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Cámara-Checa A, Perin F, Rubio-Alarcón M, Dago M, Crespo-García T, Rapún J, Marín M, Cebrián J, Gómez R, Bermúdez-Jiménez F, Monserrat L, Tamargo J, Caballero R, Jiménez-Jáimez J, Delpón E. A gain-of-function HCN4 mutant in the HCN domain is responsible for inappropriate sinus tachycardia in a Spanish family. Proc Natl Acad Sci U S A 2023; 120:e2305135120. [PMID: 38032931 DOI: 10.1073/pnas.2305135120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
In a family with inappropriate sinus tachycardia (IST), we identified a mutation (p.V240M) of the hyperpolarization-activated cyclic nucleotide-gated type 4 (HCN4) channel, which contributes to the pacemaker current (If) in human sinoatrial node cells. Here, we clinically study fifteen family members and functionally analyze the p.V240M variant. Macroscopic (IHCN4) and single-channel currents were recorded using patch-clamp in cells expressing human native (WT) and/or p.V240M HCN4 channels. All p.V240M mutation carriers exhibited IST that was accompanied by cardiomyopathy in adults. IHCN4 generated by p.V240M channels either alone or in combination with WT was significantly greater than that generated by WT channels alone. The variant, which lies in the N-terminal HCN domain, increased the single-channel conductance and opening frequency and probability of HCN4 channels. Conversely, it did not modify the channel sensitivity for cAMP and ivabradine or the level of expression at the membrane. Treatment with ivabradine based on functional data reversed the IST and the cardiomyopathy of the carriers. In computer simulations, the p.V240M gain-of-function variant increases If and beating rate and thus explains the IST of the carriers. The results demonstrate the importance of the unique HCN domain in HCN4, which stabilizes the channels in the closed state.
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Affiliation(s)
- Anabel Cámara-Checa
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Francesca Perin
- Department of Pediatric Cardiology, Virgen de las Nieves University Hospital, Granada 18014, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada 18014, Spain
| | - Marcos Rubio-Alarcón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - María Dago
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Teresa Crespo-García
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Josu Rapún
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - María Marín
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Jorge Cebrián
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Ricardo Gómez
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Francisco Bermúdez-Jiménez
- Department of Pediatric Cardiology, Virgen de las Nieves University Hospital, Granada 18014, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada 18014, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid 28029, Spain
| | - Lorenzo Monserrat
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Health in Code Sociedad Limitada, A Coruña 15008, Spain
| | - Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
| | - Ricardo Caballero
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Juan Jiménez-Jáimez
- Department of Pediatric Cardiology, Virgen de las Nieves University Hospital, Granada 18014, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada 18014, Spain
| | - Eva Delpón
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Instituto de Investigación Gregorio Marañón, 28040 Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
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Rubini-Costa R, Bermúdez-Jiménez F, Rivera-López R, Sola-García E, Nagib-Raya H, Moreno-Escobar E, López-Zúñiga MÁ, Briones-Través A, Sanz-Herrera F, Sequí-Sabater JM, Romero-Cabrera JL, Maíllo-Seco J, Fernández-Vázquez F, Rivadeneira-Ruiz M, López-Valero L, Gómez-Navarro C, Aparicio-Gómez JA, López MÁ, Tercedor L, Molina-Jiménez M, Macías-Ruiz R, Jiménez-Jáimez J. Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection. Med Clin (Engl Ed) 2022; 158:569-575. [PMID: 35761979 PMCID: PMC9219541 DOI: 10.1016/j.medcle.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/21/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND PURPOSE Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. METHODS We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. RESULTS 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. CONCLUSIONS AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
