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Ohiri JC, Dellefave-Castillo L, Tomar G, Wilsbacher L, Choudhury L, Barefield DY, Fullenkamp D, Gacita AM, Monroe TO, Pesce L, Blancard M, Vaught L, George AL, Demonbreun AR, Puckelwartz MJ, McNally EM. Reduction of Filamin C Results in Altered Proteostasis, Cardiomyopathy, and Arrhythmias. J Am Heart Assoc 2024; 13:e030467. [PMID: 38761081 DOI: 10.1161/jaha.123.030467] [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: 04/04/2023] [Accepted: 04/17/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Many cardiomyopathy-associated FLNC pathogenic variants are heterozygous truncations, and FLNC pathogenic variants are associated with arrhythmias. Arrhythmia triggers in filaminopathy are incompletely understood. METHODS AND RESULTS We describe an individual with biallelic FLNC pathogenic variants, p.Arg650X and c.970-4A>G, with peripartum cardiomyopathy and ventricular arrhythmias. We also describe clinical findings in probands with FLNC variants including Val2715fs87X, Glu2458Serfs71X, Phe106Leu, and c.970-4A>G with hypertrophic and dilated cardiomyopathy, atrial fibrillation, and ventricular tachycardia. Induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) were generated. The FLNC truncation, Arg650X/c.970-4A>G, showed a marked reduction in filamin C protein consistent with biallelic loss of function mutations. To assess loss of filamin C, gene editing of a healthy control iPSC line was used to generate a homozygous FLNC disruption in the actin binding domain. Because filamin C has been linked to protein quality control, we assessed the necessity of filamin C in iPSC-CMs for response to the proteasome inhibitor bortezomib. After exposure to low-dose bortezomib, FLNC-null iPSC-CMs showed an increase in the chaperone proteins BAG3, HSP70 (heat shock protein 70), and HSPB8 (small heat shock protein B8) and in the autophagy marker LC3I/II. FLNC null iPSC-CMs had prolonged electric field potential, which was further prolonged in the presence of low-dose bortezomib. FLNC null engineered heart tissues had impaired function after low-dose bortezomib. CONCLUSIONS FLNC pathogenic variants associate with a predisposition to arrhythmias, which can be modeled in iPSC-CMs. Reduction of filamin C prolonged field potential, a surrogate for action potential, and with bortezomib-induced proteasome inhibition, reduced filamin C led to greater arrhythmia potential and impaired function.
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Affiliation(s)
- Joyce C Ohiri
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Lisa Dellefave-Castillo
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Garima Tomar
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Lisa Wilsbacher
- Feinberg Cardiovascular and Renal Research Institute, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Lubna Choudhury
- Bluhm Cardiovascular Institute Northwestern Medicine Chicago IL USA
| | - David Y Barefield
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
- Cell and Molecular Physiology Loyola University Stritch School of Medicine Maywood IL USA
| | - Dominic Fullenkamp
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Anthony M Gacita
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Tanner O Monroe
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Lorenzo Pesce
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Malorie Blancard
- Department of Pharmacology, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Lauren Vaught
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Alfred L George
- Department of Pharmacology, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Alexis R Demonbreun
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Pharmacology, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Megan J Puckelwartz
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
- Department of Pharmacology, Feinberg School of Medicine Northwestern University Chicago IL USA
| | - Elizabeth M McNally
- Center for Genetic Medicine, Feinberg School of Medicine Northwestern University Chicago IL USA
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2
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Braunwald E. Cardio-obstetrics: a new specialty. Eur Heart J 2024; 45:1589-1592. [PMID: 38569057 DOI: 10.1093/eurheartj/ehae202] [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] [Indexed: 04/05/2024] Open
Affiliation(s)
- Eugene Braunwald
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Hale Building, Suite 7022, 60 Fenwood Road, Boston, MA 02115, USA
- Department of Medicine, Harvard Medical School, Boston, MA
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3
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Safira A, Tjahjadi AK, Adytia GJ, Waitupu A, Sutanto H. Peripartum cardiomyopathy unveiled: Etiology, diagnosis, and therapeutic insights. Curr Probl Cardiol 2024; 49:102474. [PMID: 38395115 DOI: 10.1016/j.cpcardiol.2024.102474] [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: 02/17/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Peripartum cardiomyopathy (PPCM) remains a significant challenge in maternal health, marked by its unpredictable onset and varied clinical outcomes. With rising incidence rates globally, understanding PPCM is vital for improving maternal care and prognosis. This review aims to consolidate current knowledge on PPCM, highlighting recent advancements in its diagnosis, management, and therapeutic approaches. This comprehensive review delves into the epidemiology of PPCM, underscoring its global impact and demographic variations. We explore the complex etiology of the condition, examining known risk factors and discussing the potential pathophysiological mechanisms, including oxidative stress and hormonal influences. The clinical presentation of PPCM, often similar yet distinct from other forms of cardiomyopathy, is analyzed to aid in differential diagnosis. Diagnostic challenges are addressed, emphasizing the role of advanced imaging and biomarkers. Current management strategies are reviewed, focusing on the absence of disease-specific treatments and the application of general heart failure protocols. The review also discusses the prognosis of PPCM, factors influencing recovery, and the implications for future pregnancies. Finally, we highlight emerging research directions and the urgent need for disease-specific therapies, aiming to provide a roadmap for future studies and improved patient care. This review serves as a crucial resource for clinicians and researchers, contributing to a deeper understanding and better management of PPCM.
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Affiliation(s)
- Ardea Safira
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Angela Kimberly Tjahjadi
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Galih Januar Adytia
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Alief Waitupu
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Henry Sutanto
- Internal Medicine Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.
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4
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Restrepo-Córdoba MA, Chmielewski P, Truszkowska G, Peña-Peña ML, Kubánek M, Krebsová A, Lopes LR, García-Ropero Á, Merlo M, Paldino A, Peters S, Jurcut R, Barriales-Villa R, Zorio E, Hazebroek M, Mogensen J, García-Pavía P. Pregnancy in women with dilated cardiomyopathy genetic variants. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00128-2. [PMID: 38641168 DOI: 10.1016/j.rec.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/02/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION AND OBJECTIVES Limited information is available on the safety of pregnancy in patients with genetic dilated cardiomyopathy (DCM) and in carriers of DCM-causing genetic variants without the DCM phenotype. We assessed cardiac, obstetric, and fetal or neonatal outcomes in this group of patients. METHODS We studied 48 women carrying pathogenic or likely pathogenic DCM-associated variants (30 with DCM and 18 without DCM) who had 83 pregnancies. Adverse cardiac events were defined as heart failure (HF), sustained ventricular tachycardia, ventricular assist device implantation, heart transplant, and/or maternal cardiac death during pregnancy, or labor and delivery, and up to the sixth postpartum month. RESULTS A total of 15 patients, all with DCM (31% of the total cohort and 50% of women with DCM) experienced adverse cardiac events. Obstetric and fetal or neonatal complications were observed in 14% of pregnancies (10 in DCM patients and 2 in genetic carriers). We analyzed the 30 women who had been evaluated before their first pregnancy (12 with overt DCM and 18 without the phenotype). Five of the 12 (42%) women with DCM had adverse cardiac events despite showing NYHA class I or II before pregnancy. Most of these women had a history of cardiac events before pregnancy (80%). Among the 18 women without phenotype, 3 (17%) developed DCM toward the end of pregnancy. CONCLUSIONS Cardiac complications during pregnancy and postpartum were common in patients with genetic DCM and were primarily related to HF. Despite apparently good tolerance of pregnancy in unaffected genetic carriers, pregnancy may act as a trigger for DCM onset in a subset of these women.
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Affiliation(s)
- María Alejandra Restrepo-Córdoba
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Madrid, Spain; Servicio de Cardiología, Instituto Cardiovascular, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Hospital Clínico San Carlos, Madrid, Spain. https://twitter.com/@marestrepoc
| | - Przemyslaw Chmielewski
- Unit for Screening Studies in Inherited Cardiovascular Diseases National Institute of Cardiology, Varsovia, Poland
| | - Grażyna Truszkowska
- Department of Medical Biology, National Institute of Cardiology, Varsovia, Poland
| | - María Luisa Peña-Peña
- Unidad de Imagen y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Miloš Kubánek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Praga, Czech Republic
| | - Alice Krebsová
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Praga, Czech Republic
| | - Luis R Lopes
- Institute of Cardiovascular Science, University College London, Londres, United Kingdom; St. Bartholomew's Hospital, Barts Heart Centre, Barts NHS Trust, Londres, United Kingdom
| | - Álvaro García-Ropero
- Guy's and St. Thomas' NHS Foundation Trust, Londres, United Kingdom; Lewisham and Greenwich NHS Trust, Londres, United Kingdom
| | - Marco Merlo
- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste, Italy
| | - Alessia Paldino
- Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI) e Università degli Studi di Trieste, Trieste, Italy
| | - Stacey Peters
- Department of Cardiology, Royal Melbourne Hospital, Victoria, Australia
| | - Ruxandra Jurcut
- Expert Center for Rare Genetic Cardiovascular Diseases, Emergency Institute for Cardiovascular Diseases Prof. Dr. C.C. Iliescu, UMF Carol Davila, Bucarest, Romania
| | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Unidad de Cardiopatías Familiares, Muerte Súbita y Mecanismos de Enfermedad (CaFaMuSMe), Instituto de Investigación Sanitaria La Fe, Servicio de Cardiología, Hospital La Fe, Valencia, Spain; Unidad de Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Mark Hazebroek
- Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Hobrovej r-bb, Denmark
| | - Pablo García-Pavía
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Instituto de Investigación Sanitaria Puerta de Hierro - Segovia de Arana (IDIPHISA), Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Madrid, Spain.
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5
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Roh JD, Castro C, Yu A, Rana S, Shahul S, Gray KJ, Honigberg MC, Ricke-Hoch M, Iwamoto Y, Yeri A, Kitchen R, Guerra JB, Hobson R, Chaudhari V, Chang B, Sarma A, Lerchenmüller C, Al Sayed ZR, Diaz Verdugo C, Xia P, Skarbianskis N, Zeisel A, Bauersachs J, Kirkland JL, Karumanchi SA, Gorcsan J, Sugahara M, Damp J, Hanley-Yanez K, Ellinor PT, Arany Z, McNamara DM, Hilfiker-Kleiner D, Rosenzweig A. Placental senescence pathophysiology is shared between peripartum cardiomyopathy and preeclampsia in mouse and human. Sci Transl Med 2024; 16:eadi0077. [PMID: 38630848 DOI: 10.1126/scitranslmed.adi0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
Peripartum cardiomyopathy (PPCM) is an idiopathic form of pregnancy-induced heart failure associated with preeclampsia. Circulating factors in late pregnancy are thought to contribute to both diseases, suggesting a common underlying pathophysiological process. However, what drives this process remains unclear. Using serum proteomics, we identified the senescence-associated secretory phenotype (SASP), a marker of cellular senescence associated with biological aging, as the most highly up-regulated pathway in young women with PPCM or preeclampsia. Placentas from women with preeclampsia displayed multiple markers of amplified senescence and tissue aging, as well as overall increased gene expression of 28 circulating proteins that contributed to SASP pathway enrichment in serum samples from patients with preeclampsia or PPCM. The most highly expressed placental SASP factor, activin A, was associated with cardiac dysfunction or heart failure severity in women with preeclampsia or PPCM. In a murine model of PPCM induced by cardiomyocyte-specific deletion of the gene encoding peroxisome proliferator-activated receptor γ coactivator-1α, inhibiting activin A signaling in the early postpartum period with a monoclonal antibody to the activin type II receptor improved heart function. In addition, attenuating placental senescence with the senolytic compound fisetin in late pregnancy improved cardiac function in these animals. These findings link senescence biology to cardiac dysfunction in pregnancy and help to elucidate the pathogenesis underlying cardiovascular diseases of pregnancy.
