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Nagase M, Nakashima T, Aoyama T. Message From an Automated External Defibrillator. JAMA Intern Med 2024; 184:702-703. [PMID: 38683588 DOI: 10.1001/jamainternmed.2023.7879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
This case report describes a man in his 80s who received shock from an automated external defibrillator that registered 3 types of tachycardia.
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Affiliation(s)
- Masaru Nagase
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
| | - Takashi Nakashima
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Takuma Aoyama
- Department of Cardiology, Central Japan International Medical Center, Gifu, Japan
- Department of Cardiology, Graduate School of Medicine, Gifu University, Gifu, Japan
- Department of Molecular Pathophysiology, Shinshu University Graduate School of Medicine, Matsumoto, Nagano, Japan
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2
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Rui Y, Zhou J, Zhen X, Zhang J, Liu S, Gao Y. TBX5 genetic variants and SCD-CAD susceptibility: insights from Chinese Han cohorts. PeerJ 2024; 12:e17139. [PMID: 38525280 PMCID: PMC10959103 DOI: 10.7717/peerj.17139] [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: 01/22/2024] [Accepted: 02/28/2024] [Indexed: 03/26/2024] Open
Abstract
Background The prevention and prediction of sudden cardiac death (SCD) present persistent challenges, prompting exploration into common genetic variations for potential insights. T-box 5 (TBX5), a critical cardiac transcription factor, plays a pivotal role in cardiovascular development and function. This study systematically examined variants within the 500-bp region downstream of the TBX5 gene, focusing on their potential impact on susceptibility to SCD associated with coronary artery disease (SCD-CAD) in four different Chinese Han populations. Methods In a comprehensive case-control analysis, we explored the association between rs11278315 and SCD-CAD susceptibility using a cohort of 553 controls and 201 SCD-CAD cases. Dual luciferase reporter assays and genotype-phenotype correlation studies using human cardiac tissue samples as well as integrated in silicon analysis were applied to explore the underlining mechanism. Result Binary logistic regression results underscored a significantly reduced risk of SCD-CAD in individuals harboring the deletion allele (odds ratio = 0.70, 95% CI [0.55-0.88], p = 0.0019). Consistent with the lower transcriptional activity of the deletion allele observed in dual luciferase reporter assays, genotype-phenotype correlation studies on human cardiac tissue samples affirmed lower expression levels associated with the deletion allele at both mRNA and protein levels. Furthermore, our investigation revealed intriguing insights into the role of rs11278315 in TBX5 alternative splicing, which may contribute to alterations in its ultimate functional effects, as suggested by sQTL analysis. Gene ontology analysis and functional annotation further underscored the potential involvement of TBX5 in alternative splicing and cardiac-related transcriptional regulation. Conclusions In summary, our current dataset points to a plausible correlation between rs11278315 and susceptibility to SCD-CAD, emphasizing the potential of rs11278315 as a genetic risk marker for aiding in molecular diagnosis and risk stratification of SCD-CAD.
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Affiliation(s)
- Yukun Rui
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Ju Zhou
- Medical College of Soochow University, Suzhou, China
| | - Xiaoyuan Zhen
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
| | - Jianhua Zhang
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Sciences, Ministry of Justice, Shanghai, China
| | - Shiquan Liu
- Institute of Evidence Law and Forensic Science, China University of Political Science and Law, Beijing, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou, China
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3
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Zuin M, Overvad TF, Albertsen IE, Bilato C, Piazza G. Trends of Pulmonary Embolism-Related Sudden Cardiac Death in the United States, 1999-2019. J Thromb Thrombolysis 2024; 57:483-491. [PMID: 38281229 DOI: 10.1007/s11239-024-02946-7] [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] [Accepted: 01/01/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Up-to-date population-based data on pulmonary embolism (PE)-related sudden cardiac death (SCD) mortality trends in the United States (US) are scant. We assess the current trends in PE-related SCD mortality in US over the past two decades and determine differences by sex, race, ethnicity, age, and census region. METHODS We extracted PE-related SCD mortality rates from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) database from 1999 to 2019, in patients aged ≥ 15 years old. Age-adjusted mortality rates (AAMRs) were assessed using the Joinpoint regression modeling and expressed as estimated average annual percentage change (AAPC) with relative 95% confidence intervals (CIs). RESULTS Between 1999 and 2019, the AAMR from acute PE-related SCD mortality in the US linearly increased [AAPC: +2.4% (95% CI: 2.2 to 2.6), p < 0.001)]. The AAMR increase was more pronounced in men [AAPC: +2.8% (95% CI: 2.6 to 2.9), p < 0.001], Whites [AAPC: +2.7% (95% CI: 2.3 to 3.1), p < 0.001], Latinx/Hispanic patients [AAPC:+2.0% (95% CI: 1.2 to 2.8), p < 0.001], subjects younger than 65 years [AAPC: +2.4% (95% CI: 2.1 to 2.6), p < 0.001] and in residents of rural areas [AAPC: +3.6% (95% CI: 3.3 to 3.9), p < 0.001]. Moreover, higher percentages of PE-related SCD and the relative absolute number of deaths were observed in the South compared with other geographical regions. CONCLUSIONS PE-related SCD mortality in the US has increased over the last two decades. Stratification by race, ethnicity, urbanization, and census region demonstrates ethnoracial and regional disparities that require further investigation and remedy.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Via Aldo Moro 8, Ferrara, 44124, Italy.
| | | | - Ida Ehlers Albertsen
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospital, Arzignano, Italy
| | - Gregory Piazza
- Cardiovascular Medicine Division and Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Cesur B, Elcik D, Cetinkaya Z, Kelesoglu S, Karabiyik U, Inanc MT, Kalay N, Ergin A, Topsakal R. Association between excess catecholamine synthesis and polymorphic premature ventricular contraction. J Electrocardiol 2024; 82:59-63. [PMID: 38035655 DOI: 10.1016/j.jelectrocard.2023.11.010] [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: 08/20/2023] [Revised: 10/14/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The reasons for the etiology of premature ventricular contractions (PVCs) are not specifically known. Many patients are resistant to medical treatment, and a factor that would predict response to medical treatment cannot be identified. This study aims to investigate if a high catecholamine level results in polymorphic PVC. METHODS This study was obtained by prospective data registry analysis. A total of 100 patients, 50 from the PVC group, and 50 from the control group have been evaluated. The participants who were included in the patient group had a polymorphic PVC of 5% or more in their 24-h Holter evaluations. Metanephrine showing the level of adrenaline and normetanephrine, showing the level of noradrenaline levels have been measured from these urine samples. RESULT There was no difference between the two groups in terms of biochemical and essential characteristics. Normetanephrine level has been significantly higher in the PVC group compared to the control group (323.9 ± 208.9 μg to 129.25 ± 67.88 μg; p < 0.001). Similarly, metanephrine level has also been higher in the PVC group (124.75 ± 82.43 μg to 52.615 ± 36,54 μg; p < 0.001). A positive and moderate correlation has been identified between the number and ratio of PVC and the metanephrine and normetanephrine levels. CONCLUSION In this study, we found that the catecholamine levels were higher in the polymorphic PVC group than in the healthy volunteers. Also, an increase in the number and rate of PVC has been observed as the catecholamine levels increased. CLINICAL TRIAL REGISTRATION Urine Levels of Metanephrine and Normetanephrine in Patients With Frequent PVC; ClinicalTrials.gov number NCT03447002.
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Affiliation(s)
- Burak Cesur
- Kayseri State Hospital, Department of Cardiology, Kayseri, Turkey
| | - Deniz Elcik
- Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey.
| | - Zeki Cetinkaya
- Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey
| | - Saban Kelesoglu
- Erciyes University School of Medicine, Department of Cardiology, Kayseri, Turkey
| | - Ugur Karabiyik
- Niğde State Hospital, Department of Cardiology, Niğde, Turkey
| | | | - Nihat Kalay
- Kayseri State Hospital, Department of Cardiology, Kayseri, Turkey
| | - Ali Ergin
- Kayseri State Hospital, Department of Cardiology, Kayseri, Turkey
| | - Ramazan Topsakal
- Kayseri State Hospital, Department of Cardiology, Kayseri, Turkey
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5
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Katal N, Gupta S, Verma P, Sharma B. Deep-Learning-Based Arrhythmia Detection Using ECG Signals: A Comparative Study and Performance Evaluation. Diagnostics (Basel) 2023; 13:3605. [PMID: 38132188 PMCID: PMC10742760 DOI: 10.3390/diagnostics13243605] [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: 09/18/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 12/23/2023] Open
Abstract
Heart diseases is the world's principal cause of death, and arrhythmia poses a serious risk to the health of the patient. Electrocardiogram (ECG) signals can be used to detect arrhythmia early and accurately, which is essential for immediate treatment and intervention. Deep learning approaches have played an important role in automatically identifying complicated patterns from ECG data, which can be further used to identify arrhythmia. In this paper, deep-learning-based methods for arrhythmia identification using ECG signals are thoroughly studied and their performances evaluated on the basis of accuracy, specificity, precision, and F1 score. We propose the development of a small CNN, and its performance is compared against pretrained models like GoogLeNet. The comparative study demonstrates the promising potential of deep-learning-based arrhythmia identification using ECG signals.
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Affiliation(s)
- Nitish Katal
- School of Electronics Engineering, Vellore Institute of Technology, Chennai 600127, Tamil Nadu, India;
| | - Saurav Gupta
- School of Electronics Engineering, Vellore Institute of Technology, Chennai 600127, Tamil Nadu, India;
| | - Pankaj Verma
- University Centre for Research and Development, Academic Unit 2, Chandigarh University, Mohali 140413, Punjab, India;
| | - Bhisham Sharma
- Chitkara University Institute of Engineering and Technology, Chitkara University, Rajpura 140401, Punjab, India
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Zhang L, Guo F, Xu S, Deng Q, Xie M, Sun J, Kwok RTK, Lam JWY, Deng H, Jiang H, Yu L, Tang BZ. AIEgen-Based Covalent Organic Frameworks for Preventing Malignant Ventricular Arrhythmias Via Local Hyperthermia Therapy. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023:e2304620. [PMID: 37532257 DOI: 10.1002/adma.202304620] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/14/2023] [Indexed: 08/04/2023]
Abstract
The engineering of aggregation-induced emission luminogens (AIEgen) based covalent organic frameworks (COFs), TDTA-COF, BTDTA-COF, and BTDBETA-COF are reported, as hyperthermia agents for inhibiting the occurrence of malignant ventricular arrhythmias (VAs). These AIE COFs exhibit dual functionality, as they not only directly modulate the function and neural activity of stellate ganglion (SG) through local hyperthermia therapy (LHT) but also induce the browning of white fat and improve the neuroinflammation peri-SG microenvironment, which is favorable for inhibiting ischemia-induced VAs. In vivo studies have confirmed that BTDBETA-COF-mediated LHT enhances thermogenesis and browning-related gene expression, thereby serving a synergistic role in combating VAs. Transcriptome analysis of peri-SG adipose tissue reveals a substantial downregulation of inflammatory cytokines, highlighting the potency of BTDBETA-COF-mediated LHT in ameliorating the neuroinflammation peri-SG microenvironment and offering myocardial and arrhythmia protection. The work on AIE COF-based hyperthermia agent for VAs inhibition provides a new avenue for mitigating cardiac sympathetic nerve hyperactivity.