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Affiliation(s)
- Ricardo Rubini-Costa
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Francisco Bermúdez-Jiménez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Ricardo Rivera-López
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Elena Sola-García
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Hadi Nagib-Raya
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
- Servicio de Cardiología, Hospital Clínico San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain
| | - Eduardo Moreno-Escobar
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
- Servicio de Cardiología, Hospital Clínico San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain
| | - Miguel Ángel López-Zúñiga
- Servicio de Medicina Interna, Hospital Universitario de Jaén, Av. del Ejército Español, 10, 23007 Jaén, Spain
| | - Adela Briones-Través
- Servicio de Urgencias, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - Francisco Sanz-Herrera
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - Jose Miguel Sequí-Sabater
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
| | - Juan Luis Romero-Cabrera
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
| | - Javier Maíllo-Seco
- Servicio de Cardiología, Hospital Universitario de León, Altos de nava, s/n, 24071 León, Spain
| | | | - María Rivadeneira-Ruiz
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Lucas López-Valero
- Hospital Universitario de Castellón, Avinguda de Benicàssim, 128, 12004 Castellón, Spain
| | - Carlos Gómez-Navarro
- Servicio de Cardiología, Hospital Universitario Torrecárdenas, Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Jose Antonio Aparicio-Gómez
- Servicio de Cardiología, Hospital Universitario Torrecárdenas, Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Miguel Álvarez López
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Luis Tercedor
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - María Molina-Jiménez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Rosa Macías-Ruiz
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Juan Jiménez-Jáimez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
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Jiménez-Jáimez J, Cabrera Ramos M, Bermúdez-Jiménez F, García Pinilla JM, Robles Mezcua A, Macías Ruiz R, Álvarez M, Tercedor L. Monomorphic and Polymorphic Ventricular Arrhythmias in Heterozygous Calsequestrin-2 Mutation Carriers. Circ Genom Precis Med 2022; 15:e003518. [DOI: 10.1161/circgen.121.003518] [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: 11/16/2022]
Affiliation(s)
- Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Cardiology Department, Hospital Universitario lozano Blesa, Zaragoza, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
| | - Mercedes Cabrera Ramos
- Instituto de Investigación Biosanitaria (ibs.GRANADA), Universidad de Granada, Spain (M.C.R.)
| | - Francisco Bermúdez-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Cardiology Department, Hospital Universitario lozano Blesa, Zaragoza, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain (F.B.-J.)
| | | | - Ainhoa Robles Mezcua
- Cardiology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain (J.M.G.P., A.R.M.)
| | - Rosa Macías Ruiz
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Cardiology Department, Hospital Universitario lozano Blesa, Zaragoza, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
| | - Miguel Álvarez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Cardiology Department, Hospital Universitario lozano Blesa, Zaragoza, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
| | - Luis Tercedor
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
- Cardiology Department, Hospital Universitario lozano Blesa, Zaragoza, Spain (J.J.-J., F.B.-J., R.M.R., M.A., L.T.)
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4
