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Yamagata LM, Yamagata K, Borg A, Abela M. Shifting paradigms in hypertrophic cardiomyopathy: the role of exercise in disease management. Hellenic J Cardiol 2024:S1109-9666(24)00138-6. [PMID: 38977062 DOI: 10.1016/j.hjc.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 05/29/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is traditionally associated with exercise restriction due to potential risks, yet recent evidence and guidelines suggest a more permissive stance for low-risk individuals. The aim of this comprehensive review was to examine existing research on the impact of exercise on cardiovascular outcomes, safety, and quality of life in this population and to consider implications for clinical practice. Recent studies suggest that regular exercise and physical activity in low-risk individuals with HCM are associated with positive outcomes in functional capacity, haemodynamic response, and quality of life, with consistent safety. Various studies highlight the safety of moderate-intensity exercise, showing improvements in exercise capacity without adverse cardiac remodelling or significant arrhythmias. Psychological benefits, including reductions in anxiety and depression, have been also reported following structured exercise programmes. These findings support the potential benefits of integrating individualised exercise regimens in the management of low-risk individuals with HCM, with the aim of improving their overall well-being and cardiovascular health. Adoption of the FITT (frequency, intensity, time, and type of exercise) principle, consideration of individual risk profiles, and shared decision-making are recommended. Future research is warranted to clarify the definition of 'low risk' for exercise participation and investigate the influence of physical activity on disease progression in HCM. Innovation in therapeutic strategies and lifestyle interventions, alongside improved patient and provider education, will help advance the care and safety of individuals with HCM engaging in exercise.
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Affiliation(s)
| | - Kentaro Yamagata
- Department of Cardiology, Mater Dei Hospital, Msida, Malta; Institute of Sport, Manchester Metropolitan University, Manchester, United Kingdom.
| | - Alexander Borg
- Department of Cardiology, Mater Dei Hospital, Msida, Malta
| | - Mark Abela
- Department of Cardiology, Mater Dei Hospital, Msida, Malta; Cardiovascular and Genomics Research Institute at St George's, University of London, London, United Kingdom
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2
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McKinney J, Isserow M, Wong J, Isserow S, Moulson N. New Insights and Recommendations for Athletes With Hypertrophic Cardiomyopathy. Can J Cardiol 2024; 40:921-933. [PMID: 38369259 DOI: 10.1016/j.cjca.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 02/20/2024] Open
Abstract
Hypertrophic cardiomyopathy (HCM) has long been considered to be a high-risk cardiac condition for which exercise was thought to increase the risk of sudden cardiac death (SCD). This was founded in part by initial autopsy studies reporting HCM to be a leading medical cause of SCD among young athletes. Most forms of competitive sport and exercise were therefore thought to increase the risk of SCD to a prohibitive level. Resultant expert consensus guideline recommendations universally restricted athletes with HCM from participation in moderate- to vigourous-intensity sport and exercise in a binary "yes" or "no" clinical decision making process with the goal of reducing the risk of sports-related SCD. HCM is, however, a heterogeneous genetic condition with variable penetrance and risk. The degree to which sports and exercise increases the risk of SCD at an individual patient level continues to be an area of clinical uncertainty. Emerging data and clinical experience from the past several decades have provided important new insights into exercise-related risks and have brought into question the appropriateness of overly restrictive binary clinical decision making for exercise recommendations in HCM. This includes an improved understanding of the overall prevalence of HCM in the general population, improved observational estimates of the risk of SCD related to continued sport and exercise participation, and a general shift toward improved patient-centred approaches to care through shared decision making processes. The rules by which the game is played may be changing for athletes with HCM.
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Affiliation(s)
- James McKinney
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Megan Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Saul Isserow
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nathaniel Moulson
- SportsCardiologyBC, University of British Columbia, Vancouver, British Columbia, Canada; Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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3
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Kay B, Lampert R. Devices and Athletics: Decision-Making Around Return to Play. Card Electrophysiol Clin 2024; 16:81-92. [PMID: 38280816 DOI: 10.1016/j.ccep.2023.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2024]
Abstract
Until recently, implantable cardioverter defibrillators (ICDs) were considered a contraindication to competitive athletics. Recent prospective observational registry data in athletes with ICDs who participated in sports against the societal recommendations at the time have demonstrated the safety of sports participation. While athletes did receive both appropriate and inappropriate shocks, these were not more frequent during sports participation than other activity, and there were no sports-related deaths or need for external resuscitation in the 440 athlete cohort (median followup 44 months). Optimization of medical therapies, device settings and having an emergency action plan allow many athletes to safely continue athletic activity.
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Affiliation(s)
- Bradley Kay
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA
| | - Rachel Lampert
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, Dana 319, New Haven, CT 06520, USA.
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Shafqat A, Shaik A, Koritala S, Mushtaq A, Sabbah BN, Nahid Elshaer A, Baqal O. Contemporary review on pediatric hypertrophic cardiomyopathy: insights into detection and management. Front Cardiovasc Med 2024; 10:1277041. [PMID: 38250029 PMCID: PMC10798042 DOI: 10.3389/fcvm.2023.1277041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/14/2023] [Indexed: 01/23/2024] Open
Abstract
Hypertrophic cardiomyopathy is the most common genetic cardiac disorder and is defined by the presence of left ventricular (LV) hypertrophy in the absence of a condition capable of producing such a magnitude of hypertrophy. Over the past decade, guidelines on the screening, diagnostic, and management protocols of pediatric primary (i.e., sarcomeric) HCM have undergone significant revisions. Important revisions include changes to the appropriate screening age, the role of cardiac MRI (CMR) in HCM diagnosis, and the introduction of individualized pediatric SCD risk assessment models like HCM Risk-kids and PRIMaCY. This review explores open uncertainties in pediatric HCM that merit further attention, such as the divergent American and European recommendations on CMR use in HCM screening and diagnosis, the need for incorporating key genetic and imaging parameters into HCM-Risk Kids and PRIMaCY, the best method of quantifying myocardial fibrosis and its prognostic utility in SCD prediction for pediatric HCM, devising appropriate genotype- and phenotype-based exercise recommendations, and use of heart failure medications that can reverse cardiac remodeling in pediatric HCM.
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Affiliation(s)
- Areez Shafqat
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdullah Shaik
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Ascension St. John Hospital, Detroit, MI, United States
| | - Snygdha Koritala
- Dr. Pinnamaneni Siddhartha Institute of Medical Sciences & Research Foundation, Gannavaram, India
| | - Ali Mushtaq
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States
| | | | - Ahmed Nahid Elshaer
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Creighton University School of Medicine, Omaha, NE, United States
| | - Omar Baqal
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, United States
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5
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Dorian D, Scolari FL, Habib M, Brahmbhatt DH, Chow C, Bruchal-Garbicz B, Hoss S, Billia F, Chan R, Rakowski H, Adler A. Association of duration and intensity of exercise with phenotypic expression in hypertrophic cardiomyopathy. Int J Cardiol 2023; 392:131253. [PMID: 37579850 DOI: 10.1016/j.ijcard.2023.131253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES There is limited data regarding the impact of exercise on phenotypic expression in hypertrophic cardiomyopathy (HCM). We aimed to investigate whether such an association exists in a cohort of genotype-positive HCM patients. METHODS In this cross-sectional study of genotype-positive HCM families, we used structured questionnaires to obtain data regarding intensity and duration of exercise of participants starting at the age of 10, as well as data regarding exercise recommendations and their impact on quality of life (QOL). The association of cumulative metabolic-equivalent hours of exercise at different ages with different measures of phenotypic expression (maximal wall thickness, left atrial diameter, extent of late gadolinium enhancement) was analyzed. RESULTS The study included 109 patients from 55 families, including 43 male (39%) and 90 (83%) phenotype-positive. No association was identified between exercise duration or intensity with any of the phenotypic markers with the exception of greater cumulative exercise associated with younger age at presentation. Similar results were obtained when analysis was limited to exercise until the age of 20, until the age of 30 or only after 30. Among phenotype-positive patients, 89% recalled receiving recommendations regarding exercise restriction, 29% noted reduction in exercise level following such recommendations and 25% noted this having a significant impact on their QOL. CONCLUSION We found no association between exercise intensity or duration and phenotypic expression in genotype-positive HCM patients. These findings are important for physician-patient discussions and support the recent trend towards more permissive exercise restrictions in HCM.
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Affiliation(s)
- David Dorian
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Fernando L Scolari
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Manhal Habib
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Darshan H Brahmbhatt
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cindy Chow
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Beata Bruchal-Garbicz
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sara Hoss
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Filio Billia
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raymond Chan
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Harry Rakowski
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Arnon Adler
- From The Division of Cardiology, Peter Munk Cardiac Centre, University Health Network and The Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
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MacNamara JP, Dias KA, Hearon CM, Ivey E, Delgado VA, Saland S, Samels M, Hieda M, Turer AT, Link MS, Sarma S, Levine BD. Randomized Controlled Trial of Moderate- and High-Intensity Exercise Training in Patients With Hypertrophic Cardiomyopathy: Effects on Fitness and Cardiovascular Response to Exercise. J Am Heart Assoc 2023; 12:e031399. [PMID: 37830338 PMCID: PMC10757533 DOI: 10.1161/jaha.123.031399] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/20/2023] [Indexed: 10/14/2023]
Abstract
Background Moderate intensity exercise training (MIT) is safe and effective for patients with hypertrophic cardiomyopathy, yet the efficacy of high intensity training (HIT) remains unknown. This study aimed to compare the efficacy of HIT compared with MIT in patients with hypertrophic cardiomyopathy. Methods and Results Patients with hypertrophic cardiomyopathy were randomized to either 5 months of MIT, or 1 month of MIT followed by 4 months of progressive HIT. Peak oxygen uptake (V˙O2; Douglas bags), cardiac output (acetylene rebreathing), and arteriovenous oxygen difference (Fick equation) were measured before and after training. Left ventricular outflow gradient and volumes were measured by echocardiography. Fifteen patients completed training (MIT, n=8, age 52±7 years; HIT, n=7, age 42±8 years). Both HIT and MIT improved peak V˙O2 by 1.3 mL/kg per min (P=0.009). HIT (+1.5 mL/kg per min) had a slightly greater effect than MIT (+1.1 mL/kg per min) but with no statistical difference (group×exercise P=0.628). A greater augmentation of arteriovenous oxygen difference occurred with exercise (Δ1.6 mL/100 mL P=0.005). HIT increased left ventricular end-diastolic volume (+17 mL, group×exercise P=0.015) compared with MIT. No serious arrhythmias or adverse cardiac events occurred. Conclusions This randomized trial of exercise training in patients with hypertrophic cardiomyopathy demonstrated that both HIT and MIT improved fitness without clear superiority of either. Although the study was underpowered for safety outcomes, no serious adverse events occurred. Exercise training resulted in salutary peripheral and cardiac adaptations. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03335332.
