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Ayton SL, Yeo JL, Gulsin GS, Brady EM, Arnold JR, Graham-Brown MPM, Singh A, Dey D, McCann GP, Moss AJ. Epicardial adipose tissue volume and density is associated with cardiac dysfunction in asymptomatic people with type 2 diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Type 2 diabetes (T2D) is associated with several perturbations of cardiac structure and function, which are precursors to the development of heart failure. Excess accumulation of epicardial adipose tissue (EAT) may contribute to cardiac dysfunction in individuals with T2D. Lipid-laden adipocytes have a lower computed tomography (CT) attenuation and can be readily identified using cardiac CT. Using a multimodality cardiac imaging approach, we aimed to assess the association of total and low attenuation EAT volume with early markers of cardiac dysfunction in people with T2D.
Methods
Prospective case-control study, in which participants with and without T2D and no known cardiovascular disease, underwent comprehensive cardiovascular phenotyping including multiparametric cardiac magnetic resonance imaging (MRI), echocardiography and non-contrast cardiac CT. EAT volume was measured from CT scans using a deep learning method and volumes indexed to body surface area. Total EAT was defined according to CT adipose tissue attenuation range of −30 to −190 Hounsfield Units (HU) and low attenuation EAT as −90 to −190 HU. Left ventricular (LV) volumes, function and strain measurements were derived from cardiac MRI images and diastolic function also assessed using echocardiography. Markers of early cardiac dysfunction in those with T2D were assessed for associations with EAT in T2D participants using multivariable linear regression analyses.
Results
Two hundred and fifty-four participants were included: demographic, anthropometric and imaging variables are displayed in Table 1. Subjects with T2D had increased LV concentric remodelling (higher LV mass/volume ratio), diastolic dysfunction (lower circumferential peak early diastolic strain rate (PEDSR) and average E/e') and reduced systolic function (global longitudinal strain, GLS) compared with controls. Total and low attenuation indexed EAT volumes were 1.6-fold and 2-fold higher, respectively, in participants with T2D compared to controls (Figure 1). After adjustment for age, gender, ethnicity, insulin resistance, systolic blood pressure and waist/hip ratio, total and low attenuation indexed EAT volume were independently associated with LV mass/volume ratio (total indexed EAT volume: β=0.002, p=0.02, low attenuation indexed EAT volume: β=0.004, p=0.01) and LV GLS (total indexed EAT volume: β=−0.02, p<0.01, low attenuation indexed EAT volume: β=−0.04, p=0.02) in subjects with T2D, but not indices of diastolic dysfunction.
Conclusion
Total and low attenuation EAT volumes are higher in individuals with T2D, and excess EAT accumulation is independently associated with early markers of cardiac dysfunction. Further studies into the underlying mechanisms of this interaction may facilitate the development of interventions targeted at EAT, which could mitigate against the development of heart failure in people with T2D.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): United Kingdom National Institute for Health Research
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Affiliation(s)
- S L Ayton
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - J L Yeo
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - G S Gulsin
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - E M Brady
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - J R Arnold
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - M P M Graham-Brown
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - A Singh
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - D Dey
- Cedars-Sinai Medical Center, Biomedical Imaging Research Institute , Los Angeles , United States of America
| | - G P McCann
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - A J Moss
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
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Yeo JL, Gulsin GS, Dattani A, Brady EM, Bilak JM, Ayton SL, Moss AJ, Pang W, Boulos S, House MJ, St Pierre TG, McCann GP. Association of hepatic steatosis with subclinical cardiac dysfunction in asymptomatic people with type 2 diabetes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Non-alcoholic fatty liver disease is highly prevalent among people with type 2 diabetes (T2D) and is an emerging risk factor for heart failure with preserved ejection fraction (HFpEF). Whether excess liver adiposity is simply a marker of the coexisting adverse cardiometabolic risk profile or independently contributes to the development of HFpEF is unclear.
Purpose
To assess the association between liver fat fraction and subclinical cardiac dysfunction in adults with T2D.
Methods
Prospective cross-sectional study. Two-hundred and thirty-eight adults with T2D (mean age 63±7 years, 62% males, HbA1c 7.2±1.5%, diabetes duration 10±8 years) with no signs, symptoms, or evidence of cardiovascular disease and 40 age-, sex-, and ethnicity-matched non-diabetic controls (mean age 61±8 years, 63% males, HbA1c 5.2±1.2%) underwent comprehensive phenotyping with echocardiography and multiparametric cardiac MRI including adenosine stress and rest perfusion. Volumetric liver fat fraction (VLFF) was measured using a histologically validated, proprietary MRI technique blinded to all participant details. Inter-study reproducibility was assessed in participants (n=28) who underwent a repeat MRI within two weeks. Linear regression analysis was performed to assess any independent associations between VLFF and identified markers of subclinical cardiac dysfunction in subjects with T2D.
Results
People with T2D had evidence of concentric left ventricular (LV) remodelling (higher LV mass/volume), extracellular matrix expansion (higher ECV fraction), both systolic and diastolic dysfunction (lower global longitudinal systolic strain and E/A ratio, respectively), and coronary microvascular dysfunction (lower myocardial perfusion reserve) (Table 1). VLFF demonstrated excellent inter-study reproducibility with an intra-class correlation coefficient (ICC) of 0.988 (0.974–0.994). T2Ds had higher VLFF compared to controls [7.5 (3.8–13.7)% vs 2.9 (1.7–4.7)%, p<0.001]. In multivariable regression analysis adjusting for age, sex, ethnicity, body mass index, ambulatory systolic blood pressure, HbA1c, and low-density lipoprotein, VLFF (β=−0.161, p=0.027) was independently associated with E/A, but not other imaging measures of subclinical cardiac dysfunction.
Conclusion
Liver fat fraction is elevated in people with T2D and is independently associated with early LV diastolic dysfunction. These results add to the growing evidence that ectopic fat plays an important role in the pathogenesis of HFpEF and may be a potential target for intervention.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) United Kingdom through a Research Professorship award (RP-2017-08-ST2-007).British Heart Foundation through a Clinical Research Training Fellowship (FS/16/47/32190).
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Affiliation(s)
- J L Yeo
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - G S Gulsin
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - A Dattani
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - E M Brady
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - J M Bilak
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - S L Ayton
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - A J Moss
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
| | - W Pang
- Resonance Health Ltd., Burswood , Western Australia , Australia
| | - S Boulos
- Resonance Health Ltd., Burswood , Western Australia , Australia
| | - M J House
- University of Western Australia, School of Physics , Perth , Australia
| | - T G St Pierre
- University of Western Australia, School of Physics , Perth , Australia
| | - G P McCann
- University of Leicester and the Leicester NIHR Biomedical Research Centre , Leicester , United Kingdom
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Ayton SL, Alfuhied A, Gulsin GS, Parke KS, Wormleighton JV, Arnold JR, Moss AJ, Singh A, Graham-Brown MPM, McCann GP. Inter-field strength agreement of cardiovascular magnetic resonance cine-derived strain and strain rate measures: a randomised study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) strain and strain rate measurements can be derived from routinely acquired cardiovascular magnetic resonance (CMR) cine images by feature tracking techniques. However, the inter-field strength agreement of strain measurements derived from these techniques is not known. We hypothesised that there would be excellent inter-field strength agreement (between 1.5 and 3 Tesla [T]) for the measurement of global strain and strain rate derived from cine imaging.
