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Zaffalon D, Papatheodorou E, Merghani A, Dhutia H, Moccia E, Malhotra A, Miles CJ, Attard V, Homfray T, Sharma R, Gigli M, Ferro MD, Merlo M, Papadakis M, Sinagra G, Sharma S, Finocchiaro G. Role of the electrocardiogram in differentiating genetically determined dilated cardiomyopathy from athlete's heart. Eur J Clin Invest 2022; 52:e13837. [PMID: 35849080 DOI: 10.1111/eci.13837] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/29/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). OBJECTIVES The aim of this study was to investigate the role of the electrocardiogram (ECG) in differentiating between physiological and pathological remodelling. METHODS The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter >62 mm and/or LV ejection fraction between 45% and 50%. RESULTS The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n = 14, 47%), lateral T-wave inversion (TWI) (n = 6, 20%), ventricular ectopic beats (n = 5, 17%) and anterior TWI (n = 4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% (confidence interval [CI]: 54%-88%), 93% (CI: 78%-99%) and 0.83 (CI: 0.71-0.92) respectively. CONCLUSIONS While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.
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Affiliation(s)
- Denise Zaffalon
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | | | - Ahmed Merghani
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Harshil Dhutia
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Eleonora Moccia
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Aneil Malhotra
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Christopher J Miles
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Virginia Attard
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Tessa Homfray
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Rajan Sharma
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Marta Gigli
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Michael Papadakis
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Giuliano-Isontina, University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiovascular clinical academic group, St George's, University of London, London, UK
| | - Gherardo Finocchiaro
- Cardiovascular clinical academic group, St George's, University of London, London, UK.,Royal Brompton Hospital (Guy's and St Thomas's NHS Foundation Trust), London, UK
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Zaffalon D, Papatheodorou E, Merghani A, Dhutia H, Moccia E, Malhotra A, Miles CJ, Attard V, Homfray T, Sharma R, Gigli M, Dal Ferro M, Merlo M, Papadakis M, Sinagra G, Sharma S, Finocchiaro G. 280 Role of the electrocardiogram in differentiating genotype positive dilated cardiomyopathy from cardiac remodelling in athletes. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab142.060] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aims
Physiological cardiac remodelling in highly trained athletes may overlap with dilated cardiomyopathy (DCM). The aim of this study was to investigate the role of the ECG in differentiating between physiological and pathological remodelling.
Methods and results
The study population consisted of 30 patients with DCM who revealed a pathogenic variant at genetic testing and 30 elite athletes with significant cardiac remodelling defined by a left ventricular (LV) end-diastolic diameter > 62 mm and/or LV ejection fraction between 45% and 50%. The ECG was abnormal in 22 (73%) patients with DCM. The most common abnormalities were low voltages (n = 14, 47%), lateral TWI (n = 6, 20%), ventricular ectopic beats (n = 5, 17%) and anterior TWI (n = 4, 13). Two athletes revealed an abnormal ECG: complete left bundle branch block (LBBB) in one case and atrial flutter in the other. The sensitivity, specificity and accuracy of the ECG in differentiating DCM from physiological adaptation to exercise in athletes was 73% [confidence interval (CI: 54–88%), 93% (CI: 78–99%), and 0.83 (CI: 0.71–0.92), respectively.
Conclusions
While the ECG is usually normal in athletes exhibiting significant LV dilatation and/or systolic dysfunction, this test is often abnormal in patients with DCM harbouring a pathogenic variant. Low voltages in the limb leads and lateral TWI are the most common abnormalities.
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Affiliation(s)
- Denise Zaffalon
- Cardiovascular Department, ASUGI Università degli Studi di Trieste, Italy
| | | | - Ahmed Merghani
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Harshil Dhutia
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Eleonora Moccia
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Aneil Malhotra
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | | | - Virginia Attard
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Tessa Homfray
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Rajan Sharma
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Marta Gigli
- Cardiovascular Department, ASUGI Università degli Studi di Trieste, Italy
| | - Matteo Dal Ferro
- Cardiovascular Department, ASUGI Università degli Studi di Trieste, Italy
| | - Marco Merlo
- Cardiovascular Department, ASUGI Università degli Studi di Trieste, Italy
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, ASUGI Università degli Studi di Trieste, Italy
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George’s University of London, UK
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Rajakulasingam R, Attard V, Botchu R, James SL, Saifuddin A. The value of chest and skeletal staging in parosteal osteosarcoma: two-centre experience and literature review. Skeletal Radiol 2021; 50:301-309. [PMID: 32705301 DOI: 10.1007/s00256-020-03557-y] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of chest and skeletal staging in patients with parosteal osteosarcoma (POS), and the incidence of late local and chest recurrence. MATERIALS AND METHODS Retrospective review of patients across two institutions with histological confirmation of POS diagnosed between January 2007 and March 2020. Data collected included age, sex, skeletal location, results of chest CT and whole-body bone scintigraphy (WB-BSc) or whole-body MRI (WB-MRI) obtained at initial diagnosis. The histological tumour grade based on surgical resection specimens was classified as low-grade POS (LG-POS) and dedifferentiated POS (DD-POS). Findings of chest CT and skeletal staging were correlated with tumour grade. Follow-up chest CT and MRI studies were reviewed to determine the rate of late lung metastases and local recurrence. RESULTS There were 27 males and 44 females, mean age 33 years (range 12-79 years). The femur (n = 43) and tibia (n = 14) were the most commonly involved bones. From surgical resection histology, 42 (59.2%) were LG-POS and 29 (40.8%) were DD-POS. WB-BSc/WB-MRI showed no skeletal metastases, while 1 case of DD-POS presented with bilateral calcified lung metastases. At follow-up, 7 patients (9.9%) developed lung metastases (mean of 18.9 months, range 10-48 months) from initial presentation, of which all were DD-POS. All but 1 patient who developed subsequent lung metastases had a local recurrence. CONCLUSIONS Skeletal staging is unlikely to be of value in POS. Staging chest CT is very unlikely to demonstrate lung metastases in LG-POS and could be limited to DD-POS, particularly at the time of local recurrence.
