.6% (p = 0.003) in the ARIC cohort. LV systolic dysfunction (LVEF ≤ 50%) was present in 11.6%, versus 3.6% (p < 0.01) in the Framingham and 3% (p < 0.01) in the ARIC populations. Left ventricular hypertrophy was present in 28.6%, versus 13.6% (p < 0.02) in the Framingham and 10.4% (p < 0.001) in the ARIC populations. Interpretation Given the increased prevalence of cardiovascular disease, patients with mitochondrial abnormalities on skeletal muscle biopsy should undergo routine cardiac screening with physical exam, electrocardiography, and cardiac imaging.
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Affiliation(s)
- M Scott Binder
- Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Ricardo H Roda
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrea M Corse
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sunjeet Sidhu
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sarah Stewart
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andreas S Barth
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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16
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Short stature is associated with incident sudden cardiac death in a large Asian cohort. Heart Rhythm 2020; 17:931-936. [DOI: 10.1016/j.hrthm.2020.01.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 01/24/2020] [Indexed: 12/28/2022]
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17
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Cavalcanti LRP, Sá MPBO, Perazzo ÁM, Escorel Neto AC, Gomes RAF, Weymann A, Zhigalov K, Ruhparwar A, Lima RC. Mitral Annular Calcification: Association with Atherosclerosis and Clinical Implications. Curr Atheroscler Rep 2020; 22:9. [PMID: 32034516 DOI: 10.1007/s11883-020-0825-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the pathophysiology of mitral annular calcification (MAC) with recent findings and current strategies for diagnosis and treatment. RECENT FINDINGS Major factors in MAC development seem to be shear stress of the flow past the mitral valve, local inflammation, and dysregulation in regulators of mineral metabolism. MAC itself poses daunting technical challenges. Implanting a valve on top of the calcium bar might lead to paravalvular leak (PVL) that is less likely to heal. Annular decalcification allows for better valve seating and potentially better healing and less PVL. This, however, comes with the risk for catastrophic atrioventricular groove disruption. MAC can be sharply dissected with the scalpel; the annulus can be reconstructed with the autologous pericardium. Transcatheter mitral valve replacement is a promising approach in the treatment of patients who are deemed high-risk surgical candidates with severe MAC. MAC is a multifactorial disease that has some commonalities with atherosclerosis, mainly regarding lipid accumulation and calcium deposition. It is of great clinical importance, being a risk marker of cardiovascular events (including sudden death) and, with its progression, can have a negative impact on patients' lives.
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Affiliation(s)
- Luiz Rafael P Cavalcanti
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil. .,University of Pernambuco - UPE, Recife, Brazil. .,, Recife, Brazil.
| | - Michel Pompeu B O Sá
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.,University of Pernambuco - UPE, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Brazil
| | - Álvaro M Perazzo
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.,University of Pernambuco - UPE, Recife, Brazil
| | - Antonio C Escorel Neto
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.,University of Pernambuco - UPE, Recife, Brazil
| | - Rafael A F Gomes
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.,University of Pernambuco - UPE, Recife, Brazil.,Nucleus of Postgraduate and Research in Health Sciences of Faculty of Medical Sciences and Biological Sciences Institute - FCM/ICB, Recife, Brazil
| | - Alexander Weymann
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Konstantin Zhigalov
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center Essen, University Hospital of Essen, University Duisburg-Essen, Essen, Germany
| | - Ricardo C Lima
- Division of Cardiovascular Surgery, Pronto Socorro Cardiológico de Pernambuco - PROCAPE, Recife, Brazil.,University of Pernambuco - UPE, Recife, Brazil
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18
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Joodi G, Maradey JA, Bogle B, Mirzaei M, Sadaf MI, Pursell I, Henderson C, Mounsey JP, Simpson RJ. Coronary Artery Disease and Atherosclerotic Risk Factors in a Population-Based Study of Sudden Death. J Gen Intern Med 2020; 35:531-537. [PMID: 31808130 PMCID: PMC7018927 DOI: 10.1007/s11606-019-05486-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 09/23/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden death is a public health problem with major impact on society. Coronary artery disease (CAD) is believed to underlie 60-80% of these deaths. While deaths from CAD have decreased in the recent decades, sudden death rates remain unacceptably high. OBJECTIVE We aimed to assess the prevalence of CAD and its risk factors among 18-64-year-old adults in a population-based case registry of sudden deaths and compare them to a living population from the same geographical area. DESIGN From 2013 to 2015, all sudden deaths among 18-64-year-old adults in Wake County, NC, were identified (n = 371). A comparison group was formed by randomly selecting individuals from an electronic health record repository of a major healthcare system in the area (N = 4218). MAIN MEASURES Prevalence of CAD and its risk factors among cases of sudden death and living population across sex and age groups. Odds of sudden death associated with atherosclerotic risk factors and comorbidities. KEY RESULTS CAD was present in 14.8% of sudden death cases. Among sudden death victims, most risk factors and comorbidities were more common in the older age group, except for obesity which was more common in younger cases, and diabetes which was equally prevalent in younger and older cases. Compared to living population, sudden death cases had higher prevalence of atherosclerotic risk factors across all gender and age groups. Sudden death cases had a numerically higher number of risk factors compared to living population, regardless of age group or presence of CAD. CONCLUSIONS Coronary artery disease is not common among sudden death cases, but risk factors and comorbidities are prevalent. Our findings support the changing etiology of sudden death. In the absence of clinically diagnosed CAD, use of novel imaging modalities and biomarkers may identify high-risk individuals and lead to prevention of sudden death.