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Affiliation(s)
- James P. MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Katrin A. Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Christopher M. Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Erika Ivey
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | | | - Sophie Saland
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Mitchel Samels
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
| | - Michinari Hieda
- Department of Medicine and Biosystemic Science, Hematology, Oncology, and Cardiovascular Medicine, School of MedicineKyushu UniversityFukuokaJapan
| | - Aslan T. Turer
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Mark S. Link
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
| | - Benjamin D. Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian DallasDallasTXUSA
- University of Texas Southwestern Medical CenterDallasTXUSA
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Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J 2023; 44:3503-3626. [PMID: 37622657 DOI: 10.1093/eurheartj/ehad194] [Citation(s) in RCA: 316] [Impact Index Per Article: 316.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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8
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Bryde R, Martinez MW, Emery MS. Exercise recommendations for patients with hypertrophic cardiomyopathy. Prog Cardiovasc Dis 2023; 80:53-59. [PMID: 37201741 DOI: 10.1016/j.pcad.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023]
Abstract
Individuals with hypertrophic cardiomyopathy (HCM) have historically been advised to limit exercise and sports participation to mild-intensity activities due to concerns for sudden cardiac arrest (SCA). However, more contemporary data have shown SCA is rare in patients with HCM and emerging data is shifting towards support for the safety of exercise in this patient population. Recent guidelines endorse exercise in patients with HCM after a comprehensive evaluation and shared-decision making with an expert provider.
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Affiliation(s)
- Robyn Bryde
- Department of Cardiovascular Diseases, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ, USA; Sports Cardiology and Hypertrophic Cardiomyopathy, Morristown Medical Center, Morristown, NJ, USA
| | - Michael S Emery
- Sports Cardiology Center, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
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9
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Martin TG, Juarros MA, Leinwand LA. Regression of cardiac hypertrophy in health and disease: mechanisms and therapeutic potential. Nat Rev Cardiol 2023; 20:347-363. [PMID: 36596855 PMCID: PMC10121965 DOI: 10.1038/s41569-022-00806-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2022] [Indexed: 01/05/2023]
Abstract
Left ventricular hypertrophy is a leading risk factor for cardiovascular morbidity and mortality. Although reverse ventricular remodelling was long thought to be irreversible, evidence from the past three decades indicates that this process is possible with many existing heart disease therapies. The regression of pathological hypertrophy is associated with improved cardiac function, quality of life and long-term health outcomes. However, less than 50% of patients respond favourably to most therapies, and the reversibility of remodelling is influenced by many factors, including age, sex, BMI and disease aetiology. Cardiac hypertrophy also occurs in physiological settings, including pregnancy and exercise, although in these cases, hypertrophy is associated with normal or improved ventricular function and is completely reversible postpartum or with cessation of training. Studies over the past decade have identified the molecular features of hypertrophy regression in health and disease settings, which include modulation of protein synthesis, microRNAs, metabolism and protein degradation pathways. In this Review, we summarize the evidence for hypertrophy regression in patients with current first-line pharmacological and surgical interventions. We further discuss the molecular features of reverse remodelling identified in cell and animal models, highlighting remaining knowledge gaps and the essential questions for future investigation towards the goal of designing specific therapies to promote regression of pathological hypertrophy.
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Affiliation(s)
- Thomas G Martin
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Miranda A Juarros
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA
| | - Leslie A Leinwand
- Department of Molecular, Cellular and Developmental Biology, University of Colorado Boulder, Boulder, CO, USA.
- BioFrontiers Institute, University of Colorado Boulder, Boulder, CO, USA.
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10
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Katyal A, Li COY, Franciosi S, Sanatani S. The safety of sports in children with inherited arrhythmia substrates. Front Pediatr 2023; 11:1151286. [PMID: 37124180 PMCID: PMC10132466 DOI: 10.3389/fped.2023.1151286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/22/2023] [Indexed: 05/02/2023] Open
Abstract
Sudden cardiac death (SCD) is a rare and devastating event in children and remains a leading cause of death in young athletes. Channelopathies and cardiomyopathies, in particular long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT), hypertrophic cardiomyopathy (HCM), and arrhythmogenic cardiomyopathy (ACM) are associated with exercise-related SCD. Implantable cardioverter-defibrillators (ICDs) are often placed for secondary prevention for athletes with cardiomyopathy or channelopathy. There remains concern regarding the safety of return to participation with an ICD in place. Guidelines have historically recommended that patients with inherited heart rhythm disorders be restricted from competitive sports participation. Increasing evidence suggests a lower risk of exercise-related cardiac events in young athletes with inherited heart rhythm disorders. In this review, we highlight current knowledge, evolving guidelines, and present a multidisciplinary approach involving shared decision-making and appropriate planning for safe sports participation of children with inherited heart rhythm disorders.
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11
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Liu L, Zhu J, Chen H, Hong L, Jiang J. Rediscovering the value of exercise in patients with hypertrophic cardiomyopathy. Zhejiang Da Xue Xue Bao Yi Xue Ban 2022; 51:758-764. [PMID: 36915972 PMCID: PMC10262002 DOI: 10.3724/zdxbyxb-2022-0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/20/2022] [Indexed: 11/21/2022]
Abstract
It was previously thought that hypertrophic cardiomyopathy is the leading cause of sudden cardiac death in athletes. This was also extrapolated to the general population. Thereby, exercise was restrained in patients with hypertrophic cardiomyopathy. However, recent studies have shown that hypertrophic cardiomyopathy is not the main cause of sudden cardiac death, and moderate exercise is not only safe but beneficial for patients with hypertrophic cardiomyopathy. With the accumulation of evidence, relevant guidelines recommend low-intensity exercise from the beginning, then gradually recommend moderate-high intensity exercise for patients with hypertrophic cardiomyopathy. This suggests that we should rediscover the value of exercise in patients with hypertrophic cardiomyopathy. It is now widely accepted that patients with hypertrophic cardiomyopathy can benefit from the positive effects of exercise through an individualized exercise prescription based on a comprehensive assessment. This review summarizes the evidence showing patients with hypertrophic cardiomyopathy can exercise safely, and the methods to formulate related exercise prescriptions.
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12
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Cai H, Zhou L, Liu J, Li Z, Chen S. Independent and combined effects of liraglutide and aerobic interval training on glycemic control and cardiac protection in diabetic cardiomyopathy rats. Biochem Biophys Res Commun 2022; 629:112-120. [PMID: 36116373 DOI: 10.1016/j.bbrc.2022.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 08/30/2022] [Accepted: 09/03/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study intended to explore the hypoglycemic and cardioprotective effects of 8-week aerobic interval training combined with liraglutide and elucidate the underlying mechanisms. METHOD Male Wistar rats were randomly divided into 5 groups - normal control group (CON), diabetic cardiomyopathy group (DCM), high-dose liraglutide group (DH), low-dose liraglutide group (DL), and aerobic interval training combined with liraglutide group (DLE). High-fat diet and streptozotocin (STZ) were used to induce the DCM model, and both the liraglutide administration group and combination therapy group allocated to 8 weeks of either liraglutide or liraglutide and exercise intervention. Cardiac functions were analyzed by electrocardiography. Blood biochemical parameters were measured to judge glycemic control conditions. Hematoxylin and eosin (HE) staining and Sirus red staining was used to identify cardiac morphology and collagen accumulation, respectively. Advanced glycation end products (AGEs) were determined by enzymatic methods. The mRNA expression of myocardial remodeling genes (BNP, GSK3β, α-MHC, β-MHC and PPARα) and the protein expression of GLP-1, GLP-1R were analyzed. RESULTS DCM rats developed hyperglycemia, impaired cardiac function with accumulation of AGEs and collagen (P < 0.05). The development of hyperglycemia and cardiac dysfunction was significantly attenuated with all interventions, as reduced cardiac fibrosis and improved cardiac function (P < 0.05). Cardiac remodeling genes were normalized after all interventions, these positive modifications were due to increased GLP-1 and GLP-1R expression in DCM heart (P < 0.05). Liraglutide combined with AIT significantly increased the diameters of cardiomyocytes, increased the α-MHC expressionx, reduced PPARαexpression and reduced the fluctuation of blood glucose level, which showed the safety and effective of medicine combined with exercise. CONCLUSION Liraglutide combined with AIT intervention normalized blood glucose alleviates myocardial fibrosis and improves cardiac contractile function in DCM rats, supporting the efficacy and safety of the combination therapy.
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Affiliation(s)
- Huan Cai
- Tianjin University of Sport, College of Exercise and Health Sciences, Tianjin, 300060, China; NO.1 Hospital of Baoding, Department of Endocrinology, Baoding, 071066, China
| | - Linling Zhou
- Graduate School of Hebei Medical University, Shijiazhuang, 050011, China; Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050057, China
| | - Jingqin Liu
- Tianjin University of Sport, College of Exercise and Health Sciences, Tianjin, 300060, China; NO.1 Hospital of Baoding, Department of Endocrinology, Baoding, 071066, China
| | - Zelin Li
- Graduate School of Hebei Medical University, Shijiazhuang, 050011, China; Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050057, China
| | - Shuchun Chen
- Graduate School of Hebei Medical University, Shijiazhuang, 050011, China; Department of Endocrinology, Hebei General Hospital, Shijiazhuang, 050057, China.
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13
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La Gerche A, Wasfy MM, Brosnan MJ, Claessen G, Fatkin D, Heidbuchel H, Baggish AL, Kovacic JC. The Athlete's Heart-Challenges and Controversies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 80:1346-1362. [PMID: 36075838 DOI: 10.1016/j.jacc.2022.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/11/2022]
Abstract
Regular exercise promotes structural, functional, and electrical remodeling of the heart, often referred to as the "athlete's heart," with intense endurance sports being associated with the greatest degree of cardiac remodeling. However, the extremes of exercise-induced cardiac remodeling are potentially associated with uncommon side effects. Atrial fibrillation is more common among endurance athletes and there is speculation that other arrhythmias may also be more prevalent. It is yet to be determined whether this arrhythmic susceptibility is a result of extreme exercise remodeling, genetic predisposition, or other factors. Gender may have the greatest influence on the cardiac response to exercise, but there has been far too little research directed at understanding differences in the sportsman's vs sportswoman's heart. Here in part 4 of a 4-part seminar series, the controversies and ambiguities regarding the athlete's heart, and in particular, its arrhythmic predisposition, genetic, and gender influences are reviewed in depth.