Methods
Prospective, randomised cross-over observational study. Healthy volunteers each underwent CMR scans at 1.5T and 3T within 30 minutes on the same day in a randomised order. Retrospectively ECG gated, short and long-axis balanced steady state free precession cine images were obtained using standardised acquisition parameters at both field strengths. Two software packages were used to derive LV global longitudinal, circumferential and long and short axis radial systolic strain, peak systolic, early diastolic and late diastolic strain rates. All strain values are expressed as positive numbers.
Results
Twenty-two subjects (mean age 36±12 years; 45% male) were studied. No differences in heart rate and blood pressure measurements during scanning were observed between field strengths. The abstract figure shows an example of strain analysis and Bland-Altman plots for global longitudinal and circumferential strain. Minimal bias was seen in all strain and strain rate measurements between field strengths using the first software package. Strain and strain rate values derived from long axis images (longitudinal and long axis radial) showed poor to fair agreement (intraclass correlation co-efficient (ICC) range 0.39–0.71), whereas measures derived from short axis images (circumferential and short axis radial) showed good to excellent agreement between field strengths (ICC range 0.78–0.91). Similar results were observed with the second software package, though the differences in agreement between long and short axis derived measures were less pronounced.
Conclusion
Longitudinal strain and strain rate measures derived from CMR feature tracking have poor inter-field strength agreement between 1.5T and 3T. By contrast, agreement of circumferential and short axis radial strain and strain rate measurements at 1.5T and 3T is good. These results need to be considered when assessing strain at different field strengths.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): United Kingdom National Institute for Health Research
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Affiliation(s)
- S L Ayton
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - A Alfuhied
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - G S Gulsin
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - K S Parke
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - J V Wormleighton
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - J R Arnold
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - A J Moss
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - A Singh
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - M P M Graham-Brown
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
| | - G P McCann
- University of Leicester and the NIHR Leicester Biomedical Research Centre , Leicester , United Kingdom
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Griffiths L, Guerdette AM, Guillen Guio B, Gummadi M, Gupta A, Gurram S, Guthrie E, Guy Z, H Henson H, Hadley K, Haggar A, Hainey K, Hairsine B, Haldar P, Hall I, Hall L, Halling-Brown M, Hamil R, Hancock A, Hancock K, Hanley NA, Haq S, Hardwick HE, Hardy E, Hardy T, Hargadon B, Harrington K, Harris E, Harrison P, Harvey A, Harvey M, Harvie M, Haslam L, Havinden-Williams M, Hawkes J, Hawkings N, Haworth J, Hayday A, Haynes M, Hazeldine J, Hazelton T, Heeley C, Heeney JL, Heightman M, Henderson M, Hesselden L, Hewitt M, Highett V, Hillman T, Hiwot T, Hoare A, Hoare M, Hockridge J, Hogarth P, Holbourn A, Holden S, Holdsworth L, Holgate D, Holland M, Holloway L, Holmes K, Holmes M, Holroyd-Hind B, Holt L, Hormis A, Hosseini A, Hotopf M, Howard K, Howell A, Hufton E, Hughes AD, Hughes J, Hughes R, Humphries A, Huneke N, Hurditch E, Husain M, Hussell T, Hutchinson J, Ibrahim W, Ilyas F, Ingham J, Ingram L, Ionita D, Isaacs K, Ismail K, Jackson T, James WY, Jarman C, Jarrold I, Jarvis H, 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Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study. Lancet Respir Med 2022; 10:761-775. [PMID: 35472304 PMCID: PMC9034855 DOI: 10.1016/s2213-2600(22)00127-8] [Citation(s) in RCA: 144] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/23/2022] [Accepted: 03/31/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge. METHODS The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing. FINDINGS 2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters. INTERPRETATION The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials. FUNDING UK Research and Innovation and National Institute for Health Research.
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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Fletcher A, Tzolos E, Joshi S, Kwiecinski J, Bing R, Doris MK, Moss AJ, Van Beek EJ, Joshi N, Adamson P, Whiteley W, Wardlaw J, Slomka P, Newby DE, Dweck MR. 18F-Sodium fluoride positron emission tomography, aortic disease activity and ischaemic stroke risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arterial 18F-sodium fluoride (18F-NaF) activity on positron emission tomography (PET) is a marker of active microcalcification and atherosclerosis. Coronary 18F-NaF activity (CMA) predicts coronary artery disease progression and subsequent myocardial infarction.
Objective
To investigate whether aortic 18F-NaF activity (AMA) predicts thoracic aortic atherosclerotic disease progression and subsequent ischaemic stroke or myocardial infarction in patients with established cardiovascular disease.
Methods
In a post-hoc observational cohort study, we evaluated AMA and CMA in patients with stable coronary artery disease (n=239) or aortic stenosis (n=158) who had underwent thoracic 18F-NaF PET and computed tomography (CT). We assessed the associations between AMA or CMA and progression of calcified atherosclerotic plaque in both thoracic aortic and coronary territories on follow up CT, as well as subsequent ischaemic stroke or myocardial infarction.
Results
In 141 and 231 patients with repeat aortic and coronary CT imaging respectively at 12.7±2.7 months, AMA correlated with log progression of thoracic aortic calcium scores (r=0.21, p=0.011), volume (r=0.29, p<0.01) and mass (r=0.29, P<0.01) as well as log coronary calcium score progression (r=0.21, p=0.03). CMA correlated with log coronary (r=0.42, p<0.01), but not log aortic (p>0.80) calcium score progression. In 397 patients, 16 had an ischaemic stroke and 25 had a myocardial infarction after 4.7±1.6 years. After adjusting for clinical risk factors, CMA and calcium scoring, AMA was associated with stroke (hazard ratio, 1.71 [95% confidence interval 1.00–2.90], p=0.048]). AMA was superior to clinical risk and calcium scores in identifying patients with stroke (c-statistic 0.76 versus 0.58 versus 0.63 respectively, p<0.05). Survival analysis demonstrated that AMA was associated with ischaemic stroke (p<0.001) but not myocardial infarction (p=0.45), whereas CMA was associated with myocardial infarction (p<0.001) but not stroke (p=0.39).
