Relationship between sex hormones and idiopathic outflow tract ventricular arrhythmias in adult male patients

Hu, Xiaorong; Jiang, Hong; Xu, Changwu; Zhou, Xin; Cui, Bo; Lu, Zhibing

doi:10.1016/j.trsl.2009.07.007

Cited by 10 publications

(5 citation statements)

References 14 publications

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“…12 Further, they recently reported that estrogen replacement therapy significantly reduced the VPC count in postmenopausal women with idiopathic outflow tract VAs. 13 Although they did not describe the origin of the outflow tract VAs (right or left) in either of their reports, the most common origin in their patients seemed to be the right side.…”

Section: Gender Differences In Idiopathic Ventricular Arrhythmiasmentioning

confidence: 88%

Gender Differences in Idiopathic Ventricular Arrhythmias

Nogami

2011

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ustained monomorphic ventricular tachycardia (VT) is most often related to myocardial structural heart disease, including a healed myocardial infarction, and cardiomyopathies. However, no apparent structural abnormalities are identified in approximately 10% of all cases of sustained monomorphic VT in the United States 1 and in 20% of those in Japan. 2 These cases of VT are referred to as "idiopathic". Idiopathic VTs usually occur in specific locations of the heart and have specific QRS morphologies, whereas VTs associated with structural heart disease have a QRS morphology that tends to indicate the location of the scar. Idiopathic VT comprises multiple, discrete subtypes that are best differentiated by their mechanism, QRS morphology, and site of origin. The predominant site of origin for idiopathic right VT is the right ventricular outflow tract (RVOT), and the tricuspid annulus VT is the second most common idiopathic right-sided VT. In idiopathic left-sided VTs, there are Purkinje-related VTs, mitral annular VTs, and left ventricular outflow tract (LVOT) VTs. According to the mechanism, idiopathic VT has been classified into 3 subgroups: a verapamil-sensitive type (reentry), adenosine-sensitive type (triggered activity), and propranolol-sensitive type (automaticity). 1 Although the mechanism of RVOT-VT is mainly triggered activity and that of verapamil-sensitive left fascicular VT is reentry, the mechanisms of the other idiopathic VTs are not homogeneous. Article p 1585The article by Tanaka et al in this issue of the Journal contributes to the differentiation of the various forms of idiopathic VT and ventricular premature beats (VPBs) by showing that gender and age differences exist among them. 3 The authors analyzed data from their patients with drug-resistant idiopathic ventricular arrhythmias (VAs: VT or VPB), and concluded that RVOT-VAs in women were 1.5-fold more frequent than in men, whereas LVOT-VAs were more frequent in men. They also demonstrated that the prevalence of LVOT-VAs increased with age compared with that for RVOT.Gender difference in incidence has been reported for various types of arrhythmias. The first observation of a gender difference in the ECG was published 90 years ago by Bazett, who demonstrated that women had significantly longer QT intervals than men, despite having higher heart rates. 4 However, the differences in autonomic tone and menstrual cycle variability in the corrected QT in women at rest do not appear to be responsible for the gender differences in the QT interval. In a review of gender differences in cardiac repolarization, James et al 5 provided an extensive discussion of the experimental data and potential gender differences in ionic currents at the cellular level and the possible roles played by sex hormones in some of the better-characterized gender differences in cardiac repolarization. Women with the LQT1 and LQT2 variants of congenital long-QT syndrome (LQTS) are at...