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Affiliation(s)
- Liang Zhang
- Department of Chemistry and The Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, 999077, China
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Key Laboratory of Biomedical Polymers-Ministry of Education, College of Chemistry and Molecular Sciences, Wuhan University, Luojiashan, Wuhan, 430072, China
| | - Fuding Guo
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Saiting Xu
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Qiang Deng
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Mengjie Xie
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Jianwei Sun
- Department of Chemistry and The Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, 999077, China
| | - Ryan T K Kwok
- Department of Chemistry and The Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, 999077, China
| | - Jacky W Y Lam
- Department of Chemistry and The Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, 999077, China
| | - Hexiang Deng
- Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Key Laboratory of Biomedical Polymers-Ministry of Education, College of Chemistry and Molecular Sciences, Wuhan University, Luojiashan, Wuhan, 430072, China
| | - Hong Jiang
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Lilei Yu
- Department of Cardiology, Renmin Hospital of Wuhan University, Institute of Molecular Medicine, Renmin Hospital of Wuhan University, Hubei Key Laboratory of Autonomic Nervous System Modulation, Hubei Key Laboratory of Cardiology, Cardiovascular Research Institute, Wuhan University, Cardiac Autonomic Nervous System Research Center of Wuhan University, Taikang Center for Life and Medical Sciences, Wuhan University, Wuhan University, Jiefang Road, Wuhan, 430060, China
| | - Ben Zhong Tang
- Department of Chemistry and The Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Clear Water Bay, Kowloon, Hong Kong, 999077, China
- Shenzhen Institute of Aggregate Science and Technology, School of Science and Engineering, The Chinese University of Hong Kong, Shenzhen, Guangdong, 518172, China
- Center for Aggregation-Induced Emission, South China University of Technology, Guangzhou, 510640, China
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7
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Scorza R, Jonsson M, Corander JM, Rosenqvist M, Frykman V. Prognostic impact of morphology and duration of premature ventricular contractions in a population without structural heart disease. Ann Noninvasive Electrocardiol 2023:e13067. [PMID: 37326286 DOI: 10.1111/anec.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/03/2023] [Accepted: 06/02/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavorable prognosis in patients with structural heart disease. It is unclear whether PVCs site of origin and QRS-width has a prognostic significance in patients without structural heart disease. The aim of this study was to assess the prognostic importance of PVCs morphology and duration in this patient group. METHODS We included 511 consecutive patients without a history of previous heart disease. They were examined with echocardiography and exercise test with normal findings. We categorized the PVCs from a 12 lead ECG according to morphology and width of the QRS-complex and analyzed the outcome in terms of a composite endpoint of total mortality and cardiovascular morbidity. RESULTS During a median follow-up time of 5.3 years, 19 patients (3.5%) died and 61 (11.3%) met the composite outcome. Patients with PVCs originating from the outflow tracts had a significantly lower risk for the composite outcome compared to patients with non-OT-PVCs. Similarly, patients with PVC originating from the right ventricle had a better outcome than patients with left ventricular PCVs. No difference in outcome depending on QRS-width during PVCs was noticed. CONCLUSION In our cohort of consecutively included PVC patients without structural heart disease PVCs from the outflow tracts were associated with a better prognostic outcome than non-OT PVCs; the same was true for right ventricular PVCs when compared to left ventricular ones. The classification of the origin of the PVCs was based on 12-lead ECG morphology. QRS-width during PVC did not seem to have prognostic significance.
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Affiliation(s)
- Raffaele Scorza
- Cardiovascular Unit, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Martin Jonsson
- Department for Clinical Science and Education, Södersjukhuset, Center for Resuscitation Science, Karolinska Institutet, Stockholm, Sweden
| | - John-Martin Corander
- Cardiovascular Unit, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Mårten Rosenqvist
- Cardiovascular Unit, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Viveka Frykman
- Cardiovascular Unit, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
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Gür V, Yapici F, Küçük U, Subaşi İÖ, Gökgöz MB, Karaköse R, Koçkara N. Patients with Achilles Tendon Rupture Are Prone to Develop Ventricular Arrhythmia. J Clin Med 2023; 12:jcm12103583. [PMID: 37240689 DOI: 10.3390/jcm12103583] [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: 04/08/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. MATERIALS AND METHODS Between June 2014 and July 2020, a total of 29 patients (28 males, 1 female; mean age: 40 ± 9.78 years; range, 21-66 years) who presented to the emergency department within the first three weeks of injury, and were diagnosed with acute spontaneous ATRs and treated with an open Krackow suture technique, were retrospectively analyzed. Fifty-two healthy individuals (47 males, 5 females; mean age: 39 ± 11.45 years; range, 21-66 years) were recruited as a control group from the cardiology outpatient clinic. Clinical data (demographic features and laboratory parameters (serum glucose, creatinine, hemoglobin, white blood cell count, and lipid profile)) and electrocardiograms (ECGs) were collected from medical records. ECGs were evaluated for heart rate and VR parameters of QRS width, QTc interval, cQTd interval, Tp-e interval, and Tp-e/QT ratio. The clinical data and these ECG parameters were compared between groups. RESULTS There was no statistically significant difference between groups, regarding clinical data (all p < 0.05). Among ECG parameters, heart rate, QRS width, QTc interval, and cQTd interval were similar between groups (all p < 0.05). There were two important statistically significant findings of this research: The mean Tp-e interval was longer (ATR group: 72.4 ± 24.7, control group: 58.8 ± 14.5, p: 0.01), and the Tp-e/QT ratio was higher (ATR group: 0.2 ± 0.1, control group: 0.16 ± 0.4, p: 0.027) in the ATR group. CONCLUSIONS According to the ventricular repolarization disturbances found in this study, patients with ATR may be at a higher risk of ventricular arrhythmia than healthy people. As a result, ATR patients should be assessed for ventricular arrhythmia risk by an expert cardiologist.
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Affiliation(s)
- Volkan Gür
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Furkan Yapici
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Uğur Küçük
- Department of Cardiology, Faculty of Medicine, 18 Mart University, 17020 Çanakkale, Turkey
| | - İzzet Özay Subaşi
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Mehmet Burak Gökgöz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Reşit Karaköse
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Nizamettin Koçkara
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
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9
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Teixeira RA, Fagundes AA, Baggio Junior JM, Oliveira JCD, Medeiros PDTJ, Valdigem BP, Teno LAC, Silva RT, Melo CSD, Elias Neto J, Moraes Júnior AV, Pedrosa AAA, Porto FM, Brito Júnior HLD, Souza TGSE, Mateos JCP, Moraes LGBD, Forno ARJD, D'Avila ALB, Cavaco DADM, Kuniyoshi RR, Pimentel M, Camanho LEM, Saad EB, Zimerman LI, Oliveira EB, Scanavacca MI, Martinelli Filho M, Lima CEBD, Peixoto GDL, Darrieux FCDC, Duarte JDOP, Galvão Filho SDS, Costa ERB, Mateo EIP, Melo SLD, Rodrigues TDR, Rocha EA, Hachul DT, Lorga Filho AM, Nishioka SAD, Gadelha EB, Costa R, Andrade VSD, Torres GG, Oliveira Neto NRD, Lucchese FA, Murad H, Wanderley Neto J, Brofman PRS, Almeida RMS, Leal JCF. Brazilian Guidelines for Cardiac Implantable Electronic Devices - 2023. Arq Bras Cardiol 2023; 120:e20220892. [PMID: 36700596 PMCID: PMC10389103 DOI: 10.36660/abc.20220892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | - Rodrigo Tavares Silva
- Universidade de Franca (UNIFRAN), Franca, SP - Brasil
- Centro Universitário Municipal de Franca (Uni-FACEF), Franca, SP - Brasil
| | | | - Jorge Elias Neto
- Universidade Federal do Espírito Santo (UFES), Vitória, ES - Brasil
| | - Antonio Vitor Moraes Júnior
- Santa Casa de Ribeirão Preto, Ribeirão Preto, SP - Brasil
- Unimed de Ribeirão Preto, Ribeirão Preto, SP - Brasil
| | - Anisio Alexandre Andrade Pedrosa
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Luis Gustavo Belo de Moraes
- Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | - Mauricio Pimentel
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | | | - Eduardo Benchimol Saad
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brasil
- Hospital Samaritano, Rio de Janeiro, RJ - Brasil
| | | | | | - Mauricio Ibrahim Scanavacca
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Martino Martinelli Filho
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | - Carlos Eduardo Batista de Lima
- Hospital Universitário da Universidade Federal do Piauí (UFPI), Teresina, PI - Brasil
- Empresa Brasileira de Serviços Hospitalares (EBSERH), Brasília, DF - Brasil
| | | | - Francisco Carlos da Costa Darrieux
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Sissy Lara De Melo
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Eduardo Arrais Rocha
- Hospital Universitário Walter Cantídio, Universidade Federal do Ceará (UFC), Fortaleza, CE - Brasil
| | - Denise Tessariol Hachul
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Silvana Angelina D'Orio Nishioka
- Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Roberto Costa
- Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | - Gustavo Gomes Torres
- Hospital Universitário Onofre Lopes, Universidade Federal do Rio Grande do Norte (UFRN), Natal, RN - Brasil
| | | | | | - Henrique Murad
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
| | | | | | - Rui M S Almeida
- Centro Universitário Fundação Assis Gurgacz, Cascavel, PR - Brasil
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10
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Scorza R, Jonsson M, Friberg L, Rosenqvist M, Frykman V. Prognostic implication of premature ventricular contractions in patients without structural heart disease. Europace 2022; 25:517-525. [PMID: 36261245 PMCID: PMC9935042 DOI: 10.1093/europace/euac184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/08/2022] [Indexed: 02/04/2023] Open
Abstract
AIMS Premature ventricular contractions (PVCs) are a common form of arrhythmia associated with an unfavourable prognosis in patients with structural heart disease. However, the prognostic significance in absence of heart disease is debated. With this study, we aim to investigate whether subjects with PVC, without structural heart disease, have a worse prognosis than the general population. METHODS AND RESULTS Patients evaluated for PVC at a secondary care centre in Stockholm County from January 2010 to December 2016 were identified. We included patients without history of previous heart disease who had undergone echocardiography and exercise test with normal findings. Based on sex and age, we matched the PVC cohort to a four times bigger control group from the general population and compared the outcome in terms of mortality and cardiovascular morbidity during a median follow-up time of 5.2 years. We included 820 patients and 3,264 controls. Based on a non-inferiority analysis, the PVC group did not have a higher mortality than the control group (0.44, CI 0.27-0.72). Sensitivity analysis with propensity score matching confirmed this result. CONCLUSIONS PVC patients, who after thorough evaluation showed no signs of structural heart disease, did not have a worse prognosis when compared to an age- and sex- control group based on the general population.
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Affiliation(s)
| | - Martin Jonsson
- Department for Clinical Science and Education, Karolinska Institutet,
Södersjukhuset, Center for Resuscitation Science,
Stockholm, Sweden
| | - Leif Friberg
- Department of Clinical Sciences, Karolinska Institutet, Cardiovascular
Unit, Danderyd University Hospital, Stockholm,
Sweden
| | - Mårten Rosenqvist
- Department of Clinical Sciences, Karolinska Institutet, Cardiovascular
Unit, Danderyd University Hospital, Stockholm,
Sweden
| | - Viveka Frykman
- Department of Clinical Sciences, Karolinska Institutet, Cardiovascular
Unit, Danderyd University Hospital, Stockholm,
Sweden
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11
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Shariatnia S, Ziaratban M, Rajabi A, Salehi A, Abdi Zarrini K, Vakili M. Modeling the diagnosis of coronary artery disease by discriminant analysis and logistic regression: a cross-sectional study. BMC Med Inform Decis Mak 2022; 22:85. [PMID: 35351098 PMCID: PMC8966192 DOI: 10.1186/s12911-022-01823-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Coronary artery disease (CAD) is one of the most significant cardiovascular diseases that requires accurate angiography to diagnose. Angiography is an invasive approach involving risks like death, heart attack, and stroke. An appropriate alternative for diagnosis of the disease is to use statistical or data mining methods. The purpose of the study was to predict CAD by using discriminant analysis and compared with the logistic regression. MATERIALS AND METHODS This cross-sectional study included 758 cases admitted to Fatemeh Zahra Teaching Hospital (Sari, Iran) for examination and coronary angiography for evaluation of CAD in 2019. A logistics discriminant, Quadratic Discriminant Analysis (QDA) and Linear Discriminant Analysis (LDA) model and K-Nearest Neighbor (KNN) were fitted for prognosis of CAD with the help of clinical and laboratory information of patients. RESULTS Out of the 758 examined cases, 250 (32.98%) cases were non-CAD and 508 (67.22%) were diagnosed with CAD disease. The results indicated that the indices of accuracy, sensitivity, specificity and area under the ROC curve (AUC) in the linear discriminant analysis (LDA) were 78.6, 81.3, 71.3, and 81.9%, respectively. The results obtained by the quadratic discriminant analysis were respectively 64.6, 88.2, 47.9, and 81%. The values of the metrics in K-nearest neighbor method were 74, 77.5, 63.7, and 82%, respectively. Finally, the logistic regression reached 77, 87.6, 55.6, and 82%, respectively for the evaluation metrics. CONCLUSIONS The LDA method is superior to the Quadratic Discriminant Analysis (QDA), K-Nearest Neighbor (KNN) and Logistic Regression (LR) methods in differentiating CAD patients. Therefore, in addition to common non-invasive diagnostic methods, LDA technique is recommended as a predictive model with acceptable accuracy, sensitivity, and specificity for the diagnosis of CAD. However, given that the differences between the models are small, it is recommended to use each model to predict CAD disease.