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Affiliation(s)
- Jason D Roh
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Claire Castro
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Andy Yu
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Sarosh Rana
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Chicago School of Medicine, Chicago, IL 60637, USA
| | - Sajid Shahul
- Department of Anesthesia and Critical Care, University of Chicago School of Medicine, Chicago, IL 60637, USA
| | - Kathryn J Gray
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, WA 98104, USA
| | - Michael C Honigberg
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Hannover 30625, Germany
| | - Yoshiko Iwamoto
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Ashish Yeri
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Robert Kitchen
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Justin Baldovino Guerra
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Stanley and Judith Frankel Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
| | - Ryan Hobson
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Vinita Chaudhari
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Bliss Chang
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Amy Sarma
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Carolin Lerchenmüller
- Department of Cardiology, Angiology, and Pneumology, University of Heidelberg, Heidelberg 69120, Germany
- German Center for Heart and Cardiovascular Research (DZHK), Partner Site, Heidelberg/Mannheim, Heidelberg 69120, Germany
| | - Zeina R Al Sayed
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Carmen Diaz Verdugo
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Peng Xia
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Niv Skarbianskis
- Faculty of Biotechnology and Food Engineering, Technion Israel Institute of Technology, Haifa, Israel
| | - Amit Zeisel
- Faculty of Biotechnology and Food Engineering, Technion Israel Institute of Technology, Haifa, Israel
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover 30625, Germany
| | - James L Kirkland
- Departments of Medicine and Physiology and Bioengineering, Mayo Clinic, Rochester, MN 55905, USA
| | - S Ananth Karumanchi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - John Gorcsan
- Penn State College of Medicine, Hershey, PA 17033, USA
| | - Masataka Sugahara
- Department of Cardiovascular and Renal Medicine, Hyogo Medical University, Nishinomiya, Hyogo 663-8501, Japan
| | - Julie Damp
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Karen Hanley-Yanez
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Patrick T Ellinor
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
| | - Zoltan Arany
- Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Hannover 30625, Germany
- Department of Cardiovascular Complications of Oncologic Therapies, Medical Faculty of the Philipps University Marburg, Marburg 35037, Germany
| | - Anthony Rosenzweig
- Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Stanley and Judith Frankel Institute for Heart and Brain Health, University of Michigan Medical Center, Ann Arbor, MI 48109, USA
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6
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Ghahremani S, Kanwal A, Pettinato A, Ladha F, Legere N, Thakar K, Zhu Y, Tjong H, Wilderman A, Stump WT, Greenberg L, Greenberg MJ, Cotney J, Wei CL, Hinson JT. CRISPR Activation Reverses Haploinsufficiency and Functional Deficits Caused by TTN Truncation Variants. Circulation 2024; 149:1285-1297. [PMID: 38235591 PMCID: PMC11031707 DOI: 10.1161/circulationaha.123.063972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/13/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND TTN truncation variants (TTNtvs) are the most common genetic lesion identified in individuals with dilated cardiomyopathy, a disease with high morbidity and mortality rates. TTNtvs reduce normal TTN (titin) protein levels, produce truncated proteins, and impair sarcomere content and function. Therapeutics targeting TTNtvs have been elusive because of the immense size of TTN, the rarity of specific TTNtvs, and incomplete knowledge of TTNtv pathogenicity. METHODS We adapted CRISPR activation using dCas9-VPR to functionally interrogate TTNtv pathogenicity and develop a therapeutic in human cardiomyocytes and 3-dimensional cardiac microtissues engineered from induced pluripotent stem cell models harboring a dilated cardiomyopathy-associated TTNtv. We performed guide RNA screening with custom TTN reporter assays, agarose gel electrophoresis to quantify TTN protein levels and isoforms, and RNA sequencing to identify molecular consequences of TTN activation. Cardiomyocyte epigenetic assays were also used to nominate DNA regulatory elements to enable cardiomyocyte-specific TTN activation. RESULTS CRISPR activation of TTN using single guide RNAs targeting either the TTN promoter or regulatory elements in spatial proximity to the TTN promoter through 3-dimensional chromatin interactions rescued TTN protein deficits disturbed by TTNtvs. Increasing TTN protein levels normalized sarcomere content and contractile function despite increasing truncated TTN protein. In addition to TTN transcripts, CRISPR activation also increased levels of myofibril assembly-related and sarcomere-related transcripts. CONCLUSIONS TTN CRISPR activation rescued TTNtv-related functional deficits despite increasing truncated TTN levels, which provides evidence to support haploinsufficiency as a relevant genetic mechanism underlying heterozygous TTNtvs. CRISPR activation could be developed as a therapeutic to treat a large proportion of TTNtvs.
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Affiliation(s)
| | - Aditya Kanwal
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Anthony Pettinato
- Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Feria Ladha
- Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Nicholas Legere
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Ketan Thakar
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Yanfen Zhu
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Harianto Tjong
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - Andrea Wilderman
- Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - W. Tom Stump
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Lina Greenberg
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael J. Greenberg
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Justin Cotney
- Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Chia-Lin Wei
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
| | - J. Travis Hinson
- The Jackson Laboratory for Genomic Medicine, Farmington, CT 06032, USA
- Cardiology Center, University of Connecticut Health Center, Farmington, CT 06030, USA
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7
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Antonopoulos AS, Xintarakou A, Protonotarios A, Lazaros G, Miliou A, Tsioufis K, Vlachopoulos C. Imagenetics for Precision Medicine in Dilated Cardiomyopathy. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2024; 17:e004301. [PMID: 38415367 DOI: 10.1161/circgen.123.004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Dilated cardiomyopathy (DCM) is a common heart muscle disorder of nonischemic etiology associated with heart failure development and the risk of malignant ventricular arrhythmias and sudden cardiac death. A tailored approach to risk stratification and prevention of sudden cardiac death is required in genetic DCM given its variable presentation and phenotypic severity. Currently, advances in cardiogenetics have shed light on disease mechanisms, the complex genetic architecture of DCM, polygenic contributors to disease susceptibility and the role of environmental triggers. Parallel advances in imaging have also enhanced disease recognition and the identification of the wide spectrum of phenotypes falling under the DCM umbrella. Genotype-phenotype associations have been also established for specific subtypes of DCM, such as DSP (desmoplakin) or FLNC (filamin-C) cardiomyopathy but overall, they remain elusive and not readily identifiable. Also, despite the accumulated knowledge on disease mechanisms, certain aspects remain still unclear, such as which patients with DCM are at risk for disease progression or remission after treatment. Imagenetics, that is, the combination of imaging and genetics, is expected to further advance research in the field and contribute to precision medicine in DCM management and treatment. In the present article, we review the existing literature in the field, summarize the established knowledge and emerging data on the value of genetics and imaging in establishing genotype-phenotype associations in DCM and in clinical decision making for DCM patients.
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Affiliation(s)
- Alexios S Antonopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Anastasia Xintarakou
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Alexandros Protonotarios
- Institute of Cardiovascular Science, University College London, United Kingdom (A.P.)
- Inherited Cardiovascular Disease Unit, St Bartholomew's Hospital, London, United Kingdom (A.P.)
| | - George Lazaros
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Antigoni Miliou
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Konstantinos Tsioufis
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
| | - Charalambos Vlachopoulos
- 1st Cardiology Department, Hippokration Hospital, National and Kapodistrian University of Athens, Greece (A.S.A., A.X., G.L., A.M., K.T., C.V.)
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8
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Almeida AG, Grapsa J, Gimelli A, Bucciarelli-Ducci C, Gerber B, Ajmone-Marsan N, Bernard A, Donal E, Dweck MR, Haugaa KH, Hristova K, Maceira A, Mandoli GE, Mulvagh S, Morrone D, Plonska-Gosciniak E, Sade LE, Shivalkar B, Schulz-Menger J, Shaw L, Sitges M, von Kemp B, Pinto FJ, Edvardsen T, Petersen SE, Cosyns B. Cardiovascular multimodality imaging in women: a scientific statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:e116-e136. [PMID: 38198766 DOI: 10.1093/ehjci/jeae013] [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: 12/28/2023] [Accepted: 12/31/2023] [Indexed: 01/12/2024] Open
Abstract
Cardiovascular diseases (CVD) represent an important cause of mortality and morbidity in women. It is now recognized that there are sex differences regarding the prevalence and the clinical significance of the traditional cardiovascular (CV) risk factors as well as the pathology underlying a range of CVDs. Unfortunately, women have been under-represented in most CVD imaging studies and trials regarding diagnosis, prognosis, and therapeutics. There is therefore a clear need for further investigation of how CVD affects women along their life span. Multimodality CV imaging plays a key role in the diagnosis of CVD in women as well as in prognosis, decision-making, and monitoring of therapeutics and interventions. However, multimodality imaging in women requires specific consideration given the differences in CVD between the sexes. These differences relate to physiological changes that only women experience (e.g. pregnancy and menopause) as well as variation in the underlying pathophysiology of CVD and also differences in the prevalence of certain conditions such as connective tissue disorders, Takotsubo, and spontaneous coronary artery dissection, which are all more common in women. This scientific statement on CV multimodality in women, an initiative of the European Association of Cardiovascular Imaging of the European Society of Cardiology, reviews the role of multimodality CV imaging in the diagnosis, management, and risk stratification of CVD, as well as highlights important gaps in our knowledge that require further investigation.
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Affiliation(s)
- Ana G Almeida
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Julia Grapsa
- Cardiology Department, Guys and St Thomas NHS Trust, London, UK
| | - Alessia Gimelli
- Imaging Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Chiara Bucciarelli-Ducci
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Guys' and St Thomas NHS Hospitals, London, UK
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Bernhard Gerber
- Service de Cardiologie, Département Cardiovasculaire, Cliniques Universitaires St. Luc, UCLouvain, Brussels, Belgium
- Division CARD, Institut de Recherche Expérimental et Clinique (IREC), UCLouvain, Brussels, Belgium
| | - Nina Ajmone-Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Anne Bernard
- EA4245 Transplantation, Immunologie, Inflammation, Université de Tours, Tours, France
- Service de Cardiologie, CHRU de Tours, Tours, France
| | - Erwan Donal
- CHU Rennes, Inserm, LTSI-UMR 1099, University of Rennes, Rennes, France
| | - Marc R Dweck
- Centre for Cardiovascular Science, Chancellors Building, Little France Crescent, Edinburgh, UK
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Krassimira Hristova
- Center for Cardiovascular Diseases, Faculty of Medicine, Sofia University, Sofia, Bulgaria
| | - Alicia Maceira
- Ascires Biomedical Group, Valencia, Spain
- Department of Medicine, Health Sciences School, UCH-CEU University, Valencia, Spain
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Sharon Mulvagh
- Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Doralisa Morrone
- Division of Cardiology, Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | - Leyla Elif Sade
- Cardiology Department, University of Baskent, Ankara, Turkey
- UPMC Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Jeanette Schulz-Menger
- Charité ECRC Medical Faculty of the Humboldt University Berlin and Helios-Clinics, Berlin, Germany
- DZHK, Partner site Berlin, Berlin, Germany
| | - Leslee Shaw
- Department of Medicine (Cardiology), Icahn School of Medicine at Mount Sinai New York, NY, USA
| | - Marta Sitges
- Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
- Institut Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- CIBERCV, Barcelona, Spain
| | - Berlinde von Kemp
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
| | - Fausto J Pinto
- Heart and Vessels Department, University Hospital Santa Maria, CAML, CCUL, Faculty of Medicine of Lisbon University, Lisbon, Portugal
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
- ProCardio Center for Innovation, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University London, Charterhouse Square, London, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Bernard Cosyns
- Cardiology, Centrum voor Hart en Vaatziekten (CHVZ), Universitair Ziejkenhuis Brussel (UZB), Vrij Universiteit Brussel (VUB), Brussels, Belgium
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9
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Jolfayi AG, Kohansal E, Ghasemi S, Naderi N, Hesami M, MozafaryBazargany M, Moghadam MH, Fazelifar AF, Maleki M, Kalayinia S. Exploring TTN variants as genetic insights into cardiomyopathy pathogenesis and potential emerging clues to molecular mechanisms in cardiomyopathies. Sci Rep 2024; 14:5313. [PMID: 38438525 PMCID: PMC10912352 DOI: 10.1038/s41598-024-56154-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/01/2024] [Indexed: 03/06/2024] Open
Abstract
The giant protein titin (TTN) is a sarcomeric protein that forms the myofibrillar backbone for the components of the contractile machinery which plays a crucial role in muscle disorders and cardiomyopathies. Diagnosing TTN pathogenic variants has important implications for patient management and genetic counseling. Genetic testing for TTN variants can help identify individuals at risk for developing cardiomyopathies, allowing for early intervention and personalized treatment strategies. Furthermore, identifying TTN variants can inform prognosis and guide therapeutic decisions. Deciphering the intricate genotype-phenotype correlations between TTN variants and their pathologic traits in cardiomyopathies is imperative for gene-based diagnosis, risk assessment, and personalized clinical management. With the increasing use of next-generation sequencing (NGS), a high number of variants in the TTN gene have been detected in patients with cardiomyopathies. However, not all TTN variants detected in cardiomyopathy cohorts can be assumed to be disease-causing. The interpretation of TTN variants remains challenging due to high background population variation. This narrative review aimed to comprehensively summarize current evidence on TTN variants identified in published cardiomyopathy studies and determine which specific variants are likely pathogenic contributors to cardiomyopathy development.