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Affiliation(s)
- R Rajakulasingam
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - V Attard
- Department of Medical Imaging, Mater Dei Hospital, Msida, MSD, 2090, Malta
| | - R Botchu
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - S L James
- Department of Medical Imaging, Royal Orthopaedic Hospital, The Woodlands, Bristol Road South, Birmingham, B31 2AP, UK
| | - A Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Papadakis M, Papatheodorou E, Mellor G, Raju H, Bastiaenen R, Wijeyeratne Y, Wasim S, Ensam B, Finocchiaro G, Gray B, Malhotra A, D'Silva A, Edwards N, Cole D, Attard V, Batchvarov VN, Tome-Esteban M, Homfray T, Sheppard MN, Sharma S, Behr ER. The Diagnostic Yield of Brugada Syndrome After Sudden Death With Normal Autopsy. J Am Coll Cardiol 2019; 71:1204-1214. [PMID: 29544603 DOI: 10.1016/j.jacc.2018.01.031] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 10/10/2017] [Revised: 12/17/2017] [Accepted: 01/08/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Familial evaluation after a sudden death with negative autopsy (sudden arrhythmic death syndrome; SADS) may identify relatives at risk of fatal arrhythmias. OBJECTIVES This study aimed to assess the impact of systematic ajmaline provocation testing using high right precordial leads (RPLs) on the diagnostic yield of Brugada syndrome (BrS) in a large cohort of SADS families. METHODS Three hundred three SADS families (911 relatives) underwent evaluation with resting electrocardiogram using conventional and high RPLs, echocardiography, exercise, and 24-h electrocardiogram monitor. An ajmaline test with conventional and high RPLs was undertaken in 670 (74%) relatives without a familial diagnosis after initial evaluation. Further investigations were guided by clinical suspicion. RESULTS An inherited cardiac disease was diagnosed in 128 (42%) families and 201 (22%) relatives. BrS was the most prevalent diagnosis (n = 85, 28% of families; n = 140, 15% of relatives). Ajmaline testing was required to unmask the BrS in 97% of diagnosed individuals. The use of high RPLs showed a 16% incremental diagnostic yield of ajmaline testing by diagnosing BrS in an additional 49 families. There were no differences of the characteristics between individuals and families with a diagnostic pattern in the conventional and the high RPLs. On follow-up, a spontaneous type 1 Brugada pattern and/or clinically significant arrhythmic events developed in 17% (n = 25) of the concealed BrS cohort. CONCLUSIONS Systematic use of ajmaline testing with high RPLs increases substantially the yield of BrS in SADS families. Assessment should be performed in expert centers where patients are counseled appropriately for the potential implications of provocation testing.
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Affiliation(s)
- Michael Papadakis
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Efstathios Papatheodorou
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Greg Mellor
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Hariharan Raju
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Rachel Bastiaenen
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Yanushi Wijeyeratne
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Sara Wasim
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Bode Ensam
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Gherardo Finocchiaro
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Belinda Gray
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Aneil Malhotra
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Andrew D'Silva
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom
| | - Nina Edwards
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Della Cole
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Virginia Attard
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Velislav N Batchvarov
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Maria Tome-Esteban
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Tessa Homfray
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Mary N Sheppard
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
| | - Sanjay Sharma
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart; University Hospital Lewisham, Lewisham, United Kingdom.
| | - Elijah R Behr
- Cardiology Clinical Academic Group, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom, European Reference Network for rare and low prevalence diseases of the heart, Guard-Heart
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Finocchiaro G, Papadakis M, Dhutia H, Zaidi A, Malhotra A, Fabi E, Cappelletto C, Brook J, Papatheodorou E, Ensam B, Miles CJ, Bastiaenen R, Attard V, Homfray T, Sharma R, Tome M, Carr-White G, Merlo M, Behr ER, Sinagra G, Sharma S. Electrocardiographic differentiation between ‘benign T-wave inversion’ and arrhythmogenic right ventricular cardiomyopathy. Europace 2018; 21:332-338. [DOI: 10.1093/europace/euy179] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/12/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gherardo Finocchiaro
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Michael Papadakis
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Harshil Dhutia
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Abbas Zaidi
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Aneil Malhotra
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Elena Fabi
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Joe Brook
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Efstathios Papatheodorou
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Bode Ensam
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Christopher J Miles
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Rachel Bastiaenen
- Cardiovascular Department, Guy’s and St. Thomas’s Hospital, London, UK
| | - Virginia Attard
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Tessa Homfray
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Rajan Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Maite Tome
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gerald Carr-White
- Cardiovascular Department, Guy’s and St. Thomas’s Hospital, London, UK
| | - Marco Merlo
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Elijah R Behr
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, ‘Ospedali Riuniti’ Hospital, University of Trieste, Trieste, Italy
| | - Sanjay Sharma
- Cardiology Clinical and Academic Group, St George's, University of London, Cranmer Terrace, London, UK
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Sooriakumaran P, Gibbs P, Coughlin G, Attard V, Elmslie F, Kingswood C, Taylor J, Corbishley C, Patel U, Anderson C. Angiomyolipomata: challenges, solutions, and future prospects based on over 100 cases treated. BJU Int 2010; 105:101-6. [DOI: 10.1111/j.1464-410x.2009.08649.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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