THE MECHANISMS AND CAUSES OF SUDDEN CARDIAC DEATH.FACTORS AND RISK STRATIFICATION IN CLINICAL PRACTICE. DEFINITIONS AND TERMS

Atrial fibrillation is one of the most common arrhythmias, with a significant increase in incidence in recent years. AF is a major cause of stroke, heart failure, sudden cardiac death, and cardiovascular disease. Timely intervention and modification of risk factors increase chance to stop the disease. Aggressive, multilevel prevention tactics are a component of combined treatment, including – in addition to lifestyle changes, anticoagulant therapy, pharmacotherapy and invasive anti-arrhythmic treatment – prevention of cardiovascular diseases, hypertension, ischemia, valvular disease and heart failure.

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Prognostic implications of troponin T variations in inherited cardiomyopathies using systems biology

npj Genomic Medicine ◽

10.1038/s41525-021-00204-w ◽

2021 ◽

Vol 6 (1) ◽

Author(s):

Rameen Shakur ◽

Juan Pablo Ochoa ◽

Alan J. Robinson ◽

Abhishek Niroula ◽

Aneesh Chandran ◽

...

Keyword(s):

Heart Failure ◽

Systems Biology ◽

Sudden Cardiac Death ◽

Risk Stratification ◽

Clinical Data ◽

Cardiac Death ◽

Troponin T ◽

Management Options ◽

Familial Cardiomyopathy ◽

The Impact

AbstractThe cardiac troponin T variations have often been used as an example of the application of clinical genotyping for prognostication and risk stratification measures for the management of patients with a family history of sudden cardiac death or familial cardiomyopathy. Given the disparity in patient outcomes and therapy options, we investigated the impact of variations on the intermolecular interactions across the thin filament complex as an example of an unbiased systems biology method to better define clinical prognosis to aid future management options. We present a novel unbiased dynamic model to define and analyse the functional, structural and physico-chemical consequences of genetic variations among the troponins. This was subsequently integrated with clinical data from accessible global multi-centre systematic reviews of familial cardiomyopathy cases from 106 articles of the literature: 136 disease-causing variations pertaining to 981 global clinical cases. Troponin T variations showed distinct pathogenic hotspots for dilated and hypertrophic cardiomyopathies; considering the causes of cardiovascular death separately, there was a worse survival in terms of sudden cardiac death for patients with a variation at regions 90–129 and 130–179 when compared to amino acids 1–89 and 200–288. Our data support variations among 90–130 as being a hotspot for sudden cardiac death and the region 131–179 for heart failure death/transplantation outcomes wherein the most common phenotype was dilated cardiomyopathy. Survival analysis into regions of high risk (regions 90–129 and 130–180) and low risk (regions 1–89 and 200–288) was significant for sudden cardiac death (p = 0.011) and for heart failure death/transplant (p = 0.028). Our integrative genomic, structural, model from genotype to clinical data integration has implications for enhancing clinical genomics methodologies to improve risk stratification.

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Management of Cardiovascular Disease in Dialysis Patients

10.2310/im.12060 ◽

2017 ◽

Author(s):

John K. Roberts ◽

John P. Middleton

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Volume Overload ◽

Current Evidence ◽

Dialysis Patients ◽

Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes.

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Management of Cardiovascular Disease in Dialysis Patients

10.2310/nephro.12060 ◽

2017 ◽

Author(s):

John K. Roberts ◽

John P. Middleton

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Cardiovascular Disease ◽

Acute Myocardial Infarction ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Volume Overload ◽

Current Evidence ◽

Dialysis Patients ◽

Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes.