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Macias A, González-Guerra A, Moreno-Manuel AI, Cruz FM, García-Quintáns N, Gutiérrez LK, Roche-Molina M, Bermúdez-Jiménez F, Vera-Pedrosa ML, Martínez-Carrascoso I, Bernal JA, Jalife J. B-AB18-02 KIR2.1 CHANNELS IN A NOVEL SARCOPLASMIC RETICULUM MICRODOMAIN CONTROL INTRACELLULAR CA2+ DYNAMICS. Heart Rhythm 2021. [DOI: 10.1016/j.hrthm.2021.06.103] [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: 10/20/2022]
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Akhtar MM, Lorenzini M, Pavlou M, Ochoa JP, O’Mahony C, Restrepo-Cordoba MA, Segura-Rodriguez D, Bermúdez-Jiménez F, Molina P, Cuenca S, Ader F, Larrañaga-Moreira JM, Sabater-Molina M, Garcia-Alvarez MI, Arantzamendi LG, Truszkowska G, Ortiz-Genga M, Ruiz IS, Nielsen SK, Rasmussen TB, Robles Mezcua A, Alvarez-Rubio J, Eiskjaer H, Gautel M, Garcia-Pinilla JM, Ripoll-Vera T, Mogensen J, Limeres Freire J, Rodríguez-Palomares JF, Peña-Peña ML, Rangel-Sousa D, Palomino-Doza J, Arana Achaga X, Bilinska Z, Zamarreño Golvano E, Climent V, Peñalver MN, Barriales-Villa R, Charron P, Yotti R, Zorio E, Jiménez-Jáimez J, Garcia-Pavia P, Elliott PM. Association of Left Ventricular Systolic Dysfunction Among Carriers of Truncating Variants in Filamin C With Frequent Ventricular Arrhythmia and End-stage Heart Failure. JAMA Cardiol 2021; 6:891-901. [PMID: 33978673 PMCID: PMC8117057 DOI: 10.1001/jamacardio.2021.1106] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [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] [Received: 11/01/2020] [Accepted: 02/22/2021] [Indexed: 12/28/2022]
Abstract
Importance Truncating variants in the gene encoding filamin C (FLNCtv) are associated with arrhythmogenic and dilated cardiomyopathies with a reportedly high risk of ventricular arrhythmia. Objective To determine the frequency of and risk factors associated with adverse events among FLNCtv carriers compared with individuals carrying TTN truncating variants (TTNtv). Design, Setting, and Participants This cohort study recruited 167 consecutive FLNCtv carriers and a control cohort of 244 patients with TTNtv matched for left ventricular ejection fraction (LVEF) from 19 European cardiomyopathy referral units between 1990 and 2018. Data analyses were conducted between June and October, 2020. Main Outcomes and Measures The primary end point was a composite of malignant ventricular arrhythmia (MVA) (sudden cardiac death, aborted sudden cardiac death, appropriate implantable cardioverter-defibrillator shock, and sustained ventricular tachycardia) and end-stage heart failure (heart transplant or mortality associated with end-stage heart failure). The secondary end point comprised MVA events only. Results In total, 167 patients with FLNCtv were studied (55 probands [33%]; 89 men [53%]; mean [SD] age at baseline evaluation, 43 [18] years). For a median follow-up of 20 months (interquartile range, 7-60 months), 29 patients (17.4%) reached the primary end point (19 patients with MVA and 10 patients with end-stage heart failure). Eight (44%) arrhythmic events occurred among individuals with baseline mild to moderate left ventricular systolic dysfunction (LVSD) (LVEF = 36%-49%). Univariable risk factors associated with the primary end point included proband status, LVEF decrement per 10%, ventricular ectopy (≥500 in 24 hours) and myocardial fibrosis detected on cardiac magnetic resonance imaging. The LVEF decrement (hazard ratio [HR] per 10%, 1.83 [95% CI, 1.30-2.57]; P < .001) and proband status (HR, 3.18 [95% CI, 1.12-9.04]; P = .03) remained independent risk factors on multivariable analysis (excluding myocardial fibrosis and ventricular ectopy owing to case censoring). There was no difference in freedom from MVA between FLNCtv carriers with mild to moderate or severe (LVEF ≤35%) LVSD (HR, 1.29 [95% CI, 0.45-3.72]; P = .64). Carriers of FLNCtv with impaired LVEF at baseline evaluation (n = 69) had reduced freedom from MVA compared with 244 TTNtv carriers with similar baseline LVEF (for mild to moderate LVSD: HR, 16.41 [95% CI, 3.45-78.11]; P < .001; for severe LVSD: HR, 2.47 [95% CI, 1.04-5.87]; P = .03). Conclusions and Relevance The high frequency of MVA among patients with FLNCtv with mild to moderate LVSD suggests that higher LVEF values than those currently recommended should be considered for prophylactic implantable cardioverter-defibrillator therapy in FLNCtv carriers.