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Affiliation(s)
- Amir Ghaffari Jolfayi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Erfan Kohansal
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Serwa Ghasemi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Niloofar Naderi
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Hesami
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Hosseini Moghadam
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Farjam Fazelifar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samira Kalayinia
- Cardiogenetic Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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10
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Ejim EC, Karaye KM, Antia S, Isiguzo GC, Njoku PO. Peripartum cardiomyopathy in low- and middle-income countries. Best Pract Res Clin Obstet Gynaecol 2024; 93:102476. [PMID: 38395024 DOI: 10.1016/j.bpobgyn.2024.102476] [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: 09/30/2023] [Revised: 12/15/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Peripartum cardiomyopathy (PPCM) causes pregnancy-associated heart failure, typically during the last month of pregnancy, and up to 6 months post-partum, in women without known cardiovascular disease. PPCM is a global disease, but with a significant geographical variability within and between countries. Its true incidence in Africa is still unknown because of the lack of a PPCM population-based study. The variability in the epidemiology of PPCM between and within countries could be due to differences in the prevalence of both genetic and non-genetic risk factors. Several risk factors have been implicated in the aetiopathogenesis of PPCM over the years. Majority of patients with PPCM present with symptoms and signs of congestive cardiac failure. Diagnostic work up in PPCM is prompted by strong clinical suspicion, but Echocardiography is the main imaging technique for diagnosis. The management of PPCM involves multiple disciplines - cardiologists, anaesthetists, intensivists, obstetricians, neonatologists, and the prognosis varies widely.
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Affiliation(s)
- Emmanuel C Ejim
- Department of Medicine, University of Nigeria Ituku-Ozalla Campus, Enugu, Nigeria.
| | - Kamilu M Karaye
- Bayero University & Aminu Kano Teaching Hospital Kano, Nigeria.
| | - Samuel Antia
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Godsent C Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Nigeria.
| | - Paschal O Njoku
- Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
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11
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Imran TF, Ataklte F, Khalid M, Lopez D, Mohebali D, Bello NA, Gaziano JM, Djousse L, Arany Z, Sabe MA, French K, Poppas A, Wu W, Choudhary G. Clinical predictors of right ventricular dysfunction and association with adverse outcomes in peripartum cardiomyopathy. ESC Heart Fail 2024; 11:422-432. [PMID: 38030384 PMCID: PMC10804155 DOI: 10.1002/ehf2.14583] [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: 05/12/2023] [Revised: 10/05/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
AIMS We sought to identify factors associated with right ventricular (RV) dysfunction and elevated pulmonary artery systolic pressure (PASP) and association with adverse outcomes in peripartum cardiomyopathy (PPCM). METHODS AND RESULTS We conducted a multi-centre cohort study to identify subjects with PPCM with the following criteria: left ventricular ejection fraction (LVEF) < 40%, development of heart failure within the last month of pregnancy or 5 months of delivery, and no other identifiable cause of heart failure with reduced ejection fraction. Outcomes included a composite of (i) major adverse events (need for extracorporeal membrane oxygenation, ventricular assist device, orthotopic heart transplantation, or death) or (ii) recurrent heart failure hospitalization. RV function was obtained from echocardiogram reports. In total, 229 women (1993-2017) met criteria for PPCM. Mean age was 32.4 ± 6.8 years, 28% were of African descent, 50 (22%) had RV dysfunction, and 38 (17%) had PASP ≥ 30 mmHg. After a median follow-up of 3.4 years (interquartile range 1.0-8.8), 58 (25%) experienced the composite outcome of adverse events. African descent, family history of cardiomyopathy, LVEF, and PASP were significant predictors of RV dysfunction. Using Cox proportional hazards models, we found that women with RV dysfunction were three times more likely to experience the adverse composite outcome: hazard ratio 3.21 (95% confidence interval: 1.11-9.28), P = 0.03, in a multivariable model adjusting for age, race, body mass index, preeclampsia, hypertension, diabetes, kidney disease, and LVEF. Women with PASP ≥ 30 mmHg had a lower probability of survival free from adverse events (log-rank P = 0.04). CONCLUSIONS African descent and family history of cardiomyopathy were significant predictors of RV dysfunction. RV dysfunction and elevated PASP were significantly associated with a composite of major adverse cardiac events. This at-risk group may prompt closer monitoring or early referral for advanced therapies.
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Affiliation(s)
- Tasnim F. Imran
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Feven Ataklte
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Mahnoor Khalid
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Diana Lopez
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | | | - Natalie A. Bello
- Smidt Heart InstituteCedars Sinai Medical CenterLos AngelesCAUSA
| | - J. Michael Gaziano
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | - Luc Djousse
- Brigham and Women's Hospital and the VA Boston Healthcare SystemHarvard Medical SchoolBostonMAUSA
| | - Zolt Arany
- Cardiovascular Institute, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Marwa A. Sabe
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMAUSA
| | - Katharine French
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Athena Poppas
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Wen‐Chih Wu
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
| | - Gaurav Choudhary
- Providence VA Medical CenterWarren Alpert Medical School of Brown University830 Chalkstone AveProvidenceRI02809USA
- Lifespan Cardiovascular InstituteWarren Alpert Medical School of Brown UniversityProvidenceRIUSA
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12
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Hinson JT, Campbell SG. TTN truncation variants produce sarcomere-integrating proteins of uncertain functional significance. J Clin Invest 2024; 134:e175206. [PMID: 38226618 PMCID: PMC10786689 DOI: 10.1172/jci175206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Titin (TTN) is one of the largest and most complex proteins expressed in humans, and truncation variants are the most prevalent genetic lesion identified in individuals with dilated cardiomyopathy (DCM) or other disorders of impaired cardiac contractility. Two reports in this issue of the JCI shed light on a potential mechanism involving truncated TTN sarcomere integration and the potential for disruption of sarcomere structural integrity. Kellermayer, Tordai, and colleagues confirmed the presence of truncated TTN protein in human DCM samples. McAfee and authors developed a patient-specific TTN antibody to study truncated TTN subcellular localization and to explore its functional consequences. A "poison peptide" mechanism emerges that inspires alternative therapeutic approaches while opening new lines for inquiry, such as the role of haploinsufficiency of full-length TTN protein, mechanisms explaining sarcomere dysfunction, and explanations for variable penetrance.
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Affiliation(s)
- J. Travis Hinson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut, USA
- Cardiology Center, UConn Health, Farmington, Connecticut, USA
| | - Stuart G. Campbell
- Department of Biomedical Engineering, Yale University, New Haven, Connecticut, USA
- Department of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, Connecticut, USA
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13
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Arany Z. Peripartum Cardiomyopathy. N Engl J Med 2024; 390:154-164. [PMID: 38197818 DOI: 10.1056/nejmra2306667] [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] [Indexed: 01/11/2024]
Affiliation(s)
- Zoltan Arany
- From the Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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14
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Greer OYO, Anandanadesan R, Shah NM, Price S, Johnson MR. Cardiogenic shock in pregnancy. BJOG 2024; 131:127-139. [PMID: 37794623 DOI: 10.1111/1471-0528.17645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/06/2023] [Accepted: 08/20/2023] [Indexed: 10/06/2023]
Abstract
Cardiac disease complicates 1%-4% of pregnancies globally, with a predominance in low and middle-income countries (LMICs). Increasing maternal age, rates of obesity, cardiovascular comorbidities, pre-eclampsia and gestational diabetes all contribute to acquired cardiovascular disease in pregnancy. Additionally, improved survival in congenital heart disease (CHD) has led to increasing numbers of women with CHD undergoing pregnancy. Implementation of individualised care plans formulated through pre-conception counselling and based on national and international guidance have contributed to improved clinical outcomes. However, there remains a significant proportion of women of reproductive age with no apparent comorbidities or risk factors that develop heart disease during pregnancy, with no indication for pre-conception counselling. The most extreme manifestation of cardiac disease is cardiogenic shock (CS), where the primary cardiac pathology results in inadequate cardiac output and hypoperfusion, and is associated with significant mortality and morbidity. Key to management is early recognition, intervention to treat any potentially reversible underlying pathology and supportive measures, up to and including mechanical circulatory support (MCS). In this narrative review we discuss recent developments in the classification of CS, and how these may be adapted to improve outcomes of pregnant women with, or at risk of developing, this potentially lethal condition.
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Affiliation(s)
- Orene Y O Greer
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Rathai Anandanadesan
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- Department of Critical Care, King's College Hospital, London, UK
| | - Nishel M Shah
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Mark R Johnson
- Division of Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
- Chelsea & Westminster NHS Foundation Trust, London, UK
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15
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Jackson AM, Macartney M, Brooksbank K, Brown C, Dawson D, Francis M, Japp A, Lennie V, Leslie SJ, Martin T, Neary P, Venkatasubramanian S, Vickers D, Weir RA, McMurray JJV, Jhund PS, Petrie MC. A 20-year population study of peripartum cardiomyopathy. Eur Heart J 2023; 44:5128-5141. [PMID: 37804234 PMCID: PMC10733720 DOI: 10.1093/eurheartj/ehad626] [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: 03/29/2023] [Revised: 07/23/2023] [Accepted: 09/08/2023] [Indexed: 10/09/2023] Open
Abstract
BACKGROUND AND AIMS The epidemiology of peripartum cardiomyopathy (PPCM) in Europe is poorly understood and data on long-term outcomes are lacking. A retrospective, observational, population-level study of validated cases of PPCM in Scotland from 1998 to 2017 was conducted. METHODS Women hospitalized with presumed de novo left ventricular systolic dysfunction around the time of pregnancy and no clear alternative cause were included. Each case was matched to 10 controls. Incidence and risk factors were identified. Morbidity and mortality were examined in mothers and children. RESULTS The incidence of PPCM was 1 in 4950 deliveries. Among 225 women with PPCM, obesity, gestational hypertensive disorders, and multi-gestation were found to be associated with having the condition. Over a median of 8.3 years (9.7 years for echocardiographic outcomes), 8% of women with PPCM died and 75% were rehospitalized for any cause at least once. Mortality and rehospitalization rates in women with PPCM were ∼12- and ∼3-times that of controls, respectively. The composite of all-cause death, mechanical circulatory support, or cardiac transplantation occurred in 14%. LV recovery occurred in 76% and, of those who recovered, 13% went on to have a decline in LV systolic function despite initial recovery. The mortality rate for children born to women with PPCM was ∼5-times that of children born to controls and they had an ∼3-times greater incidence of cardiovascular disease over a median of 8.8 years. CONCLUSIONS PPCM affected 1 in 4950 women around the time of pregnancy. The condition is associated with considerable morbidity and mortality for the mother and child. There should be a low threshold for investigating at-risk women. Long term follow-up, despite apparent recovery, should be considered.