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Affiliation(s)
- Sahar Shariatnia
- Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medica Science, Gorgan, Iran
| | - Majid Ziaratban
- Department of Electrical Engineering, Faculty of Engineering, Golestan University, Gorgan, Iran
| | - Abdolhalim Rajabi
- Health Management and Social Development Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Aref Salehi
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Kobra Abdi Zarrini
- Intensive Care Unit of Fatemeh Zahra Hospital, Mazandaran University Medical Sciences, Sari, Iran
| | - Mohammadali Vakili
- Health Management and Social Development Research Center, Department of Biostatistics and Epidemiology, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran.
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12
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Arsenos P, Gatzoulis KA, Tsiachris D, Dilaveris P, Sideris S, Sotiropoulos I, Archontakis S, Antoniou CK, Kordalis A, Skiadas I, Toutouzas K, Vlachopoulos C, Tousoulis D, Tsioufis K. Arrhythmic risk stratification in ischemic, non-ischemic and hypertrophic cardiomyopathy: A two-step multifactorial, electrophysiology study inclusive approach. World J Cardiol 2022; 14:139-151. [PMID: 35432775 PMCID: PMC8968455 DOI: 10.4330/wjc.v14.i3.139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/28/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Annual arrhythmic sudden cardiac death ranges from 0.6% to 4% in ischemic cardiomyopathy (ICM), 1% to 2% in non-ischemic cardiomyopathy (NICM), and 1% in hypertrophic cardiomyopathy (HCM). Towards a more effective arrhythmic risk stratification (ARS) we hereby present a two-step ARS with the usage of seven non-invasive risk factors: Late potentials presence (≥ 2/3 positive criteria), premature ventricular contractions (≥ 30/h), non-sustained ventricular tachycardia (≥ 1episode/24 h), abnormal heart rate turbulence (onset ≥ 0% and slope ≤ 2.5 ms) and reduced deceleration capacity (≤ 4.5 ms), abnormal T wave alternans (≥ 65μV), decreased heart rate variability (SDNN < 70ms), and prolonged QTc interval (> 440 ms in males and > 450 ms in females) which reflect the arrhythmogenic mechanisms for the selection of the intermediate arrhythmic risk patients in the first step. In the second step, these intermediate-risk patients undergo a programmed ventricular stimulation (PVS) for the detection of inducible, truly high-risk ICM and NICM patients, who will benefit from an implantable cardioverter defibrillator. For HCM patients, we also suggest the incorporation of the PVS either for the low HCM Risk-score patients or for the patients with one traditional risk factor in order to improve the inadequate sensitivity of the former and the low specificity of the latter.
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Affiliation(s)
- Petros Arsenos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | - Polychronis Dilaveris
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Skevos Sideris
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ilias Sotiropoulos
- Department of Cardiology, Hippokration Hospital, Athens 11527, Attika, Greece
| | | | | | - Athanasios Kordalis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Ioannis Skiadas
- Fifth Department of Cardiology, Hygeia Hospital, Marousi 15123, Attika, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
| | - Konstantinos Tsioufis
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens 11527, Attika, Greece
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13
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Radwan YA, Kurmann RD, Sandhu AS, El-Am EA, Crowson CS, Matteson EL, Osborn TG, Warrington KJ, Mankad R, Makol A. Systemic Sclerosis Portends Increased Risk of Conduction and Rhythm Abnormalities at Diagnosis and During Disease Course: A US Population-Based Cohort. JOURNAL OF SCLERODERMA AND RELATED DISORDERS 2022; 6:277-285. [PMID: 35295788 DOI: 10.1177/23971983211034074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To study the incidence, risk factors and outcomes of conduction and rhythm disorders in a population-based cohort of patients with systemic sclerosis (SSc) vs. non-SSc comparators. Methods An incident cohort of patients with SSc (1980-2016) from Olmsted County, MN was compared to age- and sex-matched non-SSc subjects (1:2). Electrocardiograms (ECGs), Holter ECGs, and need for cardiac interventions were reviewed to determine the occurrence of any conduction or rhythm abnormalities. Results 78 incident SSc cases and 156 comparators were identified (mean age 56 y, 91% female). The prevalence of any conduction disorder prior to SSc diagnosis compared to non-SSc subjects was 15% vs. 7% (p=0.06), and any rhythm disorder was 18% vs. 13% (p=0.33). During a median follow-up of 10.5 years in patients with SSc and 13.0 years in non-SSc comparators, conduction disorders developed in 25 patients with SSc with cumulative incidence of 20.5% (95% CI: 12.4-34.1%) vs. 28 non-SSc patients with cumulative incidence of 10.4% (95% CI: 6.2-17.4%) (HR: 2.57; 95% CI: 1.48-4.45), while rhythm disorders developed in 27 patients with SSc with cumulative incidence of 27.3% (95% CI: 17.9-41.6%) vs. 43 non-SSc patients with cumulative incidence of 18.0% (95% CI: 12.3-26.4%) (HR: 1.62; 95% CI: 1.00-2.64). Age, pulmonary hypertension and smoking were identified as risk factors. Conclusion Patients with SSc have an increased risk of conduction and rhythm disorders both at disease onset and over time, compared to non-SSc patients. These findings warrant increased vigilance and screening for ECG abnormalities in SSc patients with pulmonary hypertension.
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Affiliation(s)
- Yasser A Radwan
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Internal Medicine, Michigan State University, East Lansing, MI, USA
| | - Reto D Kurmann
- Division of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Cardiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Avneek S Sandhu
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Edward A El-Am
- Division of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Eric L Matteson
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.,Department of Health Sciences Research, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Thomas G Osborn
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Rekha Mankad
- Division of Cardiovascular Disease, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ashima Makol
- Division of Rheumatology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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14
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AKDİ A, TEKİN TAK B, ÖZCAN ÇETİN EH, ÇETİN MS, YAYLA Ç. Electrocardiography clues in assessment of patients with premature ventricular contractions. Turk J Med Sci 2021; 51:2986-2993. [PMID: 34493030 PMCID: PMC10734884 DOI: 10.3906/sag-2012-70] [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: 12/05/2020] [Revised: 12/13/2021] [Accepted: 09/07/2021] [Indexed: 12/29/2022] Open
Abstract
Background/aim Some electrocardiography (ECG) parameters such as Tp-e interval, Tp-e / QT ratio, fragmented QRS (fQRS), and heart rate variability (HRV) are related to cardiovascular mortality and morbidity. We aim to investigate the relation between premature ventricular contraction burden and these parameters on 24-h ECG recording. Materials and methods The study is a retrospective investigation of the 24-h Holter ECG and echocardiography of 199 patients who underwent the procedures due to complaints of palpitation. A frequency of < 10% PVCs / 24 h was classified as seldom group (98 patients), while > 10% PVCs / 24 h was designated as frequent group (101 patients). Results Tp-e interval was significantly longer (62 [54–78] vs 75 [60–84], p < 0.001), Tp-e / QT ratio was significantly increased (0.18 [0.16–0.20] vs 0.21 [0.18–0.22], p = 0.001) in frequent PVC group. The percentage of fQRS was significantly increased in frequent PVC group (30.6% vs 47.5%, p = 0.015). When the groups were compared, no significant difference was found in HRV time domain indices. Positive correlations were observed between PVC burden and Tp-e (r = 0.304, p < 0.001), Tp-e / QT (r = 0.275, p < 0.001). Conclusion Our study showed that Tp-e interval, Tp-e / QT and fQRS are associated with frequency of PVCs. These measurements in patients with PVCs may form part of assessment of cardiovascular risk.
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Affiliation(s)
- Ahmet AKDİ
- Department of Cardiology, Ankara City Hospital, Ankara,
Turkey
| | - Bahar TEKİN TAK
- Department of Cardiology, Ankara City Hospital, Ankara,
Turkey
| | | | | | - Çağrı YAYLA
- Department of Cardiology, Ankara City Hospital, University of Health Sciences, Ankara,
Turkey
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15
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Das B, Ramasubbu SK, Agnihotri A, Kumar B, Rawat VS. Leading 20 drug-drug interactions, polypharmacy, and analysis of the nature of risk factors due to QT interval prolonging drug use and potentially inappropriate psychotropic use in elderly psychiatry outpatients. Ther Adv Cardiovasc Dis 2021; 15:17539447211058892. [PMID: 34841978 PMCID: PMC8641120 DOI: 10.1177/17539447211058892] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Psychotropic medications extend corrected QT (QTc) period in the electrocardiogram (ECG). Psychiatric patients exposed to ⩾1 psychotropic medication(s) represent a group with marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to greater risk of all-cause and coronary heart disease deaths. This study aimed at investigating pattern of utilization of QTc-interval protracting medications, QT-extending drug interactions, and prevalence of QTc-interval extending hazard factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from 1 October 2017 to 30 August 2019 employing the pertinent prescriptions. RESULTS A total of 832 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study duration were investigated. About 420 (50.5%) patients were males while 412 (49.5%) were females. Of the 832 patients, 588 (70.7%) were using interacting agents with capacity to produce TdP. Almost 1152 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 1016 (48.8%), 724 (34.8%), and 248 (12%) agents with potential to interact were identified with 'known', 'possible', and 'conditional risk of TdP', respectively. The common interacting medications belonged to antidepressant (288), proton pump inhibitor (364), antipsychotic (340), antinausea (184), antimicrobial (156), and H2 receptor antagonist (60) therapeutic categories. The all-inclusive frequency of potentially inappropriate psychotropic (PIP) agents administered was 62% (1343/2166) with Beers Criteria 2019, and 46% (997/2166) with STOPP Criteria 2015. CONCLUSION Many geriatric patients were administered drugs and drug combinations with heightened proclivity toward QT-interval prolongation. Furthermore, reliable evidence-based online drug knowledge resources, such as AzCERT/CredibleMeds Drug Lists, Medscape Drug Interactions Checker, Epocrates Online Interaction Check, and Drugs.com Drug Interactions Checker, can facilitate clinical professionals in selecting drugs for psychiatric patients. A wise choice of medications is imperative to preclude serious adverse sequelae. Therefore, we need to exigently embrace precautionary safety means, be vigilant, and forestall QT-extension and TdP in clinical environments.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Virbhadra Road, Rishikesh 249 203, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Akash Agnihotri
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Rishikesh, India
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16
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Gender Differences in Implantable Cardioverter-Defibrillator Utilization for Primary Prevention of Sudden Cardiac Death. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00954-x] [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: 10/19/2022]
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17
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van Dongen LH, Blom MT, Bardai A, Homma PCM, Beulens JWJ, van der Heijden AA, Elders P, Tan HL. High haemoglobin A1c level is a possible risk factor for ventricular fibrillation in sudden cardiac arrest among non-diabetic individuals in the general population. Europace 2021; 22:394-400. [PMID: 31950980 PMCID: PMC7058970 DOI: 10.1093/europace/euz338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 12/12/2019] [Indexed: 01/09/2023] Open
Abstract
Aims This study aimed to establish whether higher levels of glycated haemoglobin (HbA1c) are associated with increased sudden cardiac arrest (SCA) risk in non-diabetic individuals. Methods and results Case–control study in non-diabetic individuals (HbA1c < 6.5%) in the Netherlands. Cases were SCA patients with electrocardiogram (ECG)-documented ventricular fibrillation (VF, the predominant cause of SCA) and HbA1c measurements immediately after VF, prospectively included in September 2009–December 2012. Controls (up to 10 per case) were age/sex-matched non-SCA individuals, included in July 2006–November 2007. We studied 306 cases (56.4 ± 6.8 years, 79.1% male) and 1722 controls (54.0 ± 6.8 years, 64.8% male). HbA1c levels were higher in cases than in controls (5.8 ± 0.3% vs. 5.4 ± 0.3%, P < 0.001). The proportion of increased HbA1c (≥5.7%) was 63.1% in cases and 19.3% in controls (P < 0.001). Multivariate regression models indicated that increased HbA1c was associated with a > six-fold increased VF risk [adjusted odds ratio (ORadj) 6.74 (5.00–9.09)] and that 0.1% increase in HbA1c level was associated with 1.4-fold increase in VF risk, independent of concomitant cardiovascular risk factors. Increased VF risk at higher HbA1c is associated with acute myocardial infarction (MI) as cause of VF [OR 1.14 (1.04–1.24)], but the association between HbA1c and VF was similar in non-MI patients [OR 1.32 (1.21–1.44)] and MI patients [OR 1.47 (1.37–1.58)]. Conclusion Among non-diabetic individuals, risk of VF increased with rising HbA1c levels, independent of concomitant cardiovascular disease. Future studies should establish whether HbA1c level may be used as biomarker to recognize individuals at risk for VF.
