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Liu H, Wang L, Wang H, Hao X, Du Z, Li C, Hou X. Triglyceride-glucose index correlates with the incidences and prognoses of cardiac arrest following acute myocardial infarction: data from two large-scale cohorts. Cardiovasc Diabetol 2025; 24:108. [PMID: 40057710 PMCID: PMC11890517 DOI: 10.1186/s12933-025-02641-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Accepted: 02/10/2025] [Indexed: 05/13/2025] Open
Abstract
BACKGROUND The triglyceride-glucose (TyG) index, renowned for its efficacy and convenience in assessing insulin resistance, has been validated as a reliable indicator for various cardiovascular conditions. The current study aims for clarifying the link of TyG with the incidences and prognoses of cardiac arrest (CA) following acute myocardial infarction (AMI). METHODS Our analysis is a multicenter, retrospective study utilizing data from the Medical Information Mart for Intensive Care IV and the eICU Collaborative Research Database. Patients with AMI for whom TyG could be calculated within the first 24 h after admission were included. The main endpoints were in-hospital and ICU mortalities. Correlations between TyG and outcomes were evaluated using logistic regression models, restricted cubic splines (RCS), as well as correlation and linear analyses. Overlap weighting (OW), inverse probability of treatment weighting (IPTW), and propensity score matching (PSM) methodologies were utilized to balance the cohorts, thereby minimizing potential biases. Subgroup analyses were performed in accordance with identified modifiers. RESULTS In total, 5208 individuals diagnosed with AMI, among whom 371 developed CA, were ultimately included. Higher TyG levels were observed among AMI populations with CA compared to those without [9.2 (8.7-9.7) vs. 9.0 (8.5-9.4)], and TyG demonstrated a moderate discriminatory capacity for identifying CA occurrences within entire AMI populations. Multivariate logistic regressions revealed TyG serves a significant risk indicator for both in-hospital (OR 1.711) and ICU mortalities (OR 1.520) in AMI-CA patients, and it is also associated with prolonged LOSs. RCS analyses confirmed linear relationships of ascending TyG with increased mortality risks for AMI-CA (P for nonlinearity: 0.592 and 0.816, respectively), which persisted following PSM, OW, and IPTW adjustments. Subgroup analyses further identified a strong link of the TyG with mortality rates among elders, females, individuals with BMI < 28 kg/m2, and those with hypertension. CONCLUSIONS Elevated TyG levels were found to apparently correlate with higher prevalence and adverse outcomes regarding CA in patients with AMI. Our findings point a fresh insight into the significance of the TyG in critically ill coronary conditions.
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Affiliation(s)
- Huiruo Liu
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Liangshan Wang
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Hong Wang
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Xing Hao
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Zhongtao Du
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Chenglong Li
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China
| | - Xiaotong Hou
- Centre for Cardiac Intensive Care, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, People's Republic of China.
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Galka K, McLernon DJ, Hannaford PC, Iversen L. Does Rose angina in midlife women matter? Further evidence from the Royal College of General Practitioners' Oral Contraception Study. Maturitas 2025; 194:108189. [PMID: 39798249 DOI: 10.1016/j.maturitas.2024.108189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 11/27/2024] [Accepted: 12/24/2024] [Indexed: 01/15/2025]
Abstract
BACKGROUND AND AIMS Globally, ischaemic heart disease (IHD) is a leading cause of death among women; however, disparities remain in the diagnosis and treatment of IHD between females and males. There is limited evidence about mortality risks among women with symptoms of IHD who remain undiagnosed. We re-examined the mortality risks in midlife women who completed the Rose Angina Questionnaire, among a subset of the Royal College of General Practitioners' Oral Contraception Study cohort. METHODS 8694 women in the cohort completed the Rose Angina Questionnaire, enquiring about symptoms of exertional chest pain, likely angina, and prior myocardial infarction. The women were followed for vital status and cause of death information until 30 June 2022. The relationship between different types of Rose angina and all-cause and cause-specific mortality was examined using Kaplan-Meier survival curves, and unadjusted and adjusted Cox regression. RESULTS After 27 years, 3263 (37.5 %) women had died. Compared with women who did not report symptoms, women with Rose angina had an increased risk of all-cause and IHD death. Women without a prior IHD diagnosis and grade II Rose angina at survey had the highest all-cause (adjusted hazard ratio [aHR] 2.14, 95 % confidence interval [CI] 1.55 to 2.97) and IHD-specific (aHR 3.18, 95 % CI 1.64 to 6.17) mortality risks. CONCLUSIONS Women reporting Rose chest pain had a higher risk of all-cause and IHD death, even in the absence of a prior IHD history. These findings highlight the importance of identifying symptomatic women in midlife, so their IHD risk can be managed appropriately by their healthcare providers.
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Affiliation(s)
- Katarzyna Galka
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - David J McLernon
- Medical Statistics, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Philip C Hannaford
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
| | - Lisa Iversen
- Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, UK.
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Zohora FT, Nazari MA, Sinusas AJ. Novel F-18-labeled Tracers of Sympathetic Function for Improved Risk Stratification and Clinical Outcomes. Curr Cardiol Rep 2025; 27:61. [PMID: 40009333 DOI: 10.1007/s11886-025-02197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2025] [Indexed: 02/27/2025]
Abstract
PURPOSE OF REVIEW This review summarizes the role of the novel 18F-labeled positron emission tomography (PET) sympathetic radiotracers for risk stratification in patients with ischemic heart disease. PET tracers have demonstrated prognostic value by characterizing myocardial sympathetic nerve density and by extension the extent of myocardial sympathetic denervation. The unique features of these PET radiotracers are discussed in relation to clinical application. RECENT FINDINGS Absolute quantification of sympathetic denervation has been possible with 18F-labeled PET tracers which outperform low ejection fraction (<35%) in predicting sudden cardiac death (SCD) and allow for more optimal risk stratification in patients with heart failure. This underscores their utility in selecting patients for preventable strategies with implantable cardioverter defibrillators (ICD). Appropriate candidate selection for ICD placement is a major priority as at present 80% of patients that die from SCD do not receive an ICD (potentially preventable mortality) while only 1 in 8 patients with an ICD receive a life-saving shock. Furthermore, 1 in 3 patients with ICDs receive inappropriate shocks. Thus, there is a pressing need to more appropriately select and exclude patients who will and will not benefit from ICD placement, respectively, as both suffer poor outcomes. Despite the clear prognostic benefit offered by prior PET sympathetic radiotracers in imaging myocardial sympathetic denervation, their short half-lives necessitated costly onsite cyclotron synthesis obviating their pragmatic clinical use. 18F-labeled radiotracers have a longer half-life allowing centralized synthesis and transport to their point of use. As such, 18F-labeled sympathetic radiotracers define an innovation and may offer a more affordable and clinically practical approach for evaluation of risk in patients with cardiovascular disease. 18F-labeled sympathetic radiotracers are currently available for evaluation and risk stratification of patients with ischemic heart disease and heart failure. These radiotracers may offer a more practical approach for selection of ICD placement and consequent prevention of SCD; a major, yet unmet need, in heart failure patients and those that suffer SCD at large. However, further development and clinical testing of these 18F-labeled sympathetic radiotracers is required.
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Affiliation(s)
- Fatema Tuj Zohora
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Matthew A Nazari
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, 06520, USA.
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA.
- Yale Translational Research Imaging Center, Yale University School of Medicine, DANA3, P.O. Box 208017, New Haven, CT, 06520-8017, USA.
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Harms PP, van Dongen LH, Bennis F, Swart KMA, Hoogendoorn M, Beulens JWJ, Tan HL, Elders PPJM, Blom MT. Associations of Clinical Characteristics With Sudden Cardiac Arrest in People With Type 2 Diabetes With and Without Cardiovascular Disease: A Longitudinal Case-Control Study Using Routine Primary Care Data. Diabetes Care 2025; 48:125-135. [PMID: 39556475 DOI: 10.2337/dc24-0715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 10/24/2024] [Indexed: 11/20/2024]
Abstract
OBJECTIVE To assess longitudinal associations with sudden cardiac arrest (SCA) of clinical characteristics recorded in primary care in people with type 2 diabetes (T2D), both with and without cardiovascular disease (CVD). RESEARCH DESIGN AND METHODS We performed a case-control study, with SCA case subjects with T2D from the Amsterdam Resuscitation Studies (ARREST) registry of out-of-hospital resuscitation attempts in the Dutch Noord-Holland region (2010-2020) and up to five matched (age, sex, T2D, general practitioner [GP] practice) non-SCA control subjects. We collected relevant clinical measurements, medication use, and medical history from GPs' electronic health care records. We analyzed the associations of clinical characteristics and medication use with SCA in the total sample and in subgroups with or without CVD using multivariable time-dependent Cox regression (hazard ratios, 95% confidence intervals). RESULTS We included 689 SCA case subjects and 3,230 non-SCA control subjects. In multivariable models, low fasting glucose (<4.5 mmol/mol: 1.91 [1.00-3.64]), antihypertensive (1.80 [1.39-2.33]), glucose lowering (oral only: 1.32 [1.06-1.63]; insulin only: 2.31 [1.71-3.12]; oral and insulin: 1.64 [1.21-2.22]), heart failure (1.91 [1.55-2.35]), and QTc-prolonging prokinetic (1.78 [1.27-2.50]), antibiotic (1.35 [1.05-1.73]), and antipsychotic (2.10 [1.42-3.09]) medication were associated with SCA in the total sample. In subgroup effect modification analyses, QTc-prolonging antibiotic (1.82 [1.26-2.63]) and antipsychotic (3.10 [2.09-4.59]) medication use were associated with SCA only in those without CVD. CONCLUSIONS In people with T2D, low fasting glucose and QTc-prolonging prokinetic, antibiotic, or antipsychotic medication use and a history of heart failure are associated with SCA risk. Subgroup analyses indicate antibiotic and antipsychotic medication use increases SCA risk specifically in those without CVD.
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Affiliation(s)
- Peter P Harms
- Department of General Practice Medicine, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam Public Health Institute, Amsterdam, the Netherlands
- Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam Cardiovascular Sciences Institute, Amsterdam, the Netherlands
| | - Laura H van Dongen
- Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam, the Netherlands
| | - Frank Bennis
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Karin M A Swart
- PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands
| | - Mark Hoogendoorn
- Department of Computer Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam Public Health Institute, Amsterdam, the Netherlands
- Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam Cardiovascular Sciences Institute, Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Hanno L Tan
- Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam Cardiovascular Sciences Institute, Amsterdam, the Netherlands
- Department of Clinical and Experimental Cardiology, University of Amsterdam, Amsterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Petra P J M Elders
- Department of General Practice Medicine, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam Public Health Institute, Amsterdam, the Netherlands
- Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam Cardiovascular Sciences Institute, Amsterdam, the Netherlands
| | - Marieke T Blom
- Department of General Practice Medicine, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Personalized Medicine, and Health Behaviors & Chronic Diseases, Amsterdam Public Health Institute, Amsterdam, the Netherlands
- Heart Failure & Arrhythmias, and Diabetes & Metabolism, Amsterdam Cardiovascular Sciences Institute, Amsterdam, the Netherlands
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Järvensivu-Koivunen M, Hernesniemi J, Tynkkynen J. Smoking and sudden cardiac death in patients with previous coronary artery disease. Coron Artery Dis 2025; 36:59-64. [PMID: 39652651 PMCID: PMC11617078 DOI: 10.1097/mca.0000000000001421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 07/28/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Smoking is a known risk for sudden cardiac death (SCD) in the general population. However, its significance in patients with acute coronary syndrome (ACS), a condition that also elevates the risk of SCD, is disputable. METHODS A total of 9704 consecutive ACS patients with available smoking data were included in the analysis. Comprehensive patient data were obtained from the Mass Data in Detection and Prevention of Serious Adverse Events in Cardiovascular Disease research database. A composite endpoint of SCD, SCD aborted by successful resuscitation and accurate implantable cardioverter defibrillator therapy to otherwise potentially fatal ventricular fibrillation/ventricular tachycardia was used. Univariate, age- and sex-adjusted, and a multivariate fine-gray competing risk regression with adjustment to traditional risk factors was conducted. RESULTS Median follow-up time was 6.8 years (IQR, 4.1-10.2), and 454 (4.7%) SCD cases were identified. At the baseline, 23.7% ( N = 2444) were active smokers, and 20.8% ( N = 2146) were ex-smokers. In the multivariate model, active smokers had an elevated risk of 1.79 (95% CI, 1.41-2.27; P < 0.001) for future SCD. Ex-smokers had no elevated risk for SCD in fine-gray subdistribution hazard. Also, active smokers were notably younger (mean age 58.7 years) than non- or ex-smokers (71.1 years and 68.9 years, respectively, P < 0.001 for both comparisons). CONCLUSION Active smokers had a 79% higher risk of SCD when compared with nonsmokers. Smoking cessation should be heavily encouraged after ACS. Also, a person's smoking status should be considered in further studies developing SCD and implantable cardioverter defibrillator-benefit risk scores.
