Ryanodine receptor

Ryanodine 受体
  • 文章类型: Journal Article
    在胰岛素抵抗和β细胞质量降低的情况下,β细胞工作量增加,发生在2型和1型糖尿病中,分别。在糖尿病的发病过程中,胰岛素产生和分泌的长期升高会导致β细胞内质网应激。内质网应激过程中β细胞Ca2+内质网的消耗激活了未折叠的蛋白反应,导致β细胞功能障碍。Ca2+ER参与许多对β细胞功能至关重要的途径,比如蛋白质加工,调节细胞器和胞质Ca2+处理,和调节脂质稳态。促进β细胞内质网应激和耗尽Ca2+内质网储存的突变与糖尿病相关或引起糖尿病(例如,ryanodine受体和胰岛素的突变)。因此,改善β细胞Ca2+ER处理和减少糖尿病条件下的ER应激可以保持β细胞功能并延缓或预防糖尿病的发作。这篇综述着重于控制β细胞Ca2ER的机制在糖尿病的发病过程中如何受到干扰并导致β细胞衰竭。
    The β-cell workload increases in the setting of insulin resistance and reduced β-cell mass, which occurs in type 2 and type 1 diabetes, respectively. The prolonged elevation of insulin production and secretion during the pathogenesis of diabetes results in β-cell ER stress. The depletion of β-cell Ca2+ER during ER stress activates the unfolded protein response, leading to β-cell dysfunction. Ca2+ER is involved in many pathways that are critical to β-cell function, such as protein processing, tuning organelle and cytosolic Ca2+ handling, and modulating lipid homeostasis. Mutations that promote β-cell ER stress and deplete Ca2+ER stores are associated with or cause diabetes (e.g., mutations in ryanodine receptors and insulin). Thus, improving β-cell Ca2+ER handling and reducing ER stress under diabetogenic conditions could preserve β-cell function and delay or prevent the onset of diabetes. This review focuses on how mechanisms that control β-cell Ca2+ER are perturbed during the pathogenesis of diabetes and contribute to β-cell failure.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    S100A1,一种小同二聚体EF-手Ca2+结合蛋白(~21kDa),在涉及各种生物学功能的Ca2+信号通路中起着重要的调节作用,包括骨骼和心肌细胞的Ca2+循环和收缩性能。S100A1相互作用体的一个关键靶标是ryanodine受体(RyR),肌浆网巨大的同四聚体Ca2释放通道(〜2.3MDa)。这里,我们报道了与RyR1结合的S100A1的低温电子显微镜结构,在不存在和存在Ca2+的情况下。不含Ca2的apo-S100A1在桥接螺线管(BSol)下方结合,并与接合螺线管和RyR1的壳-核接头形成接触。在Ca2+结合时,S100A1经历构象变化,导致已知充当S100A1的主要相互作用位点的疏水性口袋的暴露。通过疏水口袋与RyR1的相互作用,与Ca2结合的S100A1比apo形式更深地侵入BSol下方的RyR1结构,并引起C端BSol区域向相邻RyR1质子发生器的侧向运动,从而导致更紧密的质子间接触。有趣的是,S100A1-二聚体的第二疏水口袋大部分暴露在亲水表面,使其易于与局部环境相互作用,这表明S100A1可能参与与其他蛋白质伴侣形成更大的RyRs杂复合物。由于稳定BSol的S100A1相互作用与RyR介导的Ca2释放的调节有关,RyR同工型之间保守的S100A1结合位点的表征可能为开发有关RyR相关疾病的治疗策略提供结构基础.