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Affiliation(s)
- Laura H van Dongen
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke T Blom
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdenasser Bardai
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Paulien C M Homma
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, VUmc, VU University, Amsterdam, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Amber A van der Heijden
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, VUmc, VU University, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, VUmc, VU University, Amsterdam, The Netherlands
| | - Petra Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, VUmc, VU University, Amsterdam, The Netherlands
| | - Hanno L Tan
- Department of Cardiology, Heart Centre, Amsterdam UMC, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
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18
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Zelt JGE, Wang JZ, Mielniczuk LM, Beanlands RSB, Fallavollita JA, Canty JM, deKemp RA. Positron Emission Tomography Imaging of Regional Versus Global Myocardial Sympathetic Activity to Improve Risk Stratification in Patients With Ischemic Cardiomyopathy. Circ Cardiovasc Imaging 2021; 14:e012549. [PMID: 34102857 PMCID: PMC8208501 DOI: 10.1161/circimaging.121.012549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current risk assessment approaches fail to identify the majority of patients at risk of sudden cardiac arrest (SCA). Noninvasive imaging of the cardiac sympathetic nervous system using single-photon emission computed tomography and positron emission tomography offers the potential for refining SCA risk assessment. While various [11C]meta-hydroxyephedrine quantification parameters have been proposed, it is currently unknown whether regional denervation or global innervation yields greater SCA risk discrimination. The aim of the study was to determine whether the global innervation parameters yield any independent and additive prognostic value over the regional denervation alone. METHODS In a post hoc competing-risks analysis of the PAREPET trial (Prediction of Arrhythmic Events With Positron Emission Tomography), we compared global innervation and regional denervation parameters using the norepinephrine analog [11C]meta-hydroxyephedrine for SCA risk discrimination. Patients with ischemic cardiomyopathy (n=174) eligible for an implantable cardioverter-defibrillator for the primary prevention of SCA were recruited into the trial. [11C]meta-hydroxyephedrine uptake and clearance rates were measured to assess global (left ventricle mean) retention index and volume of distribution. Regional defects were quantified as the percentage of the left ventricle having values <75% of the maximum. RESULTS During a median follow-up of 4.2 years, there were 56 cardiac-related deaths, of which 26 were SCAs. For any given regional denervation volume, there was substantial heterogeneity in global innervation scores. Global retention index and distribution volume did not decrease until regional defects exceeded 40% left ventricle. Global scale parameters, retention index, and distribution volume (area under the curve=0.61, P=0.034, P=0.046, respectively), yielded inferior SCA risk discrimination compared to regional heterogeneity (area under the curve=0.74). CONCLUSIONS Regional denervation volume has superior cause-specific mortality prediction for SCA versus global parameters of sympathetic innervation. These results have widespread implications for future cardiac sympathetic imaging, which will greatly simplify innervation analysis. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01400334.
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Affiliation(s)
- Jason G E Zelt
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.)
- Faculty of Medicine (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.), University of Ottawa, Canada
- Department of Cellular and Molecular Medicine (J.G.E.Z., L.M.M., R.S.B.B.), University of Ottawa, Canada
| | - Jean Zhuo Wang
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.)
- Faculty of Medicine (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.), University of Ottawa, Canada
| | - Lisa M Mielniczuk
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.)
- Faculty of Medicine (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.), University of Ottawa, Canada
- Department of Cellular and Molecular Medicine (J.G.E.Z., L.M.M., R.S.B.B.), University of Ottawa, Canada
| | - Rob S B Beanlands
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.)
- Faculty of Medicine (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.), University of Ottawa, Canada
- Department of Radiology (R.S.B.B.), University of Ottawa, Canada
- Department of Cellular and Molecular Medicine (J.G.E.Z., L.M.M., R.S.B.B.), University of Ottawa, Canada
| | - James A Fallavollita
- VA Western New York Healthcare System, Buffalo, NY (J.A.F., J.M.C.)
- Division of Cardiovascular Medicine, University at Buffalo, NY (J.A.F., J.M.C.)
| | - John M Canty
- VA Western New York Healthcare System, Buffalo, NY (J.A.F., J.M.C.)
- Division of Cardiovascular Medicine, University at Buffalo, NY (J.A.F., J.M.C.)
| | - Robert A deKemp
- Department of Medicine (Cardiology), University of Ottawa Heart Institute, Canada (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.)
- Faculty of Medicine (J.G.E.Z., J.Z.W., L.M.M., R.S.B.B., R.A.dk.), University of Ottawa, Canada
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19
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Fonseca AA, Lima TM, Castel-Branco M, Figueiredo IV. Feasibility of cardiovascular risk screening in Portuguese community pharmacies. Pharm Pract (Granada) 2021; 19:2255. [PMID: 34188730 PMCID: PMC8203311 DOI: 10.18549/pharmpract.2021.2.2255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiovascular disease (CVD) remains the leading cause of human mortality. As
highly accessible and qualified health professionals, community pharmacists
can be included in the early detection of patients at risk for CVD by
implementing CVD screening programs. Objective: To assess the feasibility of CVD risk screening services in Portuguese
community pharmacies from the evaluation of customers acceptability. Methods: A cross-sectional study was conducted in a community pharmacy in Portugal.
The purpose of entering the pharmacy was recorded for all customers.
Afterwards, the customers were invited to be interviewed by the pharmacist,
who registered their willingness to participate and collected the
participants’ data and biochemical and physical parameters to assess
their CV risk by applying the Systematic COronary Risk Evaluation (SCORE)
model. For the participants who were not eligible for the SCORE-based risk
assessment, the pharmacist considered the major modifiable CVD risk factors
- hypertension, dyslipidemia, smoking habits, obesity, impaired fasting
glucose and sedentary behavior - according to the ESC guidelines. Results: Picking up medication was the most prevalent reason 69.8% (n=1,600)
for entering the pharmacy, and among the contacted customers, 56.4%
(n=621) agreed to have their CVD risk assessed. Of the 588 participants,
56.6% (n=333) were already on CV pharmacotherapy and were therefore
not eligible for screening. Of the 43.4% (n=255) CV
pharmacotherapy-naïve participants, 94.9% (n=242) were
screened with at least one CVD risk factor; 52.9% (n=135) were not
eligible for the SCORE assessment, of which 92.6% (n=125) presented
CVD risk factors. Of the 120 SCORE eligible participants, 80.0%
(n=96) were at least at moderate risk of CVD. Conclusions: We determined the feasibility of CVD risk screening in Portuguese community
pharmacies, as we found high customer acceptability, noted the reasons for
nonattendance, and found a high prevalence of CVD risk factors in at-risk
patients. This is an opportunity for Portuguese community pharmacists to
take a leading role in the early detection of CVD.
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Affiliation(s)
- Anabela A Fonseca
- Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra, Coimbra (Portugal).
| | - Tácio M Lima
- PhD. Professor. Department of Pharmaceutical Sciences, Federal Rural University of Rio de Janeiro. Seropédica, RJ (Brazil).
| | - Margarida Castel-Branco
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
| | - Isabel V Figueiredo
- PhD. Professor. Coimbra Institute for Biomedical Imaging and Translational Research (iCBR), Faculty of Pharmacy, Pharmacology and Pharmaceutical Care Laboratory, University Coimbra. Coimbra (Portugal).
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20
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Quick S, Winkler M, Speiser U, Ibrahim K, Schäfer J, Linke A, Zhang K, Christoph M, Heidrich FM. Myocardial strain analysis using cardiac magnetic resonance in patients with calpainopathy. Orphanet J Rare Dis 2021; 16:194. [PMID: 33931068 PMCID: PMC8086059 DOI: 10.1186/s13023-021-01826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Limb-girdle muscular dystrophy (LGMD) is a genetically and clinically heterogeneous group of rare muscular dystrophies. Subtype 2A (LGMD2A) also known as "calpainopathy" is an inherited autosomal recessive gene defect. Cardiac dysfunction is common in several forms of LGMD. Cardiac involvement in LGMD2A, however, is not clear. The aim of this study was to perform cardiac magnetic resonance (CMR)-based strain analysis in LGMD2A patients, as this is a diagnostic parameter of subclinical cardiac involvement and a powerful independent predictor of mortality. We conducted the largest prospective cardiac magnetic resonance study to date, including 11 genetically verified LGMD2A patients and 11 age- and sex-matched control subjects and performed CMR-based strain analysis of the left and right ventricles. RESULTS Left and right global longitudinal strain (GLS) were not significantly different between the two groups and within normal reference ranges (left ventricle: control - 21.8 (5.1) % vs. patients - 22.3 (3.2) %, p = 0.38; right ventricle: control - 26.3 (7.2) % vs. patients - 26.8 (5.8) %, p = 0.85). Also, global circumferential and radial strains did not significantly differ between the two groups (p = 0.95 and p = 0.86, respectively). LGMD2A patients did not show relevant amounts of late gadolinium enhancement (LGE) or malignant ventricular arrhythmias. CONCLUSIONS No evidence of even subtle cardiac dysfunction is evident form CMR-based strain analysis in LGMD2A patients. Malignant ventricular arrhythmias were not detected. Thus, in case of non-pathological initial echocardiographic and electrocardiographic examination, a less frequent or even no cardiac follow-up may be acceptable in these patients. However, if there are signs and symptoms that suggest an underlying cardiac condition (e.g. palpitations, angina, shortness of breath), this approach needs to be individualized to account for the unknown.
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Affiliation(s)
- Silvio Quick
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Chemnitz, Germany
| | - Max Winkler
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Dresden, Germany
| | - Uwe Speiser
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Dresden, Germany
| | - Karim Ibrahim
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Chemnitz, Germany
| | - Jochen Schäfer
- Department of Neurology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Axel Linke
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Dresden, Germany
| | - Kun Zhang
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Marian Christoph
- Department of Cardiology, Angiology and Intensive Care, Klinikum Chemnitz gGmbH, Medizincampus Chemnitz der Technischen Universität Dresden, Chemnitz, Germany
| | - Felix M Heidrich
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Dresden, Germany.
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21
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Koracevic G, Stojanovic M, Lovic D, Zdravkovic M, Sakac D. Certain beta blockers (e.g., bisoprolol) may be reevaluated in hypertension guidelines for patients with left ventricular hypertrophy to diminish the ventricular arrhythmic risk. J Hum Hypertens 2021; 35:564-576. [PMID: 33654234 DOI: 10.1038/s41371-021-00505-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
Hypertensive left ventricular hypertrophy (HTN LVH) is associated with almost threefold increased risk of ventricular tachycardia (VT)/ventricular fibrillation (VF). Furthermore, HTN LVH increases the risk of sudden cardiac death (SCD). The reverse LV remodeling due to efficient antihypertensive therapy lowers the incidence rates of cardiovascular events and SCD and the vast majority of available arterial hypertension (HTN) guidelines recommend renin angiotensin system (RAS) blockers and calcium channel blockers (CCBs) for HTN LVH aiming for LVH regression. On the other hand, beta blockers (BBs) as a class are not recommended in HTN LVH due to their insufficient capacity to reverse LVH remodeling even though they are recommended as the first-line drugs for prevention/treatment of VT/VF (in general, unrelated to HTN LVH). Moreover, BBs are the best antiarrhythmic (against VT/VF) among antihypertensive drugs. Despite that, BBs are currently not recommended for LVH treatment in HTN Guidelines. It is important to prevent VT/VF in patients at high risk, such as those with HTN LVH. Therefore, certain BBs (such as Bisoprolol) may be reevaluated in guidelines for HTN (in the section of HTN LVH).
