Predisposition of functional genetic variants of A-kinase anchoring protein 10 toward acquired repolarization disorders in high-risk vascular surgery patients

Figures & data

Table 1 Definitions of cardiac complications

Term	Definition	Reference
Acute coronary syndrome	The myocardial infarction (MI) criteria were based on clinical history, findings on the electrocardiogram (ECG), and enzyme measurements in blood. MI was diagnosed by the presence of one of the following factors: – ECG showing unequivocal pathological Q waves and/or ST segment elevation or depression in serial recordings; or – the history of typical or atypical angina pectoris, together with equivocal changes in the ECG and elevated enzymes; or – the history of typical angina pectoris and elevated enzymes with no changes in the ECG	^Citation28
Acute heart failure	New onset or decompensated chronic heart failure defined as a clinical syndrome in which patients have the following features: symptoms typical of heart failure (breathlessness at rest or on exercise, fatigue, tiredness, and ankle swelling) and signs typical of heart failure (tachycardia, tachypnea, pulmonary rales, pleural effusion, raised jugular venous pressure, peripheral edema, and hepatomegaly) and objective evidence of a structural or functional abnormality of the heart at rest (cardiomegaly, third heart sound, cardiac murmurs, abnormality on the echocardiogram, and raised natriuretic peptide concentration)	^Citation29
Syncope	Sudden loss of consciousness with loss of postural tone, not related to anesthesia, with spontaneous recovery as reported by the patient or observer. Patient may experience syncope when supine	^Citation30
Sudden cardiac death	Death from an unexpected circulatory arrest, usually due to a cardiac arrhythmia occurring within an hour of the onset of symptoms	^Citation30

Table 2 Data of the study group stratified according to repolarization disturbances in Holter records

Variables	Repolarization disturbances present (n=46)	Repolarization disturbances absent (n=54)	p-value
Age (years)	66±9.9	66±8.9	0.46
BMI	26.19±3.7	26.07±3.6	0.90
EF (%)	50±9	53±9	0.04
V-POSSUM score	14.95±3.02	14.22±3.47	0.004
Mean HR (beats/min)	77±13	74±15	0.16
SBP range (mmHg)	77±22	73±28	0.25
DBP range (mmHg)	33±13	32±13	0.63
pH	7.33±0.04	7.34±0.04	0.23
Lactate (mmol/L)	1.30±0.56	1.25±0.64	0.42
Final K+ (mmol/L)	3.81±0.33	3.81±0.38	0.93
Final Hb (g/dL)	11.46±1.21	11.12±1.24	0.17
Final Hct (%)	29.93±1.89	30.66±2.32	0.09
Duration of procedure (minutes)	184±15	186±12	0.50
Aorta clamping time (minutes)**	39±13	39±14	0.99
Intraoperative blood loss (mL)	442±120	452±152	0.70
Male sex	42 (91)	45 (83)	0.37
IHD	31 (57)	24 (52)	0.68
MI	12 (26)	13 (24)	0.82
CHF	12 (26)	5 (9)	0.03
DM	10 (21)	7 (12)	0.29
HA	13 (28)	18 (33)	0.66
Dyslipidemia	11 (23)	8 (14)	0.30
History of smoking	23 (50)	24 (44)	0.68
ASA IV	5 (10)	3 (5)	0.46
Stroke	10 (21)	4 (7)	0.04
AA*	42 (79)	11 (21)
AG*	9 (26)	26 (74)	<0.01
GG*	3 (25)	9 (75)
Aortoiliac occlusive disease	11 (35)	20 (65)	0.19
Abdominal subrenal aortic aneurysm	35 (51)	34 (49)
Catecholamine support used	14 (45)	17 (55)	1.0
Without catecholamine support	32 (46)	37 (54)
Acute changes of cardiovascular system present	19 (51)	18 (49)	0.533
Acute changes of cardiovascular system absent	27 (43)	36 (57)

Notes: Values are mean ± SD or n (%).

* Genotypes of AKAP10 polymorphism,

** applied for abdominal subrenal aortic aneurysm repair only.

Abbreviations: AKAP10, A-kinase anchoring protein 10; ASA, American Society of Anaesthesiology; BMI, body mass index; CHF, congestive heart failure; DBP, diastolic blood pressure; DM, diabetes mellitus; EF, ejection fraction of the left ventricle; HA, arterial hypertension; Hb, hemoglobin; Hct, hematocrit; HR, heart rate; IHD, ischemic heart disease; MI, myocardial infarction in the past history; n, number of patients; SBP, systolic blood pressure; V-POSSUM, Vascular Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity.

Table 3 Association of AKAP10 (rs203462) gene polymorphism with repolarization disturbances

Compared genotypes or alleles	Odds ratio	95% CI range	p-value
GG + AG vs AA	11.13	4.38–28.31	<0.0001
GG vs AG + AA	4.13	1.04–16.33	0.031
GG vs AA	11.45	2.64–49.60	0.0002
G vs A	5.68	2.87–11.23	<0.0001
AG vs AA	11.03	4.02–30.21	<0.0001
GG vs AG	1.03	0.22–4.70	0.960

Abbreviation: AKAP10, A-kinase anchoring protein 10.

MendisSThygesenKKuulasmaaKWorld Health Organization definition of myocardial infarction: 2008–09 revisionInt J Epidemiol20114013914620926369

 PubMed Web of Science ®Google Scholar

McMurrayJJAdamopoulosSAnkerSDESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESCEur Heart J2012331787184722611136

 PubMed Web of Science ®Google Scholar

ZipesDPCammAJBorggrefeMACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death) Developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm SocietyEur Heart J2006272099214016923744

 PubMed Web of Science ®Google Scholar