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Affiliation(s)
- Andre La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia; National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
| | - Meagan M Wasfy
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria J Brosnan
- National Centre for Sports Cardiology, Fitzroy, Victoria, Australia; Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Diane Fatkin
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | - Hein Heidbuchel
- Antwerp University Hospital, Department of Cardiology, Antwerp, Belgium; Cardiovascular Sciences, Antwerp University, Antwerp, Belgium
| | - Aaron L Baggish
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia; School of Clinical Medicine, Faculty of Medicine and Health, UNSW Sydney, Kensington, New South Wales, Australia; Cardiology Department, St Vincent's Hospital, Darlinghurst, New South Wales, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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14
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Kay B, Lampert R. Devices and Athletics. Cardiol Clin 2022; 41:81-92. [DOI: 10.1016/j.ccl.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Athletic Activity for Patients With Hypertrophic Cardiomyopathy and Other Inherited Cardiovascular Diseases: JACC Focus Seminar 3/4. J Am Coll Cardiol 2022; 80:1268-1283. [PMID: 36075839 DOI: 10.1016/j.jacc.2022.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 02/08/2023]
Abstract
As explored throughout this JACC Focus Seminar series, participation in regular exercise offers significant positive benefits for cardiovascular health. However, patients with underlying inherited cardiovascular diseases, such as hypertrophic cardiomyopathy, have historically been restricted from sports participation because of the risk of sudden cardiac death. Over the last decade, new data has challenged this restrictive approach. Today, the notion of individualized, patient-centered shared decision-making is being progressively adopted to guide patients with an inherited cardiovascular disease to decide if they can undertake regular exercise, or even if they can participate in competitive sports. Here in this part 3 of a 4-part seminar series, we focus on these concepts and recent data with respect to exercise and the heart in patients with hypertrophic cardiomyopathy and other inherited cardiovascular diseases, with particular emphasis on participation in recreational and competitive sports for these individuals.
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16
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Zhang T, Ge J. Mechanism of CREB1 in cardiac function of rats with heart failure via regulating the microRNA-376a-3p/TRAF6 axis. Mamm Genome 2022; 33:490-501. [PMID: 35217880 DOI: 10.1007/s00335-022-09947-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/14/2022] [Indexed: 10/19/2022]
Abstract
Heart failure (HF) is a complicated disease resulting from impaired heart function. CREB1 is a candidate target in heart-concerning diseases. This paper attempts to explore the role of CREB1 in HF. Initially, the HF rat model was established by constricted abdominal aortic surgery and the cardiac function of HF rats was assessed by ultrasonic cardiogram. Levels of CK-MB and LDH and activity of Caspase-3 and Caspase-9 in HF rats were determined. Subsequently, myocardium pathological injury and myocardium apoptosis were detected. Additionally, the interactions between CREB1 and miR-376a-3p and between miR-376a-3p and TRAF6 were verified. The roles of CREB1, miR-376a-3p, and TRAF6 in HF were evaluated. In HF rats, CREB1 and miR-376a-3p were both downregulated while TRAF6 was upregulated. Besides, HF rats had decreased values of EF and FS, elevated levels of CK-MB and LDH, inflammatory infiltration, promoted cardiomyocyte apoptosis, and elevated activity of Caspase-3 and Caspase-9, which were all reversed by CREB1. Additionally, CREB1 activated miR-376a-3p expression, and miR-376a-3p targeted TRAF6 transcription. Both miR-376a-3p knockdown and TRAF6 overexpression annulled the protective role of CREB1 overexpression in cardiac function of HF rats. CREB1 activated miR-376a-3p expression to suppress TRAF6, thereby promoting the cardiac function of HF rats.
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Affiliation(s)
- Tao Zhang
- Department of Cardiac Surgery, The Affiliated First Hospital of USTC, No. 1 Swan Lake Road, Shushan District, Hefei, 230000, Anhui, China
| | - Jianjun Ge
- Department of Cardiac Surgery, The Affiliated First Hospital of USTC, No. 1 Swan Lake Road, Shushan District, Hefei, 230000, Anhui, China.
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17
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Pelliccia A. New evidences recommend an active lifestyle in young HCM patients. Int J Cardiol 2022; 369:82-83. [PMID: 35987311 PMCID: PMC9550157 DOI: 10.1016/j.ijcard.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/10/2022] [Indexed: 11/25/2022]
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18
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Coscarella IL, Landim-Vieira M, Pinto JR, Chelko SP. Arrhythmogenic Cardiomyopathy: Exercise Pitfalls, Role of Connexin-43, and Moving beyond Antiarrhythmics. Int J Mol Sci 2022; 23:ijms23158753. [PMID: 35955883 PMCID: PMC9369094 DOI: 10.3390/ijms23158753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/11/2022] Open
Abstract
Arrhythmogenic Cardiomyopathy (ACM), a Mendelian disorder that can affect both left and right ventricles, is most often associated with pathogenic desmosomal variants that can lead to fibrofatty replacement of the myocardium, a pathological hallmark of this disease. Current therapies are aimed to prevent the worsening of disease phenotypes and sudden cardiac death (SCD). Despite the use of implantable cardioverter defibrillators (ICDs) there is no present therapy that would mitigate the loss in electrical signal and propagation by these fibrofatty barriers. Recent studies have shown the influence of forced vs. voluntary exercise in a variety of healthy and diseased mice; more specifically, that exercised mice show increased Connexin-43 (Cx43) expression levels. Fascinatingly, increased Cx43 expression ameliorated the abnormal electrical signal conduction in the myocardium of diseased mice. These findings point to a major translational pitfall in current therapeutics for ACM patients, who are advised to completely cease exercising and already demonstrate reduced Cx43 levels at the myocyte intercalated disc. Considering cardiac dysfunction in ACM arises from the loss of cardiomyocytes and electrical signal conduction abnormalities, an increase in Cx43 expression-promoted by low to moderate intensity exercise and/or gene therapy-could very well improve cardiac function in ACM patients.
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Affiliation(s)
- Isabella Leite Coscarella
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - Maicon Landim-Vieira
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - José Renato Pinto
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
| | - Stephen P. Chelko
- Department of Biomedical Sciences, Florida State University College of Medicine, Tallahassee, FL 32303, USA
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21215, USA
- Correspondence: ; Tel.: +1-850-644-2215
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19
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Andreassen K, Dejgaard LA, Lie Ø, Fink TS, Lunde IG, Edvardsen T, Haugaa KH, Stokke MK. Exercise training during childhood and adolescence is associated with favorable diastolic function in hypertrophic cardiomyopathy. Int J Cardiol 2022; 364:65-71. [PMID: 35714718 DOI: 10.1016/j.ijcard.2022.06.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/03/2022] [Accepted: 06/12/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Diastolic dysfunction is an important part of the clinical phenotype in hypertrophic cardiomyopathy (HCM). While exercise training is known to improve left ventricular (LV) diastolic function in normal hearts, the effects of exercise training during childhood and adolescence in carriers of HCM-associated genetic variants are unknown. METHODS In a cross-sectional and retrospective study, we combined clinical and echocardiographic data with history of exercise training from childhood to time of examination in 187 participants with HCM or an HCM-causative genotype. Multiple linear regression was used to identify correlations between exercise training performed prior to 20 years of age and LV diastolic parameters from echocardiography. RESULTS Exercise training during childhood and adolescence was correlated with a favorable e', E/e', E deceleration time, and end-diastolic volume (EDV), when adjusting for the effects of age at examination, and presence of left ventricular hypertrophy (LVH). This correlation was evident both in patients with a HCM phenotype (HCM LVH+), and in individuals with an HCM-causative genotype without LV hypertrophy (G+ LVH-). None of the diastolic parameters correlated unfavorably with increasing exercise exposure. CONCLUSION More exercise training during childhood and adolescence was associated with favorable LV diastolic function in both HCM LVH+ and G+ LVH- groups, regardless of presence of hypertrophy at the time of examination. These results indicate that exercise training initiated during childhood and adolescence has positive effects on cardiac function later in life for individuals with HCM or an HCM-causative genotype.
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Affiliation(s)
- Kristine Andreassen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; K. G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Lars A Dejgaard
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; K. G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; ProCardio, Center for Innovation, Oslo University Hospital, Oslo, Norway
| | - Øyvind Lie
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; ProCardio, Center for Innovation, Oslo University Hospital, Oslo, Norway
| | - Trine S Fink
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Ida G Lunde
- Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; K. G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; K. G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway; ProCardio, Center for Innovation, Oslo University Hospital, Oslo, Norway
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; ProCardio, Center for Innovation, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Karolinska Institute and Cardiovascular Division, Karolinska University Hospital, Stockholm, Sweden
| | - Mathis K Stokke
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute for Experimental Medical Research, Oslo University Hospital Ullevål and University of Oslo, Oslo, Norway; K. G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway.
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20
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Gati S, Sharma S. Exercise prescription in individuals with hypertrophic cardiomyopathy: what clinicians need to know. Heart 2022; 108:1930-1937. [PMID: 35197306 DOI: 10.1136/heartjnl-2021-319861] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/01/2022] [Indexed: 01/02/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is the most frequently cited cause of exercise-related sudden cardiac death (SCD) in young individuals and has claimed the lives of some high-profile athletes. The circumstantial link between exercise and SCD from HCM has resulted in conservative exercise recommendations which focus on activities that should be avoided rather than the minimal amount of physical activity required to reap the multiple rewards of exercise. Consequently, most patients with HCM are confined to a sedentary lifestyle through fear of SCD, with accruing risk factors such as obesity and low cardiorespiratory fitness that confer a worse prognosis. Recent exercise programmes in asymptomatic and symptomatic individuals with HCM have shown that mild and moderate exercise is safe and accompanied by increased functional capacity and improved quality of life. Population studies also reveal that individuals with HCM in the higher quartiles of self-reported physical activity have lower total cardiovascular mortality compared with those in the lower quartiles. The impact of vigorous exercise on the natural history of HCM is unknown, although current experience suggests that affected adults with mild morphology and absence of high-risk factors may partake in such activity without adverse events. This review highlights the evidence base that has resulted in a paradigm shift in the approach to exercise in HCM and liberalised recent international exercise guidelines in HCM. Practical tips for prescribing exercise in symptomatic patients and relevant precautions are provided to aid clinicians when recommending exercise as part of the management plan for all patients with HCM.