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Affiliation(s)
- Goran Koracevic
- Department for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | | | - Dragan Lovic
- Clinic for Internal Diseases Inter Medica, Nis, Serbia.,Singidunum University, School of Medicine, Belgrade, Serbia
| | - Marija Zdravkovic
- University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Dejan Sakac
- Institute for Cardiovascular Diseases of Vojvodina, Sremska Kamenica & Medical Faculty Novi Sad, Novi Sad, Serbia
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22
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Shkolnikova MA, Ildarova RA, Jdanov DA, Shalnova SA, Shkolnikov VM. Prevalence, correlates, and mortality impacts of ventricular arrhythmia among older men and women: a population-based cohort study in Moscow. BMC Cardiovasc Disord 2021; 21:80. [PMID: 33557760 PMCID: PMC7871639 DOI: 10.1186/s12872-021-01883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND In Russia, cardiovascular disease (CVD) mortality is high and the mortality gap between men and women is large. Conventional risk factors cannot explain these phenomena. Ventricular arrhythmia (VA) is an important contributor to the death toll in community-based populations. The study examines the prevalence and the mortality impacts of VA in men and women and the role of VA in the male mortality excess at older ages. METHODS This is a secondary analysis of data from the Stress, Aging, and Health in Russia (SAHR) study that was fielded in 2007-9 in Moscow (1800 individuals, mean age 68.8 years), with mean mortality follow-up of 7.4 years (416 deaths, 248 CVD deaths). Indicators reflecting the frequency and the complexity of VA were derived from 24-h ambulatory ECG recordings. Other covariates were: socio-demographic characteristics, conventional risk factors, markers of inflammation, reported myocardial infarction, and stroke. The impacts of VA and other variables on CVD and all-cause mortality among men and women were estimated with the proportional hazard models. We assessed the contributions of VAs to the male-female mortality gap using hazard models that do and do not include groups of the predictors. Logistic models were used to assess the associations between VA and other biomarkers. RESULTS VAs were about twice as prevalent among men as among women. In both sexes, they were significantly associated with CVD and all-cause mortality independently of conventional risk factors. The highest hazard ratios (HRs) for CVD death were found for the runs of ventricular premature complexes (VPCs) HR = 2.45, 95% CI 1.63-3.68 for men and 2.75, 95% CI 1.18-6.40 for women. The mortality impacts of the polymorphic VPCs were significant among men only (HR = 1.50, 95% CI 1.08-2.07). VA indicators can potentially explain 12.3% and 9.1% of the male-female gaps in mortality from CVD and all causes, respectively. VAs were associated with ECG-registered ischemic problems and reported MI, particularly among men. CONCLUSIONS VA indicators predicted mortality in older Muscovites independently of other risk factors, and have the potential to explain a non-trivial share of the excess male mortality. The latter may be related to more severe coronary problems in men compared to women.
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Affiliation(s)
- Maria A Shkolnikova
- Centre for Cardiac Arrhythmia, Pirogov Russian National Research Medical University, Taldomskaya 2, Moscow, Russian Federation, 125412
| | - Rukijat A Ildarova
- Centre for Cardiac Arrhythmia, Pirogov Russian National Research Medical University, Taldomskaya 2, Moscow, Russian Federation, 125412
| | - Dmitri A Jdanov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany
- National Research University Higher School of Economics, Bol'shoj Trehsvjatitel'skij Pereulok, Moscow, Russian Federation, 109028
| | - Svetlana A Shalnova
- National Research Center for Preventive Medicine, Petroverigskiy pereulok 10, Moscow, Russian Federation, 101990
| | - Vladimir M Shkolnikov
- Max Planck Institute for Demographic Research, Konrad-Zuse-Str. 1, 18057, Rostock, Germany.
- National Research University Higher School of Economics, Bol'shoj Trehsvjatitel'skij Pereulok, Moscow, Russian Federation, 109028.
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23
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Das B, Ramasubbu SK, Kumar B, Rawat VS. Top 20 drug - drug interactions, polypharmacy and analysis of the nature of risk factors due to QT interval prolonging drug use in elderly psychiatry outpatients. J Family Med Prim Care 2020; 9:6023-6040. [PMID: 33681037 PMCID: PMC7928114 DOI: 10.4103/jfmpc.jfmpc_1060_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Psychotropic medications extend the corrected QT (QTc) period in the ECG. Psychiatric patients exposed to ≥ 1 psychotropic medication (s) represent a group with a marked probability of drug-activated QTc-prolongation. Prolonged QTc interval in elderly patients (age > 60 years) is connected to a greater risk of all-cause and coronary heart disease deaths. We investigated the pattern of utilization of QTc-interval prolonging medications, QT-extending interactions between drugs, and prevalence of QTc-interval prolonging risk factors in elderly patients. METHODS This was a cross-sectional, prospective study at the Psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to December 31, 2018 employing the pertinent prescriptions. RESULTS A total of 208 elderly patients (age 60 years or more) visiting the Psychiatry OPD during the aforementioned study period were investigated. 105 (50.5%) patients were males whereas 103 (49.5%) were females in our study. 147 out of 208 patients (70.7%) were using interacting agents with the capacity to produce TdP. 288 interacting torsadogenic medication pairs were unraveled. As per AzCERT/CredibleMeds Classification, 254 (48.8%), 181 (34.8%), and 62 (12%) interacting medications were identified with known, possible, and conditional risk of TdP, respectively. The common interacting medications belonged to antidepressant (144), proton pump inhibitor (91), antipsychotic (85), anti-nausea (46), antimicrobial (39), and H2 receptor antagonist (15) therapeutic categories. CONCLUSIONS Many geriatric patients were administered drugs and drug combinations with heightened proclivity towards QT-interval prolongation. Therefore, we need to exigently embrace precautionary safety interventions, to be vigilant, and forestall QT-prolongation and TdP in clinical settings. Online evidence-based drug information resources can aid clinicians in choosing drugs for psychiatric patients.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Virbhadra Road, Rishikesh, Uttarakhand, India
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24
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Windsor JS, Newman J, Sheppard M. Cardiovascular Disease and Triathlon-Related Deaths in the United Kingdom. Wilderness Environ Med 2020; 31:31-37. [PMID: 32057629 DOI: 10.1016/j.wem.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 10/24/2019] [Accepted: 11/04/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Triathlon is one of the fastest growing sports in the United Kingdom. However, in recent years several deaths have occurred. The intention of this study is to identify these cases and examine the role cardiovascular disease played in these deaths. METHODS An extensive online search was performed to identify triathlon-related deaths (TRDs) in the United Kingdom and UK citizens who died during or as a result of competing in triathlons abroad. British Triathlon provided the number of participants who took part in UK-based events. Coroners provided information on all those who died. RESULTS Between 2009 and 2015, 991,186 participants took part in British Triathlon-sanctioned events. Five TRDs in the United Kingdom were identified. The mortality rate was 0.5 per 100,000 participants. Deaths occurred during or after the swim (3), cycle (1), and run (1) events. During the same period, 5 TRDs were identified among UK citizens competing abroad. These deaths occurred during or after the swim (2), cycle (1), and run (2) events. Cardiovascular pathology was cited as a cause or contributing factor in half of the fatalities. Four deaths were referred to a specialist cardiac pathology service for autopsy. CONCLUSIONS Cardiovascular disease was found to be the most common cause of TRD. Further research is needed to determine the underlying cardiac pathology that triggers TRDs. With this information it may be possible to develop screening tools that can prevent similar fatalities from occurring in the future.
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Affiliation(s)
| | | | - Mary Sheppard
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, United Kingdom
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25
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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26
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Association of Genetic Polymorphisms in the Matrix Gla Protein (MGP) Gene with Coronary Artery Disease and Serum MGP Levels. Balkan J Med Genet 2020; 22:43-50. [PMID: 31942416 PMCID: PMC6956629 DOI: 10.2478/bjmg-2019-0020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Matrix Gla protein (MGP) is an important regulatory protein for inhibition of calcification in the vessel wall and cartilage. The MGP gene polymorphisms are suspected to increase the risk of extracellular calcification through altering the related gene expression and serum MGP levels. The goal of this study was to examine the correlation between rs4236 (Thr83-Ala), rs12304 (Glu60-X) and rs1800802 (T138-C) polymorphisms of the MGP gene and coronary artery calcification. Serum MGP levels of 168 subjects who had undergone coronary angiography were analyzed along with genotyping of MGP gene polymorphisms. The results indicated that serum MGP levels were significantly associated with rs4236 and rs1800802 polymorphisms of the MGP gene with the occurrence of coronary artery diseases (CAD). Allelic distributions of MGP gene polymorphisms and serum MGP levels, respectively, were not significantly interconnected with the presence of CAD. Our results revealed that serum MGP levels of CAD patients show association with rs4236 and rs1800802 polymorphisms, but serum MGP levels alone do not directly reflect the risk of CAD. The role of MGP genetic variants on formation and progression of arterial calcification should be regarded in cardiovascular diseases.
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27
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Zhang J, Zhou X, Xing Q, Li Y, Zhang L, Zhou Q, Lu Y, Zhai M, Bao J, Tang B. Sudden cardiac death in the Kazakh and Han peoples of Xinjiang, China: A comparative cross-sectional study. Medicine (Baltimore) 2019; 98:e18126. [PMID: 31852072 PMCID: PMC6922496 DOI: 10.1097/md.0000000000018126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Sudden cardiac death (SCD) is a major cause of mortality in China. This study collected reference data for future programs of prevention of SCD among the ethnic Kazakh and Han populations in Xinjiang, China.From January 1, 2015 to December 31, 2015, 2 monitoring locations in northern Xinjiang China were utilized. These locations were selected based on the geographic, economic, and administrative structures of the ethnic Kazakh settlements in Xinjiang. Investigators were trained to investigate SCDs in Kazakh and Han people, a study population totaling more than 400,000. The populations were compared for SCD incidence.The average age of the Han population was significantly higher than that of the Kazakh. During the year 2015, there were 135 SCDs, specifically 67 and 68 in the Han and Kazakh populations, respectively, incidences of 37.94 and 36.2 per 100,000. After standardizing for age, the incidence in these populations was 29.36 and 51.85 per 100,000. Among those who experienced SCD, the prevalence of hypertension was higher in the Kazakh group than in the Han. The multivariate analysis of populations with SCD showed that, among the patients with coronary heart disease, the Kazakh were more likely to have SCD than the Han (odds ratio: 3.58, confidence interval: 1.18-10.95).Among the elderly, the incidence of SCD was much higher in the Kazakh population than in the Han population. Basic medical services and health education should be strengthened in the Kazakh pastoral areas.
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Affiliation(s)
- Jianghua Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Xianhui Zhou
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Qiang Xing
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Yaodong Li
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Ling Zhang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Qina Zhou
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | - Yanmei Lu
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
| | | | - Jianfu Bao
- Barkol People's Hospital, Barkol, Xinjiang Uygur Autonomous Region, China
| | - Baopeng Tang
- First Affiliated Hospital of Xinjiang Medical University, Urumqi
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28
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Abstract
Ventricular arrhythmias are associated with significant morbidity and mortality. In the perioperative period, more than 10% of patients undergoing a general anesthetic have an abnormal heart rhythm. Arrhythmia development is a dynamic interplay between an arrhythmogenic substrate, myocardial electrophysiologic properties, modifying factors, and triggering factors. Imbalances in the autonomic nervous system can lead to increased myocardial excitability, which is a major contributor to the pathophysiology of ventricular tachyarrhythmias. Myocardial excitability and ventricular arrhythmogenesis is modulated perioperatively through hemodynamic management, electrolyte balance, anesthetic agents, or regional anesthetic and surgical techniques.
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Affiliation(s)
- Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Yuki Kuwabara
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh School of Medicine, Biomedical Science Tower W1401, 200 Lothrop Street, Pittsburgh, PA 15213, USA
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29
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Harrison JW, Manola A, Kalluri LK, Duvall WL, Giedrimiene D, Kluger JW. Clinical predictors of antitachycardia pacing response in implantable cardioverter defibrillator patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1219-1225. [PMID: 31322287 DOI: 10.1111/pace.13760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antitachycardia pacing (ATP) provides safe and painless termination of reentrant ventricular arrhythmias in patients with implantable cardioverter defibrillator (ICDs), improving their quality of life. Established predictors of ATP responsiveness are not well known; only longer ventricular tachycardia (VT) cycle length and higher ejection fraction have been found to predict ATP success. OBJECTIVE To investigate clinical and ECG predictors of ATP response in ICD patients with monomorphic VT. METHODS The ICD clinic database was searched for monomorphic VT events requiring ICD therapy in patients with ischemic or non-ischemic cardiomyopathy. Each patient's first ICD encounter for VT was assessed. Patient demographics, clinical characteristics, VT rate, and ATP responsiveness (always, sometimes, and never successful) were recorded. An ECG was analyzed for QRS morphology and duration. Data was assessed for predictors of ATP responsiveness. RESULTS In 527 patients, characteristics associated with always successful ATP included ACE-I/ARB therapy and slower VT rate (never successful ATP 197 ± 28 bpm, sometimes successful ATP 190 ± 27 bpm, always successful ATP 183 ± 22 bpm, P < .0001). Secondary prevention indication, amiodarone therapy, and longer QRS duration were associated with ATP failure. After multivariate analysis, only faster VT rate and amiodarone therapy were predictive of ATP failure. CONCLUSIONS Neither QRS morphology nor duration was predictive of ATP success. Slower VT rate was predictive of repeated ATP responsiveness. Amiodarone therapy, which is known to increase VT cycle length, interestingly was associated with ATP failure for unclear reasons. More individualized and possibly more aggressive ATP programming may be warranted in patients on amiodarone.