    S100A1, a small homodimeric EF-hand Ca2+-binding protein (~21 kDa), plays an important regulatory role in Ca2+ signaling pathways involved in various biological functions including Ca2+ cycling and contractile performance in skeletal and cardiac myocytes. One key target of the S100A1 interactome is the ryanodine receptor (RyR), a huge homotetrameric Ca2+ release channel (~2.3 MDa) of the sarcoplasmic reticulum. Here, we report cryoelectron microscopy structures of S100A1 bound to RyR1, the skeletal muscle isoform, in absence and presence of Ca2+. Ca2+-free apo-S100A1 binds beneath the bridging solenoid (BSol) and forms contacts with the junctional solenoid and the shell-core linker of RyR1. Upon Ca2+-binding, S100A1 undergoes a conformational change resulting in the exposure of the hydrophobic pocket known to serve as a major interaction site of S100A1. Through interactions of the hydrophobic pocket with RyR1, Ca2+-bound S100A1 intrudes deeper into the RyR1 structure beneath BSol than the apo-form and induces sideways motions of the C-terminal BSol region toward the adjacent RyR1 protomer resulting in tighter interprotomer contacts. Interestingly, the second hydrophobic pocket of the S100A1-dimer is largely exposed at the hydrophilic surface making it prone to interactions with the local environment, suggesting that S100A1 could be involved in forming larger heterocomplexes of RyRs with other protein partners. Since S100A1 interactions stabilizing BSol are implicated in the regulation of RyR-mediated Ca2+ release, the characterization of the S100A1 binding site conserved between RyR isoforms may provide the structural basis for the development of therapeutic strategies regarding treatments of RyR-related disorders.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    在美国,心律失常每年造成30多万人死亡,大约一半的死亡与心脏病有关。心律失常风险的潜在机制是复杂的;然而,在过去的25年中,在人类和动物模型中的工作已经确定了许多与心律失常底物和触发因素有关的分子途径。本章将重点介绍通过将人类临床和遗传数据与动物模型联系起来解决的选择心律失常途径。
    Arrhythmias account for over 300,000 annual deaths in the United States, and approximately half of all deaths are associated with heart disease. Mechanisms underlying arrhythmia risk are complex; however, work in humans and animal models over the past 25 years has identified a host of molecular pathways linked with both arrhythmia substrates and triggers. This chapter will focus on select arrhythmia pathways solved by linking human clinical and genetic data with animal models.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    本章将描述心脏肌肉细胞收缩装置的基本结构和功能特征,即,心肌细胞和平滑肌细胞。心肌细胞形成心脏的收缩心肌,而平滑肌细胞形成收缩的冠状血管。两种肌肉类型都具有不同的特性,并且将考虑其细胞外观(砖状横纹与纺锤状光滑),收缩蛋白的排列(肌节组织与非肌节组织),钙激活机制(细丝与粗丝调节),收缩特征(快速和阶段性与缓慢和补品),能量代谢(高氧与低氧需求),分子马达(具有高二磷酸腺苷[ADP]释放速率的II型肌球蛋白同工酶与具有低ADP释放速率的肌球蛋白同工酶),化学机械能量转换(高三磷酸腺苷[ATP]消耗和短占空比与低ATP消耗和肌球蛋白II交叉桥[XBs]的高占空比),和兴奋-收缩耦合(钙诱导的钙释放与药物机械耦合)。部分工作已经发表(神经科学-从分子到行为”,Chap.22,Galizia和Lledoeds2013,Springer-Verlag;获得SpringerScience+BusinessMedia的善意许可)。
    This chapter will describe basic structural and functional features of the contractile apparatus of muscle cells of the heart, namely, cardiomyocytes and smooth muscle cells. Cardiomyocytes form the contractile myocardium of the heart, while smooth muscle cells form the contractile coronary vessels. Both muscle types have distinct properties and will be considered with respect to their cellular appearance (brick-like cross-striated versus spindle-like smooth), arrangement of contractile proteins (sarcomeric versus non-sarcomeric organization), calcium activation mechanisms (thin-filament versus thick-filament regulation), contractile features (fast and phasic versus slow and tonic), energy metabolism (high oxygen versus low oxygen demand), molecular motors (type II myosin isoenzymes with high adenosine diphosphate [ADP]-release rate versus myosin isoenzymes with low ADP-release rates), chemomechanical energy conversion (high adenosine triphosphate [ATP] consumption and short duty ratio versus low ATP consumption and high duty ratio of myosin II cross-bridges [XBs]), and excitation-contraction coupling (calcium-induced calcium release versus pharmacomechanical coupling). Part of the work has been published (Neuroscience - From Molecules to Behavior\", Chap. 22, Galizia and Lledo eds 2013, Springer-Verlag; with kind permission from Springer Science + Business Media).