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Affiliation(s)
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University
- Heart Hospital, Tampere University Hospital
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
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Kashkosh A, Dar BY, Ahmed S. Percutaneous Coronary Intervention (PCI) Post Out-of-Hospital Cardiac Arrest: A Narrative Review. Cureus 2024; 16:e71420. [PMID: 39411368 PMCID: PMC11479787 DOI: 10.7759/cureus.71420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2024] [Indexed: 10/19/2024] Open
Abstract
Cardiovascular disease is a leading cause of mortality worldwide; therefore, preventing death and improving patient outcomes are a priority. Increasing numbers of patients are surviving hospital admissions after an out-of-hospital cardiac arrest (OHCA). An OHCA has a poor prognosis, and myocardial infarctions (MIs) are the most common cause; hence, the use of emergency coronary angiography and percutaneous coronary intervention (PCI) is an important tool in trying to improve survival. This narrative review explores the role of PCI in OHCA management; understanding angiography findings in OHCA patients offers critical insights into underlying coronary artery disease burden, informing the necessity for PCI. Also, looking at specific subgroups, like females, is essential for equitable intervention access and outcome optimization. Understanding the role of support devices such as Impella and extracorporeal membrane oxygenation (ECMO), which show promise in enhancing outcomes by providing hemodynamic support during PCI and improved overall survival, is linked to better neurological outcomes, highlighting the significance of timely PCI and comprehensive post-PCI care.
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Affiliation(s)
- Abdulrahman Kashkosh
- Internal Medicine, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, GBR
| | - Bilaal Yousaf Dar
- Medicine, Faculty of Life Sciences and Medicine, King's College London, London, GBR
| | - Sabahat Ahmed
- Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, GBR
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Pesaresi M, Bernini Di Michele A, Melchionda F, Onofri V, Alessandrini F, Turchi C. Sudden Cardiac Death and Channelopathies: What Lies behind the Clinical Significance of Rare Splice-Site Alterations in the Genes Involved? Genes (Basel) 2024; 15:1272. [PMID: 39457396 PMCID: PMC11507433 DOI: 10.3390/genes15101272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 09/23/2024] [Accepted: 09/26/2024] [Indexed: 10/28/2024] Open
Abstract
Background and objectives: Sudden cardiac death (SCD) is a natural and unexpected death of cardiac origin that occurs within 1 h from the onset of acute symptoms. The major leading causes of SCD are cardiomyopathies and channelopathies. In this review, we focus on channelopathies, inherited diseases caused by mutations affecting genes encoding membrane ion channels (sodium, potassium or calcium channels) or cellular structures that affect Ca2+ availability. The diagnosis of diseases such as long QT, Brugada syndrome, short QT and catecholaminergic polymorphic ventricular tachycardia (CPVT) is still challenging. Currently, genetic testing and next-generation sequencing allow us to identify many rare alterations. However, some non-coding variants, e.g., splice-site variants, are usually difficult to interpret and to classify. Methods: In our review, we searched for splice-site variants of genes involved in channelopathies, focusing on variants of unknown significance (VUSs) registered on ClinVar up to now. Results: The research led to a high number of splice-site VUSs of genes involved in channelopathies, suggesting the performance of deeper studies. Conclusions: In order to interpret the correlation between variants and pathologies, we discuss experimental studies, such as RNA sequencing and functional analysis of proteins. Unfortunately, as these in vitro analyses cannot always be performed, we draw attention to in silico studies as future perspectives in genetics. This review has the aim of discussing the potential methods of detection and interpretation of VUSs, bringing out the need for a future reclassification of variants with currently unknown significance.
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Affiliation(s)
- Mauro Pesaresi
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Via Tronto, 60126 Ancona, Italy; (M.P.); (A.B.D.M.); (F.M.); (F.A.)
| | - Alessia Bernini Di Michele
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Via Tronto, 60126 Ancona, Italy; (M.P.); (A.B.D.M.); (F.M.); (F.A.)
| | - Filomena Melchionda
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Via Tronto, 60126 Ancona, Italy; (M.P.); (A.B.D.M.); (F.M.); (F.A.)
| | - Valerio Onofri
- Legal Medicine Unit, AOU Azienda Ospedaliero Universitaria delle Marche, 60126 Ancona, Italy;
| | - Federica Alessandrini
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Via Tronto, 60126 Ancona, Italy; (M.P.); (A.B.D.M.); (F.M.); (F.A.)
| | - Chiara Turchi
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Via Tronto, 60126 Ancona, Italy; (M.P.); (A.B.D.M.); (F.M.); (F.A.)
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Perry J, Brody JA, Fong C, Sunshine JE, O'Reilly-Shah VN, Sayre MR, Rea TD, Simon N, Shojaie A, Sotoodehnia N, Chatterjee NA. Predicting Out-of-Hospital Cardiac Arrest in the General Population Using Electronic Health Records. Circulation 2024; 150:102-110. [PMID: 38860364 DOI: 10.1161/circulationaha.124.069105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND The majority of out-of-hospital cardiac arrests (OHCAs) occur among individuals in the general population, for whom there is no established strategy to identify risk. In this study, we assess the use of electronic health record (EHR) data to identify OHCA in the general population and define salient factors contributing to OHCA risk. METHODS The analytical cohort included 2366 individuals with OHCA and 23 660 age- and sex-matched controls receiving health care at the University of Washington. Comorbidities, electrocardiographic measures, vital signs, and medication prescription were abstracted from the EHR. The primary outcome was OHCA. Secondary outcomes included shockable and nonshockable OHCA. Model performance including area under the receiver operating characteristic curve and positive predictive value were assessed and adjusted for observed rate of OHCA across the health system. RESULTS There were significant differences in demographic characteristics, vital signs, electrocardiographic measures, comorbidities, and medication distribution between individuals with OHCA and controls. In external validation, discrimination in machine learning models (area under the receiver operating characteristic curve 0.80-0.85) was superior to a baseline model with conventional cardiovascular risk factors (area under the receiver operating characteristic curve 0.66). At a specificity threshold of 99%, correcting for baseline OHCA incidence across the health system, positive predictive value was 2.5% to 3.1% in machine learning models compared with 0.8% for the baseline model. Longer corrected QT interval, substance abuse disorder, fluid and electrolyte disorder, alcohol abuse, and higher heart rate were identified as salient predictors of OHCA risk across all machine learning models. Established cardiovascular risk factors retained predictive importance for shockable OHCA, but demographic characteristics (minority race, single marital status) and noncardiovascular comorbidities (substance abuse disorder) also contributed to risk prediction. For nonshockable OHCA, a range of salient predictors, including comorbidities, habits, vital signs, demographic characteristics, and electrocardiographic measures, were identified. CONCLUSIONS In a population-based case-control study, machine learning models incorporating readily available EHR data showed reasonable discrimination and risk enrichment for OHCA in the general population. Salient factors associated with OCHA risk were myriad across the cardiovascular and noncardiovascular spectrum. Public health and tailored strategies for OHCA prediction and prevention will require incorporation of this complexity.
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Affiliation(s)
- Jessica Perry
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Jennifer A Brody
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Christine Fong
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Jacob E Sunshine
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Vikas N O'Reilly-Shah
- Department of Medicine, Department of Anesthesiology and Pain Medicine (C.F., J.E.S., V.N.O.), University of Washington, Seattle
| | - Michael R Sayre
- Department of Emergency Medicine (M.R.S.), University of Washington, Seattle
- Seattle Fire Department (M.R.S.), WA
| | - Thomas D Rea
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
| | - Noah Simon
- Cardiovascular Health Research Unit (J.A.B., N.S., T.D.R.), University of Washington, Seattle
- King County Emergency Medical Services (T.D.R.), Seattle, WA
| | - Ali Shojaie
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
| | - Nona Sotoodehnia
- Department of Biostatistics (J.P., N.S., A.S.), University of Washington, Seattle
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Rahola JT, Mattila SM, Kiviniemi AM, Ukkola OH, Tulppo MP, Junttila MJ, Huikuri HV, Kenttä TV, Perkiömäki JS. Prognostic significance of beat-to-beat variability of spatial heterogeneity of repolarization analyzed from a 5-minute resting electrocardiogram in coronary artery disease. Heart Rhythm 2024; 21:1093-1099. [PMID: 38597856 DOI: 10.1016/j.hrthm.2024.02.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Data on the prognostic significance of temporal variability of spatial heterogeneity of electrocardiographic repolarization in coronary artery disease (CAD) are limited. OBJECTIVE The purpose of this study was to evaluate the prognostic value of temporal variability of T-wave morphology analyzed from a 5-minute resting electrocardiogram in CAD. METHODS The standard deviation (SD) of T-wave morphology dispersion (TMD-SD) and the SD of total cosine R-to-T were analyzed on a beat-to-beat basis from a 5-minute period of the standard resting 12-lead electrocardiogram obtained before the clinical stress test in 1702 patients with angiographically verified CAD and well-preserved left ventricular function. RESULTS During an average of 8.7 ± 2.2 years of follow-up, 60 patients experienced sudden cardiac death/arrest (SCD/SCA) (3.5%), 69 patients nonsudden cardiac death (NSCD) (4.1%), and 161 patients noncardiac death (9.5%). TMD-SD was significantly higher in patients who experienced SCD/SCA than in other patients (1.72 ± 2.00 vs 1.12 ± 1.75; P = .01) and higher in patients who succumbed to NSCD than in other patients (1.57 ± 1.74 vs 1.12 ± 1.76; P = .04), but it did not differ significantly between patients who experienced noncardiac death and those without such an event (1.16 ± 1.42 vs 1.14 ± 1.79; P = .86). In the Cox multivariable hazards model, TMD-SD retained its significant association with the risk of SCD/SCA (hazard ratio 1.119; 95% confidence interval 1.015-1.233; P = .024) but not with the risk of NSCD (hazard ratio 1.089; 95% confidence interval 0.983-1.206; P = .103). CONCLUSION TMD-SD is independently associated with the long-term risk of SCD/SCA in patients with CAD.
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Affiliation(s)
- Janne T Rahola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Severi M Mattila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Antti M Kiviniemi
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Olavi H Ukkola
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Mikko P Tulppo
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tuomas V Kenttä
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Juha S Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Lynge TH, Albert CM, Basso C, Garcia R, Krahn AD, Semsarian C, Sheppard MN, Behr ER, Tfelt-Hansen J. Autopsy of all young sudden death cases is important to increase survival in family members left behind. Europace 2024; 26:euae128. [PMID: 38715537 PMCID: PMC11164113 DOI: 10.1093/europace/euae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Sudden cardiac death (SCD) is an important public health problem worldwide, accounting for an estimated 6-20% of total mortality. A significant proportion of SCD is caused by inherited heart disease, especially among the young. An autopsy is crucial to establish a diagnosis of inherited heart disease, allowing for subsequent identification of family members who require cardiac evaluation. Autopsy of cases of unexplained sudden death in the young is recommended by both the European Society of Cardiology and the American Heart Association. Overall autopsy rates, however, have been declining in many countries across the globe, and there is a lack of skilled trained pathologists able to carry out full autopsies. Recent studies show that not all cases of sudden death in the young are autopsied, likely due to financial, administrative, and organizational limitations as well as awareness among police, legal authorities, and physicians. Consequently, diagnoses of inherited heart disease are likely missed, along with the opportunity for treatment and prevention among surviving relatives. This article reviews the evidence for the role of autopsy in sudden death, how the cardiologist should interpret the autopsy-record, and how this can be integrated and implemented in clinical practice. Finally, we identify areas for future research along with potential for healthcare reform aimed at increasing autopsy awareness and ultimately reducing mortality from SCD.
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Affiliation(s)
- Thomas H Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cristina Basso
- The Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Via Aristide Gabelli, 61, 35121 Padova PD, Italy
| | - Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, Poitiers, France
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Pathology Unit, Cardiovascular and Genetics Research Institute, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Cardiovascular and Genetics Research Institute, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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11
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Stampe NK, Glinge C, Rasmussen BS, Bhardwaj P, Linnet K, Jabbari R, Paludan-Müller C, Hassager C, Kjærgaard J, Tfelt-Hansen J, Winkel BG. Toxicological profile using mass spectrometry in sudden cardiac arrest survivors admitted to a tertiary centre. Resuscitation 2024; 198:110197. [PMID: 38582441 DOI: 10.1016/j.resuscitation.2024.110197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND There has been no previous thorough toxicological examination of a cohort of patients with resuscitated sudden cardiac arrest. We aimed to determine the qualitative and quantitative drug composition in a resuscitated sudden cardiac arrest population, using forensic toxicology, with focus on prescribed, non-prescribed, and commonly abused drugs. METHODS Individuals aged 18-90 years with resuscitated sudden cardiac arrest of presumed cardiac causes were prospectively included from a single tertiary center. Data from the sudden cardiac arrest hospitalization was collected from medical reports. Drugs used during resuscitation or before the blood sampling were identified and excluded in each patient. Mass spectrometry-based toxicology was performed to determine the absence or presence of most drugs and to quantify the findings. RESULTS Among 186 consecutively enrolled resuscitated sudden cardiac arrest patients (median age 62 years, 83% male), 90% had a shockable rhythm, and were primarily caused by ischemic heart disease (66%). In total, 90 different drugs (excluding metabolites) were identified, and 82% of patients had at least one drug detected (median of 2 detected drugs (IQR:1-4)) (polypharmacy). Commonly abused drugs were present in 16%, and QT-prolonging drugs were present in 12%. Polypharmacy (≥5drugs) were found in 19% of patients. Importantly, none had potentially lethal concentrations of any drugs. CONCLUSION In resuscitated sudden cardiac arrest patients with cardiac arrest of presumed cardiac cause, routine toxicological screening provides limited extra information. However, the role of polypharmacy in sudden cardiac arrest requires further investigation. No occult overdose-related cardiac arrests were identified.