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MESH Headings
- Adult
- Cardiomyopathy, Dilated/genetics
- Cardiomyopathy, Dilated/mortality
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Codon, Nonsense
- Connectin/genetics
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Female
- Filamins/genetics
- Heart Failure/genetics
- Heart Failure/mortality
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Transplantation/statistics & numerical data
- Humans
- Male
- Middle Aged
- Mutation
- Stroke Volume
- Tachycardia, Ventricular/epidemiology
- Tachycardia, Ventricular/genetics
- Tachycardia, Ventricular/physiopathology
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/physiopathology
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Affiliation(s)
- Mohammed Majid Akhtar
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Massimiliano Lorenzini
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
| | - Menelaos Pavlou
- Department of Statistical Science, University College London, London, United Kingdom
| | | | - Constantinos O’Mahony
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Maria Alejandra Restrepo-Cordoba
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | | | | | - Pilar Molina
- Pathology Department, Institute of Legal Medicine and Forensic Sciences of Valencia and Faculty of Medicine of the Universitat de València, CAFAMUSME Research Group, IIS La Fe, Valencia, Spain
| | - Sofia Cuenca
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Flavie Ader
- APHP, UF Cardiogénétique et Myogénétique, Service de Biochimie Métabolique, Hôpitaux Universitaires de la Pitié- Salpêtrière- Charles Foix, 47-83 Bd de l’Hôpital, Paris, France
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
| | - Jose M. Larrañaga-Moreira
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Maria Sabater-Molina
- Inherited Cardiac Disease Unit, Hospital Universitario Virgen Arrixaca, Murcia, Spain
- Universidad de Murcia, Murcia, Spain
| | - Maria I. Garcia-Alvarez
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Grazyna Truszkowska
- Molecular Biology Laboratory, Department of Medical Biology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Itziar Solla Ruiz
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | | | | | - Ainhoa Robles Mezcua
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Jorge Alvarez-Rubio
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hans Eiskjaer
- Department of Cardiology, Aarhus University Hospital, Hjertesygdomme, Aarhus, Denmark
| | - Mathias Gautel
- Randall Institute, King’s College London, London, United Kingdom
| | - José M. Garcia-Pinilla
- Heart Failure and Familial Heart Diseases Unit, Cardiology Department, Hospital Universitario Virgen de la Victoria, CIBER-CV, IBIMA, Malaga, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Diseases Unit, Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Javier Limeres Freire
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jose F. Rodríguez-Palomares
- Department of Cardiology, Vall d’ Hebron Institut de Recerca (VHIR), Hospital Universitari Vall d’ Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria Luisa Peña-Peña
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Diego Rangel-Sousa
- Heart Failure and Heart Transplantation Unit, Virgen del Rocio University Hospital, Sevilla, Spain
| | - Julian Palomino-Doza
- Hereditary Cardiopathies Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de Investigación 12 de Octubre i+12, Madrid, Spain
| | - Xabier Arana Achaga
- Cardiology Specialist in Heart Failure and Inherited Cardiac Diseases, Department of Cardiology, Hospital Universitario Donostia, Spain
| | - Zofia Bilinska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland
| | | | - Vincent Climent
- Cardiology Department, University General Hospital of Alicante, Alicante, Spain
- Institute of Health and Biomedical Research (ISABIAL), Alicante, Spain
| | | | - Roberto Barriales-Villa
- Unidad de Cardiopatías Familiares, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
- Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde (SERGAS), A Coruña, Spain
- Department of Cardiology, Universidade da Coruña, A Coruña, Spain
- Centro de Investigación Biomédica en Red (CIBERCV), Madrid, Spain
| | - Philippe Charron
- Sorbonne Universités, UPMC Univ. Paris 06, INSERM, UMR_S 1166 and ICAN Institute for Cardiometabolism and Nutrition, Paris, France
- APHP, Centre de Référence pour les Maladies Cardiaques Héréditaires, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Raquel Yotti
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Hospital General Universitario Gregorio Marañon, Madrid, Spain
- Instituto de Investigación Sanitarias Gregorio Marañón, Spain
| | - Esther Zorio
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department at Hospital Universitario y Politécnico La Fe and Research Group on Inherited Heart Diseases, Sudden Death and Mechanisms of Disease (CaFaMuSMe) from the Instituto de Investigación Sanitaria La Fe, Valencia, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Spain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARDHEART)
| | - Perry M. Elliott
- Department of Inherited Cardiovascular Diseases, Bart’s Heart Centre St Bartholomew’s Hospital, London, United Kingdom