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Affiliation(s)
- Golsa Joodi
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Joan A Maradey
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Brittany Bogle
- Senior Data Scientist, Data Science Elite Team, IBM Corporation, Durham, NC, USA
| | - Mojtaba Mirzaei
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - Murrium I Sadaf
- Department of Internal Medicine, Yale University School of Medicine, Waterbury, CT, USA
| | - Irion Pursell
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Cory Henderson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA
| | - John Paul Mounsey
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ross J Simpson
- Division of Cardiology, Department of Medicine , University of North Carolina, Chapel Hill, NC, USA.
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19
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Pandat S, Nagaura T, Nair SG, Uy-Evanado A, Stecker EC, Nichols GA, Jui J, Shiota T, Chugh SS, Reinier K. An association between right ventricular dysfunction and sudden cardiac death. Heart Rhythm 2019; 17:169-174. [PMID: 31634617 DOI: 10.1016/j.hrthm.2019.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The effectiveness of severely reduced left ventricular ejection fraction (LVEF <35%) as a predictor of sudden cardiac death (SCD) has diminished, and improvements in risk stratification await discovery of novel markers. Right ventricular (RV) abnormalities can be observed in conditions such as chronic obstructive pulmonary disease and sleep apnea, which have been linked to SCD. OBJECTIVE The purpose of this study was to evaluate whether RV abnormalities were associated with SCD after accounting for LVEF and other patient characteristics. METHODS In a large, prospective ongoing community-based study of SCD in the Portland, Oregon, metropolitan area, SCD cases (age ≥18 years; 2002-2014) were compared to controls with coronary artery disease but no SCD. Using a novel archive of digital echocardiograms, a standardized approach was used to evaluate RV basal diameter, RV end-diastolic area, and right ventricular fractional area change (RVFAC). RESULTS A total of 350 subjects were studied, including 81 SCD cases (age 68.7 ± 13.6 years; 73% male) and 269 controls (age 66.5 ± 10.2 years; 69% male). In multivariate analysis, RVFAC was significantly associated with SCD (odds ratio 1.14 for each 5% decrease; 95% confidence interval 1.03-1.25; P = .01). When modeled with LVEF ≤35%, RVFAC ≤35% was significantly associated with increased risk of SCD. Individuals with both left ventricular and RV dysfunction had a 3× higher odds of SCD than those with neither (odds ratio 3.19; 95% confidence interval 1.33-7.68; P = .01). CONCLUSION RV dysfunction was associated with a significantly increased risk of SCD independent of LVEF and, when combined with LVEF, had additive effects on SCD risk.
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Affiliation(s)
- Summit Pandat
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Nagaura
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sandeep G Nair
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Audrey Uy-Evanado
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Eric C Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kyndaron Reinier
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
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20
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Verdecchia P, Angeli F, Cavallini C, Aita A, Turturiello D, De Fano M, Reboldi G. Sudden Cardiac Death in Hypertensive Patients. Hypertension 2019; 73:1071-1078. [DOI: 10.1161/hypertensionaha.119.12684] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Paolo Verdecchia
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Fabio Angeli
- Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Hospital S. Maria della Misericordia, Perugia, Italy (F.A., D.T.)
| | - Claudio Cavallini
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Adolfo Aita
- From the Fondazione Umbra Cuore e Ipertensione-ONLUS and Struttura Complessa di Cardiologia, Hospital S. Maria della Misericordia, Perugia, Italy (P.V., C.C., A.A.)
| | - Dario Turturiello
- Struttura Complessa di Cardiologia e Fisiopatologia Cardiovascolare, Hospital S. Maria della Misericordia, Perugia, Italy (F.A., D.T.)