Conclusions
In patients with established cardiovascular disease, AMA is associated with progression of aortic atherosclerosis and future ischaemic stroke. Arterial 18F-NaF identifies localised areas of atherosclerotic disease activity that relate to regional atherothrombotic events.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart Foundation AMA, disease progression and outcomesVariables associated with stroke
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Affiliation(s)
- A Fletcher
- University of Edinburgh, Edinburgh, United Kingdom
| | - E Tzolos
- University of Edinburgh, Edinburgh, United Kingdom
| | - S Joshi
- University of Edinburgh, Edinburgh, United Kingdom
| | - J Kwiecinski
- University of Edinburgh, Edinburgh, United Kingdom
| | - R Bing
- University of Edinburgh, Edinburgh, United Kingdom
| | - M K Doris
- University of Edinburgh, Edinburgh, United Kingdom
| | - A J Moss
- University of Edinburgh, Edinburgh, United Kingdom
| | - E J Van Beek
- Queen's Medical Research Institute, Edinburgh Imaging Facility, Edinburgh, United Kingdom
| | - N Joshi
- Bristol Heart Institute, Bristol, United Kingdom
| | - P Adamson
- University of Otago Christchurch, Christchurch Heart Institute, Christchurch, New Zealand
| | - W Whiteley
- University of Edinburgh, Centre for Clinical Brain Science, Edinburgh, United Kingdom
| | - J Wardlaw
- University of Edinburgh, Centre for Clinical Brain Science, Edinburgh, United Kingdom
| | - P Slomka
- Cedars-Sinai Medical Center, Department of Imaging (Division of Nuclear Cardiology), Los Angeles, United States of America
| | - D E Newby
- University of Edinburgh, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, Edinburgh, United Kingdom
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Doris M, Moss AJ, Andrews JPM, Williams M, Van Beek EJR, Forsyth L, Dweck MR, Newby DE, Adamson PD. 172Coronary 18F-sodium fluoride uptake predicts progression of coronary arterial calcification. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Combined positron emission tomography and computed tomography (PET-CT) using 18F-sodium fluoride (18F-NaF) to detect microcalcification provides the opportunity to gain important insights into disease activity in coronary atherosclerosis. However, the relationship between 18F-NaF uptake and progression of coronary calcification has not been determined.
Purpose
To determine the relationship between 18F-NaF uptake and progression of coronary calcification in patients with clinically stable coronary artery disease (CAD).
Methods
Patients with established, multivessel CAD underwent 18F-NaF PET-CT and CT coronary calcium scoring at baseline, with repeat CT calcium scoring at one year. Coronary arterial PET uptake was analysed qualitatively and semi-quantitatively in diseased vessels by measuring maximum tissue-to-background ratio (TBRmax) – defined as the maximum standardised uptake value in a plaque divided by mean blood pool activity measured in the right atrium. Coronary calcification was quantified by measuring calcium mass, volume, average calcium density and total Agatston score (AU).
Results
In total, 185 patients underwent baseline and repeat imaging (median age 66 years, 80% men), and 118 (64%) had increased 18F-NaF uptake in at least one vessel. Median total calcium score, volume, mass and average density were higher in patients with compared to those without increased 18F-NaF uptake (Table 1). At one year, patients with evidence of increased 18F-NaF uptake demonstrated more rapid progression of coronary calcification (97 [39–166] AU) versus those without uptake (35 [7–93] AU; p<0.0001). Amongst 18F-NaF-positive patients, the calcium score increased only in coronary segments with 18F-NaF uptake (baseline 90.5 [27.5–202] AU versus one year 135.5 [59.3–281.8] AU; p<0.0001) and not in 18F-NaF-negative segments (baseline 44.5 [16–110.5] AU versus one year 46.5 [18.25–114] AU; p=0.446). There was a moderate correlation between TBRmax and change in total calcium score, volume and mass at 1 year (Spearman's Rho = 0.37, 0.38, 0.46 respectively; p<0.0001 for all).
Coronary calcification at baseline in PET-negative and PET-positive patients All patients (n=185) 18F-NaF Positive (n=118) 18F-NaF Negative (n=67) P value Agatston Score (AU) 381 [107–892] 541 [245–1130] 136 [55–361] p<0.0001 Calcium Volume (mm3) 358 [131–787] 506 [251–1014] 131 [64–343] p<0.0001 Calcium Mass (mg) 71 [23–155] 100 [48–222] 24 [11–69] p<0.0001 Average Density (mg/mm3) 0.19 [0.17–0.22] 0.20 [0.18–0.23] 0.18 [0.16–0.20] p<0.0001
Conclusions
Coronary 18F-NaF uptake identifies both patients and individual coronary segments with greater disease and more rapid progression of coronary calcification over one year.
Acknowledgement/Funding
AstraZeneca (unrestricted educational grant). British Heart Foundation (CH/09/002, RE/13/3/30183, FS/17/79/33226) Wellcome Trust (WT103782AIA).
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Affiliation(s)
- M Doris
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A J Moss
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J P M Andrews
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M Williams
- University of Edinburgh, Edinburgh Imaging, Queen's Medical Research Institute., Edinburgh, United Kingdom
| | - E J R Van Beek
- University of Edinburgh, Edinburgh Imaging, Queen's Medical Research Institute., Edinburgh, United Kingdom
| | - L Forsyth
- University of Edinburgh, Edinburgh Clinical Trials Unit, Edinburgh, United Kingdom
| | - M R Dweck
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- University of Edinburgh, British Heart Foundation Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- University of Otago Christchurch, Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
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Moss AJ, Dweck MR, Doris MK, Andrews JPM, Daghem M, Shah ASV, Mills NL, Newby DE, Adamson PD. 244dual antiplatelet therapy to inhibit myocardial injury in patients with high-risk coronary artery plaque: a randomised controlled trial. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez145.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A J Moss
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M R Dweck
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M K Doris
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - J P M Andrews
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - M Daghem
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - A S V Shah
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - N L Mills
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - D E Newby
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - P D Adamson
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom of Great Britain & Northern Ireland
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Quesada Ocete B, Quesada Dorador A, Klein HU, McNitt S, Jimenez-Bello J, Quesada Ocete FJ, Zareba W, Solomon SD, Goldenberg I, Moss AJ, Kutyifa V. P1951Effects of biventricular pacing on ventricular arrhythmia risk in asymptomatic heart failure patients with ischemic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- B Quesada Ocete
- University Medical Center of Mainz, Department of Cardiology, Mainz, Germany
| | - A Quesada Dorador
- University General Hospital of Valencia, Cardiology, Valencia, Spain
| | - H U Klein
- University of Rochester Medical Center, Rochester, United States of America
| | - S McNitt
- University of Rochester Medical Center, Rochester, United States of America
| | - J Jimenez-Bello
- University General Hospital of Valencia, Cardiology, Valencia, Spain
| | - F J Quesada Ocete
- University General Hospital of Valencia, Cardiology, Valencia, Spain
| | - W Zareba
- University of Rochester Medical Center, Rochester, United States of America
| | - S D Solomon
- Brigham and Women's Hospital, Boston, United States of America
| | | | - A J Moss
- University of Rochester Medical Center, Rochester, United States of America
| | - V Kutyifa
- University of Rochester Medical Center, Rochester, United States of America
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Moss AJ, Adamson PD, Doris MK, Andrews JPM, Sim A, Dweck MR, Newby DE. 6177Precision imaging of coronary atherosclerotic microcalcification using 18F-Fluoride. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A J Moss
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M K Doris
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - J P M Andrews
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A Sim
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M R Dweck
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - D E Newby
