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2.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 288-291, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017985

RESUMO

Machine learning has become increasingly useful in various medical applications. One such case is the automatic categorization of ECG voltage data. A method of categorization is proposed that works in real time to provide fast and accurate classifications of heart beats. This proposed method uses machine learning principles to allow for results to be determined based on a training dataset. The goal of this project is to develop a method of automatically classifying heartbeats that can be done on a low level and run on portable hardware.


Assuntos
Eletrocardiografia , Processamento de Sinais Assistido por Computador , Arritmias Cardíacas/diagnóstico , Doença do Sistema de Condução Cardíaco , Humanos , Redes Neurais de Computação
3.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 296-299, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33017987

RESUMO

Recent developments in the field of deep learning has shown a rise in its use for clinical applications such as electrocardiogram (ECG) analysis and cardiac arrhythmia classification. Such systems are essential in the early detection and management of cardiovascular diseases. However, due to privacy concerns and also the lack of resources, there is a gap in the data available to run such powerful and data-intensive models. To address the lack of annotated, high-quality ECG data for heart disease research, ECG data generation from a small set of ECG to obtain huge annotated data is seen as an effective solution. Generative Feature Matching Network (GFMN) was shown to resolve few drawbacks of commonly used generative adversarial networks (GAN). Based on this, we developed a deep learning model to generate ECGs that resembles real ECG by feature matching with the existing data.Clinical relevance- This work addresses the lack of a large quantity of good quality, publicly available annotated ECG data required to build deep learning models for cardiac signal processing research. We can use the model presented in this paper to generate ECG signals of a target rhythm pattern and also subject-specific ECG morphology that could improve their cardiac health monitoring while maintaining privacy.


Assuntos
Arritmias Cardíacas , Cardiopatias , Arritmias Cardíacas/diagnóstico , Doença do Sistema de Condução Cardíaco , Eletrocardiografia , Humanos , Processamento de Sinais Assistido por Computador
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 406-409, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018014

RESUMO

Catheter ablation is increasingly used to treat atrial fibrillation (AF), the most common sustained cardiac arrhythmia encountered in clinical practice. A recent breakthrough finding in AF ablation consists in identifying ablation sites based on their spatiotemporal dispersion (STD). STD stands for a delay of the cardiac activation observed in intracardiac electrograms (EGMs) across contiguous leads. In practice, interventional cardiologists localize STD sites visually using the PentaRay multipolar mapping catheter. This work aims at automatically characterizing STD by classifying EGM data into STD vs. non STD groups using machine learning (ML) techniques. A dataset of 23082 multichannel EGM recordings acquired by the PentaRay coming from 16 persistent AF patients is included in this study. A major problem hampering the classification performance lies in the highly imbalanced dataset ratio. We suggest to tackle data imbalance using adapted data augmentation techniques including 1) undersampling 2) oversampling 3) lead shift 4) time reversing and 5) time shift. These tools are designed to preserve the integrity of the cardiac data and are validated by a partner cardiologist. They provide enhancement in classification performance in terms of sensitivity, which increases from 50% to 80% while maintaining accuracy and AUC around 90% with oversampling. Bootstrapping is applied to check the variability of the trained classifiers.Clinical relevance-The machine learning techniques developed in this contribution are expected to aid cardiologists in performing patient-tailored catheter ablation procedures for treating persistent AF.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Fibrilação Atrial/cirurgia , Doença do Sistema de Condução Cardíaco , Técnicas Eletrofisiológicas Cardíacas , Humanos , Aprendizado de Máquina
5.
Am J Cardiol ; 134: 108-115, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32933756