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21
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Tamariz L, Goldberger JJ, Palacio A, Chen G, Dawkins E, Forbes E, Tajiri T, Ghany R. The additive role of echocardiography in the screening for sudden death. Echocardiography 2019; 36:451-457. [PMID: 30712271 DOI: 10.1111/echo.14256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 11/19/2018] [Accepted: 12/17/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND A clinically based sudden cardiac death (SCD) risk score has predictive value. Echocardiographic parameters predict SCD. Our aim was to evaluate the effect of adding echocardiographic parameters to the clinical SCD risk score for the prediction of all-cause mortality. METHODS We conducted a retrospective cohort of screening echocardiograms performed on primary care patients. We calculated the SCD risk score and added the left ventricular (LV) mass index, LV hypertrophy, diastolic dysfunction, and LV ejection fraction (EF). We calculated the c-statistic, net reclassification index (NRI), and Hosmer-Lemeshow chi-square for the SCD score alone or combined with each echocardiographic parameter in predicting all-cause mortality. RESULTS We included 6447 primary care patients who underwent a screening echocardiogram and had a SCD score. The c-statistic of the SCD score for mortality was 0.61; 95% CI 0.58-0.62 and the c-statistic for the score combined with LV mass index increased to 0.64; 95% CI 0.63-0.65 and for the score combined with LVEF, the c-statistic was 0.64;95% CI 0.63-0.67. When diastolic dysfunction and LV hypertrophy were added to the SCD score, the c-statistic did not significantly change (P > 0.05). The NRI for the addition of LV mass index and LVEF was 0.52 ± 0.02, and the Hosmer-Lemeshow statistic was nonsignificant (P > 0.05). CONCLUSIONS Adding LV mass index or LVEF to the SCD risk score improves the ability to predict mortality, but in the primary care setting, the improvement is small and underscores the challenge of SCD prediction and prevention in the community.
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Affiliation(s)
- Leonardo Tamariz
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida.,Department of Medicine, Veterans Affairs Medical Center, Miami, Florida
| | - Jeffrey J Goldberger
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida.,Department of Medicine, Division of Cardiology, University of Miami, Miami, Florida
| | - Ana Palacio
- Department of Medicine, Miller School of Medicine at the University of Miami, Miami, Florida.,Department of Medicine, Veterans Affairs Medical Center, Miami, Florida
| | - Gordon Chen
- Department of Medicine, Chen Neighborhood Medical Centers, Miami, Florida
| | - Elissa Dawkins
- Department of Medicine, Chen Neighborhood Medical Centers, Miami, Florida
| | - Emancia Forbes
- Department of Medicine, Chen Neighborhood Medical Centers, Miami, Florida
| | - Thiago Tajiri
- Department of Medicine, Chen Neighborhood Medical Centers, Miami, Florida
| | - Reyan Ghany
- Department of Medicine, Chen Neighborhood Medical Centers, Miami, Florida
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22
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Porthan K, Kenttä T, Niiranen TJ, Nieminen MS, Oikarinen L, Viitasalo M, Hernesniemi J, Jula AM, Salomaa V, Huikuri HV, Albert CM, Tikkanen JT. ECG left ventricular hypertrophy as a risk predictor of sudden cardiac death. Int J Cardiol 2019; 276:125-129. [DOI: 10.1016/j.ijcard.2018.09.104] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
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23
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An unusual association of hypertrophic obstructive cardiomyopathy. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2018; 88:509-510. [DOI: 10.1016/j.acmx.2017.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 11/20/2022] Open
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Morofuji T, Saito M, Inaba S, Morioka H, Sumimoto T. Prognostic value of proximal left coronary artery flow velocity detected by transthoracic Doppler echocardiography. IJC HEART & VASCULATURE 2018; 19:52-57. [PMID: 29946565 PMCID: PMC6016069 DOI: 10.1016/j.ijcha.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 04/17/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Lesions in the proximal left coronary artery (LCA) are associated with a poor prognosis compared with other lesional sites. Transthoracic Doppler echocardiography (TTDE) can help to detect proximal LCA flow, and an accelerated coronary flow velocity (CFV) indicates the presence of proximal LCA lesions. This study aimed to investigate the prognostic value of CFV in the proximal LCA measured by TTDE. METHODS We enrolled 1472 consecutive hemodynamically stable patients with known or suspected heart disease whose CFV was successfully detected using TTDE accompanied by routine echocardiography between 2008 and 2011. The primary outcome was cardiac death (acute myocardial infarction, heart failure, or sudden cardiac death) and patients were followed up over a median of 6.3 years. RESULTS Overall, 42 cardiac deaths (3%) were observed. An increased CFV was significantly associated with the outcome in several models based on potential confounders (age, rate pressure product, Framingham Risk Score, diabetes, coronary artery disease, hemoglobin, brain natriuretic peptide, estimated glomerular filtration rate, left ventricular mass, left ventricular ejection fraction, and E/e'). Using a receiver operating characteristic curve analysis, the optimal cut-off value for the CFV to the association of the outcome was 37 cm/s (area under the curve, 0.70; sensitivity, 82%; specificity, 62%). In sequential Cox proportional hazards models, the CFV added incremental prognostic information to the clinical and basic echocardiographic parameters (chi-squared: 110.7 to 146.6, P < 0.01). CONCLUSIONS An increased CFV in the proximal LCA was associated with cardiac death, incremental to the clinical and basic echocardiographic parameters.