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Moss AJ, Zuling ET, Adamson PD, Freestone MR, Shah AV, Cruden NL. P4607Left ventricular thrombus in patients after primary percutaneous coronary intervention for ST-elevation myocardial infarction: incidence and 12-month clinical outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- A J Moss
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - E T Zuling
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - P D Adamson
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M R Freestone
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - A V Shah
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - N L Cruden
- Royal Infirmary of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Nagy KV, Merkely B, Geller L, Kosztin A, McNitt S, Polonsky S, Goldenberg I, Zareba W, Moss AJ, Kutyifa V. P1943Quality of life predicting long-term outcomes in cardiac resynchronization therapy patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K V Nagy
- Semmelweis University, Heart Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - A Kosztin
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - S McNitt
- University of Rochester, Medical Center, Rochester, United States of America
| | - S Polonsky
- University of Rochester, Medical Center, Rochester, United States of America
| | - I Goldenberg
- University of Rochester, Medical Center, Rochester, United States of America
| | - W Zareba
- University of Rochester, Medical Center, Rochester, United States of America
| | - A J Moss
- University of Rochester, Medical Center, Rochester, United States of America
| | - V Kutyifa
- University of Rochester, Medical Center, Rochester, United States of America
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13
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Ballantyne C, Cushman M, Psaty B, Furberg C, Khaw KT, Sandhu M, Oldgren J, Rossi GP, Maiolino G, Cesari M, Lenzini L, James SK, Rimm E, Collins R, Anderson J, Koenig W, Brenner H, Rothenbacher D, Berglund G, Persson M, Berger P, Brilakis E, McConnell JP, Koenig W, Sacco R, Elkind M, Talmud P, Rimm E, Cannon CP, Packard C, Barrett-Connor E, Hofman A, Kardys I, Witteman JCM, Criqui M, Corsetti JP, Rainwater DL, Moss AJ, Robins S, Bloomfield H, Collins D, Packard C, Wassertheil-Smoller S, Ridker P, Ballantyne C, Cannon CP, Cushman M, Danesh J, Gu D, Hofman A, Nelson JJ, Thompson S, Zalewski A, Zariffa N, Di Angelantonio E, Kaptoge S, Thompson A, Thompson S, Walker M, Watson S, Wood A. Collaborative meta-analysis of individual participant data from observational studies of Lp-PLA2 and cardiovascular diseases. ACTA ACUST UNITED AC 2016; 14:3-11. [PMID: 17301621 DOI: 10.1097/01.hjr.0000239464.18509.f1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large number of observational epidemiological studies have reported generally positive associations between circulating mass and activity levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) and the risk of cardiovascular diseases. Few studies have been large enough to provide reliable estimates in different circumstances, such as in different subgroups (e.g., by age group, sex, or smoking status) or at different Lp-PLA2 levels. Moreover, most published studies have related disease risk only to baseline values of Lp-PLA2 markers (which can lead to substantial underestimation of any risk relationships because of within-person variability over time) and have used different approaches to adjustment for possible confounding factors. OBJECTIVES By combination of data from individual participants from all relevant observational studies in a systematic 'meta-analysis', with correction for regression dilution (using available data on serial measurements of Lp-PLA2), the Lp-PLA2 Studies Collaboration will aim to characterize more precisely than has previously been possible the strength and shape of the age and sex-specific associations of plasma Lp-PLA2 with coronary heart disease (and, where data are sufficient, with other vascular diseases, such as ischaemic stroke). It will also help to determine to what extent such associations are independent of possible confounding factors and to explore potential sources of heterogeneity among studies, such as those related to assay methods and study design. It is anticipated that the present collaboration will serve as a framework to investigate related questions on Lp-PLA2 and cardiovascular outcomes. METHODS A central database is being established containing data on circulating Lp-PLA2 values, sex and other potential confounding factors, age at baseline Lp-PLA2 measurement, age at event or at last follow-up, major vascular morbidity and cause-specific mortality. Information about any repeat measurements of Lp-PLA2 and potential confounding factors has been sought to allow adjustment for possible confounding and correction for regression dilution. The analyses will involve age-specific regression models. Synthesis of the available observational studies of Lp-PLA2 will yield information on a total of about 15 000 cardiovascular disease endpoints.
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Sood N, Ruwald ACH, Solomon S, Daubert JP, McNitt S, Polonsky B, Jons C, Clyne CA, Zareba W, Moss AJ. Association between myocardial substrate, implantable cardioverter defibrillator shocks and mortality in MADIT-CRT. Eur Heart J 2013; 35:106-15. [DOI: 10.1093/eurheartj/eht451] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Herscovici R, Moss AJ, Kutyifa V, Barsheshet A, Mcnitt S, Zareba W, Goldenberg I. Risk factors and clinical implications of the development of ischemic events in patients who receive cardiac resynchronization therapy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Huth Ruwald AC, Zareba W, Jons C, Ruwald MH, Mcnitt S, Polonsky S, Bloch Thomsen PE, Moss AJ. Statin therapy reduces inappropriate shock in non-ischemic patients with mild heart failure: a MADIT-CRT sub study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Huth Ruwald AC, Daubert J, Kutyifa V, Stockburger M, Mcnitt S, Ruwald MH, Jons C, Bloch Thomsen PE, Zareba W, Moss AJ. Appropriate ICD therapy for slow-rate VT predicts increased risk of appropriate therapy for high-rate VT/VF in the MADIT-RIT trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Huth Ruwald AC, Daubert JP, Schuger C, Olshansky B, Ruwald MH, Kutifya V, Jons C, Bloch Thomsen PE, Zareba W, Moss AJ. Mode of death and factors associated with cardiac and non-cardiac death in the MADIT-RIT trial. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Herscovici R, Moss AJ, Kutyifa V, Barsheshet A, Mcnitt S, Zareba W, Goldenberg I. Benefit of cardiac resynchronization therapy in patients without a history of advanced heart failure symptoms enrolled in MADIT-CRT. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oakes D, Moss AJ, Fleiss JL, Bigger JT, Therneau T, Eberly SW, McDermott MP, Manatunga A, Carleen E, Benhorin J, The Multicenter Diltiazem Post-Infa. Use of Compliance Measures in an Analysis of the Effect of Diltiazem on Mortality and Reinfarction After Myocardial Infarction. J Am Stat Assoc 2012. [DOI: 10.1080/01621459.1993.10594287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- D. Oakes
- a Department of Statistics and Professor of Statistics/Biostatistics , University of Rochester , NY , 14627
| | | | - J. L. Fleiss
- c Division of Biostatistics , Columbia University School of Public Health , New York , NY , 10032
| | | | | | - S. W. Eberly
- f Department of Biostatistics , University of Rochester , NY , 14642
| | - M. P. McDermott
- g Department of Biostatistics/Statistics , University of Rochester , NY , 14642
| | - A. Manatunga
- h Department of Biostatistics & Medicine , Indiana School of Medicine , Indianapolis , IN , 46202
| | - E. Carleen
- i Carter Wallace, Inc. , Princeton , NJ , 08540
| | - J. Benhorin
- j Cardiology Department , Bikur-Cholim Hospital and The Hebrew University , Jerusalem , Israel
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Abstract
The familial long-QT syndrome (LQTS) is an infrequently occurring disorder in which affected family members have QT prolongation on the ECG, often associated with recurrent syncope and fatal ventricular arrhythmias. Autosomal recessive and autosomal dominant modes of inheritance were suggested by the pattern of occurrence of this disorder in the first reported LQTS families. Statistical genetic analysis (segregation analysis) has substantiated a major gene effect on QTc length in two large pedigrees. Gene linkage studies have uncovered tight linkage between a DNA marker at the Harvey ras-1 locus on chromosome 11 and LQTS in one large pedigree, substantiating a genetic basis of this disorder.