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Affiliation(s)
- Alice M Jackson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | | | - Katriona Brooksbank
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | | | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, University of Aberdeen, UK
| | | | - Alan Japp
- BHF Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | | | | | | | | | - John J V McMurray
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Pardeep S Jhund
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
| | - Mark C Petrie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
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16
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Chapman K, Njue F, Rucklidge M. Anaesthesia and peripartum cardiomyopathy. BJA Educ 2023; 23:464-472. [PMID: 38009139 PMCID: PMC10667612 DOI: 10.1016/j.bjae.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 11/28/2023] Open
Affiliation(s)
- K. Chapman
- Royal Devon and Exeter Hospital, Exeter, UK
| | - F. Njue
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - M. Rucklidge
- King Edward Memorial Hospital, Subiaco, Western Australia, Australia
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17
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Kasiakogias A, Ragavan A, Halliday BP. Your Heart Function Has Normalized-What Next After TRED-HF? Curr Heart Fail Rep 2023; 20:542-554. [PMID: 37999902 PMCID: PMC10746577 DOI: 10.1007/s11897-023-00636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE OF REVIEW With the widespread implementation of contemporary disease-modifying heart failure therapy, the rates of normalization of ejection fraction are continuously increasing. The TRED-HF trial confirmed that heart failure remission rather than complete recovery is typical in patients with dilated cardiomyopathy who respond to therapy. The present review outlines key points related to the management and knowledge gaps of this growing patient group, focusing on patients with non-ischaemic dilated cardiomyopathy. RECENT FINDINGS There is substantial heterogeneity among patients with normalized ejection fraction. The specific etiology is likely to affect the outcome, although a multiple-hit phenotype is frequent and may not be identified without comprehensive characterization. A monogenic or polygenic genetic susceptibility is common. Ongoing pathophysiological processes may be unraveled with advanced cardiac imaging, biomarkers, multi-omics, and machine learning technologies. There are limited studies that have investigated the withdrawal of specific heart failure therapies in these patients. Diuretics may be safely withdrawn if there is no evidence of congestion, while continued therapy with at least some disease-modifying therapy is likely to be required to reduce myocardial workload and sustain remission for the vast majority. Understanding the underlying disease mechanisms of patients with normalized ejection fraction is crucial in identifying markers of myocardial relapse and guiding individualized therapy in the future. Ongoing clinical trials should inform personalized approaches to therapy.
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Affiliation(s)
- Alexandros Kasiakogias
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aaraby Ragavan
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Brian P Halliday
- Inherited Cardiac Conditions Care Group, Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK.
- National Heart and Lung Institute, Imperial College London, London, UK.
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18
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Bala R, Mehta S, Roy VC, Kaur G, de Marvao A. Peripartum cardiomyopathy: A review. Rev Port Cardiol 2023; 42:917-924. [PMID: 37414337 DOI: 10.1016/j.repc.2023.01.029] [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: 01/04/2023] [Accepted: 01/07/2023] [Indexed: 07/08/2023] Open
Abstract
Peripartum cardiomyopathy is a rare type of heart failure manifesting towards the end of pregnancy or in the months following delivery, in the absence of any other cause of heart failure. There is a wide range of incidence across countries reflecting different population demographics, uncertainty over definitions and under-reporting. Race, ethnicity, multiparity and advanced maternal age are considered important risk factors for the disease. Its etiopathogenesis is incompletely understood and is likely multifactorial, including hemodynamic stresses of pregnancy, vasculo-hormonal factors, inflammation, immunology and genetics. Affected women present with heart failure secondary to reduced left ventricular systolic function (LVEF <45%) and often with associated phenotypes such as LV dilatation, biatrial dilatation, reduced systolic function, impaired diastolic function, and increased pulmonary pressure. Electrocardiography, echocardiography, magnetic resonance imaging, endomyocardial biopsy, and certain blood biomarkers aid in diagnosis and management. Treatment for peripartum cardiomyopathy depends on the stage of pregnancy or postpartum, disease severity and whether the woman is breastfeeding. It includes standard pharmacological therapies for heart failure, within the safety restrictions for pregnancy and lactation. Targeted therapies such as bromocriptine have shown promise in early, small studies, with large definitive trials currently underway. Failure of medical interventions may require mechanical support and transplantation in severe cases. Peripartum cardiomyopathy carries a high mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, but over half of women present normalization of LV function within a year of diagnosis.
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Affiliation(s)
- Rajni Bala
- Department of Biotechnology, Punjabi University, Patiala, India; Adduct Healthcare Pvt. Ltd., Mohali, India
| | - Sakshi Mehta
- Adduct Healthcare Pvt. Ltd., Mohali, India; Department of Experimental Medicine and Biotechnology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Vikas C Roy
- Department of Pharmacy, Global College of Pharmacy, Kahanpur, Punjab, India
| | - Geetika Kaur
- Integrative Biosciences Center, Wayne State University, Detroit, MI 48202, USA; Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, MI 48202, USA
| | - Antonio de Marvao
- Department of Women and Children's Health, King's College London, London, United Kingdom; British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine and Sciences, King's College London, London, United Kingdom
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19
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Hughes ZH, Hughes LM, Khan SS. Genetic contributions to risk of adverse pregnancy outcomes. CURRENT CARDIOVASCULAR RISK REPORTS 2023; 17:185-193. [PMID: 38186860 PMCID: PMC10768680 DOI: 10.1007/s12170-023-00729-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 01/09/2024]
Abstract
Purpose of Review Adverse pregnancy outcomes (APOs), including hypertensive disorders of pregnancy (HDP), low birthweight (LBW), and preterm birth (PTB), along with peripartum cardiomyopathy (PPCM) are associated with short- and long-term maternal and fetal cardiovascular risks. This review focuses on the genetic contributions to the risk of APOs and PPCM. Recent Findings The expansion of genome-wide association studies (GWAS) has led to better understanding of the biologic mechanisms underpinning APO, PPCM, and the predisposition to cardiovascular disease across the life course. Genetic loci known to be involved with the risk of hypertension (FTO, ZNF831) have been associated with the development of overall HDP and preeclampsia. Additionally, four loci significantly associated with type 2 diabetes have been associated with GDM (CDKAL1, MTNR1B, TCF7L2, CDK2NA-CDKN2B). Variants in loci known to affect genes coding for proteins involved in immune cell function and placental health (EBF1, EEFSEC, AGTR2, 2q13) have been implicated in the development of PTB and future cardiovascular risks for both the mother and the offspring. Genetic similarities in rare variants between PPCM and dilated cardiomyopathy have been described suggesting shared pathophysiologic origins as well as predisposition for future risk of heart failure, highlighting the need for the development PPCM genetic counseling guidelines. Summary Genetics may inform mechanisms, risk, and counseling for individuals after an APO or PPCM. Through recent advances in genetic techniques and analytic approaches, new insights into the underlying biologic mechanisms and genetic variants leading to these risks have been discovered.
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Affiliation(s)
- Zachary H. Hughes
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, UA
| | - Lydia M. Hughes
- Department of Obstetrics & Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, UA
| | - Sadiya S. Khan
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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20
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 200] [Impact Index Per Article: 200.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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21
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Díez-Villanueva P, Jiménez-Méndez C, López-Lluva MT, Wasniewski S, Solís J, Fernández-Friera L, Martínez-Sellés M. Heart Failure in the Elderly: the Role of Biological and Sociocultural Aspects Related to Sex. Curr Heart Fail Rep 2023; 20:321-332. [PMID: 37498496 DOI: 10.1007/s11897-023-00619-9] [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] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE OF REVIEW Heart failure (HF) entails poor prognosis, with high morbidity and mortality burden, particularly in elderly patients. Notably, important sex differences have been described between men and women with HF. In this regard, some biological and sociocultural aspects related to sex may play a key role in the different development and prognosis of HF in elderly men and women. RECENT FINDINGS Important differences between men and women with HF, especially in the elderly population, have been specifically addressed in recent studies. Consequently, specific differences in biological and sociocultural aspects have been found to associate differences in pathophysiology, baseline clinical profile, and prognosis according to sex. Moreover, differences in comorbidities and frailty and other geriatric conditions, frequent in elderly population with HF, have also been described. Biological and sociocultural differences related to sex are key in the different clinical presentation and prognosis of heart failure in elderly women. Further studies will be required to better understand some other underlying reasons that may differently impact prognosis in elderly patients with HF.
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Affiliation(s)
- Pablo Díez-Villanueva
- Cardiology Department, Hospital Universitario de La Princesa, Calle Diego de León 62, 28006, Madrid, Spain.
| | | | | | - Samantha Wasniewski
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
| | - Jorge Solís
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Leticia Fernández-Friera
- Cardiac Imaging Unit, Hospital Universitario HM Montepríncipe-CIEC, Madrid, Spain
- Universidad Camilo José Cela, Madrid, Spain
- Atria Clinic, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
- Universidad Complutense and Universidad Europea de Madrid, Madrid, Spain
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22
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DeFilippis EM, Bhagra C, Casale J, Ging P, Macera F, Punnoose L, Rasmusson K, Sharma G, Sliwa K, Thorne S, Walsh MN, Kittleson MM. Cardio-Obstetrics and Heart Failure: JACC: Heart Failure State-of-the-Art Review. JACC. HEART FAILURE 2023; 11:1165-1180. [PMID: 37678960 DOI: 10.1016/j.jchf.2023.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/26/2023] [Accepted: 07/05/2023] [Indexed: 09/09/2023]
Abstract
Heart failure and cardiomyopathy are significant contributors to pregnancy-related deaths, as maternal morbidity and mortality have been increasing over time. In this setting, the role of the multidisciplinary cardio-obstetrics team is crucial to optimizing maternal, obstetrical and fetal outcomes. Although peripartum cardiomyopathy is the most common cardiomyopathy experienced by pregnant individuals, the hemodynamic changes of pregnancy may unmask a pre-existing cardiomyopathy leading to clinical decompensation. Additionally, there are unique management considerations for women with pre-existing cardiomyopathy as well as for those women with advanced heart failure who may be on left ventricular assist device support or have undergone heart transplantation. The purpose of this review is to discuss: 1) preconception counseling; 2) risk stratification and management strategies for pregnant women extending to the postpartum "fourth trimester" with pre-existing heart failure or "pre-heart failure;" 3) the safety of heart failure medications during pregnancy and lactation; and 4) management of pregnancy for women on left ventricular assist device support or after heart transplantation.
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Affiliation(s)
- Ersilia M DeFilippis
- Division of Cardiology, NewYork-Presbyterian Columbia University Irving Medical Center, New York, New York, USA
| | - Catriona Bhagra
- Department of Cardiology, Cambridge University and Royal Papworth NHS Foundation Trusts, Cambridge, United Kingdom
| | - Jillian Casale
- Department of Pharmacy Services, Cooperman Barnabas Medical Center, Livingston, New Jersey, USA
| | - Patricia Ging
- Department of Pharmacy, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Francesca Macera
- De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy; Department of Cardiology, Cliniques Universitaires de Bruxelles - Hôpital Erasme, Brussels, Belgium
| | - Lynn Punnoose
- Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kismet Rasmusson
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, Utah, USA
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen Sliwa
- Cape Heart Institute, Department of Medicine, Division of Cardiology, Faculty of Health Sciences, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Sara Thorne
- Division of Cardiology, Pregnancy & Heart Disease Program, Mount Sinai Hospital & University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
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23
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Reza N, Packard E, Goli R, Chowns JL, Owens AT, Arany Z, Lewey J. Clinical Predictors of Referral for and Yield of Genetic Testing in Peripartum Cardiomyopathy. JACC. HEART FAILURE 2023; 11:1278-1280. [PMID: 37178081 PMCID: PMC10529608 DOI: 10.1016/j.jchf.2023.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 03/23/2023] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Elizabeth Packard
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Rahul Goli
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Jessica L. Chowns
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Anjali Tiku Owens
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Zoltan Arany
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, Pennsylvania 19104, USA
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24
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Lovell JP, Bermea K, Yu J, Rousseau S, Cohen CD, Bhalodia A, Zita MD, Head RD, Blumenthal RS, Alharethi R, Damp J, Boehmer J, Alexis J, McNamara DM, Sharma G, Adamo L. Serum Proteomic Analysis of Peripartum Cardiomyopathy Reveals Distinctive Dysregulation of Inflammatory and Cholesterol Metabolism Pathways. JACC. HEART FAILURE 2023; 11:1231-1242. [PMID: 37542511 DOI: 10.1016/j.jchf.2023.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND The pathophysiology of peripartum cardiomyopathy (PPCM) and its distinctive biological features remain incompletely understood. High-throughput serum proteomic profiling, a powerful tool to gain insights into the pathophysiology of diseases at a systems biology level, has never been used to investigate PPCM relative to nonischemic cardiomyopathy. OBJECTIVES The aim of this study was to characterize the pathophysiology of PPCM through serum proteomic analysis. METHODS Aptamer-based proteomic analysis (SomaScan 7K) was performed on serum samples from women with PPCM (n = 67), women with nonischemic nonperipartum cardiomyopathy (NPCM) (n = 31), and age-matched healthy peripartum and nonperipartum women (n = 10 each). Serum samples were obtained from the IPAC (Investigation of Pregnancy-Associated Cardiomyopathy) and IMAC2 (Intervention in Myocarditis and Acute Cardiomyopathy) studies. RESULTS Principal component analysis revealed unique clustering of each patient group (P for difference <0.001). Biological pathway analyses of differentially measured proteins in PPCM relative to NPCM, before and after normalization to pertinent healthy controls, highlighted specific dysregulation of inflammatory pathways in PPCM, including the upregulation of the cholesterol metabolism-related anti-inflammatory pathway liver-X receptor/retinoid-X receptor (LXR/RXR) (P < 0.01, Z-score 1.9-2.1). Cardiac recovery by 12 months in PPCM was associated with the downregulation of pro-inflammatory pathways and the upregulation of LXR/RXR, and an additional RXR-dependent pathway involved in the regulation of inflammation and metabolism, peroxisome proliferator-activated receptor α/RXRα signaling. CONCLUSIONS Serum proteomic profiling of PPCM relative to NPCM and healthy controls indicated that PPCM is a distinct disease entity characterized by the unique dysregulation of inflammation-related pathways and cholesterol metabolism-related anti-inflammatory pathways. These findings provide insight into the pathophysiology of PPCM and point to novel potential therapeutic targets.