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Affiliation(s)
- Sabiha Gati
- Cardiovascular Medicine, Imperial College London, London, UK .,Department of Cardiology, Royal Brompton Hospital, London, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK.,St George's University Hospital NHS Foundation Trust, London, UK
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21
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Wang H, Lin Y, Zhang R, Chen Y, Ji W, Li S, Wang L, Tan R, Yuan J. Programmed Exercise Attenuates Familial Hypertrophic Cardiomyopathy in Transgenic E22K Mice via Inhibition of PKC-α/NFAT Pathway. Front Cardiovasc Med 2022; 9:808163. [PMID: 35265680 PMCID: PMC8899095 DOI: 10.3389/fcvm.2022.808163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/24/2022] [Indexed: 12/12/2022] Open
Abstract
Familial hypertrophic cardiomyopathy (FHCM), an autosomal dominant disease, is caused by mutations in genes encoding cardiac sarcomeric proteins. E22K, a mutation in the myosin regulatory light chain sarcomere gene, is associated with the development of FHCM. However, the molecular mechanisms by which E22K mutation promotes septal hypertrophy are still elusive. The hypertrophic markers, including beta-myosin heavy chain, atrial natriuretic peptide and B-type natriuretic peptide, were upregulated, as detected by fluorescence quantitative PCR. The gene expression profiles were greatly altered in the left ventricle of E22K mutant mice. Among these genes, nuclear factor of activated T cells (NFAT) and protein kinase C-alpha (PKC-α) were upregulated, and their protein expression levels were also verified to be elevated. The fibrosis markers, such as phosphorylated Smad and transforming growth factor beta receptor, were also elevated in transgenic E22K mice. After receiving 6 weeks of procedural exercise training, the expression levels of PKC-α and NFAT were reversed in E22K mouse hearts. In addition, the expression levels of several fibrosis-related genes such as transforming growth factor beta receptor 1, Smad4, and alpha smooth muscle actin in E22K mouse hearts were also reversed. Genes that associated with cardiac remodeling such as myocyte enhancer factor 2C, extracellular matrix protein 2 and fibroblast growth factor 12 were reduced after exercising. Taken together, our results indicate that exercise can improve hypertrophy and fibrosis-related indices in transgenic E22K mice via PKC-α/NFAT pathway, which provide new insight into the prevention and treatment of familial hypertrophic cardiomyopathy.
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Affiliation(s)
- Haiying Wang
- Department of Physiology, Institute of Basic Medical College, Jining Medical University, Jining, China
| | - Yuedong Lin
- Cardiac Emergency Department, Affiliated Hospital of Jining Medical University, Jining, China
| | - Ran Zhang
- Institute of Basic Medical College, Jining Medical University, Jining, China
| | - Yafen Chen
- Institute of Basic Medical College, Jining Medical University, Jining, China
| | - Wei Ji
- Institute of Basic Medical College, Jining Medical University, Jining, China
| | - Shenwei Li
- Institute of Basic Medical College, Jining Medical University, Jining, China
| | - Li Wang
- School of Nursing, Medical College, Soochow University, Suzhou, China
- *Correspondence: Li Wang
| | - Rubin Tan
- Department of Physiology, Basic Medical School, Xuzhou Medical University, Xuzhou, China
- Rubin Tan
| | - Jinxiang Yuan
- The Collaborative Innovation Center, Jining Medical University, Jining, China
- Jinxiang Yuan
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22
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Whitehill RD, Balaji S, Kelleman M, Chandler SF, Abrams DJ, Mao C, Fischbach P, Campbell R. Exercise Recommendations in Pediatric HCM: Variation and Influence of Provider Characteristics. Pediatr Cardiol 2022; 43:132-141. [PMID: 34406429 DOI: 10.1007/s00246-021-02703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Pediatric Hypertrophic Cardiomyopathy (HCM) is associated with sudden cardiac death (SCD) that can be related to physical activity. Without pediatric specific guidelines, recommendations for activity restriction may be varied. Therefore, our aim is to determine the current practice and variability surrounding exercise clearance recommendations (ER) in pediatric HCM referral centers as well as provider and patient characteristics that influence them. We designed a survey that was distributed to the Pediatric Heart Transplant Study (PHTS) providers and members of the Pediatric and Adult Congenital Electrophysiology Society (PACES) querying provider demographics and patient variables from 2 patient vignettes. The study is a multicenter survey of current practice of specialized providers caring for pediatric HCM patients. Survey of PHTS and PACES providers via email to the respective listservs with a response rate of 28% and 91 overall completing the entire survey after self-identifying as providers for pediatric HCM patients at their center. ER varies for pediatric HCM and is associated with provider training background as well as personal and professional history. Of the 91 providers who completed the survey, 42% (N = 38) trained in pediatric electrophysiology (EP), and 40% (N = 36) in pediatric heart failure (HF). Responses varied and only 53% of providers cleared for mild to moderate activity for the patient in Vignette 1, which is more in line with recent published adult guidelines. ER in both vignettes was significantly associated with type of training background. EP providers were more likely to recommend no restriction (27.8% vs 5.9%) than HF providers even when controlling for provider age and time out of training. Syncope with exercise was deemed "Most Important" by 81% of providers when making ER. ER for pediatric HCM are variable and the majority of providers make ER outside of previously published adult guidelines. Furthermore, ER are influenced by provider background and experience. Further study is needed for risks and benefits of physical activity in this population to inform the development of pediatric specific guidelines.
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Affiliation(s)
- Robert D Whitehill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA. .,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland, USA
| | - Michael Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Stephanie F Chandler
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Chad Mao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Peter Fischbach
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Robert Campbell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
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23
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Lander BS, Phelan DM, Martinez MW, Dineen EH. Hypertrophic Cardiomyopathy: Updates Through the Lens of Sports Cardiology. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:53. [PMID: 34054288 PMCID: PMC8144867 DOI: 10.1007/s11936-021-00934-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
Purpose of review This review will summarize the distinction between hypertrophic cardiomyopathy (HCM) and exercise-induced cardiac remodeling (EICR), describe treatments of particular relevance to athletes with HCM, and highlight the evolution of recommendations for exercise and competitive sport participation relevant to individuals with HCM. Recent findings Whereas prior guidelines have excluded individuals with HCM from more than mild-intensity exercise, recent data show that moderate-intensity exercise improves functional capacity and indices of cardiac function and continuation of competitive sports may not be associated with worse outcomes. Moreover, recent studies of athletes with implantable cardioverter defibrillators (ICDs) demonstrated a safer profile than previously understood. In this context, the updated American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) HCM guidelines have increased focus on shared decision-making and liberalized restrictions on exercise and sport participation among individuals with HCM. Summary New data demonstrating the safety of exercise in individuals with HCM and in athletes with ICDs, in addition to a focus on shared decision-making, have led to the most updated guidelines easing restrictions on exercise and competitive athletics in this population. Further athlete-specific studies of HCM, especially in the context of emerging therapies such as mavacamten, are important to inform accurate risk stratification and eligibility recommendations.
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Affiliation(s)
- Bradley S Lander
- Division of Cardiology, Columbia University Irving Medical Center, New York, NY 10032 USA
| | - Dermot M Phelan
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC 28203 USA
| | - Matthew W Martinez
- Department of Cardiovascular Medicine, Atlantic Health, Morristown Medical Center, Morristown, NJ 07960 USA.,Sports Cardiology and Hypertrophic Cardiomyopathy, 111 S Madison Ave, Suite 300, Morristown, NJ 07960 USA
| | - Elizabeth H Dineen
- Division of Cardiology, University of California Irvine, 333 City Blvd W, Suite 400, Orange, CA 92868 USA
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24
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Weissler Snir A, Connelly KA, Goodman JM, Dorian D, Dorian P. Exercise in hypertrophic cardiomyopathy: restrict or rethink. Am J Physiol Heart Circ Physiol 2021; 320:H2101-H2111. [PMID: 33769918 DOI: 10.1152/ajpheart.00850.2020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The detailed physiological consequences of aerobic training, in patients with hypertrophic cardiomyopathy (HCM), are not well understood. In athletes and nonathletes with HCM, there are two hypothetical concerns with respect to exercise: exercise-related worsening of the phenotype (e.g., promoting hypertrophy and fibrosis) and/or triggering of arrhythmia. The former concern is unproven and animal studies suggest an opposite effect, where exercise has been shown to be protective. The main reason for exercise restriction in HCM is fear of exercise-induced arrhythmia. Although the safety of sports in HCM has been reviewed, even more recent data suggest a substantially lower risk for sudden cardiac death (SCD) in HCM than previously thought, and there is an ongoing debate about restrictions of exercise imposed on individuals with HCM. This review outlines the pathophysiology of HCM, the impact of acute and chronic exercise (and variations of exercise intensity, modality, and athletic phenotype) in HCM including changes in autonomic function, blood pressure, cardiac dimensions and function, and cardiac output, and the underlying mechanisms that may trigger exercise-induced lethal arrhythmias. It provides a critical evaluation of the evidence regarding risk of SCD in athletes and the potential benefits of targeted exercise prescription in adults with HCM. Finally, it provides considerations for personalized recommendations for sports participation based on the available data.
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Affiliation(s)
- Adaya Weissler Snir
- Department of Medicine, University of Connecticut, Farmington, Connecticut.,Hartford HealthCare, Heart and Vascular Institute, Hartford, Connecticut
| | - Kim A Connelly
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Unity Health Toronto-St. Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jack M Goodman
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - David Dorian
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Paul Dorian
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Division of Cardiology, Unity Health Toronto-St. Michael's Hospital, Toronto, Ontario, Canada.,Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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25
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Limongelli G, Monda E, D'Aponte A, Caiazza M, Rubino M, Esposito A, Palmiero G, Moscarella E, Messina G, Calabro' P, Scudiero O, Pacileo G, Monda M, Bossone E, Day SM, Olivotto I. Combined Effect of Mediterranean Diet and Aerobic Exercise on Weight Loss and Clinical Status in Obese Symptomatic Patients with Hypertrophic Cardiomyopathy. Heart Fail Clin 2021; 17:303-313. [PMID: 33673954 DOI: 10.1016/j.hfc.2021.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We evaluated the impact of weight loss (WL) using a Mediterranean diet and mild-to-moderate-intensity aerobic exercise program, on clinical status of obese, symptomatic patients with hypertrophic cardiomyopathy (HCM). Compared with nonresponders, responders showed a significant reduction of left atrial diameter, left atrial volume index (LAVI), E/E'average, pulmonary artery systolic pressure (PASP), and a significant increase in Vo2max (%) and peak workload. Body mass index changes correlated with reduction in left atrial diameter, LAVI, E/E'average, PASP, and increase of Vo2max (mL/Kg/min), Vo2max (%), peak workload. Mediterranean diet and aerobic exercise is associated with clinical-hemodynamic improvement in obese symptomatic HCM patients.