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Affiliation(s)
- A J Moss
- Department of Medicine and the Heart Research Follow-up Program of the Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA
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Pouleur AC, Knappe D, Shah AM, Uno H, Bourgoun M, Foster E, McNitt S, Hall WJ, Zareba W, Goldenberg I, Moss AJ, Pfeffer MA, Solomon SD. Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with cardiac resynchronization therapy: the MADIT-CRT trial. Eur Heart J 2011; 32:1720-9. [DOI: 10.1093/eurheartj/ehr185] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Groh WJ, Moss AJ, Logigian EL, Moxley RT. Mexiletine is an effective antimyotonia treatment in myotonic dystrophy type 1. Neurology 2011; 76:409; author reply 409. [DOI: 10.1212/wnl.0b013e3181fe72d7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Barsheshet A, Goldenberg I, Moss AJ, Eldar M, Huang DT, McNitt S, Klein HU, Hall WJ, Brown MW, Goldberger JJ, Goldstein RE, Schuger C, Zareba W, Daubert JP. Response to preventive cardiac resynchronization therapy in patients with ischaemic and nonischaemic cardiomyopathy in MADIT-CRT. Eur Heart J 2010; 32:1622-30. [DOI: 10.1093/eurheartj/ehq407] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Moss AJ, Kang M, Brindle NP. Rational design and protein engineering of novel ligands to suppress vascular inflammation. Br J Surg 2009. [DOI: 10.1002/bjs.6494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A J Moss
- Department of Cardiovascular Sciences, University of Leicester, Leicester
| | - M Kang
- Department of Cardiovascular Sciences, University of Leicester, Leicester
| | - N P Brindle
- Department of Cardiovascular Sciences, University of Leicester, Leicester
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Abstract
The congenital long QT syndrome is a rare disease in which inherited mutations of genes coding for ion channel subunits, or channel interacting proteins, delay repolarization of the human ventricle and predispose mutation carriers to the risk of serious or fatal arrhythmias. Though a rare disorder, the long QT syndrome has provided invaluable insight from studies that have bridged clinical and pre-clinical (basic science) medicine. In this brief review, we summarize some of the key clinical and genetic characteristics of this disease and highlight novel findings about ion channel structure, function, and the causal relationship between channel dysfunction and human disease, that have come from investigations of this disorder.
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Affiliation(s)
- R S Kass
- Department of Pharmacology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA.
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Kaba NK, Francis CW, Moss AJ, Zareba W, Oakes D, Knox KL, Fernández ID, Rainwater DL. Effects of lipids and lipid-lowering therapy on hemostatic factors in patients with myocardial infarction. J Thromb Haemost 2004; 2:718-25. [PMID: 15099276 DOI: 10.1111/j.1538-7836.2004.00658.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The risk of cardiovascular disease (CVD) is associated with specific hemostatic markers and lipid profiles, and evidence indicates that there are associations between lipid profiles and the levels of certain hemostatic factors. The disturbances in hemostasis and the risk of CVD can be ameliorated by lipid-lowering therapy. OBJECTIVE We investigated the associations of lipid profiles with factor (F)VIIa, von Willebrand factor (VWF), D-dimer and plasminogen activator inhibitor-1 (PAI-1), and examined whether lipid-lowering statin therapy would affect the levels of these hemostatic markers. PATIENTS AND METHODS This cross-sectional study analyzed 1045 postmyocardial infarction patients. RESULTS In multivariate regression analyses (without adjusting for clinical covariates) HDL-cholesterol (HDL-C) and HDL size were independent and significant predictors of FVIIa; HDL size was a predictor of VWF; HDL size, HDL-C and LDL size were predictors of D-dimer; and triglyceride and HDL size were predictors of PAI-1. After adjusting for clinical covariates, HDL-C, lipoprotein (Lp)(a), apolipoprotein B (apoB) and warfarin were independent and significant predictors of FVIIa; HDL size, age, diabetes mellitus, insulin, race and warfarin were predictors of VWF; HDL-C, HDL size, LDL size, age, warfarin, hypertension and gender were predictors of D-dimer; and triglyceride, HDL size, body mass index, insulin and hypertension were predictors of PAI-1. Patients on statin therapy had significantly lower levels of D-dimer than those who were not on this therapy. CONCLUSION There are significant associations of lipid profiles with hemostatic factors, the directions of which suggest novel pathways by which dyslipidemia may contribute to coronary heart disease.
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Affiliation(s)
- N K Kaba
- University of Rochester School of Medicine & Dentistry, Rochester, NY, USA
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Abstract
The long QT syndrome (LQTS) is a congenital disorder characterized by a prolongation of the QT interval on electrocardiogram and a propensity to ventricular tachyarrhythmias, which may lead to cardiac events defined as syncope, cardiac arrest, or sudden death. Children are very frequently affected by LQTS accounting for about 50% of probands and 40% to 50% affected family members enrolled in the International LQTS Registry. LQTS probands stratified by age 0 to 5 years, 6 to 10 years, and 11 to 15 years showed that QTc is longer in the youngest group only when using Bazett's heart rate correction. However, when using Rautaharju's or Karjalainen's corrections, which adjust better for higher heart rate than Bazett's correction does, this difference is no longer present. Gender influences the risk of cardiac events in LQTS children with boys having significantly higher risk than girls by age 15 years, despite similar magnitude of QT prolongation. Genotype also influences clinical course of LQTS with LQT1 and LQT2 carriers having higher risk than LQT3 carriers. The risk varies by age among 3 genetic types of LQTS: LQT1 carriers are at higher risk of cardiac events between age 5 to 15 years than below age of 5 years, LQT2 carriers have the highest risk of cardiac events at age 10 to 15, and LQT3 carriers have infrequent cardiac events below age of 10 years. This pattern is observed in both boy and girl LQTS children. In conclusion, there is substantial age, gender, and genotype effect on the clinical course of LQTS children indicating the need of adjusting for those factors in clinical practice.
