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Waterford SD, Ad N. Surgery for Cardiac Arrhythmias: Past, Present, Future. Rambam Maimonides Med J 2024; 15:RMMJ.10516. [PMID: 38261346 PMCID: PMC10807855 DOI: 10.5041/rmmj.10516] [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] [Indexed: 01/24/2024] Open
Abstract
There is a rich history of surgery for cardiac arrhythmias, spanning from atrial fibrillation and Wolff-Parkinson-White syndrome to inappropriate sinus tachycardia and ventricular tachycardia. This review describes the history of these operations, their evolution over time, and the current state of practice. We devote considerable time to the discussion of atrial fibrillation, the most common cardiac arrhythmia addressed by surgeons. We discuss ablation of atrial fibrillation as a stand-alone operation and as a concomitant operation performed at the time of cardiac surgery. We also discuss the emergence of newer procedures to address atrial fibrillation in the past decade, such as the convergent procedure and totally thoracoscopic ablation, and their outcomes relative to historic approaches such as the Cox maze procedure.
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Affiliation(s)
- Stephen D Waterford
- University of Pittsburgh Medical Center, Department of Cardiothoracic Surgery, Pittsburgh, Pennsylvania, USA
| | - Niv Ad
- Johns Hopkins University, Department of Surgery, Division of Cardiac Surgery, Baltimore, Maryland, USA
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Faria B, Ribeiro S, Calvo L, Oliveira M, von Hafe P, Bettencourt N, Sanfins V, Lourenço A. Mitral annular disjunction: Beyond mitral valve prolapse. Rev Port Cardiol 2023; 42:873-878. [PMID: 37156414 DOI: 10.1016/j.repc.2019.09.024] [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: 05/12/2019] [Revised: 08/12/2019] [Accepted: 09/08/2019] [Indexed: 05/10/2023] Open
Abstract
Mitral annular disjunction (MAD) is an easily identifiable entity on transthoracic echocardiography, but is still poorly recognized or ignored. It is often associated with mitral valve prolapse and is itself a risk marker for ventricular arrhythmias and sudden cardiac death, but the management and risk stratification of these patients is not systematized. Two clinical cases of MAD associated with mitral valve prolapse and ventricular arrhythmias are presented. The first case is of a patient with a history of surgical intervention on the mitral valve due to Barlow's disease. He presented to the emergency department with sustained monomorphic ventricular tachycardia requiring emergent electrical cardioversion. MAD with transmural fibrosis at the level of the inferolateral wall was documented. The second report is of a young woman with palpitations and frequent premature ventricular contractions on Holter with documentation of valvular prolapse and MAD, and focuses on the risk stratification approach. The present article offers a review of the literature regarding the arrhythmic risk of MAD and mitral valve prolapse, as well as a review of risk stratification in these patients.
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Affiliation(s)
- Bebiana Faria
- Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal.
| | - Sílvia Ribeiro
- Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | - Lucy Calvo
- Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | | | - Pedro von Hafe
- Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
| | | | - Victor Sanfins
- Hospital Senhora da Oliveira - Guimarães, Guimarães, Portugal
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Hohneck A, Ansari U, Natale M, Wittig K, Overhoff D, Riffel P, Boettcher M, Akin I, Duerschmied D, Papavassiliu T. Description of a new clinical syndrome: thoracic constriction without evidence of the typical funnel-shaped depression-the "invisible" pectus excavatum. Sci Rep 2023; 13:12036. [PMID: 37491452 PMCID: PMC10368685 DOI: 10.1038/s41598-023-38739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
Pectus excavatum (PE) is a congenital malformation with a funnel-shaped depression of the sternum that can lead to cardiac symptoms. However, there are patients with thoracic constriction (defined as elevated Haller-Index > 3.25 determined by cardiac magnetic resonance imaging (CMR)) without visible evidence of PE, leading to similar complaints. Between January 2004 till June 2020, patients who underwent CMR for further evaluation of the heart, due to cardiac symptoms were enrolled and compared to controls. Biventricular global strain analysis was assessed using feature tracking (CMR-FT). ECG and/or Holter recordings were performed to detect rhythm events. Cardiac symptoms were evaluated in detail using a questionnaire. Finally, 88 patients (male 35, female 53) with elevated Haller-Index (3.9 ± 0.8) were included and compared to CMR data from 25 individuals with confirmed PE and 25 healthy controls (HC). Mean age at time of CMR was 35 ± 16 years. The most common symptoms at presentation were palpitations (41%), followed by dyspnea (24%) and atypical chest pain (14%). Three patients (3%) had atrial fibrillation or atrial flutter. Concomitant phenomena were pericardial effusion in 39% and mitral valve prolapse (MVP) in 27% of the study cohort. While there were no differences in left ventricular function or volumes, right ventricular function (RVEF) was significantly lower in patients with internal PE compared to HC (RVEF (%) 50 ± 5 vs 59 ± 4, p < 0.01). Strain analysis revealed only discrete changes in RV strain, implying a purely mechanical problem in the absence of structural changes. RV dimensions were negatively correlated with the size of thoracic indices (r = 0.41), reflecting the extent of thoracic constriction. MVP was more prevalent in patients with greater thoracic indices (r = 0.24). The described cohort, referred to as internal PE because of the absence of external changes, showed similar CMR morphologic findings as patients with real PE (especially altered dimensions of the right heart and a lower RVEF). In addition, there was a high incidence of rhythm disturbances, such as extrasystoles or arrhythmias. In one-third of the study cohort additional abnormalities such as pericardial effusion or MVP were present, with MVP being found more frequently in patients with larger thoracic indices, suggesting a possible common pathogenesis.Trial registration: ISRCTN registry, ISRCTN15355937, retrospectively registered 03.06.2022, https://www.isrctn.com/ISRCTN15355937?q=15355937&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10 .