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Affiliation(s)
- Joshua W Harrison
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | - Akrivi Manola
- Division of Cardiology Hartford Hospital, Hartford, CT.,Departemnt of Medicine, University of Connecticut, Farmington, CT
| | | | - W Lane Duvall
- Division of Cardiology Hartford Hospital, Hartford, CT
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Das B, Rawat VS, Ramasubbu SK, Kumar B. Frequency, characteristics and nature of risk factors associated with use of QT interval prolonging medications and related drug-drug interactions in a cohort of psychiatry patients. Therapie 2019; 74:599-609. [PMID: 31053339 DOI: 10.1016/j.therap.2019.03.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/22/2019] [Accepted: 03/11/2019] [Indexed: 01/08/2023]
Abstract
Quite a number of antipsychotic and antidepressant drugs are known to cause significant QT-prolongation. Psychiatric patients constitute a population at notable risk of drug-induced QT-prolongation. The aims were to explore frequency of use of QTc-interval prolonging agents and QT-prolonging drug-drug interactions, and prevalence of risk factors for QTc-interval prolongation in patients reporting to psychiatry out-patient department (OPD) in a tertiary care hospital in India. This prospective cross-sectional study was carried out in the psychiatry OPD at All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India from October 1, 2017 to September 30, 2018 using the relevant prescriptions (i.e., the OPD case record forms and treatment sheets). For each patient, the entire medication list was analyzed for the possibility of interactions, with particular attention on the high-risk QT prolonging ones. Arizona Center for Education and Research on Therapeutics (AZCERT) QT drug lists were used to classify TdP risks of psychotropic and other medications. One thousand three hundred twenty-six (1326) patients attending the psychiatry OPD during the study period were scrutinized. Seven hundred fifty-one 751 patients (56.6%) were males whereas 575 (43.4%) were females in our study. Of the 1326 patients, 636 patients (47.9%) were identified as receiving interacting medications with the ability to induce torsades de pointe (TdP). Nine hundred seventeen (917) interacting medication pairs with torsadogenic risk were encountered. The most frequently interacting medications were from antipsychotic (794), antidepressant (519), antimicrobial (84), proton pump inhibitor (80), anticonvulsant (66), and anti-nausea (25) therapeutic categories. As per AZCERT classification (CredibleMeds TdP risk-stratification lists), 597 (36.8%), 443 (27.3%) and 432 (26.7%) of the interacting medications were associated with known, possible, and conditional risk of TdP, respectively. Concurrent prescriptions of QT-prolonging drugs is frequent in psychiatry OPD setting. Appropriate precautions should be instituted to obviate undesirable outcomes arising out of these interactions. This highlights the pressing need for clear protocols & strategies for implementation to motivate careproviders with clarity in the context of drug use guidelines for rational and safe prescribing in psychiatry.
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Affiliation(s)
- Biswadeep Das
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India.
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
| | - Saravana Kumar Ramasubbu
- Department of Pharmacology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences (AIIMS), Rishikesh 249 203, Uttarakhand, India
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Maqsood MH, Rubab K. The Role of the Cardioversion Defibrillator in Post Myocardial Infarction Sudden Cardiac Death: A Systematic Review of Clinical Trials and Observational Studies. Cureus 2019; 11:e4314. [PMID: 31183294 PMCID: PMC6538101 DOI: 10.7759/cureus.4314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Sudden cardiac death (SCD) accounts for approximately half of all the deaths attributed to cardiovascular disease in the United States. Survivors of an acute myocardial infarction (AMI) are at high risk of SCD, largely due to cardiac arrhythmias and severe left ventricular (LV) systolic dysfunction. The implantable cardioverter defibrillator (ICD) or automated implantable cardioverter defibrillator (AICD) is a device that is implantable inside the body, able to perform cardioversion, defibrillation, and (in modern versions) pacing of the heart. According to a study included in our review, patients who received an ICD contributed to an adjusted 44% reduction (hazard ratio [HR] 0.56, 95% CI: 0.32-1.01; P = 0.053) of all-cause mortality compared to those with a comparable baseline. Patients with an ICD implant three months after a myocardial infarction (MI) demonstrated a non-significantly higher mortality than patients who did not receive an ICD. The factors favoring ICD implantation were multiple MIs, increased resting heart rate, occurrence of non-sustained ventricular tachycardia, QRS duration = 120 ms, syncope events, anti-arrhythmic drug treatment (mostly Class III), and an index MI of more than one year. The likelihood of receiving an ICD diminished with the patient’s age. Increased periodic repolarization dynamics were a significant predictor of mortality. It can be concluded that cardioverter defibrillators help reduce not only all-cause mortality but also sudden cardiac death. It is important to note that ICDs are only significant if implanted after a sufficient time-gap post-MI.
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Affiliation(s)
| | - Kinza Rubab
- Internal Medicine, King Edward Medical University / Mayo Hospital, Lahore, PAK
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Tague L, Wiggs J, Li Q, McCarter R, Sherwin E, Weinberg J, Sable C. Comparison of Left Ventricular Hypertrophy by Electrocardiography and Echocardiography in Children Using Analytics Tool. Pediatr Cardiol 2018; 39:1378-1388. [PMID: 29774391 DOI: 10.1007/s00246-018-1907-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/08/2018] [Indexed: 12/16/2022]
Abstract
Left ventricular hypertrophy (LVH) is a common finding on pediatric electrocardiography (ECG) leading to many referrals for echocardiography (echo). This study utilizes a novel analytics tool that combines ECG and echo databases to evaluate ECG as a screening tool for LVH. SQL Server 2012 data warehouse incorporated ECG and echo databases for all patients from a single institution from 2006 to 2016. Customized queries identified patients 0-18 years old with LVH on ECG and an echo performed within 24 h. Using data visualization (Tableau) and analytic (Stata 14) software, ECG and echo findings were compared. Of 437,699 encounters, 4637 met inclusion criteria. ECG had high sensitivity (≥ 90%) but poor specificity (43%), and low positive predictive value (< 20%) for echo abnormalities. ECG performed only 11-22% better than chance (AROC = 0.50). 83% of subjects with LVH on ECG had normal left ventricle (LV) structure and size on echo. African-Americans with LVH were least likely to have an abnormal echo. There was a low correlation between V6R on ECG and echo-derived Z score of left ventricle diastolic diameter (r = 0.14) and LV mass index (r = 0.24). The data analytics client was able to mine a database of ECG and echo reports, comparing LVH by ECG and LV measurements and qualitative findings by echo, identifying an abnormal LV by echo in only 17% of cases with LVH on ECG. This novel tool is useful for rapid data mining for both clinical and research endeavors.
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Affiliation(s)
- Lauren Tague
- Division of Cardiology, Children's National Health System, Washington, DC, USA.
- Department of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Suite WW3-200, Washington, DC, 20010, USA.
| | - Justin Wiggs
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Qianxi Li
- Philips Research North America, Cambridge, MA, USA
| | - Robert McCarter
- Division of Biostatistics and Study Methods, Children's National Health System, Washington, DC, USA
| | - Elizabeth Sherwin
- Division of Cardiology, Children's National Health System, Washington, DC, USA
| | - Jacqueline Weinberg
- Division of Cardiology, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Craig Sable
- Division of Cardiology, Children's National Health System, Washington, DC, USA
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Liu A, Wang S, Zhang C, Sun D, Song X. Role of angiotensin-converting enzyme insertion/deletion polymorphism in sudden cardiac arrest. J Cell Biochem 2018; 120:3474-3478. [PMID: 30242890 DOI: 10.1002/jcb.27622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/14/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between angiotensin-converting enzyme (ACE) insertion/deletion (I/D) polymorphism and to understand sudden cardiac arrest (SCA) in the Chinese population. METHODS In this study, 232 patients were divided into the SCA group and the coronary disease group with coronary disease, but no SCA occurred during the treatment period. After comparing the genotype frequencies of the two groups, all patients were further divided into three groups as the II homozygotes, ID heterozygotes, and DD homozygotes to investigate the relationship in ACE I/D polymorphism and other risk factors of SCA. RESULTS The frequencies of DD genotype in the SCA group were significantly higher than the coronary disease group, as well as the D allele frequencies in the SCA group were high when compared with the coronary disease group. According to the genotypes of the ACE I/D polymorphism, the distribution of patients' characteristics had no significant differences among all the characteristics. Both, the patients who survived SCA, with II genotype and the ones who died of SCA, with DD genotype had significant higher percentages. CONCLUSION The DD genotype was associated with a higher prevalence of SCA and might be a risk factor of survival rate in sudden cardiac death.
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Affiliation(s)
- Aifen Liu
- Department of Cardiovascular, Shengli Oilfield Central Hospital, Dongying, China
| | - Sai Wang
- Department of Cardiovascular, Shengli Oilfield Central Hospital, Dongying, China
| | - Chunxiao Zhang
- Department of Cardiovascular, Shengli Oilfield Central Hospital, Dongying, China
| | - Di Sun
- Department of Cardiovascular, Shengli Oilfield Central Hospital, Dongying, China
| | - Xiaozheng Song
- Department of Cardiovascular, Shengli Oilfield Central Hospital, Dongying, China
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Electrocardiogram as a predictor of sudden cardiac death in middle-aged subjects without a known cardiac disease. IJC HEART & VASCULATURE 2018; 20:50-55. [PMID: 30167454 PMCID: PMC6111047 DOI: 10.1016/j.ijcha.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/09/2018] [Accepted: 08/10/2018] [Indexed: 02/03/2023]
Abstract
Background Abnormal 12‑lead electrocardiogram (ECG) findings and proposing its ability for enhanced risk prediction, majority of the studies have been carried out with elderly populations with prior cardiovascular diseases. This study aims to denote the association of sudden cardiac death (SCD) and various abnormal ECG morphologies using middle-aged population without a known cardiac disease. Methods In total, 9511 middle-aged subjects (mean age 42 ± 8.2 years, 52% males) without a known cardiac disease were included in this study. Risk for SCD was assessed after 10 and 30-years of follow-up. Results Abnormal ECG was present in 16.3% (N = 1548) of subjects. The incidence of SCD was distinctly higher among those with any ECG abnormality in 10 and 30-year follow-ups (1.7/1000 years vs. 0.6/1000 years, P < 0.001; 3.4/1000 years vs. 1.9/1000 years, P < 0.001). At 10-year point, competing risk multivariate regression model showed HR of 1.62 (95% CI 1.0–2.6, P = 0.05) for SCD in subjects with abnormal ECG. QRS duration ≥ 110 ms, QRST-angle > 100°, left ventricular hypertrophy, and T-wave inversions were the most significant independent ECG risk markers for 10-year SCD prediction with up to 3-fold risk for SCD. Those with ECG abnormalities had a 1.3-fold risk (95% CI 1.07–1.57, P = 0.007) for SCD in 30-year follow-up, whereas QRST-angle > 100°, LVH, ER ≥ 0.1 mV and ≥0.2 mV were the strongest individual predictors. Subjects with multiple ECG abnormalities had up to 6.6-fold risk for SCD (P < 0.001). Conclusion Several ECG abnormalities are associated with the occurrence of early and late SCD events in the middle-age subjects without known history of cardiac disease.