RESUMO

Aim is to report on the results of an optimized balloon filling algorithm and suggest a refinement of the implantation approach to maximize safety. Appropriate sizing of balloon expandable valves during transcatheter aortic valve implantation is crucial. Study comprised 370 consecutive patients receiving SAPIEN 3 valve between 2015 and 2018. Valve expansion/recoil measurement in the inflow area, annular area, and outflow area was performed previously and postimplantation. Nominal balloon filling resulted in underexpansion-23 mm (20.96 mm), 26 mm (23.88 mm), and 29 mm (27.56 mm) SAPIEN 3 valves at the annular level. Increased balloon filling by 2 cc resulted in a gradual increase in valve diameter reaching 97.35% (23 mm), 96.50% (26 mm), and 96.11% (29 mm) of the nominal valve diameter. Final diameters were usually higher in the valvular inflow and outflow tracts. The 29 mm valve did not reach its nominal diameter with 2 cc overfilling and in none of inflow area (95.48%), annular area (96.11%), or outflow area (96.86%). Device success (by VARC II) was 96.2%. No root or septal rupture, device migration, mitral valve injury, coronary obstruction, or dissection occurred. Rate of new permanent pacemaker implantation was 8.3%. Paravalvular leakage was none or trace in most patients. Mean valve gradient was 10.77 mm Hg postprocedure. 1.9% of the patients had a maximum gradient of >40 mm Hg, 2.2% >20 mm Hg. In conclusion, an optimized balloon filling algorithm resulted in appropriate valve gradients, low levels of paravalvular leakage, low rates of permanent pacemaker implantation and no annular rupture.


Assuntos
Algoritmos , Estenose da Valva Aórtica/cirurgia , Doença do Sistema de Condução Cardíaco/epidemiologia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/patologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/epidemiologia , Doença do Sistema de Condução Cardíaco/terapia , Feminino , Humanos , Masculino , Tamanho do Órgão , Complicações Pós-Operatórias/diagnóstico por imagem , Pressão , Ajuste de Prótese
6.
Medicine (Baltimore) ; 99(34): e21797, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846814

RESUMO

LMNA gene encodes Lamin A and C (Lamin A/C), which are intermediate filament protein implicating in DNA replication and transcription. Mutations in LMNA are validated to cause cardiac conduction disease (CCD) and cardiomyopathy.In a Chinese family, we identified 5 members harboring the identical heterozygous LMNA (c.686T>C, I229T) disease-causing mutation, which was not found in the 535 healthy controls. In silico analysis, we revealed structural alteration in Lamin A/C I229T mutant. Furthermore, molecular docking identified human polycomb repressive complex 2 and Lamin A/C interact with higher affinity in the presence of I229T, thus may downregulate Nav1.5 channel expression.Our findings expanded the spectrum of mutations associated with CCD and were valuable in the genetic diagnosis and clinical screening for CCD. Molecular docking analysis provided useful information of increased binding affinity between mutant Lamin A/C and polycomb repressive complex 2. However, the concrete mechanism of LMNA mutation (I229T) remains undetermined in our study, future genetics and molecular studies are still needed.


Assuntos
Doença do Sistema de Condução Cardíaco/genética , Lamina Tipo A/genética , Adulto , Idoso , Estudos de Casos e Controles , Análise Mutacional de DNA , Eletrocardiografia , Feminino , Heterozigoto , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Lamina Tipo A/metabolismo , Masculino , Pessoa de Meia-Idade , Simulação de Acoplamento Molecular , Mutação , Linhagem , Adulto Jovem
8.
Kardiologiia ; 60(5): 4-8, 2020 May 04.
Artigo em Russo | MEDLINE | ID: mdl-32515698

RESUMO

The beginning of 2020 was characterized by the development of a new coronavirus pandemic (COVID-19). Information about the epidemiology, etiology, pathogenesis, clinical and laboratory diagnostics, as well as prevention and therapy for this disease is constantly being expanded and reviewed. The COVID-19 pandemic creates the need for the emergence of new conditions of specialized care for patients with heart rhythm and conduction disorders [1]. These recommendations are intended for general practitioners, internists, cardiologists, electrophysiologists/arrhythmologists, cardiovascular surgeons, functional diagnostics doctors, anesthesiologists-resuscitators, laboratory diagnostics specialists, health care organizers in the system of organizations and healthcare institutions that provide specialized care to patients with heart rhythm and conduction disorders.