- Institute of Cardiovascular Science, University College London, London, United Kingdom
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Rubini-Costa R, Bermúdez-Jiménez F, Rivera-López R, Sola-García E, Nagib-Raya H, Moreno-Escobar E, López-Zúñiga MÁ, Briones-Través A, Sanz-Herrera F, Sequí-Sabater JM, Romero-Cabrera JL, Maíllo-Seco J, Fernández-Vázquez F, Rivadeneira-Ruiz M, López-Valero L, Gómez-Navarro C, Aparicio-Gómez JA, López MÁ, Tercedor L, Molina-Jiménez M, Macías-Ruiz R, Jiménez-Jáimez J. Prevalence of bleeding secondary to anticoagulation and mortality in patients with atrial fibrillation admitted with SARS-CoV-2 infection. Med Clin (Barc) 2021; 158:569-575. [PMID: 34364707 PMCID: PMC8279935 DOI: 10.1016/j.medcli.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023]
Abstract
Introduction and purpose Atrial fibrillation (AF) is common in patients admitted with severe COVID-19. However, there is limited data about the management of chronic anticoagulation therapy in these patients. We assessed the anticoagulation and incidence of major cardiovascular events in hospitalized patients with AF and COVID-19. Methods We retrospectively investigated all consecutive patients with AF admitted with COVID-19 between March and May 2020 in 9 Spanish hospitals. We selected a control group of non-AF patients consecutively admitted with COVID-19. We compared baseline characteristics, incidence of major bleeding, thrombotic events and mortality. We used propensity score matching (PSM) to minimize potential confounding variables, as well as a multivariate analysis to predict major bleeding and death. Results 305 patients admitted with AF and COVID-19 were included. After PSM, 151 AF patients were matched with 151 control group patients. During admission, low-molecular-weight heparin was the principal anticoagulant and the incidence of major bleeding and mortality were higher in the AF group [16 (10.6%) vs 3 (2%), p = 0.003; 52 (34.4%) vs 35 (23.2%), p = 0.03, respectively]. The multivariate analysis showed the presence of AF as independent predictor of in-hospital major bleeding and mortality in COVID-19 patients. In AF group, a secondary multivariate analysis identified high levels of D-dimer as independent predictor of in-hospital major bleeding. Conclusions AF patients admitted with COVID-19 represent a population at high risk for bleeding and mortality during admission. It seems advisable to individualize anticoagulation therapy during admission, considering patient specific bleeding and thrombotic risk.
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Affiliation(s)
- Ricardo Rubini-Costa
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Francisco Bermúdez-Jiménez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Melchor Fernández Almagro, 3, 28029 Madrid, Spain
| | - Ricardo Rivera-López
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Elena Sola-García
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Hadi Nagib-Raya
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain; Servicio de Cardiología, Hospital Clínico San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain
| | - Eduardo Moreno-Escobar
- Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain; Servicio de Cardiología, Hospital Clínico San Cecilio, Av. del Conocimiento, s/n, 18016 Granada, Spain
| | - Miguel Ángel López-Zúñiga
- Servicio de Medicina Interna, Hospital Universitario de Jaén, Av. del Ejército Español, 10, 23007 Jaén, Spain
| | - Adela Briones-Través
- Servicio de Urgencias, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - Francisco Sanz-Herrera
- Servicio de Neumología, Consorcio Hospital General Universitario de Valencia, Av. de les Tres Creus, 2, 46014 Valencia, Spain
| | - Jose Miguel Sequí-Sabater
- Servicio de Reumatología, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
| | - Juan Luis Romero-Cabrera
- Servicio de Medicina Interna, Hospital Universitario Reina Sofía, Av. Menendez Pidal, s/n, 14004 Córdoba, Spain
| | - Javier Maíllo-Seco
- Servicio de Cardiología, Hospital Universitario de León, Altos de nava, s/n, 24071 León, Spain
| | | | - María Rivadeneira-Ruiz
- Servicio de Cardiología, Hospital Universitario Virgen Macarena, Dr. Fedriani, 3, 41009 Sevilla, Spain
| | - Lucas López-Valero
- Hospital Universitario de Castellón, Avinguda de Benicàssim, 128, 12004 Castellón, Spain
| | - Carlos Gómez-Navarro
- Servicio de Cardiología, Hospital Universitario Torrecárdenas, Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Jose Antonio Aparicio-Gómez
- Servicio de Cardiología, Hospital Universitario Torrecárdenas, Hermandad de Donantes de Sangre, s/n, 04009 Almería, Spain
| | - Miguel Álvarez López
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Luis Tercedor
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - María Molina-Jiménez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Rosa Macías-Ruiz
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain
| | - Juan Jiménez-Jáimez
- Servicio de Cardiología, Hospital General Universitario Virgen de las Nieves, Avda. de las Fuerzas Armadas 2, 18014 Granada, Spain; Instituto de Investigación Biosanitaria IBS, Universidad de Granada, Hospital Real, Avenida del Hospicio, s/n, 18010 Granada, Spain.