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Affiliation(s)
- Niels Kjær Stampe
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Charlotte Glinge
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Brian Schou Rasmussen
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Priya Bhardwaj
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Kristian Linnet
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Paludan-Müller
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Thakkar N, Alam P, Thaker A, Ahukla A, Shah J, Saxena D, Shah K. Incidence of Sudden Cardiac Death in Low- and Middle-Income Countries: A Systematic Review of Cohort Studies. Indian J Community Med 2024; 49:279-289. [PMID: 38665450 PMCID: PMC11042141 DOI: 10.4103/ijcm.ijcm_468_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 11/20/2023] [Indexed: 04/28/2024] Open
Abstract
Sudden cardiac death (SCD) is a leading cause of mortality worldwide and, in recent years, has become an urgent public health concern in low- and middle-income countries (LMICs). Data from LMICs, however, remains limited. As such, the aim of this article is to systematically review the current literature on the incidence of SCD in LMICs to inform policymakers and identify potential research gaps. A search of PubMed and Embase was utilized to capture the targeted condition, outcome, and setting. Only peer-reviewed cohort studies in LMICs reporting SCD incidence estimates in the general population of individuals aged ≥1 year were eligible for selection. Papers providing incidence data for specific types of SCD, including sudden coronary death or death from sudden cardiac arrest, were also included. After deduplication, 1941 citations were identified and screened. Seven studies representing four countries-Cameroon, China, India, and Iran-met the criteria for inclusion and were considered in our analysis. The crude incidence rate for SCD ranged from 19.9 to 190 cases per 100,000 person-years, while age-adjusted rates ranged from 33.6 to 230 cases per 100,000 person-years. There was notable variability in methods utilized to ascertain SCD cases. These findings suggest that the incidence of all-cause SCD in LMICs and may exceed that of high-income countries; however, observed disparities may be partly attributable to differences in case ascertainment methods. Additional research is needed to better understand the true incidence of SCD in developing countries. It is crucial that future studies across regions utilize standard diagnostic criteria and methodology for identifying SCD, which would provide a framework by which to compare outcomes between settings.
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Affiliation(s)
- Nandan Thakkar
- Office of Graduate Education, University of North Carolina School of Medicine, Chapel Hill, NC, United States of America
| | - Prima Alam
- Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Abhi Thaker
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Aakansha Ahukla
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Jay Shah
- Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Radiology and Imaging Sciences, Division of Pediatric Radiology, Emory University School of Medicine, Atlanta, GA, United States
| | - Deepak Saxena
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Komal Shah
- Department of Epidemiology, Indian Institute of Public Health, Gandhinagar, Gujarat, India
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13
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Oknińska M, Duda MK, Czarnowska E, Bierła J, Paterek A, Mączewski M, Mackiewicz U. Sex- and age-dependent susceptibility to ventricular arrhythmias in the rat heart ex vivo. Sci Rep 2024; 14:3460. [PMID: 38342936 PMCID: PMC10859380 DOI: 10.1038/s41598-024-53803-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/13/2024] Open
Abstract
The incidence of life-threatening ventricular arrhythmias, the most common cause of sudden cardiac death (SCD), depends largely on the arrhythmic substrate that develops in the myocardium during the aging process. There is a large deficit of comparative studies on the development of this substrate in both sexes, with a particular paucity of studies in females. To identify the substrates of arrhythmia, fibrosis, cardiomyocyte hypertrophy, mitochondrial density, oxidative stress, antioxidant defense and intracellular Ca2+ signaling in isolated cardiomyocytes were measured in the hearts of 3- and 24-month-old female and male rats. Arrhythmia susceptibility was assessed in ex vivo perfused hearts after exposure to isoproterenol (ISO) and hydrogen peroxide (H2O2). The number of ventricular premature beats (PVBs), ventricular tachycardia (VT) and ventricular fibrillation (VF) episodes, as well as intrinsic heart rate, QRS and QT duration, were measured in ECG signals recorded from the surfaces of the beating hearts. After ISO administration, VT/VFs were formed only in the hearts of males, mainly older ones. In contrast, H2O2 led to VT/VF formation in the hearts of rats of both sexes but much more frequently in older males. We identified several components of the arrhythmia substrate that develop in the myocardium during the aging process, including high spontaneous ryanodine receptor activity in cardiomyocytes, fibrosis of varying severity in different layers of the myocardium (nonheterogenic fibrosis), and high levels of oxidative stress as measured by nitrated tyrosine levels. All of these elements appeared at a much greater intensity in male individuals during the aging process. On the other hand, in aging females, antioxidant defense at the level of H2O2 detoxification, measured as glutathione peroxidase expression, was weaker than that in males of the same age. We showed that sex has a significant effect on the development of an arrhythmic substrate during aging. This substrate determines the incidence of life-threatening ventricular arrhythmias in the presence of additional stimuli with proarrhythmic potential, such as catecholamine stimulation or oxidative stress, which are constant elements in the pathomechanism of most cardiovascular diseases.
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Affiliation(s)
- Marta Oknińska
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Monika Katarzyna Duda
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Elżbieta Czarnowska
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736, Warsaw, Poland
- Department of Pathology, Medical University of Warsaw, Żwirki i Wigury 61, 02-091, Warsaw, Poland
| | - Joanna Bierła
- Department of Pathology, The Children's Memorial Health Institute, Aleja Dzieci Polskich 20, 04-736, Warsaw, Poland
| | - Aleksandra Paterek
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Michał Mączewski
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland
| | - Urszula Mackiewicz
- Department of Clinical Physiology, Centre of Postgraduate Medical Education, Marymoncka 99/103, 01-813, Warsaw, Poland.
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Pluta R, Czuczwar SJ. Ischemia-Reperfusion Programming of Alzheimer's Disease-Related Genes-A New Perspective on Brain Neurodegeneration after Cardiac Arrest. Int J Mol Sci 2024; 25:1291. [PMID: 38279289 PMCID: PMC10816023 DOI: 10.3390/ijms25021291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/17/2024] [Accepted: 01/18/2024] [Indexed: 01/28/2024] Open
Abstract
The article presents the latest data on pathological changes after cerebral ischemia caused by cardiac arrest. The data include amyloid accumulation, tau protein modification, neurodegenerative and cognitive changes, and gene and protein changes associated with Alzheimer's disease. We present the latest data on the dysregulation of genes related to the metabolism of the amyloid protein precursor, tau protein, autophagy, mitophagy, apoptosis, and amyloid and tau protein transport genes. We report that neuronal death after cerebral ischemia due to cardiac arrest may be dependent and independent of caspase. Moreover, neuronal death dependent on amyloid and modified tau protein has been demonstrated. Finally, the results clearly indicate that changes in the expression of the presented genes play an important role in acute and secondary brain damage and the development of post-ischemic brain neurodegeneration with the Alzheimer's disease phenotype. The data indicate that the above genes may be a potential therapeutic target for brain therapy after ischemia due to cardiac arrest. Overall, the studies show that the genes studied represent attractive targets for the development of new therapies to minimize ischemic brain injury and neurological dysfunction. Additionally, amyloid-related genes expression and tau protein gene modification after cerebral ischemia due to cardiac arrest are useful in identifying ischemic mechanisms associated with Alzheimer's disease. Cardiac arrest illustrates the progressive, time- and area-specific development of neuropathology in the brain with the expression of genes responsible for the processing of amyloid protein precursor and the occurrence of tau protein and symptoms of dementia such as those occurring in patients with Alzheimer's disease. By carefully examining the common genetic processes involved in these two diseases, these data may help unravel phenomena associated with the development of Alzheimer's disease and neurodegeneration after cerebral ischemia and may lead future research on Alzheimer's disease or cerebral ischemia in new directions.
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Affiliation(s)
- Ryszard Pluta
- Department of Pathophysiology, Medical University of Lublin, 20-090 Lublin, Poland;
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15
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Jung E, Park JH, Ro YS, Ryu HH, Cha KC, Do Shin S, Hwang SO. Family history, socioeconomic factors, comorbidities, health behaviors, and the risk of sudden cardiac arrest. Sci Rep 2023; 13:21341. [PMID: 38049526 PMCID: PMC10696087 DOI: 10.1038/s41598-023-48357-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/25/2023] [Indexed: 12/06/2023] Open
Abstract
Genetic, environment, and behaviour factors have a role in causing sudden cardiac arrest (SCA). We aimed to determine the strength of the association between various risk factors and SCA incidence. We conducted a multicentre case-control study at 17 hospitals in Korea from September 2017 to December 2020. The cases included out-of-hospital cardiac arrest aged 19-79 years with presumed cardiac aetiology. Community-based controls were recruited at a 1:1 ratio after matching for age, sex, and urban residence level. Multivariable conditional logistic regression analysis was conducted. Among the 1016 cases and 1731 controls, 948 cases and 948 controls were analysed. A parental history of SCA, low educational level, own heart disease, current smoking, and non-regular exercise were associated with SCA incidence (Adjusted odds ratio [95% confidence interval]: 2.51 [1.48-4.28] for parental history of SCA, 1.37 [1.38-2.25] for low edication level, 3.77 [2.38-5.90] for non-coronary artery heart disease, 4.47 [2.84-7.03] for coronary artery disease, 1.39 [1.08-1.79] for current smoking, and 4.06 [3.29-5.02] for non-regular exercise). Various risk factors related to genetics, environment, and behaviour were independently associated with the incidence of SCA. Establishing individualised SCA prevention strategies in addition to general prevention strategies is warranted.
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Affiliation(s)
- Eujene Jung
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
| | - Jeong Ho Park
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea.
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea.
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Kyoung-Chul Cha
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, South Korea
- Department of Emergency Medicine, Seoul National University College of Medicine and Hospital, Seoul, South Korea
- Disaster Medicine Research Center, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, South Korea
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16
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Li B, Chen L, Zheng M, Yan P, Wang L, Feng S, Yin W, Zhang K, Zhang S, Chen X, Wang Z, Yuan H. Supra-Normal Left Ventricular Ejection Fraction as a Prognostic Marker for Long-Term Outcomes in Patients with Acute Coronary Syndrome. Int Heart J 2023; 64:979-985. [PMID: 37967991 DOI: 10.1536/ihj.22-661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Recently, the supra-normal left ventricular ejection fraction (snLVEF) has been proposed, based on extensive datasets indicating increased all-cause mortality in individuals with an LVEF exceeding 65%. However, the implications of an LVEF > 65% in the context of acute coronary syndrome (ACS) remain underexplored.The aim of the present study was to investigate the correlation between supra-normal left ventricular ejection fraction (snLVEF) and major adverse cardiovascular events (MACE) in patients with ACS.Methods: A total of 874 ACS patients (560 men, mean age 59.5 ± 10.0; 314 women, mean age 61.5 ± 8.9) who underwent their first coronary angiography during the period from March 2013 to October 2015 were divided into 2 groups: normal LVEF (nLVEF) (55% ≤ EF ≤ 65%) and snLVEF (EF > 65%), according to their echocardiography results. The patients were evaluated for MACE after surgery by collecting clinical data and long-term follow-up data. This correlation was further analyzed by Kaplan-Meier analysis and Cox regression analysis.The follow-up data revealed a significantly higher incidence of MACE among snLVEF patients compared to the nLVEF group (15.6% versus 7.4%; P = 0.020). This heightened risk persisted even after adjustment for multiple variables, indicating a strong association between snLVEF and increased MACE risk (HR: 2.346; 95% CI: 1.196-4.602; P = 0.013).SnLVEF was independently associated with poor prognosis after ACS. Enhanced management strategies for snLVEF patients could potentially reduce the incidence of MACE in ACS patients.
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Affiliation(s)
- Baona Li
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | - Liuxin Chen
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Man Zheng
- Department of Cardiology, Dongying People's Hospital
| | - Pengcheng Yan
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | - Leiyan Wang
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Shuai Feng
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Wenchao Yin
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
| | | | - Shaohui Zhang
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University
| | - Xueying Chen
- Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University
- Postdoctoral Mobile Station of Shandong University of Traditional Chinese Medicine
| | - Zhaoyang Wang
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
| | - Haitao Yuan
- Department of Cardiology, Shandong Provincial Hospital, Shandong University
- Department of Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University
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Ahmed A, Mewes JC, Lepage-Nefkens I, Tan HL, Vrijhoef HJM, for the ESCAPE-NET Investigators. Early modelling of the effects and healthcare costs of the Dutch citizen-rescuer system for out-of-hospital cardiac arrests. PLoS One 2023; 18:e0293965. [PMID: 37948427 PMCID: PMC10637662 DOI: 10.1371/journal.pone.0293965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/24/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVES 1) to analyse the total average healthcare costs of a patient with an out-of-hospital cardiac arrest (OHCA), as well as estimating the operational costs of the citizen-rescuer system (CRS); 2) to conduct an early modelling of the effects and healthcare costs of the Dutch CRS in comparison to no CRS. METHODS A health economic modelling study was conducted. Adult patients with OHCA from cardiac causes in the province of Limburg (the Netherlands) were included. The time horizon was from OHCA occurrence up to one year after hospital discharge. First, the total average healthcare costs of OHCA patients were analysed as well as the yearly operating costs of the CRS. Second, an early modelling was conducted to compare from the healthcare perspective the healthcare costs of OHCA patients with the CRS being activated but no responders attended (CRS-NV) versus the CRS being activated with attendance of ≥1 responder(s) (CRS-V). RESULTS The total average healthcare costs per patient are €42,533. The yearly operating costs for the CRS are approximately €1.5 million per year in the Netherlands. The early modelling of costs and effects showed that the incremental healthcare costs per patient thus were €4,131 in the CRS-V versus the CRS-NV group (€25,184 in the CRS-V group and €21,053 in the CRS-NV group). Incremental quality-adjusted life years (QALYs) was 5 per 100 patients (16 per 100 patients in the CRS-V group versus 11 per 100 patients in the CRS-NV group). The incremental cost-effectiveness ratio (ICER) was €79,662 per QALY for the CRS-V group. CONCLUSION This study shows that patients in the CSR-V group had additional health care costs of €4,131 per patient compared to patients in the CRS-NV group. This increase is caused by patients surviving more often, who then continue to utilise health services, which results in a (logic) increase in healthcare costs. For future research, accurate and up-to-date data on effectiveness and costs of the CRS needs to be collected.