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Affiliation(s)
- Jana P Lovell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kevin Bermea
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jinsheng Yu
- Department of Genetics, McDonnell Genome Institute, Washington University, St. Louis, Missouri, USA
| | - Sylvie Rousseau
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charles D Cohen
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aashik Bhalodia
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Marcelle Dina Zita
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Richard D Head
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Roger S Blumenthal
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Julie Damp
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - John Boehmer
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Jeffrey Alexis
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, Maryland, USA. https://twitter.com/GarimaVSharmaMD
| | - Luigi Adamo
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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25
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Nugrahani AD, Maulana S, Tjandraprawira KD, Santoso DPJ, Setiawan D, Pribadi A, Siddiq A, Pramatirta AY, Aziz MA, Irianti S. Analysis of Clinical Profiles and Echocardiographic Cardiac Outcomes in Peripartum Cardiomyopathy (PPCM) vs. PPCM with Co-Existing Hypertensive Pregnancy Disorder (HPD-PPCM) Patients: A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:5303. [PMID: 37629345 PMCID: PMC10455411 DOI: 10.3390/jcm12165303] [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: 06/06/2023] [Revised: 07/15/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a form of new-onset heart failure that has a high rate of maternal morbidity and mortality. This was the first study to systematically investigate and compare clinical factors and echocardiographic findings between women with PPCM and co-incident hypertensive pregnancy disorders (HPD-PPCM) and PPCM-only women. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) framework. We used four databases and a single search engine, namely PubMed/Medline, Scopus, Web of Science, and Cochrane. We used Cochrane Risk of Bias (RoB) 2.0 for quality assessment. Databases were searched for relevant articles published from 2013 to the end of April 2023. The meta-analysis used the DerSimonian-Laird random-effects model to analyze the pooled mean difference (MD) and its p-value. We included four studies with a total of 64,649 participants and found that systolic blood pressure was significantly more likely to be associated with the PPCM group than the HPD-PPCM group (SMD = -1.63) (95% CI; -4.92,0.28, p = 0.01), while the other clinical profiles were not significant. HPD-PPCM was less likely to be associated with LVEF reduction (SMD = -1.55, [CI: -2.89, -0.21], p = 0.02). HPD-PPCM was significantly associated with less LV dilation (SMD = 1.81; 95% (CI 0.07-3.01), p = 0.04). Moreover, HPD-PPCM was less likely to be associated with relative wall thickness reduction (SMD = 0.70; 95% CI (-1.08--0.33), p = 0.0003). In conclusion, PPCM and HPD-PPCM shared different clinical profiles and remodeling types, which may affect each disease's response to pharmacological treatment. Patients with HPD-PPCM exhibited less eccentric remodeling and seemed to have a higher chance of recovering their LV ejection fraction, which means they might not benefit as much from ACEi/ARB and beta-blockers. The findings of this study will guide the development of guidelines for women with PPCM and HPD-PPCM from early detection to further management.
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Affiliation(s)
- Annisa Dewi Nugrahani
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Slamet General Hospital Garut, Bandung 45363, West Java, Indonesia;
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Sidik Maulana
- Nursing Internship Program, University of Padjadjaran, Sumedang 45363, West Java, Indonesia;
| | - Kevin Dominique Tjandraprawira
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Dhanny Primantara Johari Santoso
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Slamet General Hospital Garut, Bandung 45363, West Java, Indonesia;
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Dani Setiawan
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Adhi Pribadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Amillia Siddiq
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Akhmad Yogi Pramatirta
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Muhammad Alamsyah Aziz
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
| | - Setyorini Irianti
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Padjadjaran, Dr. Hasan Sadikin General Hospital, Bandung 45363, West Java, Indonesia; (K.D.T.); (D.S.); (A.P.); (A.S.); (A.Y.P.); (M.A.A.); (S.I.)
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26
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Pachariyanon P, Bogabathina H, Jaisingh K, Modi M, Modi K. Long-Term Outcomes of Women With Peripartum Cardiomyopathy Having Subsequent Pregnancies. J Am Coll Cardiol 2023; 82:16-26. [PMID: 37380299 DOI: 10.1016/j.jacc.2023.04.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Long-term maternal outcomes of subsequent pregnancies (SSPs) in patients with peripartum cardiomyopathy (PPCM) have not been analyzed. OBJECTIVES The goal of this study was to evaluate the long-term survival of SSPs in women with PPCM. METHODS We conducted a retrospective review of 137 PPCMs in the registry. The clinical and echocardiographic findings were compared between the recovery group (RG) and nonrecovery group (NRG), defined as left ventricular ejection fraction ≥50% and <50% after an index of pregnancy, respectively. RESULTS Forty-five patients with SSPs were included with a mean age of 27.0 ± 6.1 years, 80% were of African American descent, and 75.6% from a low socioeconomic background. Thirty (66.7%) women were in the RG. Overall, SSPs were associated with a decrease in mean left ventricular ejection fraction from 45.1% ± 13.7% to 41.2% ± 14.5% (P = 0.009). At 5 years, adverse outcomes were significantly higher in the NRG compared with the RG (53.3% vs 20%; P = 0.04), driven by relapse PPCM (53.3% vs 20.0%; P = 0.03). Five-year all-cause mortality was 13.33% in the NRG compared with 3.33% in the RG (P = 0.25). At a median follow-up of 8 years, adverse outcomes and all-cause mortality rates were similar in the NRG and RG (53.3% vs 33.3% [P = 0.20] and 20% vs 20%, respectively). CONCLUSIONS Subsequent pregnancies in women with PPCM are associated with adverse events. The normalization of left ventricular function does not guarantee a favorable outcome in the SSPs.
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Affiliation(s)
- Pavida Pachariyanon
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Hari Bogabathina
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Keerthish Jaisingh
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Morni Modi
- School of Medicine, Louisiana State University Health, Shreveport, Louisiana, USA
| | - Kalgi Modi
- Department of Cardiology, Louisiana State University Health, Shreveport, Louisiana, USA.
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27
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Yamada S, Ko T, Katagiri M, Morita H, Komuro I. Recent Advances in Translational Research for Heart Failure in Japan. J Card Fail 2023; 29:931-938. [PMID: 37321698 DOI: 10.1016/j.cardfail.2022.11.018] [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: 07/05/2022] [Revised: 11/13/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
Despite decades of intensive research and therapeutic development, heart failure remains a leading cause of death worldwide. However, recent advances in several basic and translational research fields, such as genomic analysis and single-cell analysis, have increased the possibility of developing novel diagnostic approaches to heart failure. Most cardiovascular diseases that predispose individuals to heart failure are caused by genetic and environmental factors. It follows that genomic analysis can contribute to the diagnosis and prognostic stratification of patients with heart failure. In addition, single-cell analysis has shown great potential for unveiling the pathogenesis and/or pathophysiology and for discovering novel therapeutic targets for heart failure. Here, we summarize the recent advances in translational research on heart failure in Japan, based mainly on our studies.
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Affiliation(s)
- Shintaro Yamada
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mikako Katagiri
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Cardiovascular Medicine, Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan.
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28
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Mansoori GA, Mahmeed WA, Wani S, Salih BT, Ansari TE, Farook F, Farooq Z, Khair H, Zaręba K, Dhahouri NA, Raj A, Foo RS, Ali BR, Jasmi FA, Akawi N. Introducing and Implementing Genetic Assessment in Cardio-Obstetrics Clinical Practice: Clinical and Genetic Workup of Patients with Cardiomyopathy. Int J Mol Sci 2023; 24:ijms24119119. [PMID: 37298070 DOI: 10.3390/ijms24119119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
Cardiovascular disease (CVD) during pregnancy varies significantly worldwide, influenced by factors such as access to healthcare, delayed diagnosis, causes, and risk factors. Our study sought to explore the spectrum of CVD present in pregnant women in the United Arab Emirates to better understand this population's unique needs and challenges. Central to our study is an emphasis on the importance of implementing a multidisciplinary approach that involves the collaboration of obstetricians, cardiologists, geneticists, and other healthcare professionals to ensure that patients receive comprehensive and coordinated care. This approach can also help identify high-risk patients and implement preventive measures to reduce the occurrence of adverse maternal outcomes. Furthermore, increasing awareness among women about the risk of CVD during pregnancy and obtaining detailed family histories can help in the early identification and management of these conditions. Genetic testing and family screening can also aid in identifying inherited CVD that can be passed down through families. To illustrate the significance of such an approach, we provide a comprehensive analysis of five women's cases from our retrospective study of 800 women. The findings from our study emphasize the importance of addressing maternal cardiac health in pregnancy and the need for targeted interventions and improvements in the existing healthcare system to reduce adverse maternal outcomes.
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Affiliation(s)
- Ghadeera Al Mansoori
- Department of Cardiology, Sheikh Shakhbout Medical City, Abu Dhabi 11001, United Arab Emirates
| | - Wael Al Mahmeed
- Heart, Vascular & Thoracic Institute, Cleveland Clinic, Abu Dhabi 112412, United Arab Emirates
| | - Saleema Wani
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Bashir Taha Salih
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Tarek El Ansari
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Fathima Farook
- Department of Obstetrics & Gynecology, Corniche Hospital, Abu Dhabi 3788, United Arab Emirates
| | - Zenab Farooq
- College of Medicine and Health Sciences, Khalifa University, Abu Dhabi 127788, United Arab Emirates
| | - Howaida Khair
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Kornelia Zaręba
- Department of Obstetrics & Gynecology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Nahid Al Dhahouri
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Anjana Raj
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Roger S Foo
- Cardiovascular Research Institute, National University Healthcare Systems, Singapore 117599, Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore 138672, Singapore
| | - Bassam R Ali
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Fatma Al Jasmi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
| | - Nadia Akawi
- Department of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain 15551, United Arab Emirates
- Division of Cardiovascular Medicine, University of Oxford, Oxford OX3 9DU, UK
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29
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Masri A, Reza N. Genetic Testing for Cardiomyopathies in Japan: Embarking on a Journey of Discovery. J Card Fail 2023; 29:815-817. [PMID: 37169423 DOI: 10.1016/j.cardfail.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/07/2023] [Indexed: 05/13/2023]
Affiliation(s)
- Ahmad Masri
- Division of Cardiovascular Medicine, Knight Cardiovascular Institute, Oregon Health and Science University, Portland
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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30
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Taylor J, Yeung ACY, Ashton A, Faiz A, Guryev V, Fang B, Lal S, Grosser M, Dos Remedios CG, Braet F, McLachlan CS, Li A. Transcriptomic Comparison of Human Peripartum and Dilated Cardiomyopathy Identifies Differences in Key Disease Pathways. J Cardiovasc Dev Dis 2023; 10:jcdd10050188. [PMID: 37233155 DOI: 10.3390/jcdd10050188] [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: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/27/2023] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a rare form of acute onset heart failure that presents in otherwise healthy pregnant women around the time of delivery. While most of these women respond to early intervention, about 20% progress to end-stage heart failure that symptomatically resembles dilated cardiomyopathy (DCM). In this study, we examined two independent RNAseq datasets from the left ventricle of end-stage PPCM patients and compared gene expression profiles to female DCM and non-failing donors. Differential gene expression, enrichment analysis and cellular deconvolution were performed to identify key processes in disease pathology. PPCM and DCM display similar enrichment in metabolic pathways and extracellular matrix remodeling suggesting these are similar processes across end-stage systolic heart failure. Genes involved in golgi vesicles biogenesis and budding were enriched in PPCM left ventricles compared to healthy donors but were not found in DCM. Furthermore, changes in immune cell populations are evident in PPCM but to a lesser extent compared to DCM, where the latter is associated with pronounced pro-inflammatory and cytotoxic T cell activity. This study reveals several pathways that are common to end-stage heart failure but also identifies potential targets of disease that may be unique to PPCM and DCM.