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Section: Gender Differences In Idiopathic Ventricular Arrhythmiasmentioning

confidence: 88%

Gender Differences in Idiopathic Ventricular Arrhythmias

Nogami

2011

Circ J

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“…This finding supports the role of estradiol as a cardioprotective hormone and is well in line with several studies demonstrating its antiarrhythmic effects. 21,23 Another recent study proposed that estradiol prevents apoptosis due to beneficial effects against oxidative stress in non-reproductive tissue. 34 Reduced estradiol levels in female patients may therefore lead to an aggravation of ARVC/D after the onset of menopause, and likely explain the late disease onset in females as compared to males.…”

Section: Discussionmentioning

confidence: 99%

“…Estrogens suppress ischaemia-related arrhythmias and have been associated with fewer idiopathic ventricular arrhythmias originating from the RV outflow tract. [21][22][23] The aim of this study was to investigate the influence of sex hormones on the arrhythmic outcome in patients with ARVC/D and on the pathophysiology of this disease.…”

Section: Introductionmentioning

confidence: 99%

Sex hormones affect outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia: from a stem cell derived cardiomyocyte-based model to clinical biomarkers of disease outcome

Akdiş¹,

Saguner²,

Shah

et al. 2017

European Heart Journal

126

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Aims Arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D) is characterized by fibrofatty infiltration of the myocardium and ventricular arrhythmias that may lead to sudden cardiac death. It has been observed that male patients develop the disease earlier and present with more severe phenotypes as compared to females. Thus, we hypothesized that serum levels of sex hormones may contribute to major arrhythmic cardiovascular events (MACE) in patients with ARVC/D. Methods and results The serum levels of five sex hormones, sex hormone-binding globulin, high sensitivity troponin T, pro-brain natriuretic peptide, cholesterol, triglycerides, insulin, and glucose were measured in 54 ARVC/D patients (72% male). Twenty-six patients (48%) experienced MACE. Total and free testosterone levels were significantly increased in males with MACE as compared to males with a favourable outcome, whereas estradiol was significantly lower in females with MACE as compared to females with a favourable outcome. Increased testosterone levels remained independently associated with MACE in males after adjusting for age, body mass index, Task Force criteria, ventricular function, and desmosomal mutation status. Furthermore, an induced pluripotent stem cell-derived ARVC/D cardiomyocyte model was used to investigate the effects of sex hormones. In this model, testosterone worsened and estradiol improved ARVC/D-related pathologies such as cardiomyocyte apoptosis and lipogenesis, strongly supporting our clinical findings. Conclusions Elevated serum testosterone levels in males and decreased estradiol levels in females are independently associated with MACE in ARVC/D, and directly influence disease pathology. Therefore, determining the levels of sex hormones may be useful for risk stratification and may open a new window for preventive interventions.

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“…More support on the importance of female sex hormones on VA was actually found in men. The level of estradiol, but not testosterone, in male patients with outflow-tract VA was shown to be significantly lower compared to male controls (p < 0.05) and a significant negative correlation was observed between the number of PVCs and the level of estradiol [42].…”

Section: Sex Hormonesmentioning

confidence: 75%

Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation

Krisai¹,

Cheniti²,

Takagi³

et al. 2022

Rev. Cardiovasc. Med.

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Evidence on sex differences in the pathophysiology and interventional treatment of ventricular arrhythmia in ischemic (ICM) or nonischemic cardiomyopathies (NICM) is limited. However, women have different etiologies and types of structural heart disease due to sex differences in genetics, proteomics and sex hormones. These differences may influence ventricular electrophysiological parameters and may require different treatment strategies. Considering that women were consistently under-represented in all randomized-controlled trials on VT ablation, the applicability of the study results to female patients is not known. In this article, we review the current knowledge and gaps in evidence about sex differences in the epidemiology, pathophysiology and catheter ablation in patients with ventricular arrhythmias.

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Relationship between sex hormones and idiopathic outflow tract ventricular arrhythmias in adult male patients

Cited by 10 publications

References 14 publications

Gender Differences in Idiopathic Ventricular Arrhythmias

Gender Differences in Idiopathic Ventricular Arrhythmias

Sex hormones affect outcome in arrhythmogenic right ventricular cardiomyopathy/dysplasia: from a stem cell derived cardiomyocyte-based model to clinical biomarkers of disease outcome

Sex differences in ventricular arrhythmia: epidemiology, pathophysiology and catheter ablation

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