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Affiliation(s)
- Anna Hohneck
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany.
| | - Uzair Ansari
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michèle Natale
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Karsten Wittig
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Daniel Overhoff
- Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Philipp Riffel
- Department of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Michael Boettcher
- Department of Pediatric Surgery, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ibrahim Akin
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Daniel Duerschmied
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
- European Center for AngioScience (ECAS) and German Center for Cardiovascular Research (DZHK) partner site Heidelberg/Mannheim, Mannheim, Germany
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Li R, Assadi H, Matthews G, Mehmood Z, Grafton-Clarke C, Kasmai B, Hewson D, Greenwood R, Spohr H, Zhong L, Zhao X, Sawh C, Duehmke R, Vassiliou VS, Nelthorpe F, Ashman D, Curtin J, Yashoda GK, Van der Geest RJ, Alabed S, Swift AJ, Hughes M, Garg P. The Importance of Mitral Valve Prolapse Doming Volume in the Assessment of Left Ventricular Stroke Volume with Cardiac MRI. Med Sci (Basel) 2023; 11:medsci11010013. [PMID: 36810480 PMCID: PMC9945133 DOI: 10.3390/medsci11010013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/20/2023] [Accepted: 01/20/2023] [Indexed: 01/26/2023] Open
Abstract
There remains a debate whether the ventricular volume within prolapsing mitral valve (MV) leaflets should be included in the left ventricular (LV) end-systolic volume, and therefore factored in LV stroke volume (SV), in cardiac magnetic resonance (CMR) assessments. This study aims to compare LV volumes during end-systolic phases, with and without the inclusion of the volume of blood on the left atrial aspect of the atrioventricular groove but still within the MV prolapsing leaflets, against the reference LV SV by four-dimensional flow (4DF). A total of 15 patients with MV prolapse (MVP) were retrospectively enrolled in this study. We compared LV SV with (LV SVMVP) and without (LV SVstandard) MVP left ventricular doming volume, using 4D flow (LV SV4DF) as the reference value. Significant differences were observed when comparing LV SVstandard and LV SVMVP (p < 0.001), and between LV SVstandard and LV SV4DF (p = 0.02). The Intraclass Correlation Coefficient (ICC) test demonstrated good repeatability between LV SVMVP and LV SV4DF (ICC = 0.86, p < 0.001) but only moderate repeatability between LV SVstandard and LV SV4DF (ICC = 0.75, p < 0.01). Calculating LV SV by including the MVP left ventricular doming volume has a higher consistency with LV SV derived from the 4DF assessment. In conclusion, LV SV short-axis cine assessment incorporating MVP dooming volume can significantly improve the precision of LV SV assessment compared to the reference 4DF method. Hence, in cases with bi-leaflet MVP, we recommend factoring in MVP dooming into the left ventricular end-systolic volume to improve the accuracy and precision of quantifying mitral regurgitation.
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Affiliation(s)
- Rui Li
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Hosamadin Assadi
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Gareth Matthews
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Zia Mehmood
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | | | - Bahman Kasmai
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - David Hewson
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Richard Greenwood
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Hilmar Spohr
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
- Cardiovascular Sciences Academic Clinical Programme, Duke-NUS Medical School, 8 College Road, Singapore 169856, Singapore
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre Singapore, 5 Hospital Drive, Singapore 169609, Singapore
| | - Chris Sawh
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Rudolf Duehmke
- Cardiology Department, Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust, King’s Lynn PE30 4ET, UK
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Faye Nelthorpe
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - David Ashman
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - John Curtin
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Gurung-Koney Yashoda
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Rob J. Van der Geest
- Department of Radiology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Samer Alabed
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Andrew J. Swift
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
| | - Marina Hughes
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norfolk NR4 7TJ, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norfolk NR4 7UY, UK
- Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK
- Department of Clinical Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield S10 2JF, UK
- Correspondence: ; Tel.: +44-016-0359-2534
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Jaouadi H, Théron A, Hourdain J, Martel H, Nguyen K, Habachi R, Deharo JC, Collart F, Avierinos JF, Zaffran S. SCN5A Variants as Genetic Arrhythmias Triggers for Familial Bileaflet Mitral Valve Prolapse. Int J Mol Sci 2022; 23:ijms232214447. [PMID: 36430924 PMCID: PMC9692711 DOI: 10.3390/ijms232214447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/16/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
Mitral valve prolapse (MVP) is a common valvular heart defect with variable outcomes. Several studies reported MVP as an underestimated cause of life-threatening arrhythmias and sudden cardiac death (SCD), mostly in young adult women. Herein, we report a clinical and genetic investigation of a family with bileaflet MVP and a history of syncopes and resuscitated sudden cardiac death. Using family based whole exome sequencing, we identified two missense variants in the SCN5A gene. A rare variant SCN5A:p.Ala572Asp and the well-known functional SCN5A:p.His558Arg polymorphism. Both variants are shared between the mother and her daughter with a history of resuscitated SCD and syncopes, respectively. The second daughter with prodromal MVP as well as her healthy father and sister carried only the SCN5A:p.His558Arg polymorphism. Our study is highly suggestive of the contribution of SCN5A mutations as the potential genetic cause of the electric instability leading to ventricular arrhythmias in familial MVP cases with syncope and/or SCD history.