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Affiliation(s)
- W Zareba
- Department of Medicine, Heart Research, Cardiology Unit, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
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Zareba W, Sattari MN, Rosero S, Couderc JP, Moss AJ. Altered atrial, atrioventricular, and ventricular conduction in patients with the long QT syndrome caused by the DeltaKPQ SCN5A sodium channel gene mutation. Am J Cardiol 2001; 88:1311-4. [PMID: 11728364 DOI: 10.1016/s0002-9149(01)02097-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- W Zareba
- Cardiology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
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Abstract
Increasing evidence implicates inflammation as a risk factor for coronary artery disease. We determined whether an elevated leukocyte count is associated with an increased risk of death or reinfarction in stable patients with a past acute myocardial infarction (AMI). The current analysis is a substudy of the Multicenter Diltiazem Postinfarction Trial, which investigated the effect of diltiazem on mortality and reinfarction in 2,466 patients hospitalized for AMI. We included 1,294 patients in whom a leukocyte count was obtained 6 months after the index AMI. The composite end point of reinfarction or death was used as the primary end point of the study and reinfarction or cardiac death was used as a secondary end point. The study population was divided into 4 quartiles (Q1, Q2, Q3, and Q4) based on the leukocyte count. During a mean follow-up period of 25 months, 163 patients reached the primary end point: 8.7%, 10.9%, 14.0%, and 16.7%, in Q1, Q2, Q3, and, Q4 respectively (p = 0.01). After adjusting for potential covariates, Cox proportional-hazards analysis revealed that an increased leukocyte count was associated with an increased risk of both the primary end point (hazard ratio/1 quartile increase in leukocyte count, 1.26; p = 0.003; 95% confidence interval 1.08 to 1.47) and secondary end point (hazard ratio, 1.18/1-quartile increase; p = 0.05; 95% confidence interval 1.00 to 1.40). In conclusion, an increased leukocyte count measured in the stable post-AMI period is associated with an increased risk of cardiac events. These findings indicate that the leukocyte count may be another marker of an atherosclerotic inflammatory process that contributes to cardiac events in postinfarction patients.
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Affiliation(s)
- R Hajj-Ali
- North Shore University Hospital, Cardiology Division and the Heart Research Follow-Up Program, Cardiology Unit, University of Rochester Medical Center, Rochester, New York 14642, USA
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Moss AJ, Zareba W, Benhorin J, Couderc JP, Kennedy H, Locati-Heilbron E, Maison-Blanche P. ISHNE guidelines for electrocardiographic evaluation of drug-related QT prolongation and other alterations in ventricular repolarization: task force summary. A report of the Task Force of the International Society for Holter and Noninvasive Electrocardiology (ISHNE), Committee on Ventricular Repolarization. Ann Noninvasive Electrocardiol 2001; 6:333-41. [PMID: 11686915 PMCID: PMC7027691 DOI: 10.1111/j.1542-474x.2001.tb00127.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- A J Moss
- Heart Research Follow-up Program, Box 653, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Zareba W, Pancio G, Moss AJ, Kalaria VG, Marder VJ, Weiss HJ, Watelet LF, Sparks CE. Increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients. THROMBO Investigators. Thromb Haemost 2001; 86:791-9. [PMID: 11583309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Diabetes is an established risk factor for reinfarction and cardiac death in postinfarction patients. Since the underlying mechanism of diabetes-related risk is not fully understood we aimed to evaluate the association between lipids, thrombogenic factors and diabetes in postinfarction patients. The study population consisted of 1,045 postinfarction patients (846 non-diabetic, 125 non-insulin- and 74 insulin-requiring diabetics) with the following blood tests performed 2 months after an index myocardial infarction: lipoprotein (a), apolipoprotein-B, apolipoprotein-A, cholesterol, HDL cholesterol, triglycerides, insulin, von Willebrand factor (vWF), fibrinogen, factor VII, D-dimer, and plasminogen activator inhibitor (PAI-1). After adjustment for relevant clinical covariates, non-insulin-requiring diabetes was significantly (p < 0.05) associated with elevated levels of (odd ratios per 1 log unit increase in parenthesis) vWF (1.74) and PAI-1 (1.42) whereas insulin requiring diabetes was associated with even more elevated levels of vWF (4.68), but not with increased levels of PAI-1. No significant differences in lipid levels were observed among three groups. In conclusion, increased level of von Willebrand factor is significantly and independently associated with diabetes in postinfarction patients, suggesting that endothelial damage is the primary mechanisms contributing to an increased occurrence of vascular and cardiac events in diabetic postinfarction patients.
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Affiliation(s)
- W Zareba
- Department of Medicine, University of Rochester Medical Center, NY 14642, USA.
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Abstract
Although improved patient survival has been reported in several randomized trials with the implanted cardioverter-defibrillator, <15% of patients treated with defibrillators during trials receive life-saving benefit from this therapy. We evaluated the survival benefit from defibrillator therapy in relation to the severity of the mortality risk in patients with coronary heart disease. Using data from the Multicenter Automatic Defibrillator Implantation Trial, we partitioned the study population into high- and low-risk subsets for each of 3 physiologically meaningful risk factors (ejection fraction, QRS duration, and history of heart failure requiring therapy). Risk of death was evaluated by Cox proportional-hazards regression analyses in patients with single and multiple risk factors. The defibrillator was associated with a significant (p = 0.002) reduction in mortality only in high-risk subsets with ejection fraction <0.26, QRS duration > or =0.12 second, and history of heart failure requiring treatment. The Cox hazard ratio for the risk of death progressively increased >1.0 as a function of the number of risk factors present. Defibrillator therapy was associated with a progressive reduction in the hazard ratio <1.0 (improved survival) at each increased level of mortality risk. Patients at the highest mortality risk (all 3 risk factors; hazard ratio 4.33) achieved the largest mortality reduction (hazard ratio 0.20) from defibrillator therapy. In patients with chronic coronary heart disease, the magnitude of the survival benefit from the implanted defibrillator is directly related to the severity of cardiac dysfunction and its associated mortality risk.
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Affiliation(s)
- A J Moss
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York, USA.
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Kimbrough J, Moss AJ, Zareba W, Robinson JL, Hall WJ, Benhorin J, Locati EH, Medina A, Napolitano C, Priori S, Schwartz PJ, Timothy K, Towbin JA, Vincent GM, Zhang L. Clinical implications for affected parents and siblings of probands with long-QT syndrome. Circulation 2001; 104:557-62. [PMID: 11479253 DOI: 10.1161/hc3001.093501] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Whenever a proband is identified with long-QT syndrome (LQTS), his or her parents and siblings should be evaluated regarding the possibility of carrying the disorder. In the majority of cases, one of the proband's parents and one or more siblings are affected. The aim of this study was (1) to determine whether the clinical severity of LQTS in the proband is useful in identifying first-degree family members at high risk for cardiac events, and (2) to evaluate the clinical course of affected parents and siblings of LQTS probands. METHODS AND RESULTS The clinical and ECG characteristics of 211 LQTS probands and 791 first-degree relatives (422 parents and 369 siblings) were studied to determine if the clinical profile of the proband is useful in determining the clinical severity of LQTS in affected parents and siblings. Affected female parents of an LQTS proband had a greater cumulative risk for a first cardiac event than affected male parents. The probability of a parent or sibling having a first cardiac event was not significantly influenced by the severity of the proband's clinical symptoms. Female sex and QT(c) duration were risk factors for cardiac events among affected parents, and QT(c) was the only risk factor for cardiac events in affected siblings. CONCLUSIONS The severity profile of LQTS in a proband was not found to be useful in identifying the clinical severity of LQTS in affected first-degree relatives of the proband.