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Affiliation(s)
- Anam Ahmed
- Panaxea B.V., Den Bosch, The Netherlands
| | | | | | - Hanno L. Tan
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC location AMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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18
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Jaramillo AP, Yasir M, Iyer N, Hussein S, Sn VP. Sudden Cardiac Death: A Systematic Review. Cureus 2023; 15:e42859. [PMID: 37664320 PMCID: PMC10473441 DOI: 10.7759/cureus.42859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Sudden cardiac death (SCD) is a condition that accounts for a high percentage of cardiovascular fatalities, with ventricular tachyarrhythmias being the most common cause. There are signs and symptoms of SCD that occur spontaneously without any warning and are deadly. Despite preventative efforts focusing on the use of subcutaneous implanted cardioverter defibrillators (S-ICD) in the highest-risk population categories, a high number of SCDs occur in the normal population and in people who do not have a documented cardiac condition. Therefore, primary prevention for SCD should be a more viable strategy for the general population, considering measures in the form of preventive medicine such as knowing more about any genetic predisposition, family history of any fatal arrhythmia, continuous surveillance after any syncope with unknown causes, etc. However, little data about SCD risk factors are known in comparison with other well-known diseases like ischemic heart disease and stroke. In search of medical databases for relevant medical literature, we looked at PubMed/Medline, the Cochrane Library, and Google Scholar. Thirteen publications were discovered after the papers were located, assessed, and qualifying criteria were applied. The finished articles were done to give an overview of SCD. Some others have shown that the major predisposition for SCD is related to the male gender, which increases the incidence if they have a family history of SCD. We described the importance of obstructive sleep apnea (OSA) as a comorbid condition. Patients with S-ICD and young athletes with a history of ventricular arrhythmia showed us that the predisposition for SCD can be higher than in the normal population. Based on the above, we concluded that more study is required to establish the most important approach for each of the risk factors mentioned in this systematic review in order to apply them in daily practice and have more knowledge about how to apply preventive and therapeutic medicine to the population at risk and the ones that already develop the disease.
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Affiliation(s)
| | - Mohamed Yasir
- Internal Medicine, Kursk State Medical University, Kursk, RUS
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nandhini Iyer
- Internal Medicine, Grant Government Medical College and Sir JJ Group of Hospitals, Mumbai, IND
| | - Sally Hussein
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Vijay Prabhu Sn
- Internal Medicine, Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, IND
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Boshen Y, Yuankang Z, Xinjie Z, Taixi L, Kaifan N, Zhixiang W, Juan S, Junli D, Suiji L, Xia L, Chengxing S. Triglyceride-glucose index is associated with the occurrence and prognosis of cardiac arrest: a multicenter retrospective observational study. Cardiovasc Diabetol 2023; 22:190. [PMID: 37501144 PMCID: PMC10375765 DOI: 10.1186/s12933-023-01918-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Triglyceride-glucose (TyG) index is an efficient indicator of insulin resistance and is proven to be a valuable marker in several cardiovascular diseases. However, the relationship between TyG index and cardiac arrest (CA) remains unclear. The present study aimed to investigate the association of the TyG index with the occurrence and clinical outcomes of CA. METHODS In this retrospective, multicenter, observational study, critically ill patients, including patients post-CA, were identified from the eICU Collaborative Research Database and evaluated. The TyG index for each patient was calculated using values of triglycerides and glucose recorded within 24 h of intensive care unit (ICU) admission. In-hospital mortality and ICU mortality were the primary clinical outcomes. Logistic regression, restricted cubic spline (RCS), and correlation analyses were performed to explore the relationship between the TyG index and clinical outcomes. Propensity score matching (PSM), overlap weighting (OW), and inverse probability of treatment weighting (IPTW) were adopted to balance the baseline characteristics of patients and minimize selection bias to confirm the robustness of the results. Subgroup analysis based on different modifiers was also performed. RESULTS Overall, 24,689 critically ill patients, including 1021 patients post-CA, were enrolled. The TyG index was significantly higher in patients post-CA than in those without CA (9.20 (8.72-9.69) vs. 8.89 (8.45-9.41)), and the TyG index had a moderate discrimination ability to identify patients with CA from the overall population (area under the curve = 0.625). Multivariate logistic regression indicated that the TyG index was an independent risk factor for in-hospital mortality (OR = 1.28, 95% CI: 1.03-1.58) and ICU mortality (OR = 1.27, 95% CI: 1.02-1.58) in patients post-CA. RCS curves revealed that an increased TyG index was linearly related to higher risks of in-hospital and ICU mortality (P for nonlinear: 0.225 and 0.271, respectively). Even after adjusting by PSM, IPTW, and OW, the TyG index remained a risk factor for in-hospital mortality and ICU mortality in patients experiencing CA, which was independent of age, BMI, sex, etc. Correlation analyses revealed that TyG index was negatively correlated with the neurological status of patients post-CA. CONCLUSION Elevated TyG index is significantly associated with the occurrence of CA and higher mortality risk in patients post-CA. Our findings extend the landscape of TyG index in cardiovascular diseases, which requires further prospective cohort study.
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Affiliation(s)
- Yang Boshen
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhu Yuankang
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Xinjie
- Department of Respiratory Medicine, The Fourth Affiliated Hospital, College of Medicine, Zhejiang University, Yiwu, China
| | - Li Taixi
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Niu Kaifan
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wang Zhixiang
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Song Juan
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China
| | - Duan Junli
- Institute for Developmental and Regenerative Cardiovascular Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Department of Gerontology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Suiji
- Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, China.
| | - Lu Xia
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Shen Chengxing
- Department of Cardiology, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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20
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Al-Emam AMA, Dajam A, Alrajhi M, Alfaifi W, Al-Shraim M, Helaly AM. Sudden death in the southern region of Saudi Arabia: A retrospective study. World J Clin Cases 2023; 11:4843-4851. [PMID: 37583982 PMCID: PMC10424041 DOI: 10.12998/wjcc.v11.i20.4843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND Sudden death is unanticipated, non-violent death taking place within the first 24 h after the onset of symptoms. It is a major public health problem worldwide. Moreover, the effects of living at moderate altitude on mortality are poorly understood. AIM To retrospectively report the frequency and the main causes of sudden deaths in relation to total deaths at Asir Central Hospital, 2255 m above sea level, in the southern region of Saudi Arabia over a period of 4 years from 2013 to 2016. METHODS The medical records of 1821 deaths were examined and showed 353 cases (19.4%) of sudden death. RESULTS The highest incidence of sudden death was among the elderly (51%), whereas, the lowest was among children and adolescents (6.5%). With regard to gender, the incidence of sudden death was higher in males (54.4%) compared to 45.6% in females. In this study, we found that the most common direct causes of sudden death were cardiovascular diseases (29.2%), respiratory disease (22.7%), infectious disease (12.2%), cancer (9.4%) and hematological diseases (6.2%). With respect to seasonal variation, the highest incidence was during winter (31.32%) followed by summer (25.8%). CONCLUSION The results of this study will help emergency physicians and health care providers to exercise due care to reduce the incidence of sudden death and raise public awareness about the impact of sudden death.
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Affiliation(s)
- Ahmed Mohamed Ahmed Al-Emam
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
| | | | - Mohammed Alrajhi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Waleed Alfaifi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
| | - Ahmed Mohamed Helaly
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
- Clinical Science, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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21
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Al-Emam AMA, Dajam A, Alrajhi M, Alfaifi W, Al-Shraim M, Helaly AM. Sudden death in the southern region of Saudi Arabia: A retrospective study. World J Clin Cases 2023; 11:4839-4847. [DOI: 10.12998/wjcc.v11.i20.4839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/08/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Sudden death is unanticipated, non-violent death taking place within the first 24 h after the onset of symptoms. It is a major public health problem worldwide. Moreover, the effects of living at moderate altitude on mortality are poorly understood.
AIM To retrospectively report the frequency and the main causes of sudden deaths in relation to total deaths at Asir Central Hospital, 2255 m above sea level, in the southern region of Saudi Arabia over a period of 4 years from 2013 to 2016.
METHODS The medical records of 1821 deaths were examined and showed 353 cases (19.4%) of sudden death.
RESULTS The highest incidence of sudden death was among the elderly (51%), whereas, the lowest was among children and adolescents (6.5%). With regard to gender, the incidence of sudden death was higher in males (54.4%) compared to 45.6% in females. In this study, we found that the most common direct causes of sudden death were cardiovascular diseases (29.2%), respiratory disease (22.7%), infectious disease (12.2%), cancer (9.4%) and hematological diseases (6.2%). With respect to seasonal variation, the highest incidence was during winter (31.32%) followed by summer (25.8%).
CONCLUSION The results of this study will help emergency physicians and health care providers to exercise due care to reduce the incidence of sudden death and raise public awareness about the impact of sudden death.
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Affiliation(s)
- Ahmed Mohamed Ahmed Al-Emam
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
| | | | - Mohammed Alrajhi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Waleed Alfaifi
- Medical School, King Khalid University, Asir 61421, Saudi Arabia
| | - Mubarak Al-Shraim
- Department of Pathology, College of Medicine, King Khalid University, Asir 61421, Saudi Arabia
| | - Ahmed Mohamed Helaly
- Forensic Medicine and Clinical Toxicology, Mansoura University, Mansoura 35516, Egypt
- Clinical Science, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan
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22
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Könemann H, Dagres N, Merino JL, Sticherling C, Zeppenfeld K, Tfelt-Hansen J, Eckardt L. Spotlight on the 2022 ESC guideline management of ventricular arrhythmias and prevention of sudden cardiac death: 10 novel key aspects. Europace 2023; 25:euad091. [PMID: 37102266 PMCID: PMC10228619 DOI: 10.1093/europace/euad091] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/13/2023] [Indexed: 04/28/2023] Open
Abstract
Sudden cardiac death and ventricular arrhythmias are a global health issue. Recently, a new guideline for the management of ventricular arrhythmias and prevention of sudden cardiac death has been published by the European Society of Cardiology that serves as an update to the 2015 guideline on this topic. This review focuses on 10 novel key aspects of the current guideline: As new aspects, public basic life support and access to defibrillators are guideline topics. Recommendations for the diagnostic evaluation of patients with ventricular arrhythmias are structured according to frequently encountered clinical scenarios. Management of electrical storm has become a new focus. In addition, genetic testing and cardiac magnetic resonance imaging significantly gained relevance for both diagnostic evaluation and risk stratification. New algorithms for antiarrhythmic drug therapy aim at improving safe drug use. The new recommendations reflect increasing relevance of catheter ablation of ventricular arrhythmias, especially in patients without structural heart disease or stable coronary artery disease with only mildly impaired ejection fraction and haemodynamically tolerated ventricular tachycardias. Regarding sudden cardiac death risk stratification, risk calculators for laminopathies, and long QT syndrome are now considered besides the already established risk calculator for hypertrophic cardiomyopathy. Generally, 'new' risk markers beyond left ventricular ejection fraction are increasingly considered for recommendations on primary preventive implantable cardioverter defibrillator therapy. Furthermore, new recommendations for diagnosis of Brugada syndrome and management of primary electrical disease have been included. With many comprehensive flowcharts and practical algorithms, the new guideline takes a step towards a user-oriented reference book.
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Affiliation(s)
- Hilke Könemann
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
| | - Nikolaos Dagres
- Department of Cardiac Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - José Luis Merino
- Cardiology Department, La Paz University Hospital, Madrid, Spain
| | | | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob Tfelt-Hansen
- Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Eckardt
- Department of Cardiology II: Electrophysiology, University Hospital Münster, Albert-Schweitzer Campus 1, 48149 Münster, Germany
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23
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Sefton C, Keen S, Tybout C, Lin FC, Jiang H, Joodi G, Williams JG, Simpson RJ. Characteristics of sudden death by clinical criteria. Medicine (Baltimore) 2023; 102:e33029. [PMID: 37083784 PMCID: PMC10118332 DOI: 10.1097/md.0000000000033029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/30/2023] [Indexed: 04/22/2023] Open
Abstract
Sudden death is a leading cause of deaths nationally. Definitions of sudden death vary greatly, resulting in imprecise estimates of its frequency and incomplete knowledge of its risk factors. The degree to which time-based and coronary artery disease (CAD) criteria impacts estimates of sudden death frequency and risk factors is unknown. Here, we apply these criteria to a registry of all-cause sudden death to assess its impact on sudden death frequency and risk factors. The sudden unexpected death in North Carolina (SUDDEN) project is a registry of out of-hospital, adjudicated, sudden unexpected deaths attended by Emergency Medical Services. Deaths were not excluded by time since last seen or alive or by prior symptoms or diagnosis of CAD. Common criteria for sudden death based on time since last seen alive (both 24 hours and 1 hour) and prior diagnosis of CAD were applied to the SUDDEN case registry. The proportion of cases satisfying each of the 4 criteria was calculated. Characteristics of victims within each restrictive set of criteria were measured and compared to the SUDDEN registry. There were 296 qualifying sudden deaths. Application of 24 hour and 1 hour timing criteria compared to no timing criteria reduced cases by 25.0% and 69.6%, respectively. Addition of CAD criteria to each timing criterion further reduced qualifying cases, for a total reduction of 81.8% and 90.5%, respectively. However, characteristics among victims meeting restrictive criteria remained similar to the unrestricted population. Timing and CAD criteria dramatically reduces estimates of the number of sudden deaths without significantly impacting victim characteristics.
