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Wu L, Wang K, Wang W, Wen Z, Wang P, Liu L, Wang DW. Glucagon-like peptide-1 ameliorates cardiac lipotoxicity in diabetic cardiomyopathy via the PPARα pathway. Aging Cell 2018; 17:e12763. [PMID: 29659121 PMCID: PMC6052396 DOI: 10.1111/acel.12763] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2018] [Indexed: 12/13/2022] Open
Abstract
Lipotoxicity cardiomyopathy is the result of excessive accumulation and oxidation of toxic lipids in the heart. It is a major threat to patients with diabetes. Glucagon-like peptide-1 (GLP-1) has aroused considerable interest as a novel therapeutic target for diabetes mellitus because it stimulates insulin secretion. Here, we investigated the effects and mechanisms of the GLP-1 analog exendin-4 and the dipeptidyl peptidase-4 inhibitor saxagliptin on cardiac lipid metabolism in diabetic mice (DM). The increased myocardial lipid accumulation, oxidative stress, apoptosis, and cardiac remodeling and dysfunction induced in DM by low streptozotocin doses and high-fat diets were significantly reversed by exendin-4 and saxagliptin treatments for 8 weeks. We found that exendin-4 inhibited abnormal activation of the (PPARα)-CD36 pathway by stimulating protein kinase A (PKA) but suppressing the Rho-associated protein kinase (ROCK) pathway in DM hearts, palmitic acid (PA)-treated rat h9c2 cardiomyocytes (CMs), and isolated adult mouse CMs. Cardioprotection in DM mediated by exendin-4 was abolished by combination therapy with the PPARα agonist wy-14643 but mimicked by PPARα gene deficiency. Therefore, the PPARα pathway accounted for the effects of exendin-4. This conclusion was confirmed in cardiac-restricted overexpression of PPARα mediated by adeno-associated virus serotype-9 containing a cardiac troponin T promoter. Our results provide the first direct evidence that GLP-1 protects cardiac function by inhibiting the ROCK/PPARα pathway, thereby ameliorating lipotoxicity in diabetic cardiomyopathy.
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Affiliation(s)
- Lujin Wu
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
| | - Ke Wang
- Department of Neonatal Medicine; The Central Hospital of Wuhan; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
| | - Wei Wang
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
| | - Zheng Wen
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
| | - Peihua Wang
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
| | - Lei Liu
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
| | - Dao Wen Wang
- Division of Cardiology; Department of Internal Medicine; Tongji Hospital; Tongji Medical College; Huazhong University of Science and Technology; Wuhan China
- Hubei Key Laboratory of Genetics and Molecular Mechanism of Cardiologic Disorders; Wuhan China
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Faggiano P, Vizzardi E, Pulcini E, Maffeo D, Fracassi F, Nodari S, Dei Cas L. The Study of Left Ventricular Diastolic Function by Doppler Echocardiography: The Essential for the Clinician. Heart Int 2018. [DOI: 10.1177/1826186807003001-206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Diego Maffeo
- Cardiology, University of Brescia, Brescia - Italy
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53
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Seferović PM, Petrie MC, Filippatos GS, Anker SD, Rosano G, Bauersachs J, Paulus WJ, Komajda M, Cosentino F, de Boer RA, Farmakis D, Doehner W, Lambrinou E, Lopatin Y, Piepoli MF, Theodorakis MJ, Wiggers H, Lekakis J, Mebazaa A, Mamas MA, Tschöpe C, Hoes AW, Seferović JP, Logue J, McDonagh T, Riley JP, Milinković I, Polovina M, van Veldhuisen DJ, Lainscak M, Maggioni AP, Ruschitzka F, McMurray JJV. Type 2 diabetes mellitus and heart failure: a position statement from the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2018. [PMID: 29520964 DOI: 10.1002/ejhf.1170] [Citation(s) in RCA: 384] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium-glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM.