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Affiliation(s)
- Hager Jaouadi
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Correspondence: (H.J.); (S.Z.); Tel.: +33-4-9132-4936 (H.J. & S.Z.); Fax: +33-4-9179-7227 (H.J. & S.Z.)
| | - Alexis Théron
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Jérôme Hourdain
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Hélène Martel
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Karine Nguyen
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Medical Genetics, Timone Enfant Hospital, 13005 Marseille, France
| | - Raja Habachi
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | | | - Frédéric Collart
- Department of Cardiac Surgery, La Timone Hospital, 13005 Marseille, France
| | - Jean-François Avierinos
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Department of Cardiology, La Timone Hospital, 13005 Marseille, France
| | - Stéphane Zaffran
- Marseille Medical Genetics, INSERM, Aix Marseille Université, U1251 Marseille, France
- Correspondence: (H.J.); (S.Z.); Tel.: +33-4-9132-4936 (H.J. & S.Z.); Fax: +33-4-9179-7227 (H.J. & S.Z.)
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Musella F, Azzu A, Antonopoulos AS, La Mura L, Mohiaddin RH. Comprehensive mitral valve prolapse assessment by cardiovascular MRI. Clin Radiol 2021; 77:e120-e129. [PMID: 34895911 DOI: 10.1016/j.crad.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/05/2021] [Indexed: 12/07/2022]
Abstract
Mitral valve (MV) prolapse (MVP) is a not fully understood common MV disorder. The development of sophisticated cardiovascular magnetic resonance imaging (CMRI) sequences over the last decades has allowed a more detailed assessment and provided better understanding of the pathophysiology of MVP to guide management, interventions, and risk stratification of patients affected. This review provides an overview of the most recent insights about this multifaceted pathology, particularly regarding the emerging concepts of mitral annular disjunction (MAD), and risk of arrhythmia and sudden death associated with myocardial fibrosis. We describe the emerging role of CMRI in both diagnosis and, more importantly, risk assessment of this disease, aiming to provide a comprehensive protocol for the assessment of MVP, which could represent a practical guide to clinicians and MRI practitioners working in the field.
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Affiliation(s)
- F Musella
- Department of Advanced Biomedical Sciences, University Federico II of Naples. Naples, Italy.
| | - A Azzu
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK
| | - A S Antonopoulos
- 1st Cardiology Department, Athens School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - L La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples. Naples, Italy
| | - R H Mohiaddin
- Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, UK; National Heart and Lung Institute, Imperial College London, UK.
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Wibawa K, Ivan I, Jessica G, Ridjab D. The Outcome of Ventricular Arrhythmias Associated With Mitral Valve Prolapse After Catheter Ablation: A Systematic Review and Meta-Analysis. Cureus 2021; 13:e20310. [PMID: 35024259 PMCID: PMC8742679 DOI: 10.7759/cureus.20310] [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] [Accepted: 12/09/2021] [Indexed: 12/07/2022] Open
Abstract
The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular arrhythmias (VAs) associated with MVP. Despite having high procedural success, outcome data after CA is limited, especially in a long-term setting. Therefore, this systematic review and meta-analysis were performed. Literature searching was conducted in Pubmed, EuropePMC, Proquest, and Ebsco from inception to December 2020 using keywords: ventricular arrhythmia, premature ventricular complex, ventricular tachycardia, ventricular fibrillation, mitral valve prolapse, and catheter ablation. A total of 407 potential articles were retrieved for further review. The final review resulted in six articles for systematic review and meta-analysis. The study was registered in PROSPERO (CRD42020219144). The most common origin of VAs was papillary muscle. The acute success rate of CA in the MVP group varies between 66% and 94%. Follow-up studies reported a higher percentage of VAs recurrence after CA in the MVP group (22.22%) compared with the non-MVP group (11.38%). However, the difference is not significant (P-value = 0.16). Other studies reported a 12.5%-36% rate and 40% of repeat ablation in the medium term and the long term, respectively. Episodes of sudden cardiac death during exertion could still occur following CA in patients with MVP. Distinct origin of VAs was observed during repeated ablation procedures, which may explain arrhythmic substrate progression. Diffuse left ventricular fibrosis around papillary muscle rather than local fibrosis was observed among older patients. Furthermore, the presence of mitral annular disjunction (MAD) and Filamin C mutation might increase the risk of recurrent VAs. CAn has been done as the treatment of VAs associated with MVP. The acute success rate of CA varies between studies and the number of patients requiring repeat CA varied from 12.5% to 40%. Sudden cardiac death could still occur after CA. Older age during CA, genetic predisposition, deep arrhythmic foci, multifocal VAs origin, diffuse fibrosis, and the presence of MAD may contribute to the recurrence of VAs. Further studies, stratification, and evaluation are needed to prevent fatal outcomes in VA associated with MVP, even after CA.