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Affiliation(s)
| | - Makoto Saito
- Department of Cardiology, Kitaishikai Hospital, Ozu, Japan
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Fialho GL, Wolf P, Walz R, Lin K. Increased cardiac stiffness is associated with autonomic dysfunction in patients with temporal lobe epilepsy. Epilepsia 2018; 59:e85-e90. [DOI: 10.1111/epi.14084] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Guilherme L. Fialho
- Cardiology Division; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Medical Sciences Postgraduate Program; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
| | - Peter Wolf
- Medical Sciences Postgraduate Program; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Neurology Division; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Danish Epilepsy Center; Dianalund Denmark
| | - Roger Walz
- Medical Sciences Postgraduate Program; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Neurology Division; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Center for Applied Neurosciences (CeNAp); Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
| | - Katia Lin
- Medical Sciences Postgraduate Program; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Neurology Division; Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
- Center for Applied Neurosciences (CeNAp); Federal University of Santa Catarina (UFSC); Florianópolis SC Brazil
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Fialho GL, Pagani AG, Wolf P, Walz R, Lin K. Echocardiographic risk markers of sudden death in patients with temporal lobe epilepsy. Epilepsy Res 2018; 140:192-197. [PMID: 29414527 DOI: 10.1016/j.eplepsyres.2018.01.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/18/2017] [Accepted: 01/13/2018] [Indexed: 01/22/2023]
Abstract
Patients with epilepsy (PWE) have an increased risk for sudden unexpected death compared to the general population. Echocardiography can analyze structural and functional heart changes that have impact on outcomes, including sudden cardiac and all-cause death. Our hypothesis is that subtle heart abnormalities occur in PWE. Thirty patients with temporal lobe epilepsy without any known cardiovascular disease, followed for at least 1 year, were enrolled between July 2015 and July 2016 and submitted to a 12-lead electrocardiogram, treadmill test and transthoracic echocardiogram. PWE were matched with individuals without epilepsy by sex, age and body mass index. A literature review of studies comparing echocardiographic findings in PWE and individuals without epilepsy was performed. PWE had a higher left ventricle stiffness (β= 5.97 ± 0.05 × 5.94 ± 0.03; p = 0.02), left ventricle filling pressures (9.7 ± 1.3 mmHg × 9 ± 0.8; p = 0.02) and a greater left atrial volume (44.7 ± 13.6 ml × 34.1 ± 9.6 ml; p = 0.003). Seventeen (56.6%) PWE had a total of 22 of six known echocardiographic markers related to increased risk for sudden death in the general population, versus 11 (36.7%) controls with 12 markers (p = 0.07). Stiffness is related to fibrosis through extracellular matrix deposition, which promotes systolic and diastolic dysfunction and arrhythmogenesis. Subtle echocardiographic findings in PWE could help to explain why this population has an increased risk to die suddenly.
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Affiliation(s)
- Guilherme L Fialho
- Cardiology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Medical Sciences Post-Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | - Arthur G Pagani
- School of Medicine, Graduation Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | - Peter Wolf
- Medical Sciences Post-Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark.
| | - Roger Walz
- Medical Sciences Post-Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Applied Neurosciences Center (CeNAp), Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil.
| | - Katia Lin
- Medical Sciences Post-Graduate Program, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Neurology Division, Federal University of Santa Catarina (UFSC), Florianópolis, SC, Brazil; Danish Epilepsy Centre, Dianalund, Denmark.
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Chugh SS, Uy-Evanado A. Improved Prediction of Sudden Cardiac Death Risk: Staying Within the Echocardiogram but Extending Beyond the Ejection Fraction. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005133. [PMID: 27496551 DOI: 10.1161/circimaging.116.005133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sumeet S Chugh
- From the The Heart Institute, Cedars-Sinai, Los Angeles, CA.
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