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Affiliation(s)
- Christopher Sefton
- Internal Medicine Residency Program, Cleveland Clinic Foundation, Cleveland, OH
| | - Susan Keen
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Caroline Tybout
- Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Feng-Chang Lin
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Huijun Jiang
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC
| | - Golsa Joodi
- Division of Cardiology, University of California, Los Angeles, CA
| | | | - Ross J. Simpson
- Division of Cardiology, University of North Carolina, Chapel Hill, NC
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24
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Koivunen M, Tynkkynen J, Oksala N, Eskola M, Hernesniemi J. Incidence of sudden cardiac arrest and sudden cardiac death after unstable angina pectoris and myocardial infarction. Am Heart J 2023; 257:9-19. [PMID: 36384178 DOI: 10.1016/j.ahj.2022.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/28/2022] [Accepted: 11/02/2022] [Indexed: 05/11/2023]
Abstract
BACKGROUND Sudden cardiac arrests (SCA) and sudden cardiac deaths (SCD) are believed to account for a large proportion of deaths due to cardiovascular causes. The purpose of this study is to provide comprehensive information on the epidemiology of SCAs and SCDs after acute coronary syndrome. METHODS The incidence of SCA (including SCDs) was studied retrospectively among 10,316 consecutive patients undergoing invasive evaluation for acute coronary syndrome (ACS) between 2007 and 2018 at Tays Heart Hospital (sole provider of specialized cardiac care for a catchment area of over 0.5 million residents). Baseline and follow-up information was collected by combining information from the hospital's electronic health records, death certificate data, and a full-disclosure review of written patient records and accounts of the circumstances leading to death. RESULTS During 12 years of follow-up, the cumulative incidence of SCAs (including SCDs) was 9.8% (0.8% annually) and that of SCDs 5.4% (0.5% annually). Cumulative incidence of SCAs in patients with ST-elevation myocardial infarction, non-ST-elevation myocardial infarction and unstable angina pectoris were: 11.9%,10.2% and 5.7% at 12 years. SCAs accounted for 30.5% (n = 528/1,732) of all deaths due to cardiovascular causes. The vast majority of SCAs (95.6%) occurred in patients without implantable cardioverter defibrillator (ICD) devices or among patients with no recurrent hospitalizations for coronary artery disease (89.1%). CONCLUSIONS SCAs accounted for less than a third of all deaths due to cardiovascular causes among patients with previous ACS. Incidence of SCA is highest among STEMI and NSTEMI patients. After the hospital discharge, most of SCAs happen to NSTEMI patients.
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Affiliation(s)
- Minna Koivunen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Juho Tynkkynen
- Department of Radiology, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Department of Surgery, Division of Vascular Surgery, Tampere University Hospital, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland
| | - Markku Eskola
- Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Finnish Cardiovascular Research Center Tampere, Faculty of Medicine and Health Techonology, Tampere University, Tampere, Finland; Heart Center, Department of Cardiology, Tampere University Hospital, Tampere, Finland
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25
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Mahfooz K, Vasavada AM, Joshi A, Pichuthirumalai S, Andani R, Rajotia A, Hans A, Mandalia B, Dayama N, Younas Z, Hafeez N, Bheemisetty N, Patel Y, Tumkur Ranganathan H, Sodala A. Waterpipe Use and Its Cardiovascular Effects: A Systematic Review and Meta-Analysis of Case-Control, Cross-Sectional, and Non-Randomized Studies. Cureus 2023; 15:e34802. [PMID: 36915837 PMCID: PMC10008028 DOI: 10.7759/cureus.34802] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 02/09/2023] [Indexed: 02/11/2023] Open
Abstract
Approximately 100 million people globally smoke cigarettes, making it a significant and quickly spreading global tobacco epidemic. Substance use disorders are frequently evaluated by non-randomized studies. Tobacco use and its impacts on the cardiovascular system were the subjects of a comprehensive search across five electronic databases: Cochrane, MEDLINE, Scopus, Embase, and PubMed. The findings demonstrated that waterpipe smokers in comparison to non-smokers have immediate elevations in heart rate and blood pressure, lower levels of high-density lipoprotein, higher levels of low-density lipoprotein, higher levels of triglycerides, higher levels of fasting blood glucose, and a higher heart rate. Users of waterpipes and cigarettes had similar average heart rates, blood pressure, and lipid levels, with the exception that waterpipe smokers had greater total cholesterol. Smoking a waterpipe has significant negative effects on the cardiovascular system comparable to cigarette smoking, and non-randomized studies proved to yield substantial evidence related to its cardiovascular effects. Such study designs can be used to evaluate substance use and its cardiovascular impact.
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Affiliation(s)
- Kamran Mahfooz
- Internal Medicine, Lincoln Medical Center, New York, USA
| | - Advait M Vasavada
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
| | - Arpit Joshi
- Medicine, B. J. (Byramjee Jeejeebhoy) Medical, Ahmedabad, IND
| | | | - Rupesh Andani
- Internal Medicine, Jeevandhara Hospital, Jamnagar, IND
| | | | - Aakash Hans
- Internal Medicine, Henry Ford Health System, Detroit, USA
| | - Bilvesh Mandalia
- House Officer, Lokmanya Tilak Municipal General Hospital and Medical College, Sion Mumbai, Mumbai, IND
| | - Neeraj Dayama
- Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, USA
| | - Zara Younas
- Medicine, King Edward Medical University, Lahore, PAK
| | | | - Niharika Bheemisetty
- Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Yash Patel
- Medicine, Gujarat Cancer Society Medical College, Ahmedabad, IND
| | | | - Ashok Sodala
- Medicine, Shri M. P. Shah Government Medical College, Jamnagar, IND
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26
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Kim YG, Han KD, Roh SY, Jeong JH, Choi YY, Min K, Shim J, Choi JI, Kim YH. Being Underweight Is Associated with Increased Risk of Sudden Cardiac Death in People with Diabetes Mellitus. J Clin Med 2023; 12:jcm12031045. [PMID: 36769693 PMCID: PMC9917578 DOI: 10.3390/jcm12031045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/22/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) can cause various atherosclerotic cardiovascular disease including sudden cardiac death (SCD). The impact of being underweight on the risk of SCD in people with DM remains to be revealed. We aimed to evaluate the risk of SCD according to body-mass index (BMI; kg/m2) level in DM population. METHODS We used a nationwide healthcare insurance database to conduct this study. We identified people with DM among those who underwent nationwide health screening during 2009 to 2012. Medical follow-up data was available until December 2018. RESULTS A total of 2,602,577 people with DM with a 17,851,797 person*year follow-up were analyzed. The underweight group (BMI < 18.5) showed 2.4-fold increased risk of SCD during follow-up (adjusted-hazard ratio [HR] = 2.40; 95% confidence interval [CI] = 2.26-2.56; p < 0.001). When normal-BMI group (18.5 ≤ BMI < 23) was set as a reference, underweight group (adjusted-HR = 2.01; 95% CI = 1.88-2.14) showed even higher risk of SCD compared with the obesity group (BMI ≥ 30; adjusted-HR = 0.89; 95% CI = 0.84-0.94). When BMI was stratified by one unit, BMI and SCD risk showed a U-curve association with the highest risk observed at low BMI levels. The lowest risk was observed in 27 ≤ BMI < 28 group. The association between being underweight and increased SCD risk in DM people was maintained throughout various subgroups. CONCLUSIONS Being underweight is significantly associated with an increased risk of SCD in the DM population. A steep rise in the risk of SCD was observed as the BMI level decreased below 23. The lowest risk of SCD was observed in 27 ≤ BMI < 28 group.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Guro Hospital, Seoul 08308, Republic of Korea
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Kyongjin Min
- Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul 01757, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
- Correspondence: ; Tel.: +82-2-920-5445; Fax: +82-2-927-1478
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Korea University Anam Hospital, Seoul 02841, Republic of Korea
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27
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Shenfu Injection Protects Brain Injury in Rats with Cardiac Arrest through Nogo/NgR Pathway. Anal Cell Pathol (Amst) 2022; 2022:4588999. [PMID: 36600931 PMCID: PMC9807299 DOI: 10.1155/2022/4588999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/23/2022] [Accepted: 11/19/2022] [Indexed: 12/27/2022] Open
Abstract
The effect of Shenfu injection on brain injury after cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) along with the underlying mechanism of axonal regeneration was explored. CA/CPR model in rats was established for subsequent experiments. A total of 160 rats were randomly divided into sham group, model group, conventional western medicine (CWM) group, Shenfu group, and antagonist group (n = 32 per group). After 3 hours, 24 hours, 3 days, and 7 days of drug administration, the modified Neurological Severity Score tests were performed. The ultrastructure of the brain and hippocampus was observed by electron microscopy. Real-time quantitative polymerase chain reaction (PCR), western blotting, and immunohistochemistry were used to detect Nogo receptor (NgR) expression in the hippocampus and cerebral cortex, and Nogo-NgR expression in CA/CPR model. Neurological deficits in the model group were severe at 3 hours, 24 hours, 3 days, and 7 days after the recovery of natural circulation, whereas the neurological deficits in CWM, antagonist, and Shenfu group were relatively mild. The ultrastructure of neuronal cells in Shenfu group had relatively complete cell membranes and more vesicles than those in the model group. The results of PCR and western blotting showed lower messenger ribonucleic acid and protein expression of NgR in Shenfu group than the model group and CWM group. Immunohistochemical examination indicated a reduction of Nogo-NgR expression in Shenfu group and antagonist group. Our results suggested that Shenfu injection reduced brain injury by attenuating Nogo-NgR signaling pathway and promoting axonal regeneration.
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28
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Girolami F, Spinelli V, Maurizi N, Focardi M, Nesi G, Maio V, Grifoni R, Albora G, Bertaccini B, Targetti M, Coppini R, Favilli S, Olivotto I, Cerbai E. Genetic characterization of juvenile sudden cardiac arrest and death in Tuscany: The ToRSADE registry. Front Cardiovasc Med 2022; 9:1080608. [PMID: 36588553 PMCID: PMC9795053 DOI: 10.3389/fcvm.2022.1080608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Background Sudden cardiac arrest (SCA) in young people represents a dramatic event, often leading to severe neurologic outcomes or sudden cardiac death (SCD), and is frequently caused by genetic heart diseases. In this study, we report the results of the Tuscany registry of sudden cardiac death (ToRSADE) registry, aimed at monitoring the incidence and investigating the genetic basis of SCA and SCD occurring in subjects < 50 years of age in Tuscany, Italy. Methods and results Creation of the ToRSADE registry allowed implementation of a repository for clinical, molecular and genetic data. For 22 patients, in whom a genetic substrate was documented or suspected, blood samples could be analyzed; 14 were collected at autopsy and 8 from resuscitated patients after SCA. Next generation sequencing (NGS) analysis revealed likely pathogenetic (LP) variants associated with cardiomyopathy (CM) or channelopathy in four patients (19%), while 17 (81%) carried variants of uncertain significance in relevant genes (VUS). In only one patient NGS confirmed the diagnosis obtained during autopsy: the p.(Asn480Lysfs*20) PKP2 mutation in a patient with arrhythmogenic cardiomyopathy (AC). Conclusion Systematic genetic screening allowed identification of LP variants in 19% of consecutive patients with SCA/SCD, including subjects carrying variants associated with hypertrophic cardiomyopathy (HCM) or AC who had SCA/SCD in the absence of structural cardiomyopathy phenotype. Genetic analysis combined with clinical information in survived patients and post-mortem evaluation represent an essential multi-disciplinary approach to manage juvenile SCD and SCA, key to providing appropriate medical and genetic assistance to families, and advancing knowledge on the basis of arrhythmogenic mechanisms in inherited cardiomyopathies and channelopathies.