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Affiliation(s)
- Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
| | - Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Antonello D'Aponte
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Augusto Esposito
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Giuseppe Palmiero
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Giovanni Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Paolo Calabro'
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Olga Scudiero
- Department of Molecular Medicine and Medical Biotechnology, University of Naples "Federico II", Via G. Salvatore, 80138 Naples, Italy; CEINGE Advanced Biotechnologies, Via G. Salvatore, 80138 Naples, Italy; Task Force on Microbiome Studies, University of Naples "Federico II", Via G. Salvatore, 80138 Naples, Italy
| | - Giuseppe Pacileo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetics and Sports Medicine, University of Campania "Luigi Vanvitelli", Via Santa Maria di Costantinopoli, 80138 Naples, Italy
| | - Eduardo Bossone
- Division of Cardiology, Antonio Cardarelli Hospital, Via A. Cardarelli, 80131 Naples, Italy
| | - Sharlene M Day
- Department of Internal Medicine, University of Michigan, 500 S. State Street, Ann Arbor, MI 48109, USA
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Largo Brambrilla, 50134 Florence, Italy
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26
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Huang Y, Lu H, Ren X, Li F, Bu W, Liu W, Dailey WP, Saeki H, Gabrielson K, Abraham R, Eckenhoff R, Gao WD. Fropofol prevents disease progression in mice with hypertrophic cardiomyopathy. Cardiovasc Res 2021; 116:1175-1185. [PMID: 31424496 DOI: 10.1093/cvr/cvz218] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 06/12/2019] [Accepted: 08/15/2019] [Indexed: 01/12/2023] Open
Abstract
AIMS Increased myofilament contractility is recognized as a crucial factor in the pathogenesis of hypertrophic cardiomyopathy (HCM). Direct myofilament desensitization might be beneficial in preventing HCM disease progression. Here, we tested whether the small molecule fropofol prevents HCM phenotype expression and disease progression by directly depressing myofilament force development. METHODS AND RESULTS Force, intracellular Ca2+, and steady-state activation were determined in isolated trabecular muscles from wild-type (WT) and transgenic HCM mice with heterozygous human α-myosin heavy chain R403Q mutation (αMHC 403/+). αMHC 403/+ HCM mice were treated continuously with fropofol by intraperitoneal infusion for 12 weeks. Heart tissue was analysed with histology and real-time PCR of prohypertrophic and profibrotic genes. Fropofol decreased force in a concentration-dependent manner without significantly altering [Ca2+]i in isolated muscles from both WT and αMHC 403/+ HCM mouse hearts. Fropofol also depressed maximal Ca2+-activated force and increased the [Ca2+]i required for 50% activation during steady-state activation. In whole-animal studies, chronic intra-abdominal administration of fropofol prevented hypertrophy development and diastolic dysfunction. Chronic fropofol treatment also led to attenuation of prohypertrophic and profibrotic gene expression, reductions in cell size, and decreases in tissue fibrosis. CONCLUSIONS Direct inhibition of myofilament contraction by fropofol prevents HCM disease phenotypic expression and progression, suggesting that increased myofilament contractile force is the primary trigger for hypertrophy development and HCM disease progression.
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Affiliation(s)
- Yiyuan Huang
- Department of Cardiology, 2nd Xiangya Hospital Central South University, 139 Renmin Middle Road, Changsha, Hunan 410011, China
| | - Haisong Lu
- Department of Anesthesiology, Peking Union Hospital, Peking Union Medical College and Chinese Academy of Medical Science, 1 Shuaifuyuan, Wangfujin, Dongcheng District, Beijing 100730, China
| | - Xianfeng Ren
- Department of Anesthesiology, China-Japan Friendship Hospital, 2 Yinghuanyuan East Street, Chaoying District, Beijing 100029, China
| | - Fazhao Li
- Department of General Surgery, 2nd Xiangya Hospital, 139 Renmin Middle Road, Central South University, Changsha, Hunan 410011, China
| | - Weiming Bu
- Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Wenjie Liu
- Department of Anesthesiology, South China University School of Medicine, 69 Chuanshan Road, Shigu District, Hengyang, Hunan 421001, China
| | - William P Dailey
- Department of Chemistry, University of Pennsylvania School of Arts and Sciences, 231 S. 34 Street, Philadelphia, PA 19104, USA
| | - Harumi Saeki
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, 733 N. Broadway, MRB 807, Baltimore, MD 21205, USA
| | - Kathleen Gabrielson
- Department of Molecular and Comparative Pathobiology, Johns Hopkins University School of Medicine, 733 N. Broadway, MRB 807, Baltimore, MD 21205, USA
| | - Roselle Abraham
- Division of Cardiology, Department of Medicine, University of California San Francisco, 555 Mission Bay Blvd South, Smith Cardiovascular Research Building, 452K, San Francisco, CA 94158, USA
| | - Roderic Eckenhoff
- Department of Anesthesiology, University of Pennsylvania Perelman School of Medicine, 3620 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 6208, Baltimore, MD 21287, USA
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27
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Burke RM, Burgos Villar KN, Small EM. Fibroblast contributions to ischemic cardiac remodeling. Cell Signal 2021; 77:109824. [PMID: 33144186 PMCID: PMC7718345 DOI: 10.1016/j.cellsig.2020.109824] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
The heart can respond to increased pathophysiological demand through alterations in tissue structure and function 1 . This process, called cardiac remodeling, is particularly evident following myocardial infarction (MI), where the blockage of a coronary artery leads to widespread death of cardiac muscle. Following MI, necrotic tissue is replaced with extracellular matrix (ECM), and the remaining viable cardiomyocytes (CMs) undergo hypertrophic growth. ECM deposition and cardiac hypertrophy are thought to represent an adaptive response to increase structural integrity and prevent cardiac rupture. However, sustained ECM deposition leads to the formation of a fibrotic scar that impedes cardiac compliance and can induce lethal arrhythmias. Resident cardiac fibroblasts (CFs) are considered the primary source of ECM molecules such as collagens and fibronectin, particularly after becoming activated by pathologic signals. CFs contribute to multiple phases of post-MI heart repair and remodeling, including the initial response to CM death, immune cell (IC) recruitment, and fibrotic scar formation. The goal of this review is to describe how resident fibroblasts contribute to the healing and remodeling that occurs after MI, with an emphasis on how fibroblasts communicate with other cell types in the healing infarct scar 1 –6 .
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Affiliation(s)
- Ryan M Burke
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, United States of America
| | - Kimberly N Burgos Villar
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Eric M Small
- Aab Cardiovascular Research Institute, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA; Department of Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, United States of America; Department of Pharmacology and Physiology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, United States of America; Department of Biomedical Engineering, University of Rochester, Rochester, NY 14642, United States of America.
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28
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Park JB, Kim DH, Lee H, Hwang IC, Yoon YE, Park HE, Choi SY, Kim YJ, Cho GY, Han K, Ommen SR, Kim HK. Obesity and metabolic health status are determinants for the clinical expression of hypertrophic cardiomyopathy. Eur J Prev Cardiol 2020; 27:1849-1857. [DOI: 10.1177/2047487319889714] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims
We sought to investigate the association of obesity and metabolic health status with the incidence of clinical hypertrophic cardiomyopathy (HCM) diagnosis in the general population. Our goal was to identify modifiable risk factors to attenuate clinical expression of HCM, enabling management evolution from a mostly passive strategy of risk stratification to a proactive strategy of modifying disease expression.
Methods
Using nationwide population-based data from the Korean National Health Insurance Service, 28,679,891 people who were free of prevalent HCM and who underwent health examinations between 2009 and 2015 were followed until 31 December 2016. The primary outcome was clinical HCM that was defined as incident diagnosis of HCM during the follow-up, after a blanking period of 12 months.
Results
Over a median follow-up of 5.2 years, 0.027% (n = 7851) of the study participants were diagnosed as incident HCM. The incidence rate per 1000 person-years was 0.059. A significant association was found between body mass index (BMI) and the incidence of clinical HCM after multivariate adjustment, with a hazard ratio per 1 kg/m2 increase in BMI of 1.063 (95% confidence interval 1.051–1.075). Metabolically unhealthy participants had a greater incidence of HCM than metabolically healthy participants, regardless of obesity status. The effect of BMI was more pronounced in several subgroups, including participants with no hypertension, those aged less than 65 years and men.
Conclusion
We found that individuals with obesity and/or metabolic abnormalities had a significantly higher incidence of clinical HCM diagnosis than their counterparts. Efforts to manage obesity and metabolic abnormalities may be important in modifying clinical expression of HCM.
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Affiliation(s)
- Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Da Hye Kim
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Heesun Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Chang Hwang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Yeonyee E Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Hyo Eun Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Su-Yeon Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Goo-Yeong Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea
| | - Kyungdo Han
- Department of Medical Statistics, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Steve R Ommen
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea
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29
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Sun J, Niu C, Ye W, An N, Chen G, Huang X, Wang J, Chen X, Shen Y, Huang S, Wang Y, Wang X, Wang Y, Jin L, Cong W, Li X. FGF13 Is a Novel Regulator of NF-κB and Potentiates Pathological Cardiac Hypertrophy. iScience 2020; 23:101627. [PMID: 33089113 PMCID: PMC7567043 DOI: 10.1016/j.isci.2020.101627] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 08/13/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
FGF13 is an intracellular FGF factor. Its role in cardiomyopathies has been rarely investigated. We revealed that endogenous FGF13 is up-regulated in cardiac hypertrophy accompanied by increased nuclear localization. The upregulation of FGF13 plays a deteriorating role both in hypertrophic cardiomyocytes and mouse hearts. Mechanistically, FGF13 directly interacts with p65 by its nuclear localization sequence and co-localizes with p65 in the nucleus in cardiac hypertrophy. FGF13 deficiency inhibits NF-κB activation in ISO-treated NRCMs and TAC-surgery mouse hearts, whereas FGF13 overexpression shows the opposite trend. Moreover, FGF13 overexpression alone is sufficient to activate NF-κB in cardiomyocytes. The interaction between FGF13 and p65 or the effects of FGF13 on NF-κB have nothing to do with IκB. Together, an IκB-independent mechanism for NF-κB regulation has been revealed in cardiomyocytes both under basal and stressful conditions, suggesting the promising application of FGF13 as a therapeutic target for pathological cardiac hypertrophy and heart failure. Endogenous FGF13 is up-regulated in cardiomyocytes under pressure overload FGF13 directly interacts with p65 Forced FGF13 overexpression activates NF-κB in cardiomyocytes
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Affiliation(s)
- Jia Sun
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Chao Niu
- Pediatric Research Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Weijian Ye
- Department of Pharmacy, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Ning An
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Gen Chen
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaozhong Huang
- Department of Pediatric Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jianan Wang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Xixi Chen
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Yingjie Shen
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Shuai Huang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Ying Wang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Xu Wang
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Yang Wang
- Department of Histology and Embryology, Institute of Neuroscience, Wenzhou Medical University Wenzhou, 325000, China
| | - Litai Jin
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Weitao Cong
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaokun Li
- School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325000, China
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30
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(Hypertrophic cardiomyopathy and sports - is it time for a change in strategy?). COR ET VASA 2020. [DOI: 10.33678/cor.2020.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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31
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Moreira JBN, Wohlwend M, Wisløff U. Exercise and cardiac health: physiological and molecular insights. Nat Metab 2020; 2:829-839. [PMID: 32807982 DOI: 10.1038/s42255-020-0262-1] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 07/13/2020] [Indexed: 12/19/2022]
Abstract
The cardiac benefits of exercise have been recognized for centuries. Studies have undisputedly shown that regular exercise is beneficial for the cardiovascular system in young, old, healthy and diseased populations. For these reasons, physical activity has been recommended worldwide for cardiovascular disease prevention and treatment. Although the benefits of exercise are clear, understanding of the molecular triggers that orchestrate these effects remains incomplete and has been a topic of intense research in recent years. Here, we provide a comprehensive review of the cardiac effects of physical activity, beginning with a brief history of exercise in cardiovascular medicine and then discussing seminal work on the physiological effects of exercise in healthy, diseased and aged hearts. Later, we revisit pioneering work on the molecular mechanisms underlying the cardiac benefits of exercise, and we conclude with our view on the translational potential of this knowledge as a powerful platform for cardiovascular disease drug discovery.