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Affiliation(s)
- Jude Taylor
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
| | - Anna C Y Yeung
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, The University of Technology Sydney (UTS), Sydney, NSW 2007, Australia
| | - Anthony Ashton
- Division of Cardiovascular Medicine, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Alen Faiz
- Respiratory Bioinformatics and Molecular Biology, School of Life Sciences, The University of Technology Sydney (UTS), Sydney, NSW 2007, Australia
- Groningen Research Institute for Asthma and COPD (GRIAC), The University of Groningen, 9700 Groningen, The Netherlands
| | - Victor Guryev
- Groningen Research Institute for Asthma and COPD (GRIAC), The University of Groningen, 9700 Groningen, The Netherlands
- Laboratory of Genome Structure and Ageing, European Research Institute for the Biology of Ageing (ERIBA), University Medical Centre Groningen, The University of Groningen, 9713 Groningen, The Netherlands
| | - Bernard Fang
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
| | - Sean Lal
- Charles Perkins Centre, The University of Sydney, Sydney, NSW 2006, Australia
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Cardiology, The Royal Prince Alfred Hospital, Sydney, NSW 2050, Australia
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
| | | | - Cristobal G Dos Remedios
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
- Victor Chang Cardiac Research Institute, Darlinghurst, NSW 2010, Australia
| | - Filip Braet
- School of Medical Sciences, The University of Sydney, Sydney, NSW 2006, Australia
- Australian Centre for Microscopy & Microanalysis, The University of Sydney, Sydney, NSW 2006, Australia
| | - Craig S McLachlan
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
| | - Amy Li
- Centre for Healthy Futures, Torrens University Australia, Surrey Hills, NSW 2010, Australia
- Sydney Heart Bank, The University of Sydney, Sydney, NSW 2006, Australia
- Department of Pharmacy & Biomedical Sciences, La Trobe University, Bendigo, VIC 3550, Australia
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31
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The genetic basis for adult-onset idiopathic dilated cardiomyopathy in people of African descent. Heart Fail Rev 2023:10.1007/s10741-023-10302-9. [PMID: 36917398 PMCID: PMC10011790 DOI: 10.1007/s10741-023-10302-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/16/2023]
Abstract
Cardiomyopathies are a heterogeneous group of cardiac muscle disorders that result in dilated, hypertrophic, or restrictive pathophysiological entities. Dilated cardiomyopathy (DCM) is the most common form in sub-Saharan Africa (SSA). However, population-specific research studies reporting the actual burden of DCM in this region are still lacking. Also, little is known about the genetic basis of DCM in this population, and genetic testing is still not readily accessible. This review describes the common pathogenic genes implicated in DCM globally and discusses the evidence-based management of patients with DCM. We also present a summary of studies describing genes implicated or associated with DCM in patients residing in SSA.
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32
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Abstract
PURPOSE OF REVIEW Peripartum cardiomyopathy (PPCM) contributes significantly to maternal morbidity and mortality worldwide. In this review, we describe the present-day epidemiology and current understanding of the pathogenesis of PPCM. We provide an updated approach to diagnosis and management of PPCM, and discuss risk factors and predictors of outcome. RECENT FINDINGS The highest incidences of PPCM have been reported in African, Asian, and Caribbean populations. Contemporary literature supports a 'two-hit' hypothesis, whereby the 'first hit' implies a predisposition, and the 'second hit' refers to an imbalanced peripartal hormonal milieu that results in cardiomyopathy. Whereas a half of patients will have left ventricular (LV) recovery, a tenth do not survive. Clinical findings and special investigations (ECG, echocardiography, cardiac MRI, biomarkers) can be used for risk stratification. Frequent prescription of guideline-directed medical therapy is associated with improved outcomes. SUMMARY Despite advances in elucidating the pathogenesis of PPCM, it remains unclear why only certain women develop the disease. Moreover, even with better diagnostic work-up and management, it remains unknown why some patients with PPCM have persistent LV dysfunction or die. Future research should be aimed at better understanding of the mechanisms of disease and finding new therapies that could improve survival and LV recovery.
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33
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Barrick SK, Garg A, Greenberg L, Zhang S, Lin CY, Stitziel NO, Greenberg MJ. Functional assays reveal the pathogenic mechanism of a de novo tropomyosin variant identified in patient with dilated cardiomyopathy. J Mol Cell Cardiol 2023; 176:58-67. [PMID: 36739943 DOI: 10.1016/j.yjmcc.2023.01.014] [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: 09/06/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
Dilated cardiomyopathy (DCM) is a leading cause of heart failure and a major indicator for heart transplant. Human genetic studies have identified over a thousand causal mutations for DCM in genes involved in a variety of cellular processes, including sarcomeric contraction. A substantial clinical challenge is determining the pathogenicity of novel variants in disease-associated genes. This challenge of connecting genotype and phenotype has frustrated attempts to develop effective, mechanism-based treatments for patients. Here, we identified a de novo mutation (T237S) in TPM1, the gene that encodes the thin filament protein tropomyosin, in a patient with DCM and conducted in vitro experiments to characterize the pathogenicity of this novel variant. We expressed recombinant mutant protein, reconstituted it into thin filaments, and examined the effects of the mutation on thin filament function. We show that the mutation reduces the calcium sensitivity of thin filament activation, as previously seen for known pathogenic mutations. Mechanistically, this shift is due to mutation-induced changes in tropomyosin positioning along the thin filament. We demonstrate that the thin filament activator omecamtiv mecarbil restores the calcium sensitivity of thin filaments regulated by the mutant tropomyosin, which lays the foundation for additional experiments to explore the therapeutic potential of this drug for patients harboring the T237S mutation. Taken together, our results suggest that the TPM1 T237S mutation is likely pathogenic and demonstrate how functional in vitro characterization of pathogenic protein variants in the lab might guide precision medicine in the clinic.
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Affiliation(s)
- Samantha K Barrick
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ankit Garg
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA; Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Lina Greenberg
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Shanshan Zhang
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Nathan O Stitziel
- Center for Cardiovascular Research, Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, USA; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael J Greenberg
- Department of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St. Louis, MO 63110, USA.
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34
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Kawano H, Kawamura K, Ishijima M, Abe K, Hayashi T, Eguchi M, Miura K, Maemura K. Pathological features of biopsied myocardium in patients clinically diagnosed with peripartum cardiomyopathy. Med Mol Morphol 2023; 56:58-68. [PMID: 36348099 DOI: 10.1007/s00795-022-00340-x] [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: 09/02/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
The etiology of peripartum cardiomyopathy (PPCM) is unknown. Therefore, we evaluated the etiology of patients clinically diagnosed with PPCM using endomyocardial biopsy. We studied five patients diagnosed with PPCM following endomyocardial biopsy (age, 28-42 years; mean age, 35 years). Biopsied samples were evaluated using microscopy, including immunostaining and electron microscopy. The pathological findings were as follows: myocardial hypertrophy, myocardial fibrosis, and cell infiltration. Two patients were diagnosed with lymphocytic myocarditis, one with eosinophilic myocarditis, one with hypertensive heart disease, and one with a combination of hypertension and myocarditis. Endomyocardial biopsy suggested that the causes of PPCM were varied and related to myocarditis and myocardial overload due to hypertension.
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Affiliation(s)
- Hiroaki Kawano
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Koichi Kawamura
- Faculty of Science and Engineering, Waseda University, Tokyo, Japan
| | - Mitsuaki Ishijima
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kuniko Abe
- Department of Pathology, The Japanese Red Cross Nagasaki Genbaku Hospital, Nagasaki, Japan
| | - Tomayoshi Hayashi
- Department of Pathology, Shimabara Prefectural Hospital, Shimabara, Japan
| | - Masamichi Eguchi
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Kiyonori Miura
- Department of Obstetrics and Gynecology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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35
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Kumar A, Ravi R, Sivakumar RK, Chidambaram V, Majella MG, Sinha S, Adamo L, Lau ES, Al’Aref SJ, Asnani A, Sharma G, Mehta JL. Prolactin Inhibition in Peripartum Cardiomyopathy: Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101461. [PMID: 36261102 PMCID: PMC9805509 DOI: 10.1016/j.cpcardiol.2022.101461] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
Heart failure (HF) is one of the leading causes of maternal mortality and morbidity in the United States. Peripartum cardiomyopathy (PPCM) constitutes up to 70% of all HF in pregnancy. Cardiac angiogenic imbalance caused by cleaved 16kDa prolactin has been hypothesized to contribute to the development of PPCM, fueling investigation of prolactin inhibitors for the management of PPCM. We conducted a systematic review and meta-analysis to assess the impact of prolactin inhibition on left ventricular (LV) function and mortality in patients with PPCM. We included English language articles from PubMed and EMBASE published upto March 2022. We pooled the mean difference (MD) for left ventricular ejection fraction (LVEF) at follow-up, odds ratio (OR) for LV recovery and risk ratio (RR) for all-cause mortality using random-effects meta-analysis. Among 548 studies screened, 10 studies (3 randomized control trials (RCTs), 2 retrospective and 5 prospective cohorts) were included in the systematic review. Patients in the Bromocriptine + standard guideline directed medical therapy (GDMT) group had higher LVEF% (pMD 12.56 (95% CI 5.84-19.28, I2=0%) from two cohorts and pMD 14.25 (95% CI 0.61-27.89, I2=88%) from two RCTs) at follow-up compared to standard GDMT alone group. Bromocriptine group also had higher odds of LV recovery (pOR 3.55 (95% CI 1.39-9.1, I2=62)). We did not find any difference in all-cause mortality between the groups. Our analysis demonstrates that the addition of Bromocriptine to standard GDMT was associated with a significant improvement in LVEF% and greater odds of LV recovery, without significant reduction in all-cause mortality.
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Affiliation(s)
- Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ramya Ravi
- Department of Anesthesia and Intensive Care, Chinese university of Hong Kong, Prince of Wales hospital, Shatin, Hong Kong
| | - Ranjith K. Sivakumar
- Department of Anesthesia and Intensive Care, Chinese university of Hong Kong, Prince of Wales hospital, Shatin, Hong Kong
| | - Vignesh Chidambaram
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marie G. Majella
- Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital & Research Center, Pondicherry, India
| | - Shashank Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA
| | - Luigi Adamo
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily S. Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Subhi J. Al’Aref
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aarti Asnani
- Beth Israel Deaconess Medical Center, Harvard Medical School, Cardiovascular Institute, Boston, MA
| | - Garima Sharma
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jawahar L. Mehta
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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36
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Carlson S, Schultz J, Ramu B, Davis MB. Peripartum Cardiomyopathy: Risks Diagnosis and Management. J Multidiscip Healthc 2023; 16:1249-1258. [PMID: 37163197 PMCID: PMC10164389 DOI: 10.2147/jmdh.s372747] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023] Open
Abstract
Peripartum cardiomyopathy is a rare cause of heart failure that occurs during late pregnancy or in the early postpartum period. Delays in diagnosis may occur as symptoms of heart failure mimic those of normal pregnancy. The diagnosis should be considered in any pregnant or postpartum woman with symptoms concerning for heart failure. If there are clinical concerns, labs including N-terminal pro-BNP should be checked, and an echocardiogram should be ordered to assess for systolic dysfunction. Prompt medical treatment tailored for pregnancy and lactation is essential to prevent adverse events. Outcomes are variable, including complete recovery, persistent myocardial dysfunction with heart failure symptoms, arrhythmias, thromboembolic events, and/or rapid deterioration requiring mechanical circulatory support and cardiac transplantation. It is essential that care is provided as part of a multidisciplinary cardio-obstetrics team including obstetrics, cardiology, maternal fetal medicine, anesthesiology, and nursing. All women with peripartum cardiomyopathy should have close follow-up with a cardiologist, although optimal duration of medical therapy following complete recovery is unknown. Women considering a subsequent pregnancy require preconception counseling and close collaboration between obstetrics and cardiology throughout pregnancy.