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Affiliation(s)
- J Kimbrough
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Vulapalli R, Liang C, Zareba W, Moss AJ. Recurrent coronary events are not increased in postinfarction patients with methylenetetrahydrofolate reductase gene C677T polymorphism. Am J Cardiol 2001; 87:1289-92. [PMID: 11377358 DOI: 10.1016/s0002-9149(01)01523-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- R Vulapalli
- Cardiology Unit, Department of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA
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Perkiömäki JS, Zareba W, Kalaria VG, Couderc J, Huikuri HV, Moss AJ. Comparability of nonlinear measures of heart rate variability between long- and short-term electrocardiographic recordings. Am J Cardiol 2001; 87:905-8. [PMID: 11274951 DOI: 10.1016/s0002-9149(00)01537-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J S Perkiömäki
- Cardiology Unit, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.
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Windle JR, Geletka RC, Moss AJ, Zareba W, Atkins DL. Normalization of ventricular repolarization with flecainide in long QT syndrome patients with SCN5A:DeltaKPQ mutation. Ann Noninvasive Electrocardiol 2001; 6:153-8. [PMID: 11333173 PMCID: PMC7027642 DOI: 10.1111/j.1542-474x.2001.tb00100.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Long QT Syndrome (LQTS) is a genetic channelopathy with life-threatening implications. The LQT3 form of this disease is caused by mutations of the SCN5A sodium-channel gene. A specific mutation, SCN5A:DeltaKPQ, is associated with repetitive reopenings of the sodium channel and prolonged inward current. This dominant inward current is manifest on the electrocardiogram as QT prolongation. Flecainide is a potent blocker of the open sodium channel. METHODS AND RESULTS The effect of flecainide on the duration of the QT-interval and the T-wave morphology was systematically evaluated in five male patients age 2-64 years having the SCN5A:DeltaKPQ mutation. After baseline electrocardiograms were obtained, low-dose oral flecainide was administered for 48 hours. Serial electrocardiograms and blood flecainide levels were obtained during flecainide therapy. The QTc interval decreased on average by 104 ms, from a baseline value of 565 +/- 60 ms to 461 +/- 23 ms (P < 0.04) at a mean flecainide level of 0.28 +/- 0.08 mg/L, with shortening of the QTonset interval (P < 0.003) and normalization of T-wave morphology. The effects of flecainide were compared with oral mexiletine in two patients, with flecainide showing greater QTc shortening and more complete normalization of repolarization. No adverse side effects or proarrhythmia were observed with flecainide in this study. CONCLUSION Low-dose, oral flecainide consistently shortened the QTc interval and normalized the repolarization T-wave pattern in five LQT3 patients with SCN5A:DeltaKPQ mutation. This preliminary study indicates that low-dose flecainide is a promising therapeutic agent for LQTS patients with the SCN5A:DeltaKPQ sodium channel mutation.
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Affiliation(s)
- J R Windle
- University of Nebraska Medical Center, Omaha, Nebraska, USA.
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Schwartz PJ, Priori SG, Spazzolini C, Moss AJ, Vincent GM, Napolitano C, Denjoy I, Guicheney P, Breithardt G, Keating MT, Towbin JA, Beggs AH, Brink P, Wilde AA, Toivonen L, Zareba W, Robinson JL, Timothy KW, Corfield V, Wattanasirichaigoon D, Corbett C, Haverkamp W, Schulze-Bahr E, Lehmann MH, Schwartz K, Coumel P, Bloise R. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation 2001; 103:89-95. [PMID: 11136691 DOI: 10.1161/01.cir.103.1.89] [Citation(s) in RCA: 1120] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The congenital long-QT syndrome (LQTS) is caused by mutations on several genes, all of which encode cardiac ion channels. The progressive understanding of the electrophysiological consequences of these mutations opens unforeseen possibilities for genotype-phenotype correlation studies. Preliminary observations suggested that the conditions ("triggers") associated with cardiac events may in large part be gene specific. METHODS AND RESULTS We identified 670 LQTS patients of known genotype (LQT1, n=371; LQT2, n=234; LQT3, n=65) who had symptoms (syncope, cardiac arrest, sudden death) and examined whether 3 specific triggers (exercise, emotion, and sleep/rest without arousal) differed according to genotype. LQT1 patients experienced the majority of their events (62%) during exercise, and only 3% occurred during rest/sleep. These percentages were almost reversed among LQT2 and LQT3 patients, who were less likely to have events during exercise (13%) and more likely to have events during rest/sleep (29% and 39%). Lethal and nonlethal events followed the same pattern. Corrected QT interval did not differ among LQT1, LQT2, and LQT3 patients (498, 497, and 506 ms, respectively). The percent of patients who were free of recurrence with ss-blocker therapy was higher and the death rate was lower among LQT1 patients (81% and 4%, respectively) than among LQT2 (59% and 4%, respectively) and LQT3 (50% and 17%, respectively) patients. CONCLUSIONS Life-threatening arrhythmias in LQTS patients tend to occur under specific circumstances in a gene-specific manner. These data allow new insights into the mechanisms that relate the electrophysiological consequences of mutations on specific genes to clinical manifestations and offer the possibility of complementing traditional therapy with gene-specific approaches.
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Affiliation(s)
- P J Schwartz
- Department of Cardiology, Policlinico S. Matteo IRCCS and University of Pavia, Pavia, Italy.
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Zhang L, Timothy KW, Vincent GM, Lehmann MH, Fox J, Giuli LC, Shen J, Splawski I, Priori SG, Compton SJ, Yanowitz F, Benhorin J, Moss AJ, Schwartz PJ, Robinson JL, Wang Q, Zareba W, Keating MT, Towbin JA, Napolitano C, Medina A. Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome: ECG findings identify genotypes. Circulation 2000; 102:2849-55. [PMID: 11104743 DOI: 10.1161/01.cir.102.23.2849] [Citation(s) in RCA: 260] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenital long-QT syndrome (LQTS) is caused by mutations of genes encoding the slow component of the delayed rectifier current (LQT1, LQT5), the rapid component of the delayed rectifier current (LQT2, LQT6), or the Na(+) current (LQT3), resulting in ST-T-wave abnormalities on the ECG. This study evaluated the spectrum of ST-T-wave patterns and repolarization parameters by genotype and determined whether genotype could be identified by ECG. METHODS AND RESULTS ECGs of 284 gene carriers were studied to determine ST-T-wave patterns, and repolarization parameters were quantified. Genotypes were identified by individual ECG versus family-grouped ECG analysis in separate studies using ECGs of 146 gene carriers from 29 families and 233 members of 127 families undergoing molecular genotyping, respectively. Ten typical ST-T patterns (4 LQT1, 4 LQT2, and 2 LQT3) were present in 88% of LQT1 and LQT2 carriers and in 65% of LQT3 carriers. Repolarization parameters also differed by genotype. A combination of quantified repolarization parameters identified genotype with sensitivity/specificity of 85%/70% for LQT1, 83%/94% for LQT2, and 47%/63% for LQT3. Typical patterns in family-grouped ECGs best identified the genotype, being correct in 56 of 56 (21 LQT1, 33 LQT2, and 2 LQT3) families with mutation results. CONCLUSIONS Typical ST-T-wave patterns are present in the majority of genotyped LQTS patients and can be used to identify LQT1, LQT2, and possibly LQT3 genotypes. Family-grouped ECG analysis improves genotype identification accuracy. This approach can simplify genetic screening by targeting the gene for initial study. The multiple ST-T patterns in each genotype raise questions regarding the pathophysiology and regulation of repolarization in LQTS.