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Lee JH, Uhm JS, Suh YJ, Kim M, Kim IS, Jin MN, Cho MS, Yu HT, Kim TH, Hong YJ, Lee HJ, Shim CY, Kim YJ, Kim J, Kim JY, Joung B, Hong GR, Pak HN, Nam GB, Choi KJ, Kim YH, Lee MH. Usefulness of cardiac magnetic resonance images for prediction of sudden cardiac arrest in patients with mitral valve prolapse: a multicenter retrospective cohort study. BMC Cardiovasc Disord 2021; 21:546. [PMID: 34789163 PMCID: PMC8600905 DOI: 10.1186/s12872-021-02362-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/03/2021] [Indexed: 12/07/2022] Open
Abstract
Background An association has been identified between mitral valve prolapse (MVP) and sudden cardiac arrest (SCA), and ventricular arrhythmias (VA). This study aimed to elucidate predictive factors for SCA or VA in MVP patients. Methods MVP patients who underwent cardiac magnetic resonance (CMR) were retrospectively included. Patients with other structural heart disease or causes of aborted SCA were excluded. Clinical characteristics (sex, age, body mass index, histories of diabetes, hypertension, and dyslipidemia) and electrocardiographic (PR interval, QRS duration, corrected QT interval, inverted T wave in the inferior leads, bundle branch block, and atrial fibrillation), echocardiographic [mitral regurgitation grade, prolapsing mitral leaflet, and right ventricular systolic pressure (RVSP)], and CMR [left atrial volume index, both ventricular ejection fractions, both ventricular end-diastolic and systolic volume indexes, prolapse distance, mitral annular disjunction, systolic curling motion, presence of late gadolinium enhancement (LGE), LGE volume and proportion] parameters were analyzed. Results Of the 85 patients [age, 54.0 (41.0–65.0) years; 46 men], seven experienced SCA or VA. Younger age and wide QRS complex were observed more often in the SCA/VA group than in the no-SCA/VA group. The SCA/VA group exhibited lower RVSP, more systolic curling motion and LGE, greater LGE volume, and higher LGE proportion. The presence of LGE [hazard ratio (HR), 19.8; 95% confidence interval (CI) 2.65–148.15; P = 0.004], LGE volume (HR 1.08; 95% CI 1.02–1.14; P = 0.006) and LGE proportion (HR 1.32; 95% CI 1.08–1.60; P = 0.006) were independently associated with higher risk of SCA or VA in MVP patients together with systolic curling motion in each model. Conclusions The presence of systolic curling motion, high LGE volume and proportion, and the presence of LGE on CMR were independent predictive factors for SCA or VA in MVP patients.
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Affiliation(s)
- Jae-Hyuk Lee
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae-Sun Uhm
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Joo Suh
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Min Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - In-Soo Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo-Nyun Jin
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Min Soo Cho
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae-Hoon Kim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yoo Jin Hong
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Hye-Jeong Lee
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Chi Young Shim
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Jin Kim
- Departments of Cardiology and Radiology, Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Jun Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Youn Kim
- Department of Cardiology, Gangnam Severance Hospital, College of Medicine, Yonsei University, Seoul, Republic of Korea
| | - Boyoung Joung
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Geu-Ru Hong
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hui-Nam Pak
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Gi-Byoung Nam
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kee-Joon Choi
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - You-Ho Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Departments of Cardiology, Severance Cardiovascular Hospital, College of Medicine, Yonsei University, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
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9
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Song C, Zhang Y, Zheng X, Lu J, Fang X, Wang S, Huang X. Relation of Mitral Leaflet Elongation to Nonsustained Ventricular Tachycardia in Patients with Obstructive Hypertrophic Cardiomyopathy. Am J Cardiol 2021; 158:112-117. [PMID: 34465462 DOI: 10.1016/j.amjcard.2021.07.025] [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] [Received: 04/26/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/07/2022]
Abstract
The impact of mitral valve abnormality on the occurrence of non-sustained ventricular tachycardia (NSVT) in patients with hypertrophic cardiomyopathy (HC) has not been well determined. We sought to demonstrate the relation of mitral valve abnormalities with NSVT in patients with obstructive HC. Three hundred and sixteen adult patients with obstructive HC with at least 1 Holter electrocardiographic monitoring and cardiac magnetic resonance (CMR) from 2014 to 2018 were enrolled. CMR images and Holter electrocardiography were analyzed in all patients. NSVT occurred in 50 patients (16%). Compared with those without NSVT, anterior mitral leaflet and posterior mitral leaflet lengths was significantly increased in patients with NSVT (AML 32.0 ± 5.0mm vs. 26.1±4.8mm, p<0.001; PML 17.7±3.7mm vs. 15.2±2.7mm, p<0.001, respectively). Multivariate logistic regression analysis indicated that elongated AML and PML were significantly independent predictors of NSVT (AML: OR 1.261, 95%CI 1.156-1.375, p<0.001; PML: OR 1.126, 95%CI 1.001-1.265, p=0.047). Furthermore, the area under the receiver operating characteristic curve for AML was 0.812. At a cutoff valve of 27.5mm, AML length had a sensitivity of 86% and specificity of 65%. Elongated mitral leaflets independently correlated with NSVT in patients with obstructive HC. Furthermore, the morphological abnormalities of mitral valve could serve as a useful marker for improving risk stratification of SCD and may play a role in optimizing surgical strategy for patients with obstructive HC.