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Karaman K, Karayakali M, Arisoy A, Akar I, Ozturk M, Yanik A, Yilmaz S, Celik A. Is There any Relationship Between Myocardial Repolarization Parameters and the Frequency of Ventricular Premature Contractions? Arq Bras Cardiol 2018; 110:534-541. [PMID: 30226912 PMCID: PMC6023631 DOI: 10.5935/abc.20180079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/18/2017] [Accepted: 10/18/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Ventricular premature contractions (VPCs) may trigger lethal ventricular arrhythmias in patients with structural heart disease. However, this role of VPCs in healthy people remains controversial once that not enough clinical trials are available. Recently, some myocardial repolarization markers, such as Tp-e interval, Tp-e/QT, and Tp-e/QTc ratios, have been reported to be useful for predicting lethal ventricular arrhythmias in various clinical disorders without structural heart disease. OBJECTIVE In this study, we aimed to investigate the relation between VPC frequent and myocardial repolarization markers in individuals without structural heart disease. METHODS This study included 100 patients who had complaints of dizziness and palpitations. Twelve-lead electrocardiography and 24-hour ambulatory Holter recordings were obtained from all patients. VPC burden was calculated as the total number of VPCs divided by the number of all QRS complexes in the total recording time. P-values < 0.05 were considered significant. RESULTS Tp-e interval and Tp-e/QTc ratio were significantly higher in patients with higher VPC burden than in patients with lower VPC burden, and a positive correlation was found between these markers and VPC burden. Tp-e (β = 1.318, p = 0.043) and Tp-e/QTc (β = -405.136, p = 0.024) in the lead V5 were identified as independent predictors of increased VPC burden. CONCLUSIONS Tp-e interval and Tp-e/QTc ratio increased in patients with high VPC number. Our study showed that VPCs may have a negative effect on myocardial repolarization. This interaction may lead to an increased risk of malignant arrhythmias.
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Affiliation(s)
- Kayihan Karaman
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Metin Karayakali
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Arif Arisoy
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Ilker Akar
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiovascular Surgery, Tokat - Turkey
| | - Mustafa Ozturk
- Erzurum Territorial Training and Research Hospital,
Cardiology Clinic, Erzurum - Turkey
| | - Ahmet Yanik
- Samsun Training and Research Hospital, Cardiology Clinic,
Samsun - Turkey
| | - Samet Yilmaz
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
| | - Atac Celik
- Gaziosmanpasa University Faculty of Medicine, Department
of Cardiology, Tokat - Turkey
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Li H, Wang C, Sun J, Liu C, Li N, Chen J. Pravastatin Decreases Infarct Size Induced by Coronary Artery Ischemia/Reperfusion with Elevated eNOS Expression in Rats. Int Heart J 2018; 59:154-160. [PMID: 29375110 DOI: 10.1536/ihj.16-607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Our previous study showed that pravastatin prevents ischemia and reperfusion-induced lethal ventricular fibrillation in rats. This study explored whether pravastatin decreases myocardial infarct size and this effect is associated with endothelial nitric oxide synthase (eNOS) expression in myocardium. Rats were treated with ischemia (30 minutes) and reperfusion (60 minutes) after chronic oral administration of pravastatin, fluvastatin, or vehicle once daily for 22 days. Electrocardiograms and blood pressure were continuously recorded, myocardial infarct size was measured by TTC-staining, and eNOS expression was measured by western blot. The results showed that pravastatin and fluvastatin significantly reduced myocardial infarct size. No statistical differences were found in the areas at risk among all groups. However, a significant reduction in infarct size was observed in three pravastatin groups and one fluvastatin group compared to control. Both pravastatin and fluvastatin significantly increased eNOS protein expression in ischemic and non-ischemic tissues compared to control. Our results suggest that pravastatin decreases cardiovascular mortality beyond its cholesterol-lowering effect. Pravastatin is more potent than fluvastatin in reducing infarct size. These effects may be associated with elevation of eNOS expression.
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Affiliation(s)
- He Li
- Department of Pharmacology, Pharmaceutical College, Beihua University
| | - Chunmei Wang
- Department of Pharmacology, Pharmaceutical College, Beihua University
| | - Jinghui Sun
- Department of Pharmacology, Pharmaceutical College, Beihua University
| | - Cong Liu
- Department of Pharmacology, Pharmaceutical College, Beihua University
| | - Ning Li
- Department of Pharmacology, Pharmaceutical College, Beihua University
| | - Jianguang Chen
- Department of Pharmacology, Pharmaceutical College, Beihua University
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Del-Carpio Munoz F, Gharacholou SM, Scott CG, Nkomo VT, Lopez-Jimenez F, Cha YM, Munger TM, Friedman PA, Asirvatham SJ. Prolonged Ventricular Conduction and Repolarization During Right Ventricular Stimulation Predicts Ventricular Arrhythmias and Death in Patients With Cardiomyopathy. JACC Clin Electrophysiol 2017; 3:1580-1591. [PMID: 29759841 DOI: 10.1016/j.jacep.2017.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 05/17/2017] [Accepted: 06/09/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The goal of this study was to evaluate whether prolonged ventricular conduction (paced QRS) and repolarization (paced QTc) times observed during ventricular stimulation predict ventricular arrhythmic events and death. BACKGROUND Abnormal ventricular conduction and repolarization can predispose patients to ventricular arrhythmias. METHODS Consecutive patients with left ventricular dysfunction (ejection fraction <50%) undergoing electrophysiology studies from January 2002 until May 2014 were identified at Mayo Clinic (Rochester, Minnesota). Patients were followed up until December 2014 for occurrence of ventricular arrhythmias and death. RESULTS Among the 501 patients included (mean age 65 years; mean left ventricular ejection fraction 33.1%), longer paced ventricular conduction was associated with longer baseline QRS duration, longer QT interval, and lower ejection fraction. On multivariable analysis, longer paced QRS duration was associated with higher risk of ventricular arrhythmia (hazard ratio [HR]: 1.11 per 10-ms increase; 95% confidence interval [CI]: 1.07 to 1.16; p < 0.001) and all-cause death or arrhythmia (HR: 1.09; 95% CI: 1.09 to 1.13; p < 0.001). A paced QRS duration >190 ms was associated with a 3.6 times higher risk of ventricular arrhythmia (HR: 3.6; 95% CI: 2.35 to 5.53; p < 0.001) and a 2.1 times higher risk of death or arrhythmia (HR: 2.12; 95% CI: 1.53 to 2.95; p < 0.001), independent of left ventricular function or baseline QRS duration. Longer QTc interval during ventricular pacing was associated with a higher risk of ventricular arrhythmia (HR: 1.03 per 10-ms increase; 95% CI: 1.02 to 1.12; p < 0.001) independent of paced QRS duration. CONCLUSIONS Longer paced QRS duration and paced QTc interval predict ventricular arrhythmias in patients with cardiomyopathy. Ventricular conduction and repolarization prolongation during right ventricular pacing can determine the risk of ventricular arrhythmias.
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Affiliation(s)
| | | | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | | | - Yong-Mei Cha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Thomas M Munger
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Division of Pediatric Cardiology and Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota
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Santangeli P, Epstein AE. Sudden Cardiac Death: Lessons Learned from Cardiac Implantable Rhythm Devices. Card Electrophysiol Clin 2017; 9:749-759. [PMID: 29173415 DOI: 10.1016/j.ccep.2017.08.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Trials have demonstrated that implantable-cardioverter defibrillators (ICDs) are effective in preventing sudden cardiac death (SCD). The degree of left ventricular dysfunction is the only parameter to identify primary prevention populations at higher risk of SCD in which ICDs may reduce longitudinal mortality risk. Clinical application of current stratification approaches based on left ventricular ejection fraction (LVEF) alone has failed to prevent most SCD in the general population. This lack of specificity has resulted in a significant number of potentially unnecessary ICDs. Future studies should focus on newer risk markers to improve the predictive value of LVEF and SCD prevention.
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Affiliation(s)
- Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
| | - Andrew E Epstein
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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Abstract
Premature atrial and ventricular contractions, or ectopic beats, are frequently detected on routine electrocardiogram monitoring. They are often considered to be benign with no pathological significance; however, the literature suggests that higher ectopic burdens may have clinical importance. This paper reviews the current literature and provides the treating physician with an understanding of when ectopic beats should be deemed significant and when treatment may be appropriate.
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Jabbari R, Glinge C, Risgaard B, Lynge TH, Winkel BG, Haunsø S, Albert CM, Engstrøm T, Tfelt-Hansen J. Differences in clinical characteristics in patients with first ST-segment elevation myocardial infarction and ventricular fibrillation according to sex. J Interv Card Electrophysiol 2017; 50:133-140. [DOI: 10.1007/s10840-017-0284-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Khan Q, Ismail M, Haider I, Haq IU, Noor S. QT interval prolongation in hospitalized patients on cardiology wards: a prospective observational study. Eur J Clin Pharmacol 2017; 73:1511-1518. [PMID: 28803378 DOI: 10.1007/s00228-017-2321-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/04/2017] [Indexed: 01/08/2023]
Abstract
PURPOSE Prolonged QT interval may lead to a lethal form of arrhythmia, torsades de pointes (TdP), which is associated with cardiovascular mortality. Therefore, we aimed to identify prevalence of QT interval prolongation, compare clinical characteristics of patients with normal and prolonged QT interval, and identify predictors of QT interval prolongation. METHODS A prospective observational study was conducted in cardiology wards of two teaching hospitals in Pakistan. Bazett's correction formula was used for the calculation of QTc interval. Prevalence of QT prolongation and pro-QTc scores were calculated. Comparative analysis was performed with respect to various clinical characteristics by applying t test and chi-square test. Odds ratios were calculated using regression analysis. RESULTS Among 417 patients, 44.6% were found having prolonged QT interval, of which, 17.3% presented with an abnormally high QTc interval (> 500 ms). Significant difference was recorded between the groups (normal vs. prolonged) with respect to age, all prescribed medications, QT drugs, number of risk factors, QT-DDIs (QT-prolonging drug-drug interactions), gender, and diuretics use. Multivariate logistic regression analysis showed significant results for various predictors such as male gender (p = 0.03), various age categories 41-50 years (p = 0.04), 51-60 years (p = 0.01), and > 60 years (p < 0.001), and diuretics (p = 0.008). CONCLUSION A substantial number of patients in cardiology wards presented with QT prolongation. Proper considerations are needed in order to minimize the associated risk particularly in patients with abnormally high QT prolongation, old age, polypharmacy, one or more QT-prolonging drugs, and high pro-QTc scores.
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Affiliation(s)
- Qasim Khan
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
- Department of Pharmacy, COMSATS Institute of Information Technology, Abbottabad, Pakistan
| | - Mohammad Ismail
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan.
| | - Iqbal Haider
- Department of Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Inam Ul Haq
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Sidra Noor
- Department of Pharmacy, University of Peshawar, Khyber Pakhtunkhwa, Pakistan
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Masoud S, Lim PB, Kitas GD, Panoulas V. Sudden cardiac death in patients with rheumatoid arthritis. World J Cardiol 2017; 9:562-573. [PMID: 28824786 PMCID: PMC5545140 DOI: 10.4330/wjc.v9.i7.562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death (SCD), has been shown in patients with rheumatoid arthritis (RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.
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Jahangard-Rafsanjani Z, Hakimzadeh N, Sarayani A, Najafi S, Heidari K, Javadi MR, Hadjibabaie M, Gholami K. A community pharmacy-based cardiovascular risk screening service implemented in Iran. Pharm Pract (Granada) 2017; 15:919. [PMID: 28690693 PMCID: PMC5499348 DOI: 10.18549/pharmpract.2017.02.919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 04/11/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Cardiovascular disease is a major health concern around the world. OBJECTIVE To assess the outcomes and feasibility of a pharmacy-based cardiovascular screening in an urban referral community pharmacy in Iran. METHODS A cross sectional study was conducted in a referral community pharmacy. Subjects aged between 30-75 years without previous diagnose of cardiovascular disease or diabetes were screened. Measurement of all major cardiovascular risk factors, exercise habits, medical conditions, medications, and family history were investigated. Framingham risk score was calculated and high risk individuals were given a clinical summary sheet signed by a clinical pharmacist and were encouraged to follow up with their physician. Subjects were contacted one month after the recruitment period and their adherence to the follow up recommendation was recorded. RESULTS Data from 287 participants were analyzed and 146 were referred due to at least one abnormal laboratory test. The results showed 26 patients with cardiovascular disease risk greater than 20%, 32 high systolic blood pressure, 22 high diastolic blood pressures, 50 high total cholesterol levels, 108 low HDL-C levels, and 22 abnormal blood glucose levels. Approximately half of the individuals who received a follow up recommendation had made an appointment with their physician. Overall, 15.9% of the individuals received medications and 15.9% received appropriate advice for risk factor modification. Moreover, 7.5% were under evaluation by a physician. CONCLUSION A screening program in a community pharmacy has the potential to identify patients with elevated cardiovascular risk factor. A plan for increased patient adherence to follow up recommendations is required.