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Affiliation(s)
- Selma Carlson
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
- Division of Cardiology, Minneapolis VA Medical Center, Minneapolis, MN, USA
- Correspondence: Selma Carlson, Division of Cardiology, Department of Medicine, Minneapolis VA Health Care System, Minneapolis, MN, USA, Email
| | - Jessica Schultz
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Bhavadharini Ramu
- Division of Cardiology, Department of Medicine, Medical University of South Carolina (MUSC), Charleston, SC, USA
| | - Melinda B Davis
- Division of Cardiovascular Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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37
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Harding D, Chong MHA, Lahoti N, Bigogno CM, Prema R, Mohiddin SA, Marelli-Berg F. Dilated cardiomyopathy and chronic cardiac inflammation: Pathogenesis, diagnosis and therapy. J Intern Med 2023; 293:23-47. [PMID: 36030368 DOI: 10.1111/joim.13556] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Dilated cardiomyopathy (DCM) is typically defined by left ventricular dilation and systolic dysfunction in the absence of a clear precipitant. Idiopathic disease is common; up to 50% of patients with DCM have no cause found despite imaging, genetic and biopsy assessments. Treatment remains focused on managing symptoms, reducing the risk of sudden cardiac death and ameliorating the structural and electrical complications of disease progression. In the absence of aetiology-specific treatments, the condition remains associated with a poor prognosis; mortality is approximately 40% at 10 years. The role of immune-mediated inflammatory injury in the development and progression of DCM was first proposed over 30 years ago. Despite the subsequent failures of three large clinical trials of immunosuppressive treatment (ATTACH, RENEWAL and the Myocarditis Treatment Trial), evidence for an abnormal adaptive immune response in DCM remains significant. In this review, we summarise and discuss available evidence supporting immune dysfunction in DCM, with a specific focus on cellular immunity. We also highlight current clinical and experimental treatments. We propose that the success of future immunosuppressive treatment trials in DCM will be dependent on the deep immunophenotyping of patients, to identify those with active inflammation and/or an abnormal immune response who are most likely to respond to therapy.
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Affiliation(s)
- Daniel Harding
- Centre for Biochemical Pharmacology, William Harvey Research Institute, London, UK
| | - Ming H A Chong
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Nishant Lahoti
- Conquest Hospital, East Sussex Healthcare NHS Trust, St Leonards-on-Sea, UK
| | - Carola M Bigogno
- Barts and The London School of Medicine and Dentistry, London, UK
| | - Roshni Prema
- University Hospital, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
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38
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Lewey J. Challenges and opportunities to improving research in maternal cardiovascular health. NATURE CARDIOVASCULAR RESEARCH 2023; 2:6-7. [PMID: 36875777 PMCID: PMC9979619 DOI: 10.1038/s44161-022-00201-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Pregnancy is associated with a substantial risk of short-term and long-term cardiovascular diseases. Here we discuss physiological and social factors that affect the risk of pregnancy-related cardiovascular diseases and opportunities to improve outcomes.
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Affiliation(s)
- Jennifer Lewey
- Division of Cardiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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39
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Sliwa K, Viljoen CA, Hasan B, Ntusi NAB. Nutritional Heart Disease and Cardiomyopathies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 81:S0735-1097(22)07308-9. [PMID: 36599756 DOI: 10.1016/j.jacc.2022.08.812] [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: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 01/03/2023]
Abstract
This JACC Focus Seminar provides an overview of and highlights recently published research on cardiomyopathies and nutritional heart disease that have a higher prevalence in tropical regions. The development of tropical cardiomyopathies and nutritional cardiovascular disease (CVD) is complicated by high rates of poverty, fragmented health care systems, and suboptimal access to health care because of socioeconomic inequalities, leading to the fact that children, adolescents, and young adults are disproportionally affected. Such tropical cardiomyopathies and nutritional CVD that have not been prevalent in high-income countries in the past decades are now reemerging. When treating migrants or refugees, it is important for attending physicians to consider the burden of endemic diseases in the countries of origin and the likelihood that such patients might be affected. In this review, the authors propose an approach for adequate diagnostic work-up leading to appropriate care for those with suspected or confirmed tropical cardiomyopathies and nutritional CVD.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babar Hasan
- Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplant, Karachi, Pakistan
| | - Ntobeko A B Ntusi
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
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40
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Guo Y, Wang J, Guo X, Gao R, Yang C, Li L, Sun Y, Qiu X, Xu Y, Yang Y. KLF13 Loss‐of‐Function Mutations Underlying Familial Dilated Cardiomyopathy. J Am Heart Assoc 2022; 11:e027578. [DOI: 10.1161/jaha.122.027578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background
Dilated cardiomyopathy (DCM), characterized by progressive left ventricular enlargement and systolic dysfunction, is the most common type of cardiomyopathy and a leading cause of heart failure and cardiac death. Accumulating evidence underscores the critical role of genetic defects in the pathogenesis of DCM, and >250 genes have been implicated in DCM to date. However, DCM is of substantial genetic heterogeneity, and the genetic basis underpinning DCM remains elusive in most cases.
Methods and Results
By genome‐wide scan with microsatellite markers and genetic linkage analysis in a 4‐generation family inflicted with autosomal‐dominant DCM, a new locus for DCM was mapped on chromosome 15q13.1–q13.3, a 4.77‐cM (≈3.43 Mbp) interval between markers D15S1019 and D15S1010, with the largest 2‐point logarithm of odds score of 5.1175 for the marker D15S165 at recombination fraction (θ)=0.00. Whole‐exome sequencing analyses revealed that within the mapping chromosomal region, only the mutation in the
KLF13
gene, c.430G>T (p.E144X), cosegregated with DCM in the family. In addition, sequencing analyses of
KLF13
in another cohort of 266 unrelated patients with DCM and their available family members unveiled 2 new mutations, c.580G>T (p.E194X) and c.595T>C (p.C199R), which cosegregated with DCM in 2 families, respectively. The 3 mutations were absent from 418 healthy subjects. Functional assays demonstrated that the 3 mutants had no transactivation on the target genes
ACTC1
and
MYH7
(2 genes causally linked to DCM), alone or together with GATA4 (another gene contributing to DCM), and a diminished ability to bind the promoters of
ACTC1
and
MYH7
. Add, the E144X‐mutant KLF13 showed a defect in intracellular distribution.
Conclusions
This investigation indicates
KLF13
as a new gene predisposing to DCM, which adds novel insight to the molecular pathogenesis underlying DCM, implying potential implications for prenatal prevention and precision treatment of DCM in a subset of patients.
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Affiliation(s)
- Yu‐Han Guo
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
| | - Jun Wang
- Department of Cardiology, Shanghai Jing’an District Central Hospital Fudan University Shanghai China
| | - Xiao‐Juan Guo
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
| | - Ri‐Feng Gao
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
| | - Chen‐Xi Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
| | - Li Li
- Key Laboratory of Arrhythmias of the Ministry of Education of China, Shanghai East Hospital Tongji University School of Medicine Shanghai China
- Institute of Medical Genetics Tongji University Shanghai China
| | - Yu‐Min Sun
- Department of Cardiology, Shanghai Jing’an District Central Hospital Fudan University Shanghai China
| | - Xing‐Biao Qiu
- Department of Cardiology, Shanghai Chest Hospital Shanghai Jiao Tong University Shanghai China
| | - Ying‐Jia Xu
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
| | - Yi‐Qing Yang
- Department of Cardiology, Shanghai Fifth People’s Hospital Fudan University Shanghai China
- Cardiovascular Research Laboratory and Central Laboratory, Shanghai Fifth People’s Hospital Fudan University Shanghai China
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41
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García-Hernandez S, Iglesias LM. Genetic Testing as a Guide for Treatment in Dilated Cardiomyopathies. Curr Cardiol Rep 2022; 24:1537-1546. [PMID: 35994197 DOI: 10.1007/s11886-022-01772-8] [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] [Accepted: 08/10/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Dilated cardiomyopathy (DCM) is one of the most prevalent primary cardiomyopathies and may be caused by genetic and non-genetic etiologies. DCM may also be the final common pathway of other cardiomyopathies such as hypertrophic, arrhythmogenic, or non-compaction cardiomyopathy. We review the main DCM genetic substrates, specific genotype-phenotype aspects, the role of genetic testing in risk stratification, and advances regarding genotype-based precision medicine. RECENT FINDINGS Performing a comprehensive genetic study could have a diagnostic yield up to 40% in DCM, and it is considered a cost-effective approach nowadays. The detection of a specific underlying genetic substrate explaining the disease can have important consequences for clinical management, especially for familial cascade screening, optimizing medical treatment, and improving the arrhythmic risk stratification. The identification of the genetic substrate underlying dilated cardiomyopathy makes possible the genotype-phenotype correlation analysis and a better understanding of the natural history of this disease. Nowadays, there are many promising targeting-gene therapies in different developing phases.
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Affiliation(s)
- Soledad García-Hernandez
- Scientific Department, Health in Code S.L., A Coruña, Spain.,Inherited Cardiac Diseases Unit, Hospital Universitario San Cecilio, Granada, Spain
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42
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La Gerche A, Wasfy MM, Brosnan MJ, Claessen G, Fatkin D, Heidbuchel H, Baggish AL, Kovacic JC. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80:1346-1362. [PMID: 36075838 DOI: 10.1016/j.jacc.2022.07.014] [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] [Received: 04/15/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022]
Abstract
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
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Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria J Brosnan
- National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Antwerp, Belgium; Cardiovascular Sciences, Antwerp University, Antwerp, Belgium
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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43
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Peripartum cardiomyopathy: Characteristics and outcomes among women seen at a referral hospital in Lusaka, Zambia. IJC HEART & VASCULATURE 2022; 42:101104. [PMID: 36046756 PMCID: PMC9421395 DOI: 10.1016/j.ijcha.2022.101104] [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: 05/17/2022] [Revised: 07/21/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022]
Abstract
Background Peripartum cardiomyopathy (PPCM) disproportionately affects women of African descent, however knowledge about this disease in African countries is limited. Objectives To describe the phenotype of women with PPCM seen at a referral hospital in Zambia and examine outcomes at 6 months. Methods A prospective observational study describing characteristics and 6-month outcomes was performed at the University Teaching Hospital Echocardiography Lab in Lusaka, Zambia. Results We enrolled 45 participants with PPCM and 38 were seen at 6-month follow up; 3 (7 %) died and 4 (9 %) were lost to follow up. Mean age was 32.9 years (SD:7.0); mean BMI was 25.3 kg/m2 (SD:4.1), mean parity was 3.4 (SD:2.2) children and twin pregnancies occurred in 4 (9 %). Median time from symptom onset to diagnosis was 60 days (IQR: 1–280). 20 (44 %) reported gestational hypertension and 10 (22 %) reported preeclampsia. Baseline median left ventricular ejection fraction (LVEF) was 36 % (IQR: 11–45), median left ventricular end-diastolic volume (LVEDV) was 150 mL (IQR: 58–229) and 79 % described New York Heart Association (NYHA) functional class IV symptoms. Median LVEF after 6 months was 49 % (IQR: 23–68; p < 0.001) and median LVEDV was 121 mL (IQR: 66–200; p < 0.001). At 6-month follow up 45 % had LVEF ≥ 50 %, 42 % had LVEDV ≤ 106 mL and 1 (3 %) had NYHA functional class IV symptoms. Conclusions Hypertension was prevalent in this cohort. Overall mortality rate was low and clinically significant improvements in cardiac parameters were seen in over 40%. Further research is needed to identify and mitigate gaps in diagnosis and management.