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10
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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11
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Kyryachenko S, Georges A, Yu M, Barrandou T, Guo L, Bruneval P, Rubio T, Gronwald J, Baraki H, Kutschka I, Aras KK, Efimov IR, Norris RA, Voigt N, Bouatia-Naji N. Chromatin Accessibility of Human Mitral Valves and Functional Assessment of MVP Risk Loci. Circ Res 2021; 128:e84-e101. [PMID: 33508947 PMCID: PMC8316483 DOI: 10.1161/circresaha.120.317581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
RATIONALE Mitral valve prolapse (MVP) is a common valvopathy that leads to mitral insufficiency, heart failure, and sudden death. Functional genomic studies in mitral valves are needed to better characterize MVP-associated variants and target genes. OBJECTIVE To establish the chromatin accessibility profiles and assess functionality of variants and narrow down target genes at MVP loci. METHODS AND RESULTS We mapped the open chromatin regions in nuclei from 11 human pathogenic and 7 nonpathogenic mitral valves by an assay for transposase-accessible chromatin with high-throughput sequencing. Open chromatin peaks were globally similar between pathogenic and nonpathogenic valves. Compared with the heart tissue and cardiac fibroblasts, we found that MV-specific assay for transposase-accessible chromatin with high-throughput sequencing peaks are enriched near genes involved in extracellular matrix organization, chondrocyte differentiation, and connective tissue development. One of the most enriched motifs in MV-specific open chromatin peaks was for the nuclear factor of activated T cells family of TFs (transcription factors) involved in valve endocardial and interstitial cell formation. We also found that MVP-associated variants were significantly enriched (P<0.05) in mitral valve open chromatin peaks. Integration of the assay for transposase-accessible chromatin with high-throughput sequencing data with risk loci, extensive functional annotation, and gene reporter assay suggest plausible causal variants for rs2641440 at the SMG6/SRR locus and rs6723013 at the IGFBP2/IGFBP5/TNS1 locus. CRISPR-Cas9 deletion of the sequence including rs6723013 in human fibroblasts correlated with increased expression only for TNS1. Circular chromatin conformation capture followed by high-throughput sequencing experiments provided evidence for several target genes, including SRR, HIC1, and DPH1 at the SMG6/SRR locus and further supported TNS1 as the most likely target gene on chromosome 2. CONCLUSIONS Here, we describe unprecedented genome-wide open chromatin profiles from human pathogenic and nonpathogenic MVs and report specific gene regulation profiles, compared with the heart. We also report in vitro functional evidence for potential causal variants and target genes at MVP risk loci involving established and new biological mechanisms. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
| | | | - Mengyao Yu
- Université de Paris, PARCC, Inserm, Paris,
France
| | | | - Lilong Guo
- Department of Regenerative Medicine and Cell Biology,
Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Medical University of South
Carolina, Charleston, SC, USA
| | | | - Tony Rubio
- Institute of Pharmacology and Toxicology, University
Medical Center Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner
Site Göttingen, Germany
| | - Judith Gronwald
- Institute of Pharmacology and Toxicology, University
Medical Center Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner
Site Göttingen, Germany
| | - Hassina Baraki
- DZHK (German Center for Cardiovascular Research), Partner
Site Göttingen, Germany
- Department of Thoracic and Cardiovascular Surgery,
University Medical Center, Göttingen, Germany
| | - Ingo Kutschka
- DZHK (German Center for Cardiovascular Research), Partner
Site Göttingen, Germany
- Department of Thoracic and Cardiovascular Surgery,
University Medical Center, Göttingen, Germany
| | - Kedar K. Aras
- Department of Biomedical Engineering, George Washington
University, Washington, DC, USA
| | - Igor R. Efimov
- Department of Biomedical Engineering, George Washington
University, Washington, DC, USA
| | - Russel A. Norris
- Department of Regenerative Medicine and Cell Biology,
Medical University of South Carolina, Charleston, SC, USA
- Department of Medicine, Medical University of South
Carolina, Charleston, SC, USA
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University
Medical Center Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner
Site Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from
Molecular Machines to Networks of Excitable Cells (MBExC), University of
Göttingen, Germany
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12
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Important tips reflected in our daily practice from the American College of Cardiology Electrophysiology Council report on premature ventricular contractions. Anatol J Cardiol 2021; 23:196-203. [PMID: 32235139 PMCID: PMC7163219 DOI: 10.14744/anatoljcardiol.2020.91572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Premature ventricular contractions (PVCs) is one of the most common situations in the current cardiology practice. Although PVCs are generally benign in people without any structural heart disease, they may be associated with left ventricular dysfunction, cardiomyopathy, and, rarely, sudden death. Recently, there has been a considerable research in the pathophysiology of PVC, several clinical presentations in different situations, new proposals of successful diagnostic methods, and treatment modalities. Finally, the American College of Cardiology Electrophysiology Council has published a special report that deals with all the aspects of PVC. We reviewed the important points from this report that can be reflected in our daily practice.
