In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models

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In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models. / Hoefen, Ryan; Reumann, Matthias; Goldenberg, Ilan; Moss, Arthur J.; O-Uchi, Jin; Gu, Yiping; McNitt, Scott; Zareba, Wojciech; Jons, Christian; Kanters, Jorgen K.; Platonov, Pyotr; Shimizu, Wataru; Wilde, Arthur A. M.; Rice, John Jeremy; Lopes, Coeli M.

In: Journal of the American College of Cardiology, Vol. 60, No. 21, 2012, p. 2182-2191.

Research output: Contribution to journalArticle

Harvard

Hoefen, R, Reumann, M, Goldenberg, I, Moss, AJ, O-Uchi, J, Gu, Y, McNitt, S, Zareba, W, Jons, C, Kanters, JK, Platonov, P, Shimizu, W, Wilde, AAM, Rice, JJ & Lopes, CM 2012, 'In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models', Journal of the American College of Cardiology, vol. 60, no. 21, pp. 2182-2191. https://doi.org/10.1016/j.jacc.2012.07.053

APA

CBE

Hoefen R, Reumann M, Goldenberg I, Moss AJ, O-Uchi J, Gu Y, McNitt S, Zareba W, Jons C, Kanters JK, Platonov P, Shimizu W, Wilde AAM, Rice JJ, Lopes CM. 2012. In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models. Journal of the American College of Cardiology. 60(21):2182-2191. https://doi.org/10.1016/j.jacc.2012.07.053

MLA

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Author

Hoefen, Ryan ; Reumann, Matthias ; Goldenberg, Ilan ; Moss, Arthur J. ; O-Uchi, Jin ; Gu, Yiping ; McNitt, Scott ; Zareba, Wojciech ; Jons, Christian ; Kanters, Jorgen K. ; Platonov, Pyotr ; Shimizu, Wataru ; Wilde, Arthur A. M. ; Rice, John Jeremy ; Lopes, Coeli M. / In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models. In: Journal of the American College of Cardiology. 2012 ; Vol. 60, No. 21. pp. 2182-2191.

RIS

TY - JOUR

T1 - In Silico Cardiac Risk Assessment in Patients With Long QT Syndrome Type 1: Clinical Predictability of Cardiac Models

AU - Hoefen, Ryan

AU - Reumann, Matthias

AU - Goldenberg, Ilan

AU - Moss, Arthur J.

AU - O-Uchi, Jin

AU - Gu, Yiping

AU - McNitt, Scott

AU - Zareba, Wojciech

AU - Jons, Christian

AU - Kanters, Jorgen K.

AU - Platonov, Pyotr

AU - Shimizu, Wataru

AU - Wilde, Arthur A. M.

AU - Rice, John Jeremy

AU - Lopes, Coeli M.

PY - 2012

Y1 - 2012

N2 - Objectives The study was designed to assess the ability of computer-simulated electrocardiography parameters to predict clinical outcomes and to risk-stratify patients with long QT syndrome type 1 (LQT1). Background Although attempts have been made to correlate mutation-specific ion channel dysfunction with patient phenotype in long QT syndrome, these have been largely unsuccessful. Systems-level computational models can be used to predict consequences of complex changes in channel function to the overall heart rhythm. Methods A total of 633 LQT1-genotyped subjects with 34 mutations from multinational long QT syndrome registries were studied. Cellular electrophysiology function was determined for the mutations and introduced in a 1-dimensional transmural electrocardiography computer model. The mutation effect on transmural repolarization was determined for each mutation and related to the risk for cardiac events (syncope, aborted cardiac arrest, and sudden cardiac death) among patients. Results Multivariate analysis showed that mutation-specific transmural repolarization prolongation (TRP) was associated with an increased risk for cardiac events (35% per 10-ms increment [p < 0.0001]; >= upper quartile hazard ratio: 2.80 [p < 0.0001]) and life-threatening events (aborted cardiac arrest/sudden cardiac death: 27% per 10-ms increment [p = 0.03]; >= upper quartile hazard ratio: 2.24 [p = 0.002]) independently of patients' individual QT interval corrected for heart rate (QTc). Subgroup analysis showed that among patients with mild to moderate QTc duration (<500 ms), the risk associated with TRP was maintained (36% per 10 ms [p < 0.0001]), whereas the patient's individual QTc was not associated with a significant risk increase after adjustment for TRP. Conclusions These findings suggest that simulated repolarization can be used to predict clinical outcomes and to improve risk stratification in patients with LQT1, with a more pronounced effect among patients with a lower-range QTc, in whom a patient's individual QTc may provide less incremental prognostic information. (J Am Coll Cardiol 2012;60:2182-91) (C) 2012 by the American College of Cardiology Foundation

AB - Objectives The study was designed to assess the ability of computer-simulated electrocardiography parameters to predict clinical outcomes and to risk-stratify patients with long QT syndrome type 1 (LQT1). Background Although attempts have been made to correlate mutation-specific ion channel dysfunction with patient phenotype in long QT syndrome, these have been largely unsuccessful. Systems-level computational models can be used to predict consequences of complex changes in channel function to the overall heart rhythm. Methods A total of 633 LQT1-genotyped subjects with 34 mutations from multinational long QT syndrome registries were studied. Cellular electrophysiology function was determined for the mutations and introduced in a 1-dimensional transmural electrocardiography computer model. The mutation effect on transmural repolarization was determined for each mutation and related to the risk for cardiac events (syncope, aborted cardiac arrest, and sudden cardiac death) among patients. Results Multivariate analysis showed that mutation-specific transmural repolarization prolongation (TRP) was associated with an increased risk for cardiac events (35% per 10-ms increment [p < 0.0001]; >= upper quartile hazard ratio: 2.80 [p < 0.0001]) and life-threatening events (aborted cardiac arrest/sudden cardiac death: 27% per 10-ms increment [p = 0.03]; >= upper quartile hazard ratio: 2.24 [p = 0.002]) independently of patients' individual QT interval corrected for heart rate (QTc). Subgroup analysis showed that among patients with mild to moderate QTc duration (<500 ms), the risk associated with TRP was maintained (36% per 10 ms [p < 0.0001]), whereas the patient's individual QTc was not associated with a significant risk increase after adjustment for TRP. Conclusions These findings suggest that simulated repolarization can be used to predict clinical outcomes and to improve risk stratification in patients with LQT1, with a more pronounced effect among patients with a lower-range QTc, in whom a patient's individual QTc may provide less incremental prognostic information. (J Am Coll Cardiol 2012;60:2182-91) (C) 2012 by the American College of Cardiology Foundation

KW - IKs

KW - KCNQ1

KW - KCNQ2

KW - LQT

KW - QT

U2 - 10.1016/j.jacc.2012.07.053

DO - 10.1016/j.jacc.2012.07.053

M3 - Article

VL - 60

SP - 2182

EP - 2191

JO - Journal of the American College of Cardiology

T2 - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 21

ER -