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Affiliation(s)
- Jose B N Moreira
- Cardiac Exercise Research Group at the Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin Wohlwend
- Cardiac Exercise Research Group at the Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Cardiac Exercise Research Group at the Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
- School of Human Movement & Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia.
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32
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Basu J, Malhotra A, Papadakis M. Exercise and hypertrophic cardiomyopathy: Two incompatible entities? Clin Cardiol 2020; 43:889-896. [PMID: 32048747 PMCID: PMC7403677 DOI: 10.1002/clc.23343] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 01/02/2023] Open
Abstract
A greater understanding of the pathogenic mechanisms underpinning hypertrophic cardiomyopathy (HCM) has translated to improved medical care and better survival of affected individuals. Historically these patients were considered to be at high risk of sudden cardiac death (SCD) during exercise; therefore, exercise recommendations were highly conservative and promoted a sedentary life style. There is emerging evidence that suggests that exercise in HCM has a favorable effect on cardiovascular remodeling and moderate exercise programs have not raised any safety concerns. Furthermore, individuals with HCM have a similar burden of atherosclerotic risk factors as the general population in whom exercise has been associated with a reduction in myocardial infarction, stroke, and heart failure, especially among those with a high-risk burden. Small studies revealed that athletes who choose to continue with regular competition do not demonstrate adverse outcomes when compared to those who discontinue sport, and active individuals implanted with an implantable cardioverter defibrillator do not have an increased risk of appropriate shocks or other adverse events. The recently published exercise recommendations from the European Association for Preventative Cardiology account for more contemporary evidence and adopt a more liberal stance regarding competitive and high intensity sport in individuals with low-risk HCM. This review addresses the issue of exercise in individuals with HCM, and explores current evidence supporting safety of exercise in HCM, potential caveats, and areas of further research.
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Affiliation(s)
- Joyee Basu
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
| | - Aneil Malhotra
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
- Division of Cardiovascular SciencesThe University of ManchesterManchesterUK
| | - Michael Papadakis
- Cardiac Risk in the Young Clinical Research Fellow, Cardiology Clinical Academic GroupSt George's University of LondonLondonUK
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33
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Konhilas JP, Sanchez JN, Regan JA, Constantopoulos E, Lopez-Pier M, Cannon DK, Skaria R, McKee LA, Chen H, Lipovka Y, Pollow D, Brooks HL. Using 4-vinylcyclohexene diepoxide as a model of menopause for cardiovascular disease. Am J Physiol Heart Circ Physiol 2020; 318:H1461-H1473. [PMID: 32383991 PMCID: PMC7311698 DOI: 10.1152/ajpheart.00555.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
There is a sharp rise in cardiovascular disease (CVD) risk and progression with the onset of menopause. The 4-vinylcyclohexene diepoxide (VCD) model of menopause recapitulates the natural, physiological transition through perimenopause to menopause. We hypothesized that menopausal female mice were more susceptible to CVD than pre- or perimenopausal females. Female mice were treated with VCD or vehicle for 20 consecutive days. Premenopausal, perimenopausal, and menopausal mice were administered angiotensin II (ANG II) or subjected to ischemia-reperfusion (I/R). Menopausal females were more susceptible to pathological ANG II-induced cardiac remodeling and cardiac injury from a myocardial infarction (MI), while perimenopausal, like premenopausal, females remained protected. Specifically, ANG II significantly elevated diastolic (130.9 ± 6.0 vs. 114.7 ± 6.2 mmHg) and systolic (156.9 ± 4.8 vs. 141.7 ± 5.0 mmHg) blood pressure and normalized cardiac mass (15.9 ± 1.0 vs. 7.7 ± 1.5%) to a greater extent in menopausal females compared with controls, whereas perimenopausal females demonstrated a similar elevation of diastolic (93.7 ± 2.9 vs. 100.5 ± 4.1 mmHg) and systolic (155.9 ± 7.3 vs. 152.3 ± 6.5 mmHg) blood pressure and normalized cardiac mass (8.3 ± 2.1 vs. 7.5 ± 1.4%) compared with controls. Similarly, menopausal females demonstrated a threefold increase in fibrosis measured by Picrosirus red staining. Finally, hearts of menopausal females (41 ± 5%) showed larger infarct sizes following I/R injury than perimenopausal (18.0 ± 5.6%) and premenopausal (16.2 ± 3.3, 20.1 ± 4.8%) groups. Using the VCD model of menopause, we provide evidence that menopausal females were more susceptible to pathological cardiac remodeling. We suggest that the VCD model of menopause may be critical to better elucidate cellular and molecular mechanisms underlying the transition to CVD susceptibility in menopausal women.NEW & NOTEWORTHY Before menopause, women are protected against cardiovascular disease (CVD) compared with age-matched men; this protection is gradually lost after menopause. We present the first evidence that demonstrates menopausal females are more susceptible to pathological cardiac remodeling while perimenopausal and cycling females are not. The VCD model permits appropriate examination of how increased susceptibility to the pathological process of cardiac remodeling accelerates from pre- to perimenopause to menopause.
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Affiliation(s)
- John P Konhilas
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Jessica N Sanchez
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Jessica A Regan
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Eleni Constantopoulos
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Marissa Lopez-Pier
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona
| | | | - Rinku Skaria
- Department of Physiology, University of Arizona, Tucson, Arizona
| | - Laurel A McKee
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Hao Chen
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Yulia Lipovka
- Department of Physiology, University of Arizona, Tucson, Arizona.,Sarver Molecular Cardiovascular Research Program, University of Arizona, Tucson, Arizona
| | - Dennis Pollow
- Department of Physiology, University of Arizona, Tucson, Arizona
| | - Heddwen L Brooks
- Department of Physiology, University of Arizona, Tucson, Arizona
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34
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Sitbon YH, Kazmierczak K, Liang J, Yadav S, Veerasammy M, Kanashiro-Takeuchi RM, Szczesna-Cordary D. Ablation of the N terminus of cardiac essential light chain promotes the super-relaxed state of myosin and counteracts hypercontractility in hypertrophic cardiomyopathy mutant mice. FEBS J 2020; 287:3989-4004. [PMID: 32034976 DOI: 10.1111/febs.15243] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/27/2019] [Accepted: 02/06/2020] [Indexed: 12/25/2022]
Abstract
In this study, we focus on the molecular mechanisms associated with the A57G (Ala57-to-Gly57) mutation in myosin essential light chains (ELCs), found to cause hypertrophic cardiomyopathy (HCM) in humans and in mice. Specifically, we studied the effects of A57G on the super-relaxed (SRX) state of myosin that may contribute to the hypercontractile cross-bridge behavior and ultimately lead to pathological cardiac remodeling in transgenic Tg-A57G mice. The disease model was compared to Tg-WT mice, expressing the wild-type human ventricular ELC, and analyzed against Tg-Δ43 mice, expressing the N-terminally truncated ELC, whose hearts hypertrophy with time but do not show any abnormalities in cardiac morphology or function. Our data suggest a new role for the N terminus of cardiac ELC (N-ELC) in modulation of myosin cross-bridge function in the healthy as well as in HCM myocardium. The lack of N-ELC in Tg-Δ43 mice was found to significantly stabilize the SRX state of myosin and increase the number of myosin heads occupying a low-energy state. In agreement, Δ43 hearts showed significantly decreased ATP utilization and low actin-activated myosin ATPase compared with A57G and WT hearts. The hypercontractile activity of A57G-ELC cross-bridges was manifested by the inhibition of the SRX state, increased number of myosin heads available for interaction with actin, and higher ATPase activity. Fiber mechanics studies, echocardiography examination, and assessment of fibrosis confirmed the development of two distinct forms of cardiac remodeling in these two ELC mouse models, with pathological cardiac hypertrophy in Tg-A57G, and near physiologic cardiac growth in Tg-Δ43 animals.
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Affiliation(s)
- Yoel H Sitbon
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, FL, USA
| | - Katarzyna Kazmierczak
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, FL, USA
| | - Jingsheng Liang
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, FL, USA
| | - Sunil Yadav
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, FL, USA
| | | | | | - Danuta Szczesna-Cordary
- Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, FL, USA
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35
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Sport Participation in Patients with Implantable Cardioverter-Defibrillators. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:66. [PMID: 31728782 DOI: 10.1007/s11936-019-0772-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Athletes diagnosed with cardiovascular disease may receive implantable cardioverter defibrillators (ICDs). Until recently, there were no data describing the safety of return to play for athletes receiving an ICD, and consensus recommendations restricted ICD patients to competitive sports no more vigorous than bowling or golf. RECENT FINDINGS The ICD Sports Registry prospectively followed 440 athletes who continued sports participation after receiving an ICD, for up to 4 years. While many received shocks, both appropriate and inappropriate, during competition or practice, as well as during other physical activity or rest, there were no failures to defibrillate and no injuries related to arrhythmia or shock during sports. Recent subanalyses as described below have focused on how best to program the ICD, and on the younger subgroup including interscholastic athletes. Based on these data, the most recent consensus statement from the AHA/ACC on athletic eligibility now describes sports participation with an ICD as a IIB recommendation, "may be considered".