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13
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Salas Noain J, Mizrahi E, Zheng S, Minupuri A. Isolated Flailed P3 Scallop of the Mitral Valve Leaflet in the Setting of Newly Diagnosed Heart Failure With Preserved Ejection Fraction. Cureus 2020; 12:e9919. [PMID: 32968580 PMCID: PMC7505637 DOI: 10.7759/cureus.9919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Mitral valve prolapse (MVP) is characterized by typical fibromyxomatous changes in the mitral leaflet tissue with superior displacement of one or both leaflets into the left atrium. An echocardiogram is a fundamental study required for the diagnosis of MVP with a flail leaflet and grading of mitral regurgitation (MR) severity. Most patients with MVP have a risk of cardiovascular morbidity and mortality similar to that of the general population, though moderate to severe MR and left ventricular (LV) ejection fraction less than 50% have been postulated to increase the risk of adverse cardiac events. In this case report, we present an isolated flailed P3 scallop of the mitral valve leaflet leading to severe MR and acute congestive heart failure. A 54-year-old African-American male with a medical history of hypertension, hyperlipidemia, and transient ischemic attack, presented to the emergency department (ED) for evaluation of dyspnea on exertion. The patient reported that his dyspnea started one week prior to ED visit and was associated with intermittent chest pain. He also endorsed mild orthopnea and lightheadedness, though he denied any syncopal event. Vital signs were found within normal limits on arrival. He clinically appeared to be volume overloaded which improved quickly with IV furosemide. Transesophageal echocardiogram (TEE) with 3D image acquisition showed significant for hyper-dynamic LV function and evidence of isolated flailed P3 scallop of the mitral valve (MV) leaflet resulting in a severe eccentric, anteriorly directed MR jet. The MV leaflets did not appear thickened, and there was no evidence of mitral or aortic stenosis. Cardiac catheterization showed multivessel disease for which the patient underwent coronary artery bypass grafting and MV repair. This patient presented with new-onset congestive heart failure secondary to severe MR associated with undiagnosed MVP. Commonly, the middle scallop (P2) of the posterior leaflet is more prone to prolapse due to its redundancy and variable thickness with the impact of greater systolic pressure. However, in this case of acute severe MR, we identified an isolated flail of the P3 segment. We believe that this rare TEE finding was associated with a torn chordae or ruptured papillary muscle secondary to ischemic disease as the posteromedial papillary muscle has a single blood supply and is particularly prompted to injury from myocardial infarction.
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Affiliation(s)
| | - Eddy Mizrahi
- Cardiology, Mercy Philadelphia Hospital, Philadelphia, USA
| | - Shengnan Zheng
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
| | - Arun Minupuri
- Internal Medicine, Mercy Catholic Medical Center, Darby, USA
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14
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Premature ventricular complexes: diagnostic and therapeutic considerations in clinical practice : A state-of-the-art review by the American College of Cardiology Electrophysiology Council. J Interv Card Electrophysiol 2019; 57:5-26. [PMID: 31828560 DOI: 10.1007/s10840-019-00655-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/27/2019] [Indexed: 12/16/2022]
Abstract
Premature ventricular complexes (PVCs) are common arrhythmias in the clinical setting. PVCs in the structurally normal heart are usually benign, but in the presence of structural heart disease (SHD), they may indicate increased risk of sudden death. High PVC burden may induce cardiomyopathy and left ventricular (LV) dysfunction or worsen underlying cardiomyopathy. Sometimes PVCs may be a marker of underlying pathophysiologic process such as myocarditis. Identification of PVC burden is important, since cardiomyopathy and LV dysfunction can reverse after catheter ablation or pharmacological suppression. This state-of-the-art review discusses pathophysiology, clinical manifestations, how to differentiate benign and malignant PVCs, PVCs in the structurally normal heart, underlying SHD, diagnostic procedures (physical examination, electrocardiogram, ambulatory monitoring, exercise testing, echocardiography, cardiac magnetic resonance imaging, coronary angiography, electrophysiology study), and treatment (lifestyle modification, electrolyte imbalance, medical, and catheter ablation).
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15
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Blomme B, Deroanne C, Hulin A, Lambert C, Defraigne JO, Nusgens B, Radermecker M, Colige A. Mechanical strain induces a pro-fibrotic phenotype in human mitral valvular interstitial cells through RhoC/ROCK/MRTF-A and Erk1/2 signaling pathways. J Mol Cell Cardiol 2019; 135:149-159. [PMID: 31442470 DOI: 10.1016/j.yjmcc.2019.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/13/2019] [Accepted: 08/19/2019] [Indexed: 01/16/2023]
Abstract
The mitral valve is a complex multilayered structure populated by fibroblast-like cells, valvular interstitial cells (VIC) which are embedded in an extracellular matrix (ECM) scaffold and are submitted to the mechanical deformations affecting valve at each heartbeat, for an average of 40 million times per year. Myxomatous mitral valve (MMV) is the most frequent heart valve disease characterized by disruption of several valvular structures due to alterations of their ECM preventing the complete closure of the valve resulting in symptoms of prolapse and regurgitation. VIC and their ECM exhibit reciprocal dynamic processes between the mechanical signals issued from the ECM and the modulation of VIC phenotype responsible for ECM homeostasis of the valve. Abnormal perception and responsiveness of VIC to mechanical stress may induce an inappropriate adaptative remodeling of the valve progressively leading to MMV. To investigate the response of human VIC to mechanical strain and identify the molecular mechanisms of mechano-transduction in these cells, a cyclic equibiaxial elongation of 14% at the cardiac frequency of 1.16 Hz was applied to VIC by using a Flexercell-4000 T™ apparatus for increasing time (from 1 h to 8 h). We showed that cyclic stretch induces an early (1 h) and transient over-expression of TGFβ2 and αSMA. CTGF, a profibrotic growth factor promoting the synthesis of ECM components, was strongly induced after 1 and 2 h of stretching and still upregulated at 8 h. The mechanical stress-induced CTGF up-regulation was dependent on RhoC, but not RhoA, as demonstrated by siRNA-mediated silencing approaches, and further supported by evidencing RhoC activation upon cell stretching and suppression of cell response by pharmacological inhibition of the effector ROCK1/2. It was also dependent on the MEK/Erk1/2 pathway which was activated by mechanical stress independently of RhoC and ROCK. Finally, mechanical stretching induced the nuclear translocation of myocardin related transcription factor-A (MRTF-A) which forms a transcriptional complex with SRF to promote the expression of target genes, notably CTGF. Treatment of stretched cultures with inhibitors of the identified pathways (ROCK1/2, MEK/Erk1/2, MRTF-A translocation) blocked CTGF overexpression and abrogated the increased MRTF-A nuclear translocation. CTGF is up-regulated in many pathological processes involving mechanically challenged organs, promotes ECM accumulation and is considered as a hallmark of fibrotic diseases. Pharmacological targeting of MRTF-A by newly developed inhibitors may represent a relevant therapy for MMV.