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7
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Jiménez-Jáimez J, Segura-Rodríguez D, Bermúdez-Jiménez F. Resonancia magnética cardiaca en la miocardiopatía arritmogénica: ¿hay que actualizar los criterios de 2010? Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2020.04.029] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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8
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Jiménez-Jáimez J, Segura-Rodríguez D, Bermúdez-Jiménez F. Cardiac magnetic resonance in arrhythmogenic cardiomyopathy: is it time to update the 2010 criteria? Rev Esp Cardiol (Engl Ed) 2020; 73:871-873. [PMID: 32505459 DOI: 10.1016/j.rec.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Juan Jiménez-Jáimez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.
| | - Diego Segura-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Servicio de Cardiología, Hospital Universitario San Cecilio, Granada, Spain
| | - Francisco Bermúdez-Jiménez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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9
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Ramos-Maqueda J, Bermúdez-Jiménez F, Ruiz RM, Ramos MC, Lerma MM, Millán PS, López MÁ, Sánchez LT, Jiménez-Jáimez J. Prognostic impact of misdiagnosis of cardiac channelopathies as epilepsy. PLoS One 2020; 15:e0231442. [PMID: 32298319 PMCID: PMC7161979 DOI: 10.1371/journal.pone.0231442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 03/10/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Cardiac channelopathies are a frequent cause of sudden cardiac death (SCD) and often manifest with convulsive syncope, leading to a misdiagnosis of epilepsy. We aim to evaluate the clinical impact of epilepsy misdiagnosis in a cohort of patients with cardiac channelopathies. METHODS Fifty probands/families with a cardiac channelopathy were included. We retrospectively collected information from medical records to identify all patients who presented with convulsive syncope and were diagnosed with epilepsy after neurological evaluation. Clinical data and outcome were compared with those of patients without a previous epilepsy diagnosis. RESULTS Eight patients had a previous diagnosis of epilepsy. At first episode, 3 of them presented a positive family history of SCD and 5 showed a pathological electrocardiogram; half presented with sudden cardiac arrest (SCA) and the rest with recurrent syncope despite treatment with 1 or more anti-epileptic drugs. Five patients had long QT syndrome, 2 had catecholaminergic polymorphic ventricular tachycardia, and 1 had Brugada syndrome. Epilepsy misdiagnosis was associated with an increased risk of SCA/SCD (OR 6.92, P = .04), a delay of 12 years (P = .047) in correct diagnosis, and a delay from first symptom to channelopathy diagnosis of 18.45 years (P < .0001). CONCLUSION Cardiac channelopathy patients can be misdiagnosed with epilepsy. This involves a delayed diagnosis, a delay from the first symptom to a correct diagnosis, and an increased risk of SCA/SCD.