Assuntos
Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/terapia , Doença do Sistema de Condução Cardíaco/diagnóstico , Doença do Sistema de Condução Cardíaco/terapia , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Pandemias
9.
Arq Bras Cardiol ; 114(4): 732-735, 2020 04.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32491007

RESUMO

Ranolazine (RANO) prevents cardiac arrhythmia by blocking the late sodium current (INaL). A transmural gradient of Nav1.5 is found in the left ventricular wall of the heart. Thus, we investigated the effects of RANO in healthy cardiomyocytes and in a cellular model of type 3 long QT syndrome (LQT3). We used isolated endocardium (ENDO) and epicardium (EPI) cells and a video edge detection system and fluorescence microscopy to monitor calcium transients. RANO (0.1, 1, 10 and 30 uM, at 25oC) at a range of pacing frequencies showed a minor impact on both cell types, but RANO at 30uM and 35oC for ENDO cells attenuated sarcomere shortening by~21%. Next, to mimic LQT3, we exposed ENDO and EPI cells to anemone toxin II (ATX-II), which augments INaL. Cellular arrhythmias induced by ATX-II were abrogated by RANO (30 µM) at 35oC. Based on our results we can conclude that RANO has a minor impact on sarcomere shortening of healthy ENDO and EPI cells and it abrogates arrhythmias induced by INaLto a similar level in ENDO and EPI cells.


Assuntos
Antiarrítmicos/uso terapêutico , Arritmias Cardíacas , Síndrome do QT Longo , Ranolazina/uso terapêutico , Potenciais de Ação , Arritmias Cardíacas/tratamento farmacológico , Doença do Sistema de Condução Cardíaco , Humanos
10.
Am J Physiol Heart Circ Physiol ; 318(6): H1436-H1440, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32383994

RESUMO

Cardiac arrhythmias significantly contribute to mortality in Duchenne muscular dystrophy (DMD), a degenerative muscle disease triggered by mutations in the gene encoding for the intracellular protein dystrophin. A major source for the arrhythmias in patients with DMD is impaired ventricular impulse conduction, which predisposes for ventricular asynchrony, decreased cardiac output, and the development of reentrant mechanisms. The reason for ventricular conduction impairments and the associated arrhythmias in the dystrophic heart has remained unidentified. In the present study, we explored the hypothesis that dystrophin-deficient cardiac Purkinje fibers have reduced Na+ currents (INa), which would represent a potential mechanism underlying slowed ventricular conduction in the dystrophic heart. Therefore, by using a Langendorff perfusion system, we isolated Purkinje fibers from the hearts of adult wild-type control and dystrophin-deficient mdx mice. Enhanced green fluorescent protein (eGFP) expression under control of the connexin 40 gene allowed us to discriminate Purkinje fibers from eGFP-negative ventricular working cardiomyocytes after cell isolation. Finally, we recorded INa from wild-type and dystrophic mdx Purkinje fibers for comparison by means of the whole cell patch clamp technique. We found substantially reduced INa densities in mdx compared with wild-type Purkinje fibers, suggesting that dystrophin deficiency diminishes INa. Because Na+ channels in the Purkinje fiber membrane represent key determinants of ventricular conduction velocity, we propose that reduced INa in Purkinje fibers at least partly explains impaired ventricular conduction and the associated arrhythmias in the dystrophic heart.NEW & NOTEWORTHY Dystrophic cardiac Purkinje fibers have abnormally reduced Na+ current densities. This explains impaired ventricular conduction in the dystrophic heart.