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    背景:慢性交感神经刺激在心力衰竭中引起β1肾上腺素能受体(β1AR)的脱敏和下调。我们旨在探索心脏中β1AR信号传导的差异下调亚细胞池。
    结果:我们在雄性C57BL/6J小鼠中应用了异丙肾上腺素的慢性输注来诱导心肌病。我们应用共聚焦和邻近连接测定法来检查β1AR与L型钙通道的相关性,ryanodine受体2和SERCA2a((Sarco)内质网钙ATPase2a)和基于Frster共振能量转移的生物传感器可探测心室肌细胞中的亚细胞β1AR-PKA(蛋白激酶A)信号。慢性输注异丙肾上腺素导致β1AR蛋白水平降低,通过邻近连接测量的与L型钙通道和ryanodine受体2的受体关联(puncta/cell,29.65生理盐水与14.17异丙肾上腺素,P<0.05),和受体诱导的质膜上的PKA信号(Förster共振能量转移,28.9%盐水与1.9%异丙肾上腺素,P<0.05)和ryanodine受体2复合物(Förster共振能量转移,30.2%生理盐水与10.6%异丙肾上腺素,P<0.05)。然而,β1AR与SERCA2a的关联增强(puncta/细胞,51.4盐水与87.5异丙肾上腺素,P<0.05),受体信号受到的影响最小。输注异丙肾上腺素的心脏显示PDE4D(磷酸二酯酶4D)和PDE3A减少,PDE2A增加,PDE4A,和PDE4B蛋白水平。我们观察到PDE4的作用降低,PDE2和PDE3对ryanodine受体2复合物和肌细胞缩短的β1AR-PKA活性的作用增强。尽管β1AR与SERCA2a的相关性增强,内源性去甲肾上腺素诱导的信号在SERCA2a复合物处减少。抑制单胺氧化酶A挽救了去甲肾上腺素诱导的SERCA2a处的PKA信号和肌细胞缩短。
    结论:本研究揭示了慢性肾上腺素能刺激下心脏亚细胞β1AR信号下调的独特机制。
    BACKGROUND: Chronic sympathetic stimulation drives desensitization and downregulation of β1 adrenergic receptor (β1AR) in heart failure. We aim to explore the differential downregulation subcellular pools of β1AR signaling in the heart.
    RESULTS: We applied chronic infusion of isoproterenol to induced cardiomyopathy in male C57BL/6J mice. We applied confocal and proximity ligation assay to examine β1AR association with L-type calcium channel, ryanodine receptor 2, and SERCA2a ((Sarco)endoplasmic reticulum calcium ATPase 2a) and Förster resonance energy transfer-based biosensors to probe subcellular β1AR-PKA (protein kinase A) signaling in ventricular myocytes. Chronic infusion of isoproterenol led to reduced β1AR protein levels, receptor association with L-type calcium channel and ryanodine receptor 2 measured by proximity ligation (puncta/cell, 29.65 saline versus 14.17 isoproterenol, P<0.05), and receptor-induced PKA signaling at the plasma membrane (Förster resonance energy transfer, 28.9% saline versus 1.9% isoproterenol, P<0.05) and ryanodine receptor 2 complex (Förster resonance energy transfer, 30.2% saline versus 10.6% isoproterenol, P<0.05). However, the β1AR association with SERCA2a was enhanced (puncta/cell, 51.4 saline versus 87.5 isoproterenol, P<0.05), and the receptor signal was minimally affected. The isoproterenol-infused hearts displayed decreased PDE4D (phosphodiesterase 4D) and PDE3A and increased PDE2A, PDE4A, and PDE4B protein levels. We observed a reduced role of PDE4 and enhanced roles of PDE2 and PDE3 on the β1AR-PKA activity at the ryanodine receptor 2 complexes and myocyte shortening. Despite the enhanced β1AR association with SERCA2a, the endogenous norepinephrine-induced signaling was reduced at the SERCA2a complexes. Inhibiting monoamine oxidase A rescued the norepinephrine-induced PKA signaling at the SERCA2a and myocyte shortening.