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Affiliation(s)
- L Zhang
- LDS Hospital, Salt Lake City, Utah 84103, USA
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Abstract
Carriership analysis is a statistical approach for detecting the average increase in risk (hazard ratio) for adverse time-dependent events per number of prespecified phenotypic or genotypic risk factors carried by subjects in limited-sized populations. This carriership approach was applied to phenotypic risk factor analysis in a postinfarction population, and simulated genetic modeling was performed to show how carriership analysis could be used to identify a group of oligogenic factors in common polygenic disorders.
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Affiliation(s)
- L F Watelet
- Department of Biostatistics, University of Rochester Medical Center, New York 14642, USA
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Fisher SD, Zareba W, Moss AJ, Marder VJ, Sparks CE, Hochman J, Liang C, Krone RJ. Effect of smoking on lipid and thrombogenic factors two months after acute myocardial infarction. Am J Cardiol 2000; 86:813-8. [PMID: 11024393 DOI: 10.1016/s0002-9149(00)01098-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Cigarette smoking is linked to increased cardiac morbidity and mortality, and has been shown to affect both lipid profiles and thrombotic factors in healthy subjects. However, the influence of smoking on the atherothrombotic environment has not been studied in a large population of patients after acute myocardial infarction (AMI). Blood samples and medical history, including smoking status, were obtained from 1,045 patients at a 2-month visit after AMI. Smokers were asked to refrain 24 hours before the visit, but not all complied. Measurements included total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, apolipoprotein-B, apolipoprotein-A, triglycerides, factor VII, factor VIIa, von Willebrand factor, D-dimer, and plasminogen activator inhibitor. There were 247 current, 443 past, and 349 nonsmokers. After adjustment for clinical variables, current smokers had higher levels of total cholesterol and apolipoprotein-B than past and nonsmokers (p <0.01). High-density lipoprotein cholesterol and apolipoprotein-A levels were similar between groups. Fibrinogen was elevated in current (p = 0.001) and past (p = 0.029) smokers, compared with nonsmokers. Smokers who smoked within 24 hours of blood sampling had higher apolipoprotein-B (p = 0.005), total cholesterol (p = 0.001), and fibrinogen (p = 0.015) levels than those who refrained from smoking. In conclusion, postinfarction patients, who historically have higher levels of atherogenic lipids than healthy subjects, have increased levels of these lipids attributed to active smoking. After smoking cessation, lipid profiles approach nonsmoker levels, but fibrinogen remains elevated. Smoking within 24 hours of blood sampling was associated with further adverse prothrombotic and lipogenic effects.
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Affiliation(s)
- S D Fisher
- Cardiology Unit, Department of Medicine, University of Rochester, Rochester, New York, USA
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Bili A, Moss AJ, Francis CW, Zareba W, Watelet LF, Sanz I. Anticardiolipin antibodies and recurrent coronary events: a prospective study of 1150 patients. Thrombogenic Factors, and Recurrent Coronary Events Investigators. Circulation 2000; 102:1258-63. [PMID: 10982540 DOI: 10.1161/01.cir.102.11.1258] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The association of anticardiolipin (aCL) antibodies with coronary artery disease has been shown in several studies but remains controversial. We evaluated the association of aCL and anti-beta(2)-glycoprotein I (abeta(2)GPI) antibodies with the risk of recurrent cardiac events in postinfarction patients. METHODS AND RESULTS The study population consisted of 1150 patients with acute myocardial infarction. Levels of IgG and IgM aCL and abeta(2)GPI antibodies were determined on sera collected before hospital discharge. There were 131 recurrent cardiac events (nonfatal myocardial infarctions or cardiac deaths) over a mean follow-up period of 24.6 months. Patients with elevated IgG aCL antibodies had a higher event rate than patients with low levels (P:=0.05). Multivariate Cox analysis after adjustment for relevant clinical covariates showed that elevated levels of IgG aCL (hazard ratio=1. 63; P:=0.01) and low levels of IgM aCL (hazard ratio of 1.76; P:=0. 02) antibodies contribute independent risks for recurrent cardiac events. Patients with elevated IgG aCL and low IgM aCL antibody levels had a 3-fold higher risk of recurrent cardiac events than patients with low IgG aCL and elevated IgM aCL antibody levels (P:<0. 001). There was no significant association of the abeta(2)GPI antibodies with recurrent cardiac events. CONCLUSIONS In postinfarction patients, elevated IgG aCL and low IgM aCL antibodies are independent risk factors for recurrent cardiac events. Patients with both elevated IgG aCL and low IgM aCL antibodies have the highest risk. These findings shed additional light on the mechanistic role of aCL antibodies in coronary artery disease in patients without autoimmune diseases.
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Affiliation(s)
- A Bili
- Allergy, Immunology, and Rheumatology Unit, Department of Medicine, University of Rochester, MN 55905, USA
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Splawski I, Shen J, Timothy KW, Lehmann MH, Priori S, Robinson JL, Moss AJ, Schwartz PJ, Towbin JA, Vincent GM, Keating MT. Spectrum of mutations in long-QT syndrome genes. KVLQT1, HERG, SCN5A, KCNE1, and KCNE2. Circulation 2000; 102:1178-85. [PMID: 10973849 DOI: 10.1161/01.cir.102.10.1178] [Citation(s) in RCA: 807] [Impact Index Per Article: 33.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Long-QT Syndrome (LQTS) is a cardiovascular disorder characterized by prolongation of the QT interval on ECG and presence of syncope, seizures, and sudden death. Five genes have been implicated in Romano-Ward syndrome, the autosomal dominant form of LQTS: KVLQT1, HERG, SCN5A, KCNE1, and KCNE2. Mutations in KVLQT1 and KCNE1 also cause the Jervell and Lange-Nielsen syndrome, a form of LQTS associated with deafness, a phenotypic abnormality inherited in an autosomal recessive fashion. METHODS AND RESULTS We used mutational analyses to screen a pool of 262 unrelated individuals with LQTS for mutations in the 5 defined genes. We identified 134 mutations in addition to the 43 that we previously reported. Eighty of the mutations were novel. The total number of mutations in this population is now 177 (68% of individuals). CONCLUSIONS KVLQT1 (42%) and HERG (45%) accounted for 87% of identified mutations, and SCN5A (8%), KCNE1 (3%), and KCNE2 (2%) accounted for the other 13%. Missense mutations were most common (72%), followed by frameshift mutations (10%), in-frame deletions, and nonsense and splice-site mutations (5% to 7% each). Most mutations resided in intracellular (52%) and transmembrane (30%) domains; 12% were found in pore and 6% in extracellular segments. In most cases (78%), a mutation was found in a single family or an individual.
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Affiliation(s)
- I Splawski
- Department of Human Genetics, Howard Hughes Medical Institute, Division of Cardiology, Salt Lake City, Utah, USA.
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Affiliation(s)
- A J Moss
- Department of Medicine, University of Rochester Medical Center, New York, USA.
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