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Affiliation(s)
- Javier Ramos-Maqueda
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Francisco Bermúdez-Jiménez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Rosa Macías Ruiz
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | | | - Manuel Molina Lerma
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Pablo Sánchez Millán
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Miguel Álvarez López
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Luis Tercedor Sánchez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
| | - Juan Jiménez-Jáimez
- Cardiology Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada, Granada, Spain
- * E-mail:
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10
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Dominguez F, Zorio E, Jimenez-Jaimez J, Salguero-Bodes R, Zwart R, Gonzalez-Lopez E, Molina P, Bermúdez-Jiménez F, Delgado JF, Braza-Boïls A, Bornstein B, Toquero J, Segovia J, Van Tintelen JP, Lara-Pezzi E, Garcia-Pavia P. Clinical characteristics and determinants of the phenotype in TMEM43 arrhythmogenic right ventricular cardiomyopathy type 5. Heart Rhythm 2020; 17:945-954. [PMID: 32062046 DOI: 10.1016/j.hrthm.2020.01.035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy type V (ARVC-5) is the most aggressive heterozygous form of ARVC. It is predominantly caused by a fully penetrant mutation (p.S358L) in the nondesmosomal gene TMEM43-endemic to Newfoundland, Canada. To date, all familial cases reported worldwide share a common ancestral haplotype. It is unknown whether the p.S358L mutation by itself causes ARVC-5 or whether the disease is influenced by genetic or environmental factors. OBJECTIVE The purpose of this study was to examine the phenotype, clinical course, and the impact of exercise on patients with p.S358L ARVC-5 without the Newfoundland genetic background. METHODS We studied 62 affected individuals and 73 noncarriers from 3 TMEM43-p.S358L Spanish families. The impact of physical activity on the phenotype was also evaluated. RESULTS Haplotype analysis revealed that the 3 Spanish families were unrelated to patients with ARVC-5 with the Newfoundland genetic background. Two families shared 10 microsatellite markers in a 4.9 cM region surrounding TMEM43; the third family had a distinct haplotype. The affected individuals showed a 38.7% incidence of sudden cardiac death, which was higher in men. Left ventricular involvement was common, with 40% of mutation carriers showing a left ventricular ejection fraction of <50%. Compared with noncarriers, the R-wave voltage in lead V3 was lower (3.2 ± 2.8 mV vs 7.5 ± 3.6 mV; P < .001) and QRS complex in right precordial leads wider (104.7 ± 24.0 ms vs 88.2 ± 7.7 ms; P = .001). A history of vigorous exercise showed a trend toward more ventricular arrhythmias only in women (P = .053). CONCLUSION ARVC-5 is associated with a high risk of sudden cardiac death and characteristic clinical and electrocardiographic features irrespective of geographical origin and genetic background. Our data suggest that, as in desmosomal ARVC, vigorous physical activity could aggravate the phenotype of TMEM43 mutation carriers.
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Affiliation(s)
- Fernando Dominguez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - Esther Zorio
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario La Fe, Valencia, Spain; CAFAMUSME Research group, IIS La Fe, Valencia, Spain
| | - Juan Jimenez-Jaimez
- Department of Cardiology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rafael Salguero-Bodes
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, i+12, Facultad de Medicina UCM, Madrid, Spain
| | - Robert Zwart
- Department of Genome Analysis, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther Gonzalez-Lopez
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - Pilar Molina
- CAFAMUSME Research group, IIS La Fe, Valencia, Spain; Department of Pathology, Instituto de Medicina Legal y Ciencias Forenses and Histology Unit, Universitat de València, Valencia, Spain
| | | | - Juan F Delgado
- CIBERCV, Madrid, Spain; Department of Cardiology, Hospital Universitario 12 de Octubre, i+12, Facultad de Medicina UCM, Madrid, Spain
| | - Aitana Braza-Boïls
- Department of Cardiology, Hospital Universitario La Fe, Valencia, Spain; CAFAMUSME Research group, IIS La Fe, Valencia, Spain
| | - Belen Bornstein
- Department of Biochemistry, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Jorge Toquero
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Javier Segovia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain
| | - J Peter Van Tintelen
- Department of Genetics, University Medical Centre Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Enrique Lara-Pezzi
- CIBERCV, Madrid, Spain; Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; National Heart and Lung Institute, Imperial College London, United Kingdom.
| | - Pablo Garcia-Pavia
- Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBERCV, Madrid, Spain; Universidad Francisco de Vitoria (UFV), Pozuelo de Alarcón, Spain.
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