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Affiliation(s)
- Petar M Seferović
- University of Belgrade School of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Gerasimos S Filippatos
- Department of Cardiology, National and Kapodistrian University of Athens Medical School, Athens University Hospital "Attikon", Athens, Greece
| | - Stefan D Anker
- Division of Cardiology and Metabolism - Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK); and Berlin-Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) Berlin; Charité Universitätsmedizin Berlin, Germany; Department of Cardiology and Pneumology, University Medicine Göttingen, Göttingen, Germany
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Pisana, Roma, Italy and Cardiovascular and Cell Science Institute, St George's University of London, London, UK
| | - Johann Bauersachs
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | - Walter J Paulus
- Department of Physiology and Institute for Cardiovascular Research VU, VU University Medical Center, Amsterdam, The Netherlands
| | - Michel Komajda
- Institute of Cardiometabolism and Nutrition (ICAN), Pierre et Marie Curie University, Paris VI, La Pitié-Salpétrière Hospital, Paris, France
| | - Francesco Cosentino
- Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rudolf A de Boer
- University of Groningen, University Medical Centre Groningen, Department of Cardiology, Hanzeplein Groningen, The Netherlands
| | - Dimitrios Farmakis
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Wolfram Doehner
- Charité - Campus Virchow (CVK), Center for Stroke Research, Berlin, Germany
| | | | - Yuri Lopatin
- Volgograd Medical University, Cardiology Centre, Volgograd, Russian Federation
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL, Piacenza, Italy
| | - Michael J Theodorakis
- Endocrinology, Metabolism and Diabetes Unit, Evgenideion Hospital, University of Athens, Athens, Greece
| | - Henrik Wiggers
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - John Lekakis
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Alexandre Mebazaa
- University Paris Diderot, Paris, France; and Department of Anaesthesia and Critical Care, University Hospitals Saint Louis-Lariboisière, Paris, France
| | - Mamas A Mamas
- Cardiovascular Research Group, Keele University, Stoke-on-Trent, UK
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow Klinikum, Charite - Universitaetsmedizin Berlin, Berlin, Germany
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jelena P Seferović
- Clinic of Endocrinology, Diabetes and Metabolic Diseases, Belgrade University Medical Center, Belgrade, Serbia
| | - Jennifer Logue
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Theresa McDonagh
- Department of Cardiology, King's College Hospital, Denmark Hill, London, UK
| | - Jillian P Riley
- National Heart and Lung Institute Imperial College London, London, UK
| | - Ivan Milinković
- University of Belgrade School of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Marija Polovina
- University of Belgrade School of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Dirk J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mitja Lainscak
- Department of Internal Medicine, and Department of Research and Education, General Hospital Murska Sobota, Murska Sobota, Slovenia
| | - Aldo P Maggioni
- Research Center of the Italian Association of Hospital Cardiologists, Florence, Italy
| | - Frank Ruschitzka
- University Heart Centre, University Hospital Zurich, Zurich, Switzerland
| | - John J V McMurray
- British Heart Foundation, Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Abstract
We are now entering the very exciting era of treatment and management of diabetes mellitus (DM) with the emergence of new therapeutic agents, including sodium-glucose cotransporter 2 inhibitors (SGLT2i) and dipeptidyl peptidase-4 inhibitor (DPP-4i). From a cardiology and echocardiography perspective, the existence of diabetic cardiomyopathy has been proven through over four decades of discussion. DM is highly prevalent in patients with heart failure (HF). Independent associations are found after adjusting for hypertension (HTN) and coronary artery disease (CAD). In patients with both DM and HF, the prognosis is extremely dismal. In this review, the main focus is on both diabetic cardiomyopathy per se and its typical features (including myocardial additive insult related to DM), diagnosis, and management.
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Affiliation(s)
- Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.,Royal Hobart Hospital, Hobart, Australia
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Increased left ventricular mass index is present in patients with type 2 diabetes without ischemic heart disease. Sci Rep 2018; 8:926. [PMID: 29343820 PMCID: PMC5772487 DOI: 10.1038/s41598-018-19229-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/22/2017] [Indexed: 01/13/2023] Open
Abstract
Left ventricular mass index (LVMI) increase has been described in hypertension (HTN), but less is known about its association with type 2 diabetes (T2DM). As these conditions frequently co-exist, we investigated the association of T2DM, HTN and both with echocardiographic parameters, and hypothesized that patients with both had highest LVMI, followed by patients with only T2DM or HTN. Study population included 101 T2DM patients, 62 patients with HTN and no T2DM, and 76 patients with T2DM and HTN, excluded for ischemic heart disease. Demographic and clinical data, biochemical measurements, stress echocardiography, transthoracic 2D Doppler and tissue Doppler echocardiography were performed. Multivariable logistic regression was used to determine the independent association with T2DM. Linear regression models and Pearson's correlation were used to assess the correlations between LVMI and other parameters. Patients with only T2DM had significantly greater LVMI (84.9 ± 20.3 g/m2) compared to patients with T2DM and HTN (77.9 ± 16 g/m2) and only HTN (69.8 ± 12.4 g/m2). In multivariate logistic regression analysis, T2DM was associated with LVMI (OR 1.033, 95%CI 1.003-1.065, p = 0.029). A positive correlation of LVMI was found with fasting glucose (p < 0.001) and HbA1c (p = 0.0003). Increased LVMI could be a potential, pre-symptomatic marker of myocardial structural change in T2DM.
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57
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Poudel A, Zhou JY, Story D, Li L. Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies. J Diabetes Res 2018; 2018:2742565. [PMID: 30302343 PMCID: PMC6158951 DOI: 10.1155/2018/2742565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 08/12/2018] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S. POPULATION DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.