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Affiliation(s)
- Francesca Girolami
- Cardiology Unit, Meyer Children’s University Hospital, Florence, Italy,*Correspondence: Francesca Girolami,
| | - Valentina Spinelli
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | | | - Martina Focardi
- Careggi University Hospital, Florence, Italy,Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriella Nesi
- Careggi University Hospital, Florence, Italy,Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenza Maio
- Careggi University Hospital, Florence, Italy,Division of Pathological Anatomy, Department of Health Sciences, University of Florence, Florence, Italy
| | - Rossella Grifoni
- Careggi University Hospital, Florence, Italy,Forensic Medical Sciences, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Bruno Bertaccini
- Department of Statistics, Computer Science, Applications, University of Florence, Florence, Italy
| | | | - Raffaele Coppini
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Silvia Favilli
- Cardiology Unit, Meyer Children’s University Hospital, Florence, Italy
| | - Iacopo Olivotto
- Cardiology Unit, Meyer Children’s University Hospital, Florence, Italy,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Elisabetta Cerbai
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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Paratz ED, van Heusden A, Zentner D, Morgan N, Smith K, Thompson T, James P, Connell V, Pflaumer A, Semsarian C, Ingles J, Parsons S, Stub D, Gerche AL. Causes, circumstances, and potential preventability of cardiac arrest in the young: insights from a state-wide clinical and forensic registry. Europace 2022; 24:1933-1941. [PMID: 36037012 DOI: 10.1093/europace/euac141] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 07/21/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS The causes, circumstances, and preventability of young sudden cardiac arrest remain uncertain. METHODS AND RESULTS A prospective state-wide multi-source registry identified all out-of-hospital cardiac arrests (OHCAs) in 1-50 year olds in Victoria, Australia, from 2019 to 2021. Cases were adjudicated using hospital and forensic records, clinic assessments and interviews of survivors and family members. For confirmed cardiac causes of OHCA, circumstances and cardiac history were collected. National time-use data was used to contextualize circumstances. 1319 OHCAs were included. 725 (55.0%) cases had a cardiac aetiology of OHCA, with coronary disease (n = 314, 23.8%) the most common pathology. Drug toxicity (n = 226, 17.1%) was the most common non-cardiac cause of OHCA and the second-most common cause overall. OHCAs were most likely to occur in sleep (n = 233, 41.2%). However, when compared to the typical Australian day, OHCAs occurred disproportionately more commonly during exercise (9% of patients vs. 1.3% of typical day, P = 0.018) and less commonly while sedentary (39.6 vs. 54.6%, P = 0.047). 38.2% of patients had known standard modifiable cardiovascular risk factors. 77% of patients with a cardiac cause of OHCA had not reported cardiac symptoms nor been evaluated by a cardiologist prior to their OHCA. CONCLUSION Approximately half of OHCAs in the young have a cardiac cause, with coronary disease and drug toxicity dominant aetiologies. OHCAs disproportionately occur during exercise. Of patients with cardiac cause of OHCA, almost two-thirds have no standard modifiable cardiovascular risk factors, and more than three-quarters had no prior warning symptoms or interaction with a cardiologist.
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Affiliation(s)
- Elizabeth D Paratz
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
| | | | - Dominica Zentner
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia.,Royal Melbourne Hospital Clinical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC 3000, Australia
| | - Natalie Morgan
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Karen Smith
- Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Department of Paramedicine, Monash University, Melbourne, VIC, Australia
| | - Tina Thompson
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Paul James
- Royal Melbourne Hospital, 300 Grattan St, Parkville, VIC 3050, Australia
| | - Vanessa Connell
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, 50 Flemington Rd, Parkville Melbourne, VIC 3052, Australia.,Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Rd, Parkville, VIC 3052, Australia.,Department of Paediatrics, Melbourne University, Parkville, VIC 3010, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Missenden Rd, Sydney, NSW 2050, Australia
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, NSW, Australia.,Centre for Population Genomics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Sarah Parsons
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, VIC 3006, Australia.,Department of Forensic Medicine, Monash University, 65 Kavanagh St, Southbank, VIC 3006, Australia
| | - Dion Stub
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,Ambulance Victoria, 375 Manningham Rd, Doncaster, VIC 3108, Australia.,Department of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Andre La Gerche
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Prahran, VIC 3181, Australia.,Alfred Hospital, 55 Commercial Rd, Prahran, VIC 3181, Australia.,St Vincent's Hospital Melbourne, 41 Victoria Pde, Fitzroy, VIC 3065, Australia
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30
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 1317] [Impact Index Per Article: 439.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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31
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Müller P, Leow MKS, Dietrich JW. Minor perturbations of thyroid homeostasis and major cardiovascular endpoints—Physiological mechanisms and clinical evidence. Front Cardiovasc Med 2022; 9:942971. [PMID: 36046184 PMCID: PMC9420854 DOI: 10.3389/fcvm.2022.942971] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
It is well established that thyroid dysfunction is linked to an increased risk of cardiovascular morbidity and mortality. The pleiotropic action of thyroid hormones strongly impacts the cardiovascular system and affects both the generation of the normal heart rhythm and arrhythmia. A meta-analysis of published evidence suggests a positive association of FT4 concentration with major adverse cardiovascular end points (MACE), but this association only partially extends to TSH. The risk for cardiovascular death is increased in both subclinical hypothyroidism and subclinical thyrotoxicosis. Several published studies found associations of TSH and FT4 concentrations, respectively, with major cardiovascular endpoints. Both reduced and elevated TSH concentrations predict the cardiovascular risk, and this association extends to TSH gradients within the reference range. Likewise, increased FT4 concentrations, but high-normal FT4 within its reference range as well, herald a poor outcome. These observations translate to a monotonic and sensitive effect of FT4 and a U-shaped relationship between TSH and cardiovascular risk. Up to now, the pathophysiological mechanism of this complex pattern of association is poorly understood. Integrating the available evidence suggests a dual etiology of elevated FT4 concentration, comprising both ensuing primary hypothyroidism and a raised set point of thyroid function, e. g. in the context of psychiatric disease, chronic stress and type 2 allostatic load. Addressing the association between thyroid homeostasis and cardiovascular diseases from a systems perspective could pave the way to new directions of research and a more personalized approach to the treatment of patients with cardiovascular risk.
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Affiliation(s)
- Patrick Müller
- Department for Electrophysiology, Medical Hospital I, Klinikum Vest, Recklinghausen, NRW, Germany
| | - Melvin Khee-Shing Leow
- Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (ASTAR), Singapore, Singapore
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore
- Metabolic Disorders Research Programme, Lee Kong Chian School of Medicine, Singapore, Singapore
- Cardiovascular and Metabolic Disorders Program, Duke-NUS Medical School, Singapore, Singapore
| | - Johannes W. Dietrich
- Diabetes, Endocrinology and Metabolism Section, Department of Internal Medicine I, St. Josef Hospital, Ruhr University Bochum, Bochum, NRW, Germany
- Diabetes Centre Bochum/Hattingen, St. Elisabeth-Hospital Blankenstein, Hattingen, NRW, Germany
- Centre for Rare Endocrine Diseases, Ruhr Centre for Rare Diseases (CeSER), Ruhr University Bochum and Witten/Herdecke University, Bochum, NRW, Germany
- Centre for Diabetes Technology, Catholic Hospitals Bochum, Ruhr University Bochum, Bochum, NRW, Germany
- *Correspondence: Johannes W. Dietrich
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32
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Hypertension and diabetes including their earlier stage are associated with increased risk of sudden cardiac arrest. Sci Rep 2022; 12:12307. [PMID: 35854061 PMCID: PMC9296606 DOI: 10.1038/s41598-022-16543-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 07/12/2022] [Indexed: 11/21/2022] Open
Abstract
Sudden cardiac arrest (SCA) is a medical disaster for both the victim and the society. Despite intrinsic limitations in the management of SCA, primary prevention has been overlooked and risk factors for SCA are not fully understood. We aimed to evaluate whether hypertension and diabetes mellitus (DM), including pre-hypertension and impaired fasting glucose (IFG), are associated with increased risk of SCA. We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 were enrolled. The risk of SCA was evaluated in people with hypertension and DM with a clinical follow-up through December 2018. A total of 4,056,423 people with 33,345,378 person-years of follow-up and 16,352 SCA events were examined. People with hypertension had 65.4% increased risk of SCA (adjusted hazard ratio [HR] = 1.654 [1.572–1.739]; p < 0.001). Pre-hypertension was also associated with 21.3% increased risk of SCA (adjusted HR = 1.213 [1.158–1.272]; p < 0.001). People who had IFG and DM showed 7.5% (adjusted HR = 1.075 [1.035–1.117]; p < 0.001) and 80.1% (adjusted HR = 1.801 [1.731–1.875]; p < 0.001) increased risk of SCA, respectively. People with DM who took anti-diabetic medication showed significantly lower risk of SCA compared with uncontrolled DM patients (fasting glucose ≥ 200 mg/dL) (adjusted HR = 0.625 [0.533–0.733]; p < 0.001). Coexistence of hypertension and DM was associated with an even higher risk of SCA (adjusted HR = 3.078 [2.877–3.293]; p < 0.001). In conclusion, the risk of SCA is significantly higher in people with hypertension and DM, including pre-hypertension and IFG. Adequate control of blood pressure and serum glucose can have a profound impact for the primary prevention of SCA in the general population.
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33
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Trends in Sudden Death Following Admission for Acute Heart Failure. Am J Cardiol 2022; 178:89-96. [PMID: 35831216 DOI: 10.1016/j.amjcard.2022.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/07/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
Few studies on sudden death (SD) after admission for acute heart failure (AHF) have been published. A total of 1,664 patients with AHF were enrolled in this study, and 1,261 patients who were successfully followed up during the first year after admission were analyzed. The primary end point was SD, which was defined as out-of-hospital cardiac arrest. The median follow-up period from admission was 1,008 days (range 408 to 2,132). In total, 505 patients (40.0%) died: 341 (67.5%) died of cardiovascular causes and 55 (10.9%) died of other causes. Of the 505 who died, 80 (15.8%) experienced SD. The proportion of SDs increased in the later phases of follow-up (0 to 1 year, 10.3%; 1 to 2 years, 18.0%; 2 to 5 years, 18.8%; ≥5 years, 28.2%; p <0.001). A multivariate logistic regression model showed that younger age was independently associated with SD (60 to 69 years: odds ratio 2.249, 95% confidence interval 1.060 to 4.722; <60 years: odds ratio 3.863, 95% confidence interval 1.676 to 8.905). Kaplan-Meier curves showed that the incidence of cardiovascular death was highest during the acute phase, whereas the incidence of SD increased gradually over the entire follow-up period. In conclusion, the incidence of SD was surprisingly high in patients with AHF, accounting for 16% of long-term mortality. The proportion of SDs increased during the very late follow-up phases.
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34
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Orphanou N, Papatheodorou E, Anastasakis A. Dilated cardiomyopathy in the era of precision medicine: latest concepts and developments. Heart Fail Rev 2022; 27:1173-1191. [PMID: 34263412 PMCID: PMC8279384 DOI: 10.1007/s10741-021-10139-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/27/2022]
Abstract
Dilated cardiomyopathy (DCM) is an umbrella term entailing a wide variety of genetic and non-genetic etiologies, leading to left ventricular systolic dysfunction and dilatation, not explained by abnormal loading conditions or coronary artery disease. The clinical presentation can vary from asymptomatic to heart failure symptoms or sudden cardiac death (SCD) even in previously asymptomatic individuals. In the last 2 decades, there has been striking progress in the understanding of the complex genetic basis of DCM, with the discovery of additional genes and genotype-phenotype correlation studies. Rigorous clinical work-up of DCM patients, meticulous family screening, and the implementation of advanced imaging techniques pave the way for a more efficient and earlier diagnosis as well as more precise indications for implantable cardioverter defibrillator implantation and prevention of SCD. In the era of precision medicine, genotype-directed therapies have started to emerge. In this review, we focus on updates of the genetic background of DCM, characteristic phenotypes caused by recently described pathogenic variants, specific indications for prevention of SCD in those individuals and genotype-directed treatments under development. Finally, the latest developments in distinguishing athletic heart syndrome from subclinical DCM are described.
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Affiliation(s)
- Nicoletta Orphanou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece.
- Cardiology Department, Athens General Hospital "G. Gennimatas", Athens, Greece.
| | - Efstathios Papatheodorou
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
| | - Aris Anastasakis
- Unit of Inherited and Rare Cardiovascular Diseases, Onassis Cardiac Surgery Center, Athens, Greece
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35
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Kim YG, Han K, Jeong JH, Roh SY, Choi YY, Min K, Shim J, Choi JI, Kim YH. Metabolic Syndrome, Gamma-Glutamyl Transferase, and Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11071781. [PMID: 35407389 PMCID: PMC8999874 DOI: 10.3390/jcm11071781] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/17/2022] [Accepted: 03/20/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Metabolic syndrome is associated with a significantly increased risk of sudden cardiac death (SCD). However, whether temporal changes in the metabolic syndrome status are associated with SCD is unknown. We aimed to determine whether metabolic syndrome and gamma-glutamyl transferase (ɣ-GTP), including their temporal changes, are associated with the risk of SCD. Methods: We performed a nationwide population-based analysis using the Korean National Health Insurance Service. People who underwent a national health check-up in 2009 and 2011 were enrolled. The influence of metabolic syndrome and ɣ-GTP on SCD risk was evaluated. Results: In 2009, 4,056,423 (848,498 with metabolic syndrome) people underwent health screenings, 2,706,788 of whom underwent follow-up health screenings in 2011. Metabolic syndrome was associated with a 50.7% increased SCD risk (adjusted hazard ratio (aHR) = 1.507; p < 0.001). The SCD risk increased linearly as the metabolic syndrome diagnostic criteria increased. The ɣ-GTP significantly impacted the SCD risk; the highest quartile had a 51.9% increased risk versus the lowest quartile (aHR = 1.519; p < 0.001). A temporal change in the metabolic syndrome status and ɣ-GTP between 2009 and 2011 was significantly correlated with the SCD risk. Having metabolic syndrome in 2009 or 2011 indicated a lower SCD risk than having metabolic syndrome in 2009 and 2011 but a higher risk than having no metabolic syndrome. People with a ≥20-unit increase in ɣ-GTP between 2009 and 2011 had an 81.0% increased SCD risk versus those with a change ≤5 units (aHR = 1.810; p < 0.001). Conclusions: Metabolic syndrome and ɣ-GTP significantly correlated with an increased SCD risk. SCD was also influenced by temporal changes in the metabolic syndrome status and ɣ-GTP, suggesting that appropriate medical treatment and lifestyle modifications may reduce future SCD risk.