Assuntos
Arritmias Cardíacas/metabolismo , Doença do Sistema de Condução Cardíaco/metabolismo , Distrofia Muscular de Duchenne/metabolismo , Ramos Subendocárdicos/metabolismo , Canais de Sódio/metabolismo , Potenciais de Ação/fisiologia , Animais , Arritmias Cardíacas/complicações , Arritmias Cardíacas/fisiopatologia , Doença do Sistema de Condução Cardíaco/complicações , Doença do Sistema de Condução Cardíaco/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos mdx , Distrofia Muscular de Duchenne/complicações , Distrofia Muscular de Duchenne/fisiopatologia , Sódio/metabolismo
11.
Life Sci ; 255: 117814, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32439300

RESUMO

AIMS: Amiodarone (AMIO) is currently used in medical practice to reverse ventricular tachycardia. Here we determine the effects of AMIO in the electromechanical properties of isolated left ventricle myocyte (LVM) from mice and guinea pig and in a cellular model of Long QT Syndrome Type 3 (LQTS-3) using anemone neurotoxin 2 (ATX II), which induces increase of late sodium current in LVM. MAIN METHODS AND KEY FINDINGS: Using patch-clamp technique, fluorescence imaging to detect cellular Ca2+ transient and sarcomere detection systems we evaluate the effect of AMIO in healthy LVM. AMIO produced a significant reduction in the percentage of sarcomere shortening (0.1, 1 and 10 µM) in a range of pacing frequencies, however, without significant attenuation of Ca2+ transient. Also, 10 µM of AMIO caused the opposite effect on action potential repolarization of mouse and guinea pig LVM. When LVM from mouse and guinea pig were paced in a range of pacing frequencies and exposed to ATX (10 nM), AMIO (10 µM) was only able to abrogate electromechanical arrhythmias in LVM from guinea pig at lower pacing frequency. SIGNIFICANCE: AMIO has negative inotropic effect with opposite effect on action potential waveform in mouse and guinea pig LVM. Furthermore, the antiarrhythmic action of AMIO in LQTS-3 is species and frequency-dependent, which indicates that AMIO may be beneficial for some types of arrhythmias related to late sodium current.


Assuntos
Amiodarona/farmacologia , Antiarrítmicos/farmacologia , Doença do Sistema de Condução Cardíaco/tratamento farmacológico , Síndrome do QT Longo/tratamento farmacológico , Miócitos Cardíacos/efeitos dos fármacos , Amiodarona/administração & dosagem , Animais , Antiarrítmicos/administração & dosagem , Doença do Sistema de Condução Cardíaco/fisiopatologia , Relação Dose-Resposta a Droga , Cobaias , Ventrículos do Coração/citologia , Síndrome do QT Longo/fisiopatologia , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Miócitos Cardíacos/metabolismo , Técnicas de Patch-Clamp , Sarcômeros/efeitos dos fármacos , Sarcômeros/metabolismo , Canais de Sódio/efeitos dos fármacos , Canais de Sódio/metabolismo , Especificidade da Espécie
12.
Heart Lung Circ ; 29(7): e85-e87, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32418874

RESUMO

In the context of the current global COVID-19 pandemic, this Consensus Statement provides current recommendations for patients with, or at risk of developing, genetic heart disease, and for their health care management and service provision in Australia and New Zealand. Apart from general recommendations, there are specific recommendations for the following conditions: cardiomyopathy, Brugada syndrome (including in children), long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). Other recommendations are relevant to patient self-care and primary health care.