    CONCLUSIONS: This study reveals distinct mechanisms for the downregulation of subcellular β1AR signaling in the heart under chronic adrenergic stimulation.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    Ryanodine受体(RyR)是骨骼肌和心肌肌浆网上的细胞内钙(Ca2)释放通道,在兴奋-收缩偶联中起着核心作用。RyR的基因突变或翻译后修饰会导致通道过度激活,导致各种骨骼肌和心脏疾病。目前,大多数RyR相关疾病没有特异性治疗方法。最近,已经开发了高通量筛选(HTS)测定法来鉴定治疗RyR相关肌肉疾病的潜在候选物。这些试验已经成功地鉴定了几种化合物作为新型RyR抑制剂,在动物模型中是有效的。在这次审查中,我们将重点介绍HTS检测的最新进展,并讨论这些有前途的方法的未来前景。
    Ryanodine receptors (RyR) are intracellular calcium (Ca2+) release channels on the sarcoplasmic reticulum of skeletal and cardiac muscles that play a central role in excitation-contraction coupling. Genetic mutations or posttranslational modifications of RyR causes hyperactivation of the channel, leading to various skeletal muscle and heart diseases. Currently, no specific treatments exist for most RyR-associated diseases. Recently, high-throughput screening (HTS) assays have been developed to identify potential candidates for treating RyR-related muscle diseases. These assays have successfully identified several compounds as novel RyR inhibitors, which are effective in animal models. In this review, we will focus on recent progress in HTS assays and discuss future perspectives of these promising approaches.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    骨骼肌肌纤维中的兴奋-收缩耦合取决于通过ryanodine受体/Ca2释放通道RyR1从肌浆网释放的Ca2。RyR1包含~100个Cys硫醇,其中~30个包含一个变构网络,通过S-亚硝基化进行翻译后修饰,S-棕榈酰化和S-氧化。然而,这些修饰的作用和功能尚不清楚。尽管多个未知位点的异常S-亚硝基化与营养不良疾病相关,恶性高热和其他肌病综合征,据报道,生理情况下的S-亚硝基化以pO2门控的方式对RyR1,Cys3636中的单个(〜100个中的1个)Cys具有特异性。使用表达具有Cys3636→Ala点突变的RyR1形式的小鼠来防止该位点的S-亚硝基化,我们发现Cys3636是正常肌肉功能过程中内源性S-亚硝基化的主要靶点。缺乏Cys3636S-亚硝基化抑制了生理pO2下刺激诱发的Ca2释放(至少部分通过改变Ca2/钙调蛋白对RyR1的调节),消除了pO2耦合,体外骨骼肌细胞收缩力降低,体内肌肉力量测定。此外,我们发现Cys3636S-亚硝基化的废除导致肌纤维直径减小反映的发育缺陷,改变的纤维亚型,以及与肌肉发育和萎缩有关的基因表达改变。因此,我们的发现确立了RyR1的pO2偶联S-亚硝基化在骨骼肌收缩性和发育中的生理作用,并为RyR1修饰在生理学和疾病中的未来研究提供了基础。
    Excitation-contraction coupling in skeletal muscle myofibers depends upon Ca2+ release from the sarcoplasmic reticulum through the ryanodine receptor/Ca2+-release channel RyR1. The RyR1 contains ∼100 Cys thiols of which ∼30 comprise an allosteric network subject to posttranslational modification by S-nitrosylation, S-palmitoylation and S-oxidation. However, the role and function of these modifications is not understood. Although aberrant S-nitrosylation of multiple unidentified sites has been associated with dystrophic diseases, malignant hyperthermia and other myopathic syndromes, S-nitrosylation in physiological situations is reportedly specific to a single (1 of ∼100) Cys in RyR1, Cys3636 in a manner gated by pO2. Using mice expressing a form of RyR1 with a Cys3636→Ala point mutation to prevent S-nitrosylation at this site, we showed that Cys3636 was the principal target of endogenous S-nitrosylation during normal muscle function. The absence of Cys3636 S-nitrosylation suppressed stimulus-evoked Ca2+ release at physiological pO2 (at least in part by altering the regulation of RyR1 by Ca2+/calmodulin), eliminated pO2 coupling, and diminished skeletal myocyte contractility in vitro and measures of muscle strength in vivo. Furthermore, we found that abrogation of Cys3636 S-nitrosylation resulted in a developmental defect reflected in diminished myofiber diameter, altered fiber subtypes, and altered expression of genes implicated in muscle development and atrophy. Thus, our findings establish a physiological role for pO2-coupled S-nitrosylation of RyR1 in skeletal muscle contractility and development and provide foundation for future studies of RyR1 modifications in physiology and disease.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    区域吸热是动物将身体特定区域的温度升高到周围环境温度以上的能力,并且在几种鱼类谱系中独立进化。Sarcolipin(SLN)是一种小的跨膜蛋白,它使肌浆网钙ATP酶泵(SERCA1b)解偶联,导致徒劳的Ca2循环,并被认为在受寒冷挑战的哺乳动物和可能的某些鱼类的非发抖产热(NST)中发挥作用。这项研究调查了sln和serca1转录本在三种区域吸热鱼类中的相对表达(skipjack,Katsuwonuspelamis,还有黄鳍金枪鱼,Thunnusalbacares,两者都会提高他们慢抽搐的红骨骼肌(RM)和眼外肌(EM)的温度,以及头颅吸热箭鱼,xiphiasgladius),和紧密相关的放热杂种(东太平洋博尼托,Sardachiliensis,和太平洋鲭鱼,刺槐)。使用逆转录定量PCR(RT-qPCR)和物种特异性引物,与白肌相比,所有四种杂种的RM和EM中的相对sln表达均趋于更高。此外,与白肌相比,skip鱼和黄鳍金枪鱼的RM中的相对serca1表达更高。然而,剑鱼RM的sln和serca1转录本都不高,与白肌相比,EM或颅骨加热器组织。sarcolipin的一个关键磷酸化位点,苏氨酸5,在箭鱼中保守,但在金枪鱼和吸热的暗眼太平洋opah中突变为丙氨酸或缬氨酸,兰普里斯隐姓埋名,这将导致SERCA泵的解耦增加。我们的结果支持潜在的SLN-NST在吸热金枪鱼中的作用以及对箭鱼的缺乏。