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Risk stratification and subclinical phenotyping of dilated and/or arrhythmogenic cardiomyopathy mutation-positive relatives: CVON eDETECT consortium

Netherlands Heart Journal ◽

10.1007/s12471-021-01542-1 ◽

2021 ◽

Author(s):

R. W. Roudijk ◽

K. Taha ◽

M. Bourfiss ◽

P. Loh ◽

L. van den Heuvel ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Early Detection ◽

Risk Stratification ◽

Dilated Cardiomyopathy ◽

Cardiac Death ◽

Diagnostic Techniques ◽

Arrhythmogenic Cardiomyopathy ◽

Early Detection Of Disease ◽

Non Invasive

AbstractIn relatives of index patients with dilated cardiomyopathy and arrhythmogenic cardiomyopathy, early detection of disease onset is essential to prevent sudden cardiac death and facilitate early treatment of heart failure. However, the optimal screening interval and combination of diagnostic techniques are unknown. The clinical course of disease in index patients and their relatives is variable due to incomplete and age-dependent penetrance. Several biomarkers, electrocardiographic and imaging (echocardiographic deformation imaging and cardiac magnetic resonance imaging) techniques are promising non-invasive methods for detection of subclinical cardiomyopathy. However, these techniques need optimisation and integration into clinical practice. Furthermore, determining the optimal interval and intensity of cascade screening may require a personalised approach. To address this, the CVON-eDETECT (early detection of disease in cardiomyopathy mutation carriers) consortium aims to integrate electronic health record data from long-term follow-up, diagnostic data sets, tissue and plasma samples in a multidisciplinary biobank environment to provide personalised risk stratification for heart failure and sudden cardiac death. Adequate risk stratification may lead to personalised screening, treatment and optimal timing of implantable cardioverter defibrillator implantation. In this article, we describe non-invasive diagnostic techniques used for detection of subclinical disease in relatives of index patients with dilated cardiomyopathy and arrhythmogenic cardiomyopathy.

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Familial Dilated Cardiomyopathy: Risk Stratification for Sudden Cardiac Death

Sudden Cardiac Death ◽

10.5772/intechopen.94437 ◽

2020 ◽

Author(s):

Gustav Mattsson ◽

Peter Magnusson

Keyword(s):

Heart Failure ◽

Health Care ◽

Sudden Cardiac Death ◽

Risk Stratification ◽

Dilated Cardiomyopathy ◽

Health Care Providers ◽

Cardiac Death ◽

Reduced Ejection Fraction ◽

Improve Risk Stratification ◽

Familial Dilated Cardiomyopathy

Heart failure implies a considerable burden for patients and resources for the health care system. Dilated cardiomyopathy is defined as left ventricular dilation and reduced systolic function, not solely explained by ischemic heart disease or abnormal loading conditions. Numerous genes have been identified in familial cases of dilated cardiomyopathy. Heart failure with reduced ejection fraction increases the risk for sudden cardiac death. Implantable cardioverter defibrillator therapy can provide a means of preventing sudden cardiac death in those deemed to be at high risk. Health care providers are in need of better tools in order to improve risk stratification. This chapter aims to provide an overview of the current knowledge about risk of arrhythmia and sudden death in patients with familial dilated cardiomyopathy, in particular for those patients with a specific mutation.

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Risk Stratification for Sudden Cardiac Death in Heart Failure

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/aci.47673 ◽

2019 ◽

Vol 5 (1 (P)) ◽

pp. 1

Author(s):

Hendry Purnasidha Bagaswoto

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Risk Stratification ◽

Cardiac Death ◽

Clinical Syndrome ◽

Pump Failure ◽

Failure Risk ◽

Clinical Challenge ◽

Symptoms And Signs

Heart failure (HF) is a complex clinical syndrome in which structural / functional myocardial abnormalities result in symptoms and signs of hypoperfusion and/or pulmonary or systemic congestion at rest or during exercise. More than 80% of deaths in patients with HF recognize a cardiovascular cause, with most being either sudden cardiac death (SCD) or death caused by progressive pump failure. Risk stratiﬁcation of SCD in patients with HF represents a clinical challenge. This review will give an update of current strategies for SCD risk stratiﬁcation in HF.

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