Assuntos
Doença do Sistema de Condução Cardíaco , Cardiologia , Controle de Doenças Transmissíveis , Infecções por Coronavirus , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Adulto , Austrália/epidemiologia , Betacoronavirus , Doença do Sistema de Condução Cardíaco/congênito , Doença do Sistema de Condução Cardíaco/epidemiologia , Doença do Sistema de Condução Cardíaco/terapia , Cardiologia/métodos , Cardiologia/organização & administração , Cardiologia/tendências , Criança , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Consenso , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Nova Zelândia/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Sociedades Médicas
14.
Am J Cardiol ; 125(5): 783-787, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31898969

RESUMO

The ACURATE neo transcatheter heart valve has been associated with very low rates of new conduction disorders (CDs). We assessed the clinical relevance of new CDs in patients undergoing transcatheter aortic valve replacement (TAVR) with this valve. Data of consecutive patients without a pre-existing left bundle branch block (LBBB) or a permanent pacemaker (PPM) undergoing TAVR with the ACURATE neo were analyzed from the prospective SwissTAVI registry. Patients with new CDs were compared with patients with an unchanged electrocardiogram (ECG). ACURATE neo was implanted in 203 patients (mean age 82 ± 6 years, 63% women), CDs occurred in 28 patients (22 [11%] developed a LBBB, 6 [3%] required a PPM). New CDs resulted in a longer median duration of hospitalization (7 vs 5 days, interquartile range 4 to 13 vs 3 to 8 days, p = 0.04). At 1-year follow-up, left ventricular ejection fraction was significantly lower in patients with new CDs comparedwith patients with an unchanged ECG (54% ± 13% vs 61% ± 9%, p <0.01). Kaplan-Meier estimates of survival at 1-year were 89% in patients with new CDs and 95% in patients with an unchanged ECG (hazard ratio 2.0, 95% confidence interval 0.7 to 6.2, p = 0.22). After TAVR with the self-expanding ACURATE neo valve, the rate of new CDs, including complete LBBB was low and very few patients required a new PPM. However, new CDs prolonged initial hospitalization and increased the risk for left ventricular-dysfunction at 1-year follow-up. Patients without new CDs had excellent outcomes with a very high survival rate at 1-year follow-up.


Assuntos
Valva Aórtica/cirurgia , Doença do Sistema de Condução Cardíaco/epidemiologia , Próteses Valvulares Cardíacas , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter , Idoso , Idoso de 80 Anos ou mais , Bioprótese , Bloqueio de Ramo/epidemiologia , Bloqueio de Ramo/terapia , Doença do Sistema de Condução Cardíaco/terapia , Estimulação Cardíaca Artificial , Estudos de Casos e Controles , Eletrocardiografia , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação , Masculino , Marca-Passo Artificial , Complicações Pós-Operatórias/terapia , Modelos de Riscos Proporcionais , Desenho de Prótese , Volume Sistólico , Taxa de Sobrevida
15.
Genet Med ; 22(1): 102-111, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31383942

RESUMO

PURPOSE: "Genome-first" approaches, in which genetic sequencing is agnostically linked to associated phenotypes, can enhance our understanding of rare variants' contributions to disease. Loss-of-function variants in LMNA cause a range of rare diseases, including cardiomyopathy. METHODS: We leveraged exome sequencing from 11,451 unselected individuals in the Penn Medicine Biobank to associate rare variants in LMNA with diverse electronic health record (EHR)-derived phenotypes. We used Rare Exome Variant Ensemble Learner (REVEL) to annotate rare missense variants, clustered predicted deleterious and loss-of-function variants into a "gene burden" (N = 72 individuals), and performed a phenome-wide association study (PheWAS). Major findings were replicated in DiscovEHR. RESULTS: The LMNA gene burden was significantly associated with primary cardiomyopathy (p = 1.78E-11) and cardiac conduction disorders (p = 5.27E-07). Most patients had not been clinically diagnosed with LMNA cardiomyopathy. We also noted an association with chronic kidney disease (p = 1.13E-06). Regression analyses on echocardiography and serum labs revealed that LMNA variant carriers had dilated cardiomyopathy and primary renal disease. CONCLUSION: Pathogenic LMNA variants are an underdiagnosed cause of cardiomyopathy. We also find that LMNA loss of function may be a primary cause of renal disease. Finally, we show the value of aggregating rare, annotated variants into a gene burden and using PheWAS to identify novel ontologies for pleiotropic human genes.