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Affiliation(s)
- Anil Poudel
- Department of Physician Assistant, College of Health Professions, Central Michigan University, MI 48859, USA
| | - Joseph Yi Zhou
- College of Medicine, Central Michigan University, MI 48859, USA
| | - Darren Story
- Program in Neuroscience, Central Michigan University, MI 48859, USA
| | - Lixin Li
- Department of Physician Assistant, College of Health Professions, Central Michigan University, MI 48859, USA
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Molecular mechanisms of cardiac pathology in diabetes - Experimental insights. Biochim Biophys Acta Mol Basis Dis 2017; 1864:1949-1959. [PMID: 29109032 DOI: 10.1016/j.bbadis.2017.10.035] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/09/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
Diabetic cardiomyopathy is a distinct pathology independent of co-morbidities such as coronary artery disease and hypertension. Diminished glucose uptake due to impaired insulin signaling and decreased expression of glucose transporters is associated with a shift towards increased reliance on fatty acid oxidation and reduced cardiac efficiency in diabetic hearts. The cardiac metabolic profile in diabetes is influenced by disturbances in circulating glucose, insulin and fatty acids, and alterations in cardiomyocyte signaling. In this review, we focus on recent preclinical advances in understanding the molecular mechanisms of diabetic cardiomyopathy. Genetic manipulation of cardiomyocyte insulin signaling intermediates has demonstrated that partial cardiac functional rescue can be achieved by upregulation of the insulin signaling pathway in diabetic hearts. Inconsistent findings have been reported relating to the role of cardiac AMPK and β-adrenergic signaling in diabetes, and systemic administration of agents targeting these pathways appear to elicit some cardiac benefit, but whether these effects are related to direct cardiac actions is uncertain. Overload of cardiomyocyte fuel storage is evident in the diabetic heart, with accumulation of glycogen and lipid droplets. Cardiac metabolic dysregulation in diabetes has been linked with oxidative stress and autophagy disturbance, which may lead to cell death induction, fibrotic 'backfill' and cardiac dysfunction. This review examines the weight of evidence relating to the molecular mechanisms of diabetic cardiomyopathy, with a particular focus on metabolic and signaling pathways. Areas of uncertainty in the field are highlighted and important knowledge gaps for further investigation are identified. This article is part of a Special issue entitled Cardiac adaptations to obesity, diabetes and insulin resistance, edited by Professors Jan F.C. Glatz, Jason R.B. Dyck and Christine Des Rosiers.
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59
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Aboukhoudir F, Aboukhoudir I, Rekik S. [Stress dobutamine echocardiography or resting strain rate imaging to unveil an early symptomatic diabetic cardiomyopathy?]. Ann Cardiol Angeiol (Paris) 2017; 66:330-334. [PMID: 29050744 DOI: 10.1016/j.ancard.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 09/12/2017] [Indexed: 06/07/2023]
Abstract
Diabetes mellitus has been associated with changes in the structure and function of the myocardium manifesting in the early stages of the disease as subtle systolic and diastolic dysfunction; myocardial strain imaging has recently been favored over dobutamine stress echocardiography for early detection of diabetic cardiomyopathy. We report a case of an elderly diabetic patient presenting with pulmonary edema in whom at rest echocardiographic parameters including strain rate were all within normal range, while dobutamine stress echocardiography induced a deep systolic deterioration unmasking an early-stage diabetic cardiomyopathy.
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Affiliation(s)
- F Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follerau, 84000 Avignon, France; EA4278, laboratoire de pharm-écologie-cardiovasculaire, Avignon université, 84000 Avignon, France
| | - I Aboukhoudir
- Service de cardiologie, centre hospitalier d'Avignon, 305, rue Raoul-Follerau, 84000 Avignon, France
| | - S Rekik
- Service de cardiologie, centre hospitalier Nord Franche Comté, 100, route de Moval, 90400 Trevenans, France.