    Regional endothermy is the ability of an animal to elevate the temperature of specific regions of the body above that of the surrounding environment and has evolved independently among several fish lineages. Sarcolipin (SLN) is a small transmembrane protein that uncouples the sarcoplasmic reticulum calcium ATPase pump (SERCA1b) resulting in futile Ca2+ cycling and is thought to play a role in non-shivering thermogenesis (NST) in cold-challenged mammals and possibly some fishes. This study investigated the relative expression of sln and serca1 transcripts in three regionally-endothermic fishes (the skipjack, Katsuwonus pelamis, and yellowfin tuna, Thunnus albacares, both of which elevate the temperatures of their slow-twitch red skeletal muscle (RM) and extraocular muscles (EM), as well as the cranial endothermic swordfish, Xiphias gladius), and closely related ectothermic scombrids (the Eastern Pacific bonito, Sarda chiliensis, and Pacific chub mackerel, Scomber japonicus). Using Reverse Transcription quantitative PCR (RT-qPCR) and species-specific primers, relative sln expression trended higher in both the RM and EM for all four scombrid species compared to white muscle. In addition, relative serca1 expression was found to be higher in RM of skipjack and yellowfin tuna in comparison to white muscle. However, neither sln nor serca1 transcripts were higher in swordfish RM, EM or cranial heater tissue in comparison to white muscle. A key phosphorylation site in sarcolipin, threonine 5, is conserved in the swordfish, but is mutated to alanine or valine in tunas and the endothermic smalleye Pacific opah, Lampris incognitus, which should result in increased uncoupling of the SERCA pump. Our results support the role of potential SLN-NST in endothermic tunas and the lack thereof for swordfish.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

  • 文章类型: Journal Article
    质膜中的1型电压激活钙通道(CaV1)通过两种机制触发从肌浆网(SR)释放钙。在电压诱导的钙释放(VICR)中,CaV1电压传感域直接耦合到ryanodine受体(RYRs),SR钙通道。在钙诱导的钙释放(CICR)中,通过激活的CaV1通道流动的钙离子结合并激活RYR通道。VICR被认为仅发生在脊椎动物骨骼肌中,而CICR发生在所有其他肌肉(包括所有无脊椎动物肌肉)中。这里,我们使用钙激活的SLO-2钾通道分析秀丽隐杆线虫体内肌肉中的CaV1-SR偶联。SLO-2通道被VICR和外部钙激活。VICR介导的SLO-2激活需要两个SR钙通道(RYRs和IP3受体),JPH-1/Junctophilin,EGL-19/CaV1羧基末端的PDZ(PSD95,Dlg1,ZO-1结构域)结合结构域(PBD),和SHN-1/Shank(一种结合EGL-19的PBD的支架蛋白)。因此,VICR发生在无脊椎动物肌肉中。
    Type 1 voltage-activated calcium channels (CaV1) in the plasma membrane trigger calcium release from the sarcoplasmic reticulum (SR) by two mechanisms. In voltage-induced calcium release (VICR), CaV1 voltage sensing domains are directly coupled to ryanodine receptors (RYRs), an SR calcium channel. In calcium-induced calcium release (CICR), calcium ions flowing through activated CaV1 channels bind and activate RYR channels. VICR is thought to occur exclusively in vertebrate skeletal muscle while CICR occurs in all other muscles (including all invertebrate muscles). Here, we use calcium-activated SLO-2 potassium channels to analyze CaV1-SR coupling in Caenorhabditis elegans body muscles. SLO-2 channels were activated by both VICR and external calcium. VICR-mediated SLO-2 activation requires two SR calcium channels (RYRs and IP3 Receptors), JPH-1/Junctophilin, a PDZ (PSD95, Dlg1, ZO-1 domain) binding domain (PBD) at EGL-19/CaV1\'s carboxy-terminus, and SHN-1/Shank (a scaffolding protein that binds EGL-19\'s PBD). Thus, VICR occurs in invertebrate muscles.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

       PDF(Pubmed)

  • 文章类型: Journal Article
    背景:儿茶酚胺能多形性室性心动过速(CPVT)可能会导致心脏性猝死(SCD)。因此,植入式心律转复除颤器(ICD)通常被推荐.然而,关于儿童使用ICD的结果的数据有限.