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Affiliation(s)
- Zahra Jahangard-Rafsanjani
- Assistant Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Negar Hakimzadeh
- PharmD. Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Amir Sarayani
- PharmD. Research Center for Rational Use of Drugs, Tehran University of Medical Sciences, Tehran (Iran).
| | - Sheyda Najafi
- PharmD. Department of Pharmaceutical Care, Faculty of Pharmacy, Tehran University of Medical Sciences, Imam Khomeini Hospital Complex. Tehran (Iran).
| | - Kazem Heidari
- PhD (Epidemiol). School of Public Health, Tehran University of Medical Sciences. Tehran (Iran).
| | - Mohammad R Javadi
- Professor of Clinical Pharmacy. Department of Pharmacotherapy, Faculty of Pharmacy, Tehran University of Medical Sciences. Tehran (Iran).
| | - Molouk Hadjibabaie
- Professor of Clinical Pharmacy. Research center for rational use of drugs and faculty of pharmacy, Tehran university of Medical sciences, Tehran (Iran).
| | - Kheirollah Gholami
- Professor of Clinical Pharmacy. Reseasrch Center for Rational Use of Drugs, Tehran, University of Medical Sciences. Tehran (Iran).
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Pharmacological blockade of small conductance Ca 2+-activated K + channels by ICA reduces arrhythmic load in rats with acute myocardial infarction. Pflugers Arch 2017; 469:739-750. [PMID: 28285409 DOI: 10.1007/s00424-017-1962-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/07/2017] [Accepted: 02/20/2017] [Indexed: 01/02/2023]
Abstract
Acute myocardial infarction (AMI) with development of ventricular fibrillation (VF) is a common cause of sudden cardiac death (SCD). At present, no pharmacological treatment has successfully been able to prevent VF in the acute stage of AMI. This study investigates the antiarrhythmic effect of inhibiting small conductance Ca2+-activated K+ (SK) channels using the pore blocker N-(pyridin-2-yl)-4-(pyridin-2-yl)thiazol-2-amine (ICA) in AMI rats. Acute coronary ligation was performed in 26 anesthetized rats, and ECG, monophasic action potentials (MAPs), and ventricular effective refractory period (vERP) were recorded. Rats were randomized into four groups: (i) 3 mg/kg i.v. ICA with AMI (AMI-ICA-group, n = 9), (ii) vehicle with AMI (AMI-vehicle-group, n = 9), (iii) vehicle with sham operation (sham-vehicle-group, n = 8), and (iv) 3 mg/kg i.v. ICA with sham operation (sham-ICA-group, n = 6). At the end of experiments, hearts were stained for the non-perfused area at risk (AAR). AMI resulted in the development of ventricular tachycardia (VT) in all AMI-vehicle and AMI-ICA rats; however, ICA significantly decreased VT duration. VF occurred in 44% of AMI-vehicle rats but not in AMI-ICA rats. Monophasic action potential duration at 80% repolarization (MAPD80) in the ischemic area decreased rapidly in both AMI-vehicle and AMI-ICA rats. However, 5 min after occlusion, MAPD80 returned to baseline in AMI-ICA rats but not in AMI-vehicle rats. The vERP was prolonged in the AMI-ICA group compared to AMI-vehicle after ligation. AAR was similar between the AMI-vehicle group and the AMI-ICA group. In rats with AMI, ICA reduces the burden of arrhythmia.
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Haddow GR, Neville M. Anesthetic Implications for Patients With Implantable Cardioverter Defibrillators. Semin Cardiothorac Vasc Anesth 2016. [DOI: 10.1053/scva.2000.8498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Implantable cardioverter defibrillators have become one of the preferred methods for treating many life- threatening ventricular arrhythmias. Many tens of thou sands of these devices have been implanted and this, together with the ease of worldwide travel, has made it more likely that anesthesiologists everywhere may come into contact with these patients either for elective or emergency surgery. These patients present unique anesthetic challenges because of the combination of the device and severe underlying cardiac disease. This article presents an overview of the implantable defibril lator as it affects the anesthesiologist, including device function, device assessment, electromagnetic interfer ence, and perioperative management.
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Affiliation(s)
- Gordon R. Haddow
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
| | - Michael Neville
- Department of Anesthesia, Stanford University School of Medicine, Stanford, CA
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46
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Kim YM, Park KN, Choi SP, Lee BK, Park K, Kim J, Kim JH, Chung SP, Hwang SO. Part 4. Post-cardiac arrest care: 2015 Korean Guidelines for Cardiopulmonary Resuscitation. Clin Exp Emerg Med 2016; 3:S27-S38. [PMID: 27752644 PMCID: PMC5052921 DOI: 10.15441/ceem.16.130] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 03/19/2016] [Accepted: 03/19/2016] [Indexed: 11/23/2022] Open
Affiliation(s)
- Young-Min Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Kyu Nam Park
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Seung Pill Choi
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyungil Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jeongmin Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hoon Kim
- Department of Emergency Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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47
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Wang N, Huo R, Cai B, Lu Y, Ye B, Li X, Li F, Xu H. Activation of Wnt/β-catenin signaling by hydrogen peroxide transcriptionally inhibits NaV1.5 expression. Free Radic Biol Med 2016; 96:34-44. [PMID: 27068063 PMCID: PMC4912406 DOI: 10.1016/j.freeradbiomed.2016.04.003] [Citation(s) in RCA: 24] [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] [Received: 11/19/2015] [Revised: 04/03/2016] [Accepted: 04/07/2016] [Indexed: 10/22/2022]
Abstract
Oxidants and canonical Wnt/β-catenin signaling have been shown to decrease cardiac Na(+) channel activity by suppressing NaV1.5 expression. Our aims are to determine if hydrogen peroxide (H2O2), one oxidant of reactive oxygen species (ROS), activates Wnt/β-catenin signaling and promotes β-catenin nuclear activity, leading to suppression of NaV1.5 expression and if this suppression requires the interaction of β-catenin with its nuclear partner, TCF4 (also called TCF7L2) to decrease SCN5a promoter activity. The results demonstrated that H2O2 increased β-catenin, but not TCF4 nuclear localization determined by immunofluorescence without affecting total β-catenin protein level. Furthermore, H2O2 exerted a dose- and time-dependent suppressive effect on NaV1.5 expression. RT-PCR and/or Western blot analyses revealed that overexpressing active form of β-catenin or stabilizing β-catenin by GSK-3β inhibitors, LiCl and Bio, suppressed NaV1.5 expression in HL-1 cells. In contrast, destabilization of β-catenin by a constitutively active GSK-3β mutant (S9A) upregulated NaV1.5 expression. Whole-cell recording showed that LiCl significantly inhibited Na(+) channel activity in these cells. Using immunoprecipitation (IP), we showed that β-catenin interacted with TCF4 indicating that β-catenin as a co-transfactor, regulates NaV1.5 expression through TCF4. Analyses of the SCN5a promoter sequences among different species by using VISTA tools indicated that SCN5a promoter harbors TCF4 binding sites. Chromatin IP assays demonstrated that both β-catenin and TCF4 were recruited in the SCN5a promoter, and regulated its activity. Luciferase promoter assays exhibited that β-catenin inhibited the SCN5a promoter activity at a dose-dependent manner and this inhibition required TCF4. Small interfering (Si) RNA targeting β-catenin significantly increased SCN5a promoter activity, leading to enhanced NaV1.5 expression. As expected, β-catenin SiRNA prevents H2O2 suppressive effects on both SCN5a promoter activity and NaV1.5 expression. Our findings indicate that H2O2 inhibits NaV1.5 expression by activating the Wnt/β-catenin signaling and β-catenin interacts with TCF4 to transcriptionally suppress cardiac NaV1.5 expression.
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Affiliation(s)
- Ning Wang
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Corresponding author at: Haodong Xu, MD, PhD, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., CHS 13-145E Los Angeles, CA 90095-1732 USA. Tel.: 310-206-3582; fax: 310-267-2658.
| | - Rong Huo
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Corresponding author at: Haodong Xu, MD, PhD, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., CHS 13-145E Los Angeles, CA 90095-1732 USA. Tel.: 310-206-3582; fax: 310-267-2658.
| | - Benzhi Cai
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Corresponding author at: Haodong Xu, MD, PhD, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., CHS 13-145E Los Angeles, CA 90095-1732 USA. Tel.: 310-206-3582; fax: 310-267-2658.
| | - Yan Lu
- Division of Cardiology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Bo Ye
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Xiang Li
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Faqian Li
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Haodong Xu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
- Corresponding author at: Haodong Xu, MD, PhD, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave., CHS 13-145E Los Angeles, CA 90095-1732 USA. Tel.: 310-206-3582; fax: 310-267-2658.
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48
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Out-of-hospital Cardiac Arrest Patient Characteristics: Comparing ventricular arrhythmia and Pulseless Electrical Activity. Heart Lung Circ 2016; 25:639-44. [DOI: 10.1016/j.hlc.2016.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 01/28/2016] [Accepted: 02/02/2016] [Indexed: 11/22/2022]
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49
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Ozner MD, Ahn YS, Horstman LL, Jy W, Kolodny L, Myerberg RJ. Chronic Platelet Activation and Acute Coronary Syndromes in 13 Middle-Aged Patients. Clin Appl Thromb Hemost 2016. [DOI: 10.1177/107602969700300107] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We report on clinical, laboratory, and angiographic findings that appear to characterize a group of 13 middle-aged patients who suffered acute coronary syndromes (ACS) despite little angiographic evidence of atherosclerotic heart disease (ASHD) or other risk factors. Nine of the 13 were ≤46 years of age and the rest ranged to 59 years. All had evidence of platelet disorders (PD): seven had chronic immune thrombocytopenia (ITP), one had familial thrombocytopenia, and five had other disorders affecting platelets. Evidence of long-standing chronic platelet activation was the common feature of the group, as found by (i) elevated platelet microparticles (PMP), (ii) thrombocytopenia, and (iii) enhanced procoagulant activity of plasma. Data on the 7 with ITP were compared to 20 ITP without ACS: the former had higher PMP (p < 0.01) and platelet-associated IgM (p < 0.05) relative to the ITP patient controls. Another set of patient controls consisted of 20 ACS with documented ASHD: although activation indicators were abnormal also in this group relative to normal controls (p < 0.01), the PD group of 13 had more marked abnormalities in all tests (p < 0.03), particularly in PMP and thrombocytopenia (p < 0.01). The seven youngest in the PD group appeared to respond to antiplatelet therapy since no recurrence of coronary ischemia was seen in up to 3 years of observation. It is suggested that chronic platelet activation by antibodies or immune complex may predispose those in the PD group to ACS (e.g., when under stress) despite the absence of ASHD and few other known risk factors. The true incidence of this syndrome is unknown but may be substantial. Key Words: Chronic platelet activation-Platelet microparticles-Platelet.associated IgM-Immune thrombocytopenia-Acute coronary syndromes-Middle age.
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Affiliation(s)
- Michael D. Ozner
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
| | - Yeon S. Ahn
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
| | - Lawrence L. Horstman
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
| | - Wenche Jy
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
| | - Luciano Kolodny
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
| | - Robert J. Myerberg
- The William J. Harrington Center for Blood DiseaseslSylvester Comprehensive Cancer Center, and Division of Cardiology, University of Miami School of Medicine, Miami, Florida, U.S.A
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50
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Tan AY, Ellenbogen K. Ventricular Arrhythmias in Apparently Normal Hearts: Who Needs an Implantable Cardiac Defibrillator? Card Electrophysiol Clin 2016; 8:613-21. [PMID: 27521094 DOI: 10.1016/j.ccep.2016.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Idiopathic ventricular tachycardia is often considered a benign form of ventricular arrhythmia in patients without apparent structural heart disease. However, a subset of patients may develop malignant ventricular arrhythmias and present with syncope and sudden cardiac arrest. Survivors of cardiac arrest are candidates for implantable cardiac defibrillators (ICDs). The indications for ICDs in patients with less than a full-blown cardiac arrest presentation but with electrocardiographically high-risk ectopy features remain uncertain. This article addresses some of the uncertainties and pitfalls in ICD risk stratification in this patient group and explores potential mechanisms for malignant conversion of benign premature ventricular complexes to sustained arrhythmia.
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Affiliation(s)
- Alex Y Tan
- Electrophysiology Section, Division of Cardiology, Hunter Holmes McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA; VCU Pauley Heart Center, Medical College of Virginia, Virginia Commonwealth University School of Medicine, 1250 E Marshall Street, Richmond, VA 23298, USA.
| | - Kenneth Ellenbogen
- VCU Pauley Heart Center, Medical College of Virginia, Virginia Commonwealth University School of Medicine, 1250 E Marshall Street, Richmond, VA 23298, USA
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