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Affiliation(s)
- Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Korea;
| | - Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Kyongjin Min
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
- Correspondence: ; Tel.: +82-2-920-5445; Fax: +82-2-927-1478
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea; (Y.G.K.); (J.H.J.); (S.-Y.R.); (Y.Y.C.); (K.M.); (J.S.); (Y.-H.K.)
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Corianò M, Tona F. Strategies for Sudden Cardiac Death Prevention. Biomedicines 2022; 10:639. [PMID: 35327441 PMCID: PMC8944952 DOI: 10.3390/biomedicines10030639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/06/2022] [Accepted: 03/06/2022] [Indexed: 12/12/2022] Open
Abstract
Sudden cardiac death (SCD) represents a major challenge in modern medicine. The prevention of SCD orbits on two levels, the general population level and individual level. Much research has been done with the aim to improve risk stratification of SCD, although no radical changes in evidence and in therapeutic strategy have been achieved. Artificial intelligence (AI), and in particular machine learning (ML) models, represent novel technologic tools that promise to improve predictive ability of fatal arrhythmic events. In this review, firstly, we analyzed the electrophysiological basis and the major clues of SCD prevention at population and individual level; secondly, we reviewed the main research where ML models were used for risk stratification in other field of cardiology, suggesting its potentiality in the field of SCD prevention.
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Affiliation(s)
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
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37
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Bonilla Jassir JC, Parra Medina R, Polo Nieto JF, Rocha Aguirre JE, Téllez Rodríguez JP, Cháves JJ, Nieto PD, Campuzano Larrea O, Sarquella Brugada G, Brugada J, Brugada Tarradellas R. Análisis clínico e histopatológico de la prevalencia de enfermedades cardiacas en muerte súbita. Estudio en autopsias. REPERTORIO DE MEDICINA Y CIRUGÍA 2022. [DOI: 10.31260/repertmedcir.01217372.1244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: un evento de muerte súbita supone un gran impacto para la sociedad, siendo importante su estudio para aportar conocimiento y fortalecer estrategias de promoción y prevención. Objetivo: determinar la prevalencia de los diagnósticos anatomopatológicos cardiacos definitivos y los hallazgos histopatológicos asociados con la muerte súbita de origen cardíaco en los pacientes sometidos a autopsias clínicas realizadas en el Hospital de San José de Bogotá DC, Colombia, durante el período 2015 a 2018. Métodos: estudio descriptivo de corte transversal retrospectivo en pacientes a quienes se les realizó autopsia con diagnóstico de muerte súbita de origen cardiovascular en el servicio de patología del Hospital de San José, Bogotá DC, Colombia. Resultados: se incluyeron 178 autopsias con diagnóstico de muerte súbita cardíaca. El promedio global de edad fue 56.1 años (DE: 15.06) con una relación hombre-mujer de 3:1. El hallazgo macroscópico más frecuente fue cardiomegalia (promedio 428.1 g (DE 112.8), acompañado de la presencia de coronariopatía esclerótica (p=0.000) con obstrucción de la luz de las arterias coronarias mayores de 80% (p=0.037). Conclusiones: los diagnósticos anatomopatológicos definitivos prevalentes en la muerte súbita cardiaca fueron cardiopatía isquémica crónica complicada (65%) e infarto agudo de miocardio (16%), datos similares a los reportados a nivel mundial. La cardiomegalia es un hallazgo frecuente que debe valorarse en forma cuidadosa.
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38
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Warming PE, Ågesen FN, Lynge TH, Jabbari R, Smits RL, van Valkengoed IG, Welten SJ, van der Heijden AA, Elders PJ, Blom MT, Jouven X, Schwartz PJ, Albert CM, Beulens JW, Rutters F, Tan HL, Empana JP, Tfelt-Hansen J. Harmonization of the definition of sudden cardiac death in longitudinal cohorts of the European Sudden Cardiac Arrest network - towards Prevention, Education, and New Effective Treatments (ESCAPE-NET) consortium. Am Heart J 2022; 245:117-125. [PMID: 34936862 DOI: 10.1016/j.ahj.2021.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 12/10/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of sudden cardiac death (SCD) in the general population is substantial and SCD frequently occurs among people with few or no known risk factors for cardiac disease. Reported incidences of SCD vary due to differences in definitions and methodology between cohorts. This study aimed to develop a method for adjudicating SCD cases in research settings and to describe uniform case definitions of SCD in an international consortium harmonizing multiple longitudinal study cohorts. METHODS The harmonized SCD definitions include both case definitions using data from multiple sources (eg, autopsy reports, medical history, eyewitnesses) as well as a method using only information from registers (eg, cause of death registers, ICD-10 codes). Validation of the register-based method was done within the consortium using the multiple sources definition as gold standard and presenting sensitivity, specificity, accuracy and positive predictive value. RESULTS Consensus definitions of "definite," "possible" and "probable" SCD for longitudinal study cohorts were reached. The definitions are based on a stratified approach to reflect the level of certainty of diagnosis and degree of information. The definitions can be applied to both multisource and register-based methods. Validation of the method using register-information in a cohort comprising 1335 cases yielded a sensitivity of 74%, specificity of 88%, accuracy of 86%, and positive predictive value of 54%. CONCLUSIONS This study demonstrated that a harmonization of SCD classification across different methodological approaches is feasible. The developed classification can be used to study SCD in longitudinal cohorts and to merge cohorts with different levels of information.
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Scheiper-Welling S, Tabunscik M, Gross TE, Jenewein T, Beckmann BM, Niess C, Gradhand E, Wunder C, Schneider PM, Rothschild MA, Verhoff MA, Kauferstein S. Variant interpretation in molecular autopsy: a useful dilemma. Int J Legal Med 2022; 136:475-482. [PMID: 35091851 PMCID: PMC8847204 DOI: 10.1007/s00414-021-02764-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
Abstract
Sudden cardiac death (SCD) in adolescents and young adults may be the first manifestation of an inherited arrhythmic syndrome. Thus identification of a genetic origin in sudden death cases deemed inconclusive after a comprehensive autopsy and may help to reduce the risk of lethal episodes in the remaining family. Using next-generation sequencing (NGS), a large number of variants of unknown significance (VUS) are detected. In the majority of cases, there is insufficient evidence of pathogenicity, representing a huge dilemma in current genetic investigations. Misinterpretation of such variants may lead to inaccurate genetic diagnoses and/or the adoption of unnecessary and/or inappropriate therapeutic approaches. In our study, we applied current (ACMG) recommendations for variant classification in post-mortem genetic screening of a cohort of 56 SCD victims. We identified a total 53 rare protein-altering variants (MAF < 0.2%) classified as VUS or worse. Twelve percent of the cases exhibited a clinically actionable variant (pathogenic, likely pathogenic or VUS – potentially pathogenic) that would warrant cascade genetic screening in relatives. Most of the variants detected by means of the post-mortem genetic investigations were VUS. Thus, genetic testing by itself might be fairly meaningless without supporting background data. This data reinforces the need for an experienced multidisciplinary team for obtaining reliable and accountable interpretations of variant significance for elucidating potential causes for SCDs in the young. This enables the early identification of relatives at risk or excludes family members as genetic carriers. Also, development of adequate forensic guidelines to enable appropriate interpretation of rare genetic variants is fundamental.
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Affiliation(s)
| | - Monika Tabunscik
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Theresa E Gross
- Institute of Legal Medicine, Faculty of Medicine and University Clinic, University of Cologne, Cologne, Germany
| | - Tina Jenewein
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Britt M Beckmann
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Constanze Niess
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Elise Gradhand
- Institute of Pathology, Goethe University, University Hospital Frankfurt, Kennedyallee 104, 60596, Frankfurt, Germany
| | - Cora Wunder
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Peter M Schneider
- Institute of Legal Medicine, Faculty of Medicine and University Clinic, University of Cologne, Cologne, Germany
| | - Markus A Rothschild
- Institute of Legal Medicine, Faculty of Medicine and University Clinic, University of Cologne, Cologne, Germany
| | - Marcel A Verhoff
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany
| | - Silke Kauferstein
- Institute of Legal Medicine, Goethe University, University Hospital Frankfurt, Frankfurt, Germany.
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Dawwas GK, Hennessy S, Brensinger CM, Deo R, Bilker WB, Soprano SE, Dhopeshwarkar N, Flory JH, Bloomgarden ZT, Aquilante CL, Kimmel SE, Leonard CE. Comparative Safety of Dipeptidyl Peptidase-4 Inhibitors and Sudden Cardiac Arrest and Ventricular Arrhythmia: Population-Based Cohort Studies. Clin Pharmacol Ther 2022; 111:227-242. [PMID: 34331322 PMCID: PMC9450482 DOI: 10.1002/cpt.2381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/21/2021] [Indexed: 12/18/2022]
Abstract
In vivo studies suggest that arrhythmia risk may be greater with less selective dipeptidyl peptidase-4 inhibitors, but evidence from population-based studies is missing. We aimed to compare saxagliptin, sitagliptin, and linagliptin with regard to risk of sudden cardiac arrest (SCA)/ventricular arrhythmia (VA). We conducted high-dimensional propensity score (hdPS) matched, new-user cohort studies. We analyzed Medicaid and Optum Clinformatics separately. We identified new users of saxagliptin, sitagliptin (both databases), and linagliptin (Optum only). We defined SCA/VA outcomes using emergency department and inpatient diagnoses. We identified and then controlled for confounders via a data-adaptive, hdPS approach. We generated marginal hazard ratios (HRs) via Cox proportional hazards regression using a robust variance estimator while adjusting for calendar year. We identified the following matched comparisons: saxagliptin vs. sitagliptin (23,895 vs. 96,972) in Medicaid, saxagliptin vs. sitagliptin (48,388 vs. 117,383) in Optum, and linagliptin vs. sitagliptin (36,820 vs. 78,701) in Optum. In Medicaid, use of saxagliptin (vs. sitagliptin) was associated with an increased rate of SCA/VA (adjusted HR (aHR), 2.01, 95% confidence interval (CI) 1.24-3.25). However, in Optum data, this finding was not present (aHR, 0.79, 95% CI 0.41-1.51). Further, we found no association between linagliptin (vs. sitagliptin) and SCA/VA (aHR, 0.65, 95% CI 0.36-1.17). We found discordant results regarding the association between SCA/VA with saxagliptin compared with sitagliptin in two independent datasets. It remains unclear whether these findings are due to heterogeneity of treatment effect in the different populations, chance, or unmeasured confounding.
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Affiliation(s)
- Ghadeer K. Dawwas
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sean Hennessy
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Systems Pharmacology Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colleen M. Brensinger
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rajat Deo
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Warren B. Bilker
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Samantha E. Soprano
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Neil Dhopeshwarkar
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James H. Flory
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Endocrinology Service, Department of Subspecialty Medicine, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Zachary T. Bloomgarden
- Division of Endocrinology Metabolism, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christina L. Aquilante
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy Pharmaceutical Sciences, Anschutz Medical Campus, University of Colorado, Aurora, Colorado, USA
| | - Stephen E. Kimmel
- Department of Epidemiology, College of Public Health Health Professions & College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Charles E. Leonard
- Center for Pharmacoepidemiology Research Training, Center for Clinical Epidemiology Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Biostatistics, Epidemiology Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cadrin-Tourigny J, Tadros R. Predicting sudden cardiac death in genetic heart disease. Can J Cardiol 2022; 38:479-490. [DOI: 10.1016/j.cjca.2022.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
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Cho JH. Sudden Death and Ventricular Arrhythmias in Heart Failure With Preserved Ejection Fraction. Korean Circ J 2022; 52:251-264. [PMID: 35388994 PMCID: PMC8989786 DOI: 10.4070/kcj.2021.0420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/27/2022] [Accepted: 02/22/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jae Hyung Cho
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Zylyftari N, Møller SG, Wissenberg M, Folke F, Barcella CA, Møller AL, Gnesin F, Mills EHA, Jensen B, Lee CJY, Tan HL, Køber L, Lippert F, Gislason GH, Torp-Pedersen C. Contacts With the Health Care System Before Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2021; 10:e021827. [PMID: 34854313 PMCID: PMC9075404 DOI: 10.1161/jaha.121.021827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background It remains challenging to identify patients at risk of out-of-hospital cardiac arrest (OHCA). We aimed to examine health care contacts in patients before OHCA compared with the general population that did not experience an OHCA. Methods and Results Patients with OHCA with a presumed cardiac cause were identified from the Danish Cardiac Arrest Registry (2001-2014) and their health care contacts (general practitioner [GP]/hospital) were examined up to 1 year before OHCA. In a case-control study (1:9), OHCA contacts were compared with an age- and sex-matched background population. Separately, patients with OHCA were examined by the contact type (GP/hospital/both/no contact) within 2 weeks before OHCA. We included 28 955 patients with OHCA. The weekly percentages of patient contacts with GP the year before OHCA were constant (25%) until 1 week before OHCA when they markedly increased (42%). Weekly percentages of patient contacts with hospitals the year before OHCA gradually increased during the last 6 months (3.5%-6.6%), peaking at the second week (6.8%) before OHCA; mostly attributable to cardiovascular diseases (21%). In comparison, there were fewer weekly contacts among controls with 13% for GP and 2% for hospital contacts (P<0.001). Within 2 weeks before OHCA, 57.8% of patients with OHCA had a health care contact, and these patients had more contacts with GP (odds ratio [OR], 3.17; 95% CI, 3.09-3.26) and hospital (OR, 2.32; 95% CI, 2.21-2.43) compared with controls. Conclusions The health care contacts of patients with OHCA nearly doubled leading up to the OHCA event, with more than half of patients having health care contacts within 2 weeks before arrest. This could have implications for future preventive strategies.