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Affiliation(s)
- Benoit Blomme
- Laboratory of Connective Tissues Biology, GIGA-Research, University of Liège, Tour de Pathologie, B23, 4000 Sart-Tilman, Belgium; Department of Cardiovascular and Thoracic Surgery, B35, University of Liège, CHU Sart-Tilman, 4000 Sart Tilman, Belgium
| | - Christophe Deroanne
- Laboratory of Connective Tissues Biology, GIGA-Research, University of Liège, Tour de Pathologie, B23, 4000 Sart-Tilman, Belgium
| | - Alexia Hulin
- Laboratory of Cardiology, GIGA-Cardiovascular Sciences, B34, University of Liège, 4000 Sart- Tilman, Belgium
| | - Charles Lambert
- Laboratory of Connective Tissues Biology, GIGA-Research, University of Liège, Tour de Pathologie, B23, 4000 Sart-Tilman, Belgium
| | - Jean-Olivier Defraigne
- Department of Cardiovascular and Thoracic Surgery, B35, University of Liège, CHU Sart-Tilman, 4000 Sart Tilman, Belgium
| | - Betty Nusgens
- Laboratory of Connective Tissues Biology, GIGA-Research, University of Liège, Tour de Pathologie, B23, 4000 Sart-Tilman, Belgium
| | - Marc Radermecker
- Department of Cardiovascular and Thoracic Surgery, B35, University of Liège, CHU Sart-Tilman, 4000 Sart Tilman, Belgium; Department of Human Anatomy, B23, University of Liège, CHU Sart-Tilman, 4000 Sart Tilman, Belgium
| | - Alain Colige
- Laboratory of Connective Tissues Biology, GIGA-Research, University of Liège, Tour de Pathologie, B23, 4000 Sart-Tilman, Belgium.
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16
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Henriques de Gouveia RHAM, Corte Real Gonçalves FMA. Sudden cardiac death and valvular pathology. Forensic Sci Res 2019; 4:280-286. [PMID: 31489394 PMCID: PMC6713097 DOI: 10.1080/20961790.2019.1595351] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/09/2019] [Accepted: 03/11/2019] [Indexed: 12/07/2022] Open
Abstract
Sudden death due to valvular heart disease is reported to range from 1% to 5% in native valves and around 0.2%-0.9%/year in prosthesis. The nature of the diseases is varied, from heritable, congenital to acquired. It may affect both genders in multiple age groups. The authors show and comment examples of the major nosologic aetiologies underlying unexpected exitus letalis of valvular nature.
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Affiliation(s)
- Rosa H. A. M. Henriques de Gouveia
- Forensic Clinical and Pathology Service, Central Branch of the National Institute of Legal Medicine and Forensic Sciences, Coimbra, Portugal
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17
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Bennett S, Phan T, Patwala A, Thamman R, Kwok CS. Surviving cardiac arrest from mitral annular disjunction: A case report. Echocardiography 2019; 36:1405-1408. [DOI: 10.1111/echo.14411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/28/2019] [Accepted: 05/29/2019] [Indexed: 12/07/2022] Open
Affiliation(s)
| | - Thanh Phan
- Royal Stoke University Hospital Stoke‐on‐Trent UK
| | | | - Ritu Thamman
- University of Pittsburgh Pittsburgh Pennsylvania
| | - Chun Shing Kwok
- Royal Stoke University Hospital Stoke‐on‐Trent UK
- Keele University Stoke‐on‐Trent UK
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18
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The Prevalence of Mitral Valve Prolapse in Panic Disorder: A Meta-Analysis. PSYCHOSOMATICS 2019; 60:393-401. [DOI: 10.1016/j.psym.2018.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 01/04/2023]
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19
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Markman TM, Nazarian S. Treatment of ventricular arrhythmias: What's New? Trends Cardiovasc Med 2019; 29:249-261. [DOI: 10.1016/j.tcm.2018.09.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 12/17/2022]
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20
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Marantelli S, Hand R, Carapetis J, Beaton A, Wyber R. Severe adverse events following benzathine penicillin G injection for rheumatic heart disease prophylaxis: cardiac compromise more likely than anaphylaxis. HEART ASIA 2019; 11:e011191. [PMID: 31297163 DOI: 10.1136/heartasia-2019-011191] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/13/2019] [Accepted: 05/23/2019] [Indexed: 12/07/2022]
Abstract
Objective Secondary prophylaxis through long-term antibiotic administration is essential to prevent the progression of acute rheumatic fever to rheumatic heart disease (RHD). Benzathine penicillin G (BPG) has been shown to be the most efficacious antibiotic for this purpose; however, adverse events associated with BPG administration have been anecdotally reported. This study therefore aimed to collate case reports of adverse events associated with BPG administration for RHD prophylaxis. Study design A literature review was used to explore reported adverse reactions to BPG and inform development of a case report questionnaire. This questionnaire was circulated through professional networks to solicit retrospective reports of adverse events from treating physicians. Returned surveys were tabulated and thematically analysed. Reactions were assessed using the Brighton Collaboration case definition to identity potential anaphylaxis. Results We obtained 10 case reports from various locations, with patients ranging in age from early-teens to adults. All patients had clinical or echocardiogram-obtained evidence of valvular disease. The majority of patients (80%) had received BPG prior to the event with no previous adverse reaction. In eight cases, the reaction was fatal; in one case resuscitation was successful and in one case treatment was not required. Only three cases met Level 1 Brighton criteria consistent with anaphylaxis. Conclusion These results indicate that anaphylaxis is not a major cause of adverse reactions to BPG. An alternative mechanism for sudden death following BPG administration in people with severe RHD is proposed.