Assuntos
Doença do Sistema de Condução Cardíaco/genética , Cardiomiopatias/genética , Lamina Tipo A/genética , Mutação com Perda de Função , Insuficiência Renal Crônica/genética , Sequenciamento Completo do Exoma/métodos , Idoso , Comorbidade , Biologia Computacional/métodos , Registros Eletrônicos de Saúde , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Fenótipo
16.
Heart ; 106(4): 299-306, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31391205

RESUMO

OBJECTIVE: Limited data are currently available regarding the long-term prognosis of patients with J-wave syndrome (JWS). The aim of this study was to investigate the long-term prognosis of patients with JWS and identify predictors of the recurrence of ventricular fibrillation (VF). METHODS: This was a multicentre retrospective study (seven Japanese hospitals) involving 134 patients with JWS (Brugada syndrome (BrS): 85; early repolarisation syndrome (ERS): 49) treated with an implantable cardioverter defibrillator. All patients had a history of VF. All patients with ERS underwent drug provocation testing with standard and high intercostal ECG recordings to rule out BrS. The impact of global J waves (type 1 ECG or anterior J waves and inferolateral J waves in two or more leads) on the prognosis was evaluated. RESULTS: During the 91±66 months of the follow-up period, 52 (39%) patients (BrS: 37; ERS: 15) experienced recurrence of VF. Patients with BrS and ERS with global J waves showed a significantly higher incidence of VF recurrence than those without (BrS: log-rank, p=0.014; ERS: log-rank, p=0.0009). The presence of global J waves was a predictor of VF recurrence in patients with JWS (HR: 2.16, 95% CI 1.21 to 3.91, p=0.0095), while previously reported high-risk electrocardiographic parameters (high-amplitude J waves ≥0.2 mV and J waves associated with a horizontal or descending ST segment) were not predictive of VF recurrence. CONCLUSIONS: This multicentre long-term study showed that the presence of global J waves was associated with a higher incidence of VF recurrence in patients with JWS.


Assuntos
Síndrome de Brugada/fisiopatologia , Desfibriladores Implantáveis , Taquicardia Ventricular/fisiopatologia , Fibrilação Ventricular/fisiopatologia , Adulto , Antiarrítmicos/uso terapêutico , Síndrome de Brugada/tratamento farmacológico , Doença do Sistema de Condução Cardíaco/tratamento farmacológico , Doença do Sistema de Condução Cardíaco/fisiopatologia , Morte Súbita Cardíaca/prevenção & controle , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos
17.
Clin Exp Hypertens ; 42(1): 93-98, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31204516

RESUMO

Introduction: There is no study evaluating the Tp-e/QT and Tp-e/QTc ratios with T wave peak to end interval (Tp-e interval) used for evaluation of cardiac arrhythmia risk and ventricular repolarization changes in patients with primary aldosteronism (PA). We aimed to investigate whether there was a change in Tp-e interval, Tp-e/QT and Tp-e/QTc ratios in patients with PA.Method: Thirty patients with newly diagnosed hypertension (HT) and PA and 30 patients with primary HT were included. Twelve-lead electrocardiography (ECG) was performed in all patients. Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured in addition to routine measurements in ECG.Results: Sodium, potassium, and plasma renin activity (PRA) were significantly lower in patients with PA; systolic and diastolic blood pressure, plasma aldosterone, plasma aldosterone/PRA were significantly higher in patients with PA (p < .05 for each one). When ventricular repolarization parameters were examined; while QT and QTc interval were similar between two groups, Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were significantly higher in patients with PA (p < .05 for each one). Tp-e interval, Tp-e/QT and Tp-e/QTc ratio values were positively correlated with the serum calcium, aldosterone, and aldosterone/PRA levels and negatively correlated with serum sodium, potassium, renin levels (p < .05 for each one). In linear regression analyses, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were independently associated with the aldosterone/PRA ratio.Conclusion: Tp-e interval, Tp-e/QT and Tp-e/QTc were increased in hypertensive patients with PA and were independently associated with aldosterone/PRA levels. This may be related to the changing neuroendocrine state in patients with PA.