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Affiliation(s)
- Nertila Zylyftari
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Sidsel G Møller
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | - Mads Wissenberg
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Frederik Folke
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Carlo A Barcella
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark
| | | | - Filip Gnesin
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | | | - Britta Jensen
- Department of Health Science and Technology Aalborg University Aalborg Denmark
| | - Christina Ji-Young Lee
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,Department of Cardiology Nordsjaellands Hospital Hillerød Denmark
| | - Hanno L Tan
- Department of Cardiology Academic Medical Center University of Amsterdam The Netherlands.,Netherlands Heart Institute Utrecht The Netherlands
| | - Lars Køber
- The Heart Centre Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services and University of Copenhagen Copenhagen Denmark
| | - Gunnar H Gislason
- Department of Cardiology Copenhagen University Hospital Herlev and Gentofte Hellerup Denmark.,The Danish Heart Foundation Copenhagen Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology Nordsjaellands Hospital Hillerød Denmark.,Department of Cardiology Aalborg University Hospital Aalborg Denmark
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Scrocco C, Bezzina CR, Ackerman MJ, Behr ER. Genetics and genomics of arrhythmic risk: current and future strategies to prevent sudden cardiac death. Nat Rev Cardiol 2021; 18:774-784. [PMID: 34031597 DOI: 10.1038/s41569-021-00555-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/04/2023]
Abstract
A genetic risk of sudden cardiac arrest and sudden death due to an arrhythmic cause, known as sudden cardiac death (SCD), has become apparent from epidemiological studies in the general population and in patients with ischaemic heart disease. However, genetic susceptibility to sudden death is greatest in young people and is associated with uncommon, monogenic forms of heart disease. Despite comprehensive pathology and genetic evaluations, SCD remains unexplained in a proportion of young people and is termed sudden arrhythmic death syndrome, which poses challenges to the identification of relatives from affected families who might be at risk of SCD. In this Review, we assess the current understanding of the epidemiology and causes of SCD and evaluate both the monogenic and the polygenic contributions to the risk of SCD in the young and SCD associated with drug therapy. Finally, we analyse the potential clinical role of genomic testing in the prevention of SCD in the general population.
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Affiliation(s)
- Chiara Scrocco
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Connie R Bezzina
- Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA.,Windland Smith Rice Genetic Heart Rhythm Clinic and the Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, UK.
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Roh SY, Choi JI, Park SH, Kim YG, Shim J, Kim JS, Han KD, Kim YH. The 10-Year Trend of Out-of-hospital Cardiac Arrests: a Korean Nationwide Population-Based Study. Korean Circ J 2021; 51:866-874. [PMID: 34595855 PMCID: PMC8484994 DOI: 10.4070/kcj.2021.0127] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/02/2021] [Accepted: 07/28/2021] [Indexed: 01/31/2023] Open
Abstract
We aimed to evaluate the epidemiologic features and outcomes of non-traumatic out-of-hospital cardiac arrest (OHCA) on the basis of nationwide population-based data from Korean National Health Insurance System. This study showed the incidence of OHCA in Korea had increased during the last decade (48.2 per 100,000 person-years in 2008 to 66.7 in 2017). Coronary artery disease was the main cause (59.8%). The 1-year mortality rate tended to decline steadily. Despite the advances in medical care system, the incidence of OHCA has increased and mortality rate was still high. Background and Objectives It is crucial to understand the exact public health burden of out-of-hospital cardiac arrest (OHCA) cases; this is presently unknown since sufficient episodes are not reported in registry studies. We aimed to evaluate the epidemiologic features and outcomes of non-traumatic OHCA. Methods During January 2008 to December 2017, we enrolled 387,665 patients who had been assigned a code for sudden cardiac arrest or had undergone cardiopulmonary resuscitation in the emergency room using the Korean National Health Insurance Service database. Those whose arrest was of non-cardiac origin were excluded. Results The incidence of OHCA per 100,000 patients increased steadily from 48.2 in 2008 to, 53.8 in 2011, 60.1 in 2014, and 66.7 in 2017, with a 1-year survival rate of 8.2%. Age and sex-adjusted mortality rates showed a decreasing trend. The hazard ratio was 1.0015 in 2009, 0.9865 in 2012, 0.9769 in 2015, and 0.9629 in 2017 (p for trend <0.0001), with coronary artery disease-related OHCA accounting for 59.8% of the total. Subgroups with coronary artery disease-related OHCA were more likely to be older and have a higher prevalence of all related comorbidities, excluding malignancy, than those with non-coronary artery disease-related OHCA. Conclusions This nationwide population-based study showed that the incidence of OHCA in Korea had increased during the last decade. The post OHCA 1-year mortality rate showed a poor outcome but improved gradually.
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Affiliation(s)
- Seung-Young Roh
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea.
| | - Sang Hyun Park
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Jin-Seok Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
| | - Kyung Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Medical Center, Seoul, Korea
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Myocardial Fibrosis as a Predictor of Sudden Death in Patients With Coronary Artery Disease. J Am Coll Cardiol 2021; 77:29-41. [PMID: 33413938 DOI: 10.1016/j.jacc.2020.10.046] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The "gray zone" of myocardial fibrosis (GZF) on cardiovascular magnetic resonance may be a substrate for ventricular arrhythmias (VAs). OBJECTIVES The purpose of this study was to determine whether GZF predicts sudden cardiac death (SCD) and VAs (ventricular fibrillation or sustained ventricular tachycardia) in patients with coronary artery disease (CAD) and a wide range of left ventricular ejection fractions (LVEFs). METHODS In this retrospective study of CAD patients, the presence of myocardial fibrosis on visual assessment (MFVA) and GZF mass in patients with MFVA were assessed in relation to SCD and the composite, arrhythmic endpoint of SCD or VAs. RESULTS Among 979 patients (mean age [± SD]: 65.8 ± 12.3 years), 29 (2.96%) experienced SCD and 80 (8.17%) met the arrhythmic endpoint over median 5.82 years (interquartile range: 4.1 to 7.3 years). In the whole cohort, MFVA was strongly associated with SCD (hazard ratio: 10.1; 95% confidence interval [CI]: 1.42 to 1,278.9) and the arrhythmic endpoint (hazard ratio: 28.0; 95% CI: 4.07 to 3,525.4). In competing risks analyses, associations between LVEF <35% and SCD (subdistribution hazard ratio [sHR]: 2.99; 95% CI: 1.42 to 6.31) and the arrhythmic endpoint (sHR: 4.71; 95% CI: 2.97 to 7.47) were weaker. In competing risk analyses of the MFVA subcohort (n = 832), GZF using the 3SD method (GZF3SD) >5.0 g was strongly associated with SCD (sHR: 10.8; 95% CI: 3.74 to 30.9) and the arrhythmic endpoint (sHR: 7.40; 95% CI: 4.29 to 12.8). Associations between LVEF <35% and SCD (sHR: 2.62; 95% CI: 1.24 to 5.52) and the arrhythmic endpoint (sHR: 4.14; 95% CI: 2.61 to 6.57) were weaker. CONCLUSIONS In CAD patients, MFVA plus quantified GZF3SD mass was more strongly associated with SCD and VAs than LVEF. In selecting patients for implantable cardioverter-defibrillators, assessment of MFVA followed by quantification of GZF3SD mass may be preferable to LVEF.
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Ischemic Heart Disease Related Sudden Cardiac Death in Autopsied Cases: An Egyptian perspective. Am J Forensic Med Pathol 2021; 42:354-362. [PMID: 34091496 DOI: 10.1097/paf.0000000000000694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Diagnosis of the underlying cause of sudden unexpected death in a previously healthy individual remains one of the important challenges in forensic practice. Ischemic heart disease is the most common cause of sudden death. The current study aims to investigate the incidence and pathology of sudden ischemic cardiac death in Egypt. All cases of sudden cardiac death (SCD) examined by different forensic departments throughout Egypt during the period of January 2010 through December 2014 were included. Cases underwent complete autopsy examination including a thorough gross and microscopic examination of the heart and great blood vessels. Of 535 cases of SCD diagnosed during the period of the study, coronary atherosclerosis was the principle finding in 420 (78.5%) cases. The highest numbers of deaths were reported in fifth and sixth decades with male preference. Other causes of SCD included myocarditis, cardiomyopathies, valvular heart disease, and hypertensive heart disease (7.8%, 4.1%, 4.1%, and 2.8%, respectively). There was severe stenosis (>75%) of at least 1 coronary artery in 74% of cases. Type VI atherosclerosis was found in 40.7% of cases. The left anterior descending branch was the most affected artery by atherosclerosis. Acute coronary pathological events were demonstrated in 27.6% of cases. Recent myocardial infarction was evident in 55.5% of cases, whereas old infarcts were demonstrated in 44.5% of cases. Features of hypertensive heart disease were present in 18.3% of cases. In conclusion, ischemic heart disease is the leading cause of SCD in Egypt.
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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Ågesen FN, Lynge TH, Blanche P, Banner J, Prescott E, Jabbari R, Tfelt-Hansen J. Temporal trends and sex differences in sudden cardiac death in the Copenhagen City Heart Study. Heart 2021; 107:1303-1309. [PMID: 34021040 DOI: 10.1136/heartjnl-2020-318881] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 04/04/2021] [Accepted: 04/16/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE More knowledge about the development of sudden cardiac death (SCD) in the general population is needed to develop meaningful predictors of SCD. Our aim with this study was to estimate the incidence of SCD in the general population and examine the temporal changes, demographics and clinical characteristics. METHODS All participants in the Copenhagen City Heart Study were followed from 1993 to 2016. All death certificates, autopsy reports and national registry data were used to identify all cases of SCD. RESULTS A total of 14 562 subjects were included in this study. There were 8394 deaths with all information available, whereof 1335 were categorised as SCD. The incidence of SCD decreased during the study period by 41% for persons aged 40-90 years, and the standardised incidence rates decreased from 504 per 100 000 person-years (95% CI 447 to 569) to 237 per 100 000 person-years (95% CI 195 to 289). The incidence rate ratio of SCD between men and women ≤75 years was 1.99 (95% CI 1.62 to 2.46). The proportion of SCD of all cardiac deaths decreased during the observation period and decreased with increasing age. Men had more cardiovascular comorbidities (OR 1.34, 95% CI 1.07 to 1.68, p<0. 01), and SCD was the first registered manifestation of cardiac disease in 50% of all cases. CONCLUSION The incidence of SCD in the general population has declined significantly during the study period but should be further investigated for more recent variations as well as novel risk predictors for persons with low to medium risk of SCD.
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Affiliation(s)
- Frederik Nybye Ågesen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Hadberg Lynge
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Paul Blanche
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Cardiology, University of Copenhagen, Gentofte, Denmark.,Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, University of Copenhagen, Bispebjerg Hospital, Copenhagen, Denmark.,Copenhagen City Heart Study, Frederiksberg Hospital, Copenhagen, Denmark
| | - Reza Jabbari
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Health and Medical Sciences, Copenhagen, Denmark
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Lynge TH, Risgaard B, Banner J, Nielsen JL, Jespersen T, Stampe NK, Albert CM, Winkel BG, Tfelt-Hansen J. Nationwide burden of sudden cardiac death: A study of 54,028 deaths in Denmark. Heart Rhythm 2021; 18:1657-1665. [PMID: 33965606 DOI: 10.1016/j.hrthm.2021.05.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/21/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND A large proportion of all deaths are sudden cardiac deaths (SCDs). Reliable estimates of nationwide incidence of SCD, however, are missing. OBJECTIVES The goals of this study were to estimate SCD burden across all age groups in Denmark and to compare it with the estimates of other common causes of death. METHODS All deaths in Denmark (population of 5.5 million) in 2010 were manually reviewed case by case. Autopsy reports, death certificates, and information from nationwide health registries were systematically examined to identify all SCD cases in 2010. According to the level of detail of the available information, all deaths were categorized as either non-SCD, definite SCD, probable SCD, or possible SCD. RESULTS There were 54,028 deaths in Denmark in 2010, of which 6867 (13%) were categorized as SCD (591 (9%) definite SCD, 1568 (23%) probable SCD, and 4708 (68%) possible SCD). The incidence rate of definite SCD was 11 (95% confidence interval 10-12) per 100,000 person-years. Including definite, probable, and possible SCD cases, the highest possible overall SCD incidence rate was 124 (95% confidence interval 121-127) per 100,000 person-years. Estimated SCD burden was similar to or greater than the estimates of all other common causes of death. Of all SCD cases, 49% were not diagnosed with cardiovascular disease before death. CONCLUSION SCD accounted for up to 13% of all deaths. Almost half of all SCD cases occurred in persons without a history of cardiovascular disease. Consequently, the optimization of risk stratification and prevention of SCD in the general population should be given high priority.
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Affiliation(s)
- Thomas Hadberg Lynge
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.
| | - Bjarke Risgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jytte Banner
- Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
| | - Jakob Lund Nielsen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas Jespersen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Kjær Stampe
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christine M Albert
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, California; Division of Preventive Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark; Section of Forensic Pathology, Copenhagen University, Copenhagen, Denmark
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