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36
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Wasserstrum Y, Barbarova I, Lotan D, Kuperstein R, Shechter M, Freimark D, Segal G, Klempfner R, Arad M. Efficacy and safety of exercise rehabilitation in patients with hypertrophic cardiomyopathy. J Cardiol 2019; 74:466-472. [DOI: 10.1016/j.jjcc.2019.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/31/2019] [Accepted: 04/24/2019] [Indexed: 12/13/2022]
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37
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Skaria T, Mitchell KJ, Vogel O, Wälchli T, Gassmann M, Vogel J. Blood Pressure Normalization-Independent Cardioprotective Effects of Endogenous, Physical Activity-Induced αCGRP (α Calcitonin Gene-Related Peptide) in Chronically Hypertensive Mice. Circ Res 2019; 125:1124-1140. [PMID: 31665965 DOI: 10.1161/circresaha.119.315429] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
RATIONALE αCGRP (α calcitonin gene-related peptide), one of the strongest vasodilators, is cardioprotective in hypertension by reducing the elevated blood pressure. OBJECTIVE However, we hypothesize that endogenous, physical activity-induced αCGRP has blood pressure-independent cardioprotective effects in chronic hypertension. METHODS AND RESULTS Chronically hypertensive (one-kidney-one-clip surgery) wild-type and αCGRP-/- sedentary or voluntary wheel running mice were treated with vehicle, αCGRP, or the αCGRP receptor antagonist CGRP8-37. Cardiac function and myocardial phenotype were evaluated echocardiographically and by molecular, cellular, and histological analysis, respectively. Blood pressure was similar among all hypertensive experimental groups. Endogenous αCGRP limited pathological remodeling and heart failure in sedentary, chronically hypertensive wild-type mice. In these mice, voluntary wheel running significantly improved myocardial phenotype and function, which was abolished by CGRP8-37 treatment. In αCGRP-/- mice, αCGRP treatment, in contrast to voluntary wheel running, improved myocardial phenotype and function. Specific inhibition of proliferation and myofibroblast differentiation of primary, murine cardiac fibroblasts by αCGRP suggests involvement of these cells in αCGRP-dependent blunting of pathological cardiac remodeling. CONCLUSIONS Endogenous, physical activity-induced αCGRP has blood pressure-independent cardioprotective effects and is crucial for maintaining cardiac function in chronic hypertension. Consequently, inhibiting endogenous αCGRP signaling, as currently approved for migraine prophylaxis, could endanger patients with hypertension.
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Affiliation(s)
- Tom Skaria
- From the Institute of Veterinary Physiology (T.S., O.V., M.G., J.V.), Vetsuisse Faculty, University of Zürich, Switzerland.,Zürich Center for Integrative Human Physiology (ZIHP), Switzerland (T.S., M.G., J.V.)
| | - Katharyn Jean Mitchell
- Clinic for Equine Internal Medicine, Equine Department (K.J.M.), Vetsuisse Faculty, University of Zürich, Switzerland
| | - Olga Vogel
- From the Institute of Veterinary Physiology (T.S., O.V., M.G., J.V.), Vetsuisse Faculty, University of Zürich, Switzerland
| | - Thomas Wälchli
- Group of CNS Angiogenesis and Neurovascular Link, Institute for Regenerative Medicine, Neuroscience Center Zürich (T.W.), University Hospital Zürich, Switzerland.,Division of Neurosurgery (T.W.), University Hospital Zürich, Switzerland.,Group of Brain Vasculature and Neurovascular Unit, Division of Neurosurgery, Department of Clinical Neurosciences, University Hospital Geneva, Switzerland (T.W.).,Department of Fundamental Neurobiology, Krembil Research Institute (T.W.), University Health Network, University of Toronto, Canada.,Division of Neurosurgery, Department of Surgery, Toronto Western Hospital (T.W.), University Health Network, University of Toronto, Canada
| | - Max Gassmann
- From the Institute of Veterinary Physiology (T.S., O.V., M.G., J.V.), Vetsuisse Faculty, University of Zürich, Switzerland.,Zürich Center for Integrative Human Physiology (ZIHP), Switzerland (T.S., M.G., J.V.).,Universidad Peruana Cayetano Heredia (UPCH), Lima, Peru (M.G.)
| | - Johannes Vogel
- From the Institute of Veterinary Physiology (T.S., O.V., M.G., J.V.), Vetsuisse Faculty, University of Zürich, Switzerland.,Zürich Center for Integrative Human Physiology (ZIHP), Switzerland (T.S., M.G., J.V.)
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Popa-Fotea NM, Micheu MM, Bataila V, Scafa-Udriste A, Dorobantu L, Scarlatescu AI, Zamfir D, Stoian M, Onciul S, Dorobantu M. Exploring the Continuum of Hypertrophic Cardiomyopathy-From DNA to Clinical Expression. ACTA ACUST UNITED AC 2019; 55:medicina55060299. [PMID: 31234582 PMCID: PMC6630598 DOI: 10.3390/medicina55060299] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 12/29/2022]
Abstract
The concepts underlying hypertrophic cardiomyopathy (HCM) pathogenesis have evolved greatly over the last 60 years since the pioneering work of the British pathologist Donald Teare, presenting the autopsy findings of “asymmetric hypertrophy of the heart in young adults”. Advances in human genome analysis and cardiac imaging techniques have enriched our understanding of the complex architecture of the malady and shaped the way we perceive the illness continuum. Presently, HCM is acknowledged as “a disease of the sarcomere”, where the relationship between genotype and phenotype is not straightforward but subject to various genetic and nongenetic influences. The focus of this review is to discuss key aspects related to molecular mechanisms and imaging aspects that have prompted genotype–phenotype correlations, which will hopefully empower patient-tailored health interventions.
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Affiliation(s)
- Nicoleta Monica Popa-Fotea
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Vlad Bataila
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Alexandru Scafa-Udriste
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
| | - Lucian Dorobantu
- Cardiomyopathy Center, Monza Hospital, Tony Bulandra Street 27, 021968 Bucharest, Romania.
| | - Alina Ioana Scarlatescu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Diana Zamfir
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Monica Stoian
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
| | - Sebastian Onciul
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
| | - Maria Dorobantu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Floreasca Street 8, 014461 Bucharest, Romania.
- Department 4-Cardiothoracic Pathology, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
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39
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Biswas A, Kapoor M, Das S, Seth S, Bhargava B, Rao VR. TNNT2 5 bp deletion, sedentary lifestyle & abdominal adiposity accentuate the phenotypic severity in hypertrophic cardiomyopathy patients. Meta Gene 2019. [DOI: 10.1016/j.mgene.2019.100567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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40
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Aengevaeren VL, Gommans DHF, Dieker HJ, Timmermans J, Verheugt FWA, Bakker J, Hopman MTE, DE Boer MJ, Brouwer MA, Thompson PD, Kofflard MJM, Cramer GE, Eijsvogels TMH. Association between Lifelong Physical Activity and Disease Characteristics in HCM. Med Sci Sports Exerc 2019; 51:1995-2002. [PMID: 31033902 PMCID: PMC6798742 DOI: 10.1249/mss.0000000000002015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Hypertrophic cardiomyopathy (HCM) is characterized by inappropriate left ventricular (LV) wall thickness. Adaptations to exercise can occasionally mimic certain HCM characteristics. However, it is unclear whether physical activity affects HCM genotype expression and disease characteristics. Consequently, we compared lifelong physical activity volumes between HCM gene carriers with and without HCM phenotype, and compared disease characteristics among tertiles of physical activity in phenotypic HCM patients. METHODS We enrolled n = 22 genotype positive/phenotype negative (G+/P-) HCM gene carriers, n = 44 genotype positive/phenotype positive (G+/P+) HCM patients, and n = 36 genotype negative/phenotype positive (G-/P+) HCM patients. Lifelong physical activity was recorded using a questionnaire and quantified as metabolic equivalent of task hours per week. RESULTS We included 102 participants (51 ± 16 yr, 49% male). Lifelong physical activity volumes were not different between G+/P+ and G+/P- subjects (16 [10-29] vs 14 [6-26] metabolic equivalent of task-hours per week, P = 0.33). Among phenotypic HCM patients, there was no difference in LV wall thickness, mass, and late gadolinium enhancement across physical activity tertiles. Patients with the highest reported physical activity volumes were younger at the time of diagnosis (tertile 1: 52 ± 14 yr, tertile 2: 49 ± 15 yr, tertile 3: 41 ± 18 yr; P = 0.03), and more often had a history of nonsustained ventricular tachycardia (4% vs 30% vs 30%, P = 0.03). CONCLUSIONS Lifelong physical activity volumes are not associated with genotype-to-phenotype transition in HCM gene carriers. We also found no difference in LV wall thickness across physical activity tertiles. However, the most active HCM patients were younger at the time of diagnosis and had a higher arrhythmic burden. These observations warrant further exploration of the role of exercise in HCM disease development.
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Affiliation(s)
- Vincent L Aengevaeren
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS.,Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - D H Frank Gommans
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Hendrik-Jan Dieker
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Janneke Timmermans
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Freek W A Verheugt
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Jeannette Bakker
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the NETHERLANDS
| | - Maria T E Hopman
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Menko-Jan DE Boer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Marc A Brouwer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | | | - Marcel J M Kofflard
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the NETHERLANDS
| | - G Etienne Cramer
- Radboud Institute for Health Sciences, Department of Cardiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS
| | - Thijs M H Eijsvogels
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Nijmegen, the NETHERLANDS.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, England, UNITED KINGDOM
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41
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Brand CS, Lighthouse JK, Trembley MA. Protective transcriptional mechanisms in cardiomyocytes and cardiac fibroblasts. J Mol Cell Cardiol 2019; 132:1-12. [PMID: 31042488 DOI: 10.1016/j.yjmcc.2019.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
Abstract
Heart failure is the leading cause of morbidity and mortality worldwide. Several lines of evidence suggest that physical activity and exercise can pre-condition the heart to improve the response to acute cardiac injury such as myocardial infarction or ischemia/reperfusion injury, preventing the progression to heart failure. It is becoming more apparent that cardioprotection is a concerted effort between multiple cell types and converging signaling pathways. However, the molecular mechanisms of cardioprotection are not completely understood. What is clear is that the mechanisms underlying this protection involve acute activation of transcriptional activators and their corresponding gene expression programs. Here, we review the known stress-dependent transcriptional programs that are activated in cardiomyocytes and cardiac fibroblasts to preserve function in the adult heart after injury. Focus is given to prominent transcriptional pathways such as mechanical stress or reactive oxygen species (ROS)-dependent activation of myocardin-related transcription factors (MRTFs) and transforming growth factor beta (TGFβ), and gene expression that positively regulates protective PI3K/Akt signaling. Together, these pathways modulate both beneficial and pathological responses to cardiac injury in a cell-specific manner.