    目的:比较有和没有ICD的儿童CPVT患者发生心律失常事件的风险。
    方法:我们比较了有或没有ICD的RYR2变异和表型阳性症状CPVT患者的SCD风险,年龄<19岁,表型诊断时无心脏骤停(SCA)病史。主要结果是SCD;次要结果是SCD的复合发病率,SCA,适当的ICD冲击,有/没有心律失常性晕厥。
    结果:该研究包括235名患者,73(31.1%)有ICD,162(68.9%)没有ICD。中位随访时间为8.0年(IQR4.3-13.4),7例(3.0%)患者发生SCD,其中4例(57.1%)不符合药物治疗,且无ICD.ICD患者有两个次要复合结局的风险较高(无晕厥:HR5.85(CI3.40-10.09);p<0.0001;有晕厥:HR2.55(CI1.50-4.34);p=0.0005)。31名(42.5%)ICD患者经历了适当的电击,18(24.7%)不适当的冲击,21例(28.8%)器械相关并发症。
    结论:SCD事件仅发生在无ICD组,那些没有接受最佳药物治疗的人。ICD患者发生适当和不适当电击的风险很高,这可以通过适当的设备编程来减少。严重的ICD并发症很常见,需要考虑ICD的风险与益处。
    BACKGROUND: Catecholaminergic polymorphic ventricular tachycardia (CPVT) may cause sudden cardiac death (SCD) despite medical therapy. Therefore, implantable cardioverter-defibrillators (ICDs) are commonly advised. However, there is limited data on the outcomes of ICD use in children.
    OBJECTIVE: The purpose of this study was to compare the risk of arrhythmic events in pediatric patients with CPVT with and without an ICD.
    METHODS: We compared the risk of SCD in patients with RYR2 (ryanodine receptor 2) variants and phenotype-positive symptomatic CPVT patients with and without an ICD who were younger than 19 years and had no history of sudden cardiac arrest at phenotype diagnosis. The primary outcome was SCD; secondary outcomes were composite end points of SCD, sudden cardiac arrest, or appropriate ICD shocks with or without arrhythmic syncope.
    RESULTS: The study included 235 patients, 73 with an ICD (31.1%) and 162 without an ICD (68.9%). Over a median follow-up of 8.0 years (interquartile range 4.3-13.4 years), SCD occurred in 7 patients (3.0%), of whom 4 (57.1%) were noncompliant with medications and none had an ICD. Patients with ICD had a higher risk of both secondary composite outcomes (without syncope: hazard ratio 5.85; 95% confidence interval 3.40-10.09; P < .0001; with syncope: hazard ratio 2.55; 95% confidence interval 1.50-4.34; P = .0005). Thirty-one patients with ICD (42.5%) experienced appropriate shocks, 18 (24.7%) inappropriate shocks, and 21 (28.8%) device-related complications.
    CONCLUSIONS: SCD events occurred only in patients without an ICD and mostly in those not on optimal medical therapy. Patients with an ICD had a high risk of appropriate and inappropriate shocks, which may be reduced with appropriate device programming. Severe ICD complications were common, and risks vs benefits of ICDs need to be considered.
    导出

    更多引用

    收藏

    翻译标题摘要

    我要上传

    求助全文

公众号