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Wolfe DS, Liu C, Alboucai J, Karten A, Mushi J, Yellin S, Berkowitz JL, Vega S, Felix N, Liaqat W, Kankaria R, Vorawandthanachai T, Bortnick AE. Maternal Outcomes in Women with Peripartum Cardiomyopathy versus Age and Race-Matched Peers in an Urban US Community. J Cardiovasc Dev Dis 2022; 9:jcdd9080250. [PMID: 36005414 PMCID: PMC9410188 DOI: 10.3390/jcdd9080250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is idiopathic systolic congestive heart failure around pregnancy. Comparisons with matched controls are lacking. We investigated maternal characteristics and outcomes up to 12 months in a cohort admitted to Montefiore Health System in Bronx, New York 1999−2015 (n = 53 cases and n = 92 age and race-matched controls, >80% Black or Hispanic/Latina). Compared to peers, women with PPCM had more chronic hypertension (24.5% vs. 8.8%, p = 0.001), prior gestational hypertension (20.8% vs. 5.4%, p = 0.001), prior preeclampsia (17.0% vs. 3.3%, p = 0.001), familial dilated cardiomyopathy (5.7% vs. 0.0%, p = 0.04), smoking (15.1% vs. 2.2%, p = 0.001), lower summary socioeconomic scores (−4.12 (IQR −6.81, −2.13) vs. −1.62 (IQR −4.20, −0.74), p < 0.001), public insurance (67.9% vs. 29.3% p = 0.001), and frequent depressive symptoms. Women with PPCM were often admitted antepartum (34.0% vs. 18.5%, p = 0.001) and underwent Cesarean section (65.4% vs. 30.4%, p = 0.001), but had less preterm labor (27.3% vs. 51.1%, p = 0.001). Women were rarely treated with bromocriptine (3.8%), frequently underwent left ventricular assist device placement (9.4% and n = 2 with menorrhagia requiring transfusion and progesterone) or heart transplantation (3.8%), but there were no in-hospital deaths. In sum, women with PPCM had worse socioeconomic disadvantage and baseline health than matched peers. Programs addressing social determinants of health may be important for women at high risk of PPCM.
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Affiliation(s)
- Diana S. Wolfe
- Department of Obstetrics and Gynecology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Correspondence:
| | - Christina Liu
- Department of Emergency Medicine, Woodhull Medical and Mental Health Center, Brooklyn, NY 11206, USA
| | - Jack Alboucai
- Department of Medicine, North Shore University Hospital, Manhasset, NY 11030, USA
| | - Ariel Karten
- Department of Medicine, Division of Cardiology, New York University Long Island School of Medicine, Mineola, NY 11501, USA
| | - Juliet Mushi
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University Maternal Fetal Medicine, Greenwich Hospital, Greenwich, CT 06830, USA
| | - Shira Yellin
- Department of Medicine, Mount Sinai Health System, New York, NY 10029, USA
| | - Julia L. Berkowitz
- Department of Medicine, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Shayna Vega
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Center, Oakland, CA 94611, USA
| | - Nicole Felix
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI 02903, USA
| | - Wasla Liaqat
- Department of Medicine, New York Health and Hospitals Jacobi Medical Center, Bronx, NY 10461, USA
| | - Rohan Kankaria
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | | | - Anna E. Bortnick
- Maternal Fetal Medicine-Cardiology Joint Program, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Bronx, NY 10461, USA
- Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Ko T, Morita H. Takotsubo Cardiomyopathy and Peripartum Cardiomyopathy. Int Heart J 2022; 63:651-653. [PMID: 35908852 DOI: 10.1536/ihj.22-133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Toshiyuki Ko
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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46
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Njoroge JN, Mangena JC, Aribeana C, Parikh VN. Emerging Genotype-Phenotype Associations in Dilated Cardiomyopathy. Curr Cardiol Rep 2022; 24:1077-1084. [PMID: 35900642 DOI: 10.1007/s11886-022-01727-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW The disease burden of inherited dilated cardiomyopathy (DCM) is large and likely underestimated. This population stands to benefit immensely from therapeutic approaches tailored to the underlying genetic causes. Here, we review recent advances in understanding novel genotype-phenotype relationships and how these can improve the care of patients with inherited DCM. RECENT FINDINGS In the last several years, discovery of novel DCM-associated genes, gene-specific DCM outcomes, and nuanced information about variant-environment interactions have advanced our understanding of inherited DCM. Specifically, novel associations of genes with specific clinical phenotypes can help to assess sudden cardiac death risk and guide counseling around behavioral and environmental exposures that may worsen disease. Important expansions of the current genotype-phenotype profiling include the newly DCM-associated FLNC variant, prognostically significant LMNA, DSP inflammatory cardiomyopathy, and the highly penetrant features of RBM20 variants as well as the role of TTN variants in compounding the effects of environmental factors on toxin-mediated DCM. Future directions to improve diagnostic accuracy and prognostic improvement in DCM will center not just on identification of new genes, but also on understanding the interaction of known and novel variants in known DCM genes with patient genetic background and environment.
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Affiliation(s)
- Joyce N Njoroge
- Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA, 94103, USA
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Jennifer C Mangena
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Chiaka Aribeana
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA
| | - Victoria N Parikh
- Stanford Center for Inherited Cardiovascular Disease, Stanford University School of Medicine, Falk CVRB room CV-154, 870 Quarry Road, Stanford, CA, 94305, USA.
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Abstract
PURPOSE OF REVIEW Truncating TTN variants (TTNtv) are the most common genetic cause of dilated cardiomyopathy (DCM), but the underlying mechanisms are incompletely understood and effective therapeutic strategies are lacking. Here we review recent data that shed new light on the functional consequences of TTNtv and how these effects may vary with mutation location. RECENT FINDINGS Whether TTNtv act by haploinsufficiency or dominant negative effects has been hotly debated. New evidence now implicates both mechanisms in TTNtv-related DCM, showing reduced titin content and persistent truncated titin that may be incorporated into protein aggregates. The extent to which aggregate formation and protein quality control defects differ with TTNtv location and contribute to contractile dysfunction is unresolved. TTNtv-associated DCM has a complex etiology that involves varying combinations of wild-type titin deficiency and dominant negative effects of truncated mutant titin. Therapeutic strategies to improve protein handling may be beneficial in some cases.
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48
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Abstract
Cardiovascular complications of pregnancy have risen substantially over the past decades, and now account for the majority of pregnancy-induced maternal deaths, as well as having substantial long-term consequences on maternal cardiovascular health. The causes and pathophysiology of these complications remain poorly understood, and therapeutic options are limited. Preclinical models represent a crucial tool for understanding human disease. We review here advances made in preclinical models of cardiovascular complications of pregnancy, including preeclampsia and peripartum cardiomyopathy, with a focus on pathological mechanisms elicited by the models and on relevance to human disease.
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Affiliation(s)
- Zolt Arany
- Department of Medicine and Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Denise Hilfiker-Kleiner
- Institute of Cardiovascular Complications in Pregnancy and in Oncologic Therapies, Philipps University Marburg, Germany (D.H.-K.)
| | - S Ananth Karumanchi
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (S.A.K.)
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49
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Minhas AS, Goldstein SA, Vaught AJ, Lewey J, Ward C, Schulman SP, Michos ED. Instituting a Curriculum for Cardio-Obstetrics Subspecialty Fellowship Training. Methodist Debakey Cardiovasc J 2022; 18:14-23. [PMID: 35734150 PMCID: PMC9165665 DOI: 10.14797/mdcvj.1101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/24/2022] [Indexed: 01/26/2023] Open
Abstract
Maternal mortality is rising in the United States, and cardiovascular disease is the leading cause. Adverse pregnancy outcomes such as preeclampsia and gestational diabetes heighten the risk of cardiovascular complications during pregnancy and the peripartum period and are associated with long-term cardiovascular risks. The field of cardio-obstetrics is a subspecialty within adult cardiology that focuses on the management of women with or at high risk for heart disease who are considering pregnancy or have become pregnant. There is growing recognition of the need for more specialists with dedicated expertise in cardio-obstetrics to improve the cardiovascular care of this high-risk patient population. Current recommendations for cardiovascular fellowship training programs accredited by the Accreditation Council for Graduate Medical Education involve establishing core competency in the knowledge of managing heart disease in pregnancy. However, little granular detail is available of what such training should entail, which can lead to knowledge gaps. Additionally, dedicated advanced subspecialty training in this area is not commonly offered. Multidisciplinary collaborative teams have been shown to improve outcomes in cardiac patients during pregnancy, and cardiovascular fellows-in-training interested in cardio-obstetrics should have the opportunity to participate in and contribute to a pregnancy heart team. In this document, we describe a proposed specialized cardio-obstetrics training pathway that could serve to adequately prepare trainees to competently and comprehensively care for women with cardiovascular disease before, during, and after pregnancy.
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Affiliation(s)
- Anum S. Minhas
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
| | | | | | - Jennifer Lewey
- University of Pennsylvania, Philadelphia, Pennsylvania, US
| | - Cary Ward
- Duke University School of Medicine, Durham, North Carolina, US
| | | | - Erin D. Michos
- Johns Hopkins University School of Medicine, Baltimore, Maryland, US
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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50
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Lukas Laws J, Lancaster MC, Ben Shoemaker M, Stevenson WG, Hung RR, Wells Q, Marshall Brinkley D, Hughes S, Anderson K, Roden D, Stevenson LW. Arrhythmias as Presentation of Genetic Cardiomyopathy. Circ Res 2022; 130:1698-1722. [PMID: 35617362 PMCID: PMC9205615 DOI: 10.1161/circresaha.122.319835] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
There is increasing evidence regarding the prevalence of genetic cardiomyopathies, for which arrhythmias may be the first presentation. Ventricular and atrial arrhythmias presenting in the absence of known myocardial disease are often labelled as idiopathic, or lone. While ventricular arrhythmias are well-recognized as presentation for arrhythmogenic cardiomyopathy in the right ventricle, the scope of arrhythmogenic cardiomyopathy has broadened to include those with dominant left ventricular involvement, usually with a phenotype of dilated cardiomyopathy. In addition, careful evaluation for genetic cardiomyopathy is also warranted for patients presenting with frequent premature ventricular contractions, conduction system disease, and early onset atrial fibrillation, in which most detected genes are in the cardiomyopathy panels. Sudden death can occur early in the course of these genetic cardiomyopathies, for which risk is not adequately tracked by left ventricular ejection fraction. Only a few of the cardiomyopathy genotypes implicated in early sudden death are recognized in current indications for implantable cardioverter defibrillators which otherwise rely upon a left ventricular ejection fraction ≤0.35 in dilated cardiomyopathy. The genetic diagnoses impact other aspects of clinical management such as exercise prescription and pharmacological therapy of arrhythmias, and new therapies are coming into clinical investigation for specific genetic cardiomyopathies. The expansion of available genetic information and implications raises new challenges for genetic counseling, particularly with the family member who has no evidence of a cardiomyopathy phenotype and may face a potentially negative impact of a genetic diagnosis. Discussions of risk for both probands and relatives need to be tailored to their numeric literacy during shared decision-making. For patients presenting with arrhythmias or cardiomyopathy, extension of genetic testing and its implications will enable cascade screening, intervention to change the trajectory for specific genotype-phenotype profiles, and enable further development and evaluation of emerging targeted therapies.
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Affiliation(s)
- J Lukas Laws
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Megan C Lancaster
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - M Ben Shoemaker
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - William G Stevenson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Rebecca R Hung
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Quinn Wells
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - D Marshall Brinkley
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Sean Hughes
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Katherine Anderson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Dan Roden
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
| | - Lynne W Stevenson
- Division of Cardiovascular Medicine, Vanderbilt Heart and Vascular Institute, Vanderbilt University Medical Center, Nashville, TN
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