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Affiliation(s)
- Cameron S Brand
- Department of Pharmacology, School of Medicine, University of California - San Diego, 9500 Gilman Drive, Biomedical Sciences Building, La Jolla, CA 92093, USA.
| | - Janet K Lighthouse
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box CVRI, Rochester, NY 14624, USA.
| | - Michael A Trembley
- Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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42
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Cardiac adaptation to exercise training in health and disease. Pflugers Arch 2019; 472:155-168. [PMID: 31016384 DOI: 10.1007/s00424-019-02266-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/13/2019] [Accepted: 02/15/2019] [Indexed: 02/08/2023]
Abstract
The heart is the primary pump that circulates blood through the entire cardiovascular system, serving many important functions in the body. Exercise training provides favorable anatomical and physiological changes that reduce the risk of heart disease and failure. Compared with pathological cardiac hypertrophy, exercise-induced physiological cardiac hypertrophy leads to an improvement in heart function. Exercise-induced cardiac remodeling is associated with gene regulatory mechanisms and cellular signaling pathways underlying cellular, molecular, and metabolic adaptations. Exercise training also promotes mitochondrial biogenesis and oxidative capacity leading to a decrease in cardiovascular disease. In this review, we summarized the exercise-induced adaptation in cardiac structure and function to understand cellular and molecular signaling pathways and mechanisms in preclinical and clinical trials.
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43
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Heidbuchel H. The athlete's heart is a proarrhythmic heart, and what that means for clinical decision making. Europace 2019; 20:1401-1411. [PMID: 29244075 DOI: 10.1093/europace/eux294] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Accepted: 08/25/2017] [Indexed: 12/19/2022] Open
Abstract
Recurring questions when dealing with arrhythmias in athletes are about the cause of the arrhythmia and, more importantly, about the eligibility of the athlete to continue sports activities. In essence, the relation between sports and arrhythmias can be understood along three lines: sports as arrhythmia trigger on top of an underlying problem, sports as arrhythmic substrate promotor, or sports as substrate inducer. Often, there is no sharp divider line between these entities. The athlete's heart, a heart that adapts so magically to cope with the demands of exercise, harbours many structural and functional changes that by themselves predispose to arrhythmia development, at the atrial, nodal and ventricular levels. In essence, the athlete's heart is a proarrhythmic heart. This review describes the changes in the athlete's heart that are related to arrhythmic expression and focuses on what this concept means for clinical decision making. The concept of the athlete's heart as a proarrhythmic heart creates a framework for evaluation and counselling of athletes, yet also highlights the difficulty in predicting the magnitude of associated risk. The management uncertainties are discussed for specific conditions like extreme bradycardic remodelling, atrioventricular nodal reentrant tachycardia, atrial fibrillation and flutter, and ventricular arrhythmias.
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Affiliation(s)
- Hein Heidbuchel
- Department of Cardiology, Antwerp University and University Hospital Antwerp, Wilrijkstraat 10, Edegem, Belgium
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44
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Abstract
Distinguishing between adaptive and maladaptive cardiovascular response to exercise is crucial to prevent the unnecessary termination of an athlete's career and to minimize the risk of sudden death. This is a challenging task essentially due to the substantial phenotypic overlap between electrical and structural changes seen in the physiological athletic heart remodeling and pathological changes seen in inherited or acquired cardiomyopathies. Stress testing is an ideal tool to discriminate normal from abnormal cardiovascular response by unmasking subtle pathologic responses otherwise undetectable at rest. Treadmill or bicycle electrocardiography, transthoracic echocardiography, and cardiopulmonary exercise testing are common clinical investigations used in sports cardiology, specifically among participants presenting with resting electrocardiographic abnormalities, frequent premature ventricular beats, or non-sustained ventricular arrhythmias. In this setting, as well as in cases of left ventricular hypertrophy or asymptomatic left ventricular dysfunction, stress imaging and myocardial tissue characterization by cardiovascular magnetic resonance show promise. In this review, we aimed to reappraise current diagnostic schemes, screening strategies and novel approaches that may be used to distinguish adaptive remodeling patterns to physical exercise from early phenotypes of inherited or acquired pathological conditions commanding prompt intervention.
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45
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Lighthouse JK, Burke RM, Velasquez LS, Dirkx RA, Aiezza A, Moravec CS, Alexis JD, Rosenberg A, Small EM. Exercise promotes a cardioprotective gene program in resident cardiac fibroblasts. JCI Insight 2019; 4:92098. [PMID: 30626739 DOI: 10.1172/jci.insight.92098] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 11/20/2018] [Indexed: 02/06/2023] Open
Abstract
Exercise and heart disease both induce cardiac remodeling, but only disease causes fibrosis and compromises heart function. The cardioprotective benefits of exercise have been attributed to changes in cardiomyocyte physiology, but the impact of exercise on cardiac fibroblasts (CFs) is unknown. Here, RNA-sequencing reveals rapid divergence of CF transcriptional programs during exercise and disease. Among the differentially expressed programs, NRF2-dependent antioxidant genes - including metallothioneins (Mt1 and Mt2) - are induced in CFs during exercise and suppressed by TGF-β/p38 signaling in disease. In vivo, mice lacking Mt1/2 exhibit signs of cardiac dysfunction in exercise, including cardiac fibrosis, vascular rarefaction, and functional decline. Mechanistically, exogenous MTs derived from fibroblasts are taken up by cultured cardiomyocytes, reducing oxidative damage-dependent cell death. Importantly, suppression of MT expression is conserved in human heart failure. Taken together, this study defines the acute transcriptional response of CFs to exercise and disease and reveals a cardioprotective mechanism that is lost in disease.
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Affiliation(s)
- Janet K Lighthouse
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ryan M Burke
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lissette S Velasquez
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Ronald A Dirkx
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Alessandro Aiezza
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | | | | | - Alex Rosenberg
- Department of Allergy, Immunology, and Rheumatology Research, and
| | - Eric M Small
- Aab Cardiovascular Research Institute, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.,Department of Medicine.,Department of Pharmacology and Physiology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Exercise Training-Induced Changes in MicroRNAs: Beneficial Regulatory Effects in Hypertension, Type 2 Diabetes, and Obesity. Int J Mol Sci 2018; 19:ijms19113608. [PMID: 30445764 PMCID: PMC6275070 DOI: 10.3390/ijms19113608] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 10/19/2018] [Indexed: 12/21/2022] Open
Abstract
MicroRNAs are small non-coding RNAs that regulate gene expression post-transcriptionally. They are involved in the regulation of physiological processes, such as adaptation to physical exercise, and also in disease settings, such as systemic arterial hypertension (SAH), type 2 diabetes mellitus (T2D), and obesity. In SAH, microRNAs play a significant role in the regulation of key signaling pathways that lead to the hyperactivation of the renin-angiotensin-aldosterone system, endothelial dysfunction, inflammation, proliferation, and phenotypic change in smooth muscle cells, and the hyperactivation of the sympathetic nervous system. MicroRNAs are also involved in the regulation of insulin signaling and blood glucose levels in T2D, and participate in lipid metabolism, adipogenesis, and adipocyte differentiation in obesity, with specific microRNA signatures involved in the pathogenesis of each disease. Many studies report the benefits promoted by exercise training in cardiovascular diseases by reducing blood pressure, glucose levels, and improving insulin signaling and lipid metabolism. The molecular mechanisms involved, however, remain poorly understood, especially regarding the participation of microRNAs in these processes. This review aimed to highlight microRNAs already known to be associated with SAH, T2D, and obesity, as well as their possible regulation by exercise training.
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Sweeting J, Ingles J, Ball K, Semsarian C. A Control Theory-Based Pilot Intervention toIncrease Physical Activity in Patients WithHypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:866-871. [PMID: 30049465 DOI: 10.1016/j.amjcard.2018.05.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/01/2018] [Accepted: 05/01/2018] [Indexed: 11/30/2022]
Abstract
Hypertrophic cardiomyopathy (HC) is the most common genetic heart disease. Consensus guidelines recommend restriction from competitive and/or high-intensity physical activities; however, sufficient light-moderate intensity physical activity remains important for health and wellbeing. This study aimed to evaluate the effectiveness and appeal of a control theory-based intervention to increase physical activity levels in individuals with HC. A pre to post trial of HC participants (n = 25) recruited from May 2016 to April 2017 from a specialized, multidisciplinary clinic was conducted. A 12-week intervention based on principles of control theory was developed. The primary outcome measures were self-reported leisure and transport-related physical activity. The mean age of participants was 42 ± 13years and the majority were men (n = 15, 60%). Although both the primary (self-report) and secondary (objective) outcome measures of physical activity increased, such as leisure-time physical activity: 98 ± 132 minutes per week to 151 ± 218 minutes per week, these were not statistically significant. Secondary outcome measures improved, including physical health-related quality of life (HR-QoL; 43 ± 6 to 50 ± 8, p = 0.004), self-efficacy (14 ± 3 to 16 ± 4, p <0.001), and the number of barriers identified (4 ± 3 to 3 ± 2 barriers, p = 0.02). This simple, easy-to-administer intervention to promote physical activity in HC improved willingness to undertake physical activity, increased self-efficacy, and improved physical quality of life. This may help patients overcome perceived barriers and a lack of confidence regarding physical activity, with the ultimate goal to improve overall health outcomes in HC patients.
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Affiliation(s)
- Joanna Sweeting
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kylie Ball
- Deakin University, Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Geelong, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Newtown, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
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48
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Exercise Training for Patients With Hypertrophic Cardiomyopathy. J Am Coll Cardiol 2018; 72:1157-1165. [DOI: 10.1016/j.jacc.2018.06.054] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/21/2022]
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49
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Friedberg MK, Barach P. A dynamic risk management approach to reduce harm in hypertrophic cardiomyopathy. PROGRESS IN PEDIATRIC CARDIOLOGY 2018. [DOI: 10.1016/j.ppedcard.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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50
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Abstract
Exercise and sports are an integral part of daily life for millions of Americans, with 16% of the US population older than age 15 years engaged in sports or exercise activities (Bureau of Labor statistics). The physical and psychological benefits of exercise are well-recognized. However, high-profile cases of athletes dying suddenly on the field, often due to undiagnosed genetic cardiomyopathies, raise questions about the risks and benefits of exercise for those with cardiomyopathy.
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