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Affiliation(s)
- Shannon Marantelli
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Robert Hand
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Andrea Beaton
- Department of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Rosemary Wyber
- Telethon Kids Institute, University of Western Australia, Subiaco, Western Australia, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
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21
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Radmilovic J, D'Andrea A, D'Amato A, Tagliamonte E, Sperlongano S, Riegler L, Scarafile R, Forni A, Muscogiuri G, Pontone G, Galderisi M, Russo MG. Echocardiography in Athletes in Primary Prevention of Sudden Death. J Cardiovasc Echogr 2019; 29:139-148. [PMID: 32089993 PMCID: PMC7011488 DOI: 10.4103/jcecho.jcecho_26_19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Echocardiography is a noninvasive imaging technique useful to provide clinical data regarding physiological adaptations of athlete's heart. Echocardiographic characteristics may be helpful for the clinicians to identify structural cardiac disease, responsible of sudden death during sport activities. The application of echocardiography in preparticipation screening might be essential: it shows high sensitivity and specificity for identification of structural cardiac disease and it is the first-line imagining technique for primary prevention of SCD in athletes. Moreover, new echocardiographic techniques distinguish extreme sport cardiac remodeling from beginning state of cardiomyopathy, as hypertrophic or dilated cardiomyopathy and arrhythmogenic right ventricle dysplasia. The aim of this paper is to review the scientific literature and the clinical knowledge about athlete's heart and main structural heart disease and to describe the rule of echocardiography in primary prevention of SCD in athletes.
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Affiliation(s)
- Juri Radmilovic
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy.,Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Andrea D'Amato
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | | | - Simona Sperlongano
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Alberto Forni
- Department of Cardiology, Umberto I, Nocera Inferiore, Italy
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Giovanna Russo
- Department of Cardiology, Luigi Vanvitelli University of Naples, Monaldi Hospital, Naples, Italy
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22
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Koo HJ, Kang JW, Oh SY, Kim DH, Song JM, Kang DH, Song JK, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW, Yang DH. Cardiac computed tomography for the localization of mitral valve prolapse: scallop-by-scallop comparisons with echocardiography and intraoperative findings. Eur Heart J Cardiovasc Imaging 2018; 20:550-557. [DOI: 10.1093/ehjci/jey139] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 09/07/2018] [Indexed: 12/07/2022] Open
Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sang Young Oh
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dae-Hee Kim
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jong-Min Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae-Kwan Song
- Division of Cardiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Joon Bum Kim
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Sung-Ho Jung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Suk Jung Choo
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Cheol Hyun Chung
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Jae Won Lee
- Department of Cardiothoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center, Asan Medical Center, University of Ulsan College of Medicine, Olympic-ro 388-1, Seoul, South Korea
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Cardiac magnetic resonance in patients with mitral valve prolapse: Focus on late gadolinium enhancement and T1 mapping. Eur Radiol 2018; 29:1546-1554. [PMID: 30088066 DOI: 10.1007/s00330-018-5634-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/01/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the incidence of late-gadolinium-enhancement (LGE) in mitral valve prolapse (MVP) (in the absence of other heart/valvular diseases), and its association with the degree of mitral regurgitation (MR) and/or with complex ventricular arrhythmia (ComVA), and to analyse the role of T1 mapping in the evaluation of MVP patients. METHODS We included all consecutive patients with MVP who underwent during 2015-2016 a comprehensive cardiac magnetic resonance (CMR) examination at 1.5 T. We evaluated the association of LGE with the MR fraction and the presence of ComVA. We compared myocardial T1-native and post-contrast times and extracellular volume (ECV)-values between MVP patients, both with and without LGE, and the control group. RESULTS Thirty-four patients with MVP were selected (56 ± 14 years old, 59% male). All patients had MR; LGE and ComVA were present in 15 (44%) and 11 (34%) patients, respectively. Significant associations of LGE with both MR severity and ComVA were not found (p=0.72 and 0.79, respectively). T1 mapping confirmed the presence of LGE in all cases. In one patient a thin signal alteration resulted in more evident T1 mapping than LGE. Patients with MVP had higher native T1-values, lower post-contrast T1-values and increased ECV-values compared with controls (p=0.01, 0.01 and 0.00, respectively). CONCLUSION Focal fibrosis with LGE was found in about half the MVP patients and it was independent of the degree of the valve dysfunction and the presence of ComVA. T1 mapping allows diffuse myocardial wall alterations to be identified, but no significant associations between the MR severity and ComVA and T1/ECV values were found. KEY POINTS • MVP is a common valvulopathy affecting 2-3% of the general population. • MVP has been associated with an increased risk of arrhythmic complications and sudden cardiac death. • CMR is a non-invasive imaging method that provides a precise and more accurate assessment of patients with MVP.
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