Assuntos
Aldosterona/sangue , Ventrículos do Coração/fisiopatologia , Hiperaldosteronismo/fisiopatologia , Hipertensão/fisiopatologia , Renina/sangue , Adulto , Pressão Sanguínea , Cálcio/sangue , Doença do Sistema de Condução Cardíaco , Eletrocardiografia , Feminino , Humanos , Hiperaldosteronismo/complicações , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Potássio/sangue , Sódio/sangue
18.
Int J Cardiol ; 298: 85-92, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31668660

RESUMO

AIMS: To recapitulate progressive human dilated cardiomyopathy (DCM) and heart block in the Lmna R225X mutant mice model and investigate the molecular basis of LMNA mutation induced cardiac conduction disorders (CD); To investigate the potential interventional impact of exercise endurance. METHODS AND RESULTS: A Lmna R225X knock-in mice model in either heterozygous or homozygous genotype was generated. Electrical remodeling was observed with higher occurrence of AV block from neonatal and aged mutant mice as measured by surface electrocardiogram and atrio-ventricular Wenckebach point detection. Histological and molecular profiles revealed an increase in apoptotic cells and activation of caspase-3 activities in heart tissue. Upon aging, extracellular cellular matrix (ECM) remodeling appeared with accumulation of collagen in Lmna R225X mutant hearts as visualized by Masson's trichrome stain. This could be explained by the upregulated ECM gene expression, such as Fibronectin: Fn1, collagen: Col12a1, intergrin: Itgb2 and 3, as detected by microarray gene chip. Also, endurance exercise for 3 month improved the ventricular ejection fraction, attenuated fibrosis and cardiomyocytes apoptosis in the aged mutant mice. CONCLUSIONS: The mechanism of LMNA nonsense mutation induced cardiac conduction defects through AV node fibrosis is due to upregulated ECM gene expression upon activation of cardiac apoptosis. Lmna R225X mutant mice hold the potential for serving as in vivo models to explore the mechanism and therapeutic methods for AV block or myopathy associated with the aging process.


Assuntos
Doença do Sistema de Condução Cardíaco/genética , Cardiomiopatia Dilatada/genética , Códon sem Sentido/genética , Lamina Tipo A/genética , Condicionamento Físico Animal/fisiologia , Animais , Animais Recém-Nascidos , Doença do Sistema de Condução Cardíaco/metabolismo , Doença do Sistema de Condução Cardíaco/terapia , Cardiomiopatia Dilatada/metabolismo , Cardiomiopatia Dilatada/terapia , Expressão Gênica , Técnicas de Introdução de Genes/métodos , Frequência Cardíaca/fisiologia , Lamina Tipo A/biossíntese , Camundongos , Condicionamento Físico Animal/métodos
20.
Trends Cardiovasc Med ; 30(7): 422-423, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-31812250

RESUMO

The implantable cardioverter defibrillator (ICD) is often considered a routine intervention for an inherited heart rhythm disorder (IHRD) despite there being little to no randomized data for non-ischemic indications. Furthermore, existing IHRD studies often do not report adverse ICD outcomes, and observational data increasingly show that complications are under-recognized. Only recently have tools emerged to address the rational use of ICDs for specific forms of IHRD, although the acceptable risk of device complications remains unestablished. Here, we summarize the evidence of ICD benefit and harm in IHRD, highlight current knowledge gaps, and propose alternative and adjunctive options to the transvenous ICD.


Assuntos
Desfibriladores Implantáveis , Cardiopatias , Arritmias Cardíacas , Doença do Sistema de Condução Cardíaco , Morte Súbita Cardíaca , Humanos
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