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Di Pino A, Mangiafico S, Urbano F, Scicali R, Scandura S, D'Agate V, Piro S, Tamburino C, Purrello F, Rabuazzo AM. HbA1c Identifies Subjects With Prediabetes and Subclinical Left Ventricular Diastolic Dysfunction. J Clin Endocrinol Metab 2017; 102:3756-3764. [PMID: 28973588 DOI: 10.1210/jc.2017-00954] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 07/27/2017] [Indexed: 02/07/2023]
Abstract
CONTEXT Prediabetes is associated with subclinical cardiac changes associated with heart failure development. OBJECTIVE We investigated diastolic function and its association with markers of glycation and inflammation related to cardiovascular disease in patients with prediabetes. We focused on individuals with prediabetes identified only by glycated hemoglobin A1c [HbA1c; 5.7% to 6.4% and normal fasting glucose (NFG) and normal glucose tolerance (NGT) after an oral glucose tolerance test (OGTT)]. DESIGN Cross-sectional study. SETTING Departments of Clinical and Experimental Medicine and Cardiology, University of Catania, Catania, Italy. MAIN OUTCOME MEASURES HbA1c, OGTT, Doppler echocardiography, soluble receptor for advanced glycation end products (sRAGEs), and endogenous secretory RAGE (esRAGE) were evaluated. PATIENTS We recruited 167 subjects with NFG/NGT who were stratified according to HbA1c level: controls (HbA1c <5.7%) and HbA1c prediabetes (HbA1c 5.7% to 6.4%). RESULTS Patients with HbA1c prediabetes (n = 106) showed a lower peak mitral inflow in early diastole (E wave) to late diastolic atrial filling velocity (A wave) ratio (E/A ratio) than controls (n = 61) (1.10 ± 0.24 vs 1.18 ± 0.23; P < 0.05). They showed a higher left atrium volume (LAV) (28.4 ± 5 vs 22.1 ± 3; P < 0.05) and sphericity index (SI) (0.6 ± 0.06 vs 0.5 ± 0.05; P < 0.05). After multiple regression analyses, HbA1c, sRAGE, and esRAGE were the major determinants of E/A ratio, LAV, and SI. CONCLUSIONS Subjects with HbA1c prediabetes exhibited subclinical cardiac alterations associated with sRAGE, esRAGE, and HbA1c. These subjects would not have been classified as having prediabetes on the basis of fasting glycemia or post-OGTT values.
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Affiliation(s)
- Antonino Di Pino
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Sarah Mangiafico
- Division of Cardiology, Ferrarotto Hospital, University of Catania, 95100 Catania, Italy
| | - Francesca Urbano
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Salvatore Scandura
- Division of Cardiology, Ferrarotto Hospital, University of Catania, 95100 Catania, Italy
| | - Veronica D'Agate
- Division of Cardiology, Ferrarotto Hospital, University of Catania, 95100 Catania, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Corrado Tamburino
- Division of Cardiology, Ferrarotto Hospital, University of Catania, 95100 Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
| | - Agata Maria Rabuazzo
- Department of Clinical and Experimental Medicine, Garibaldi Hospital, University of Catania, 95122 Catania, Italy
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Are targeted therapies for diabetic cardiomyopathy on the horizon? Clin Sci (Lond) 2017; 131:897-915. [PMID: 28473471 DOI: 10.1042/cs20160491] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 02/02/2017] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
Abstract
Diabetes increases the risk of heart failure approximately 2.5-fold, independent of coronary artery disease and other comorbidities. This process, termed diabetic cardiomyopathy, is characterized by initial impairment of left ventricular (LV) relaxation followed by LV contractile dysfunction. Post-mortem examination reveals that human diastolic dysfunction is closely associated with LV damage, including cardiomyocyte hypertrophy, apoptosis and fibrosis, with impaired coronary microvascular perfusion. The pathophysiological mechanisms underpinning the characteristic features of diabetic cardiomyopathy remain poorly understood, although multiple factors including altered lipid metabolism, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum (ER) stress, inflammation, as well as epigenetic changes, are implicated. Despite a recent rise in research interrogating these mechanisms and an increased understanding of the clinical importance of diabetic cardiomyopathy, there remains a lack of specific treatment strategies. How the chronic metabolic disturbances observed in diabetes lead to structural and functional changes remains a pertinent question, and it is hoped that recent advances, particularly in the area of epigenetics, among others, may provide some answers. This review hence explores the temporal onset of the pathological features of diabetic cardiomyopathy, and their relative contribution to the resultant disease phenotype, as well as both current and potential therapeutic options. The emergence of glucose-optimizing agents, namely glucagon-like peptide-1 (GLP-1) agonists and sodium/glucose co-transporter (SGLT)2 inhibitors that confer benefits on cardiovascular outcomes, together with novel experimental approaches, highlight a new and exciting era in diabetes research, which is likely to result in major clinical impact.
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62
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Impact of left ventricular longitudinal functional mechanics on the progression of diastolic function in diabetes mellitus. Int J Cardiovasc Imaging 2017. [DOI: 10.1007/s10554-017-1198-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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63
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The impact of diabetes on left ventricular diastolic function in patients with arterial hypertension. North Clin Istanb 2017; 2:177-181. [PMID: 28058364 PMCID: PMC5175103 DOI: 10.14744/nci.2015.55477] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 11/18/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE: The aim of this study is to analyse the impact of diabetes mellitus on the left ventricular diastolic function in patients with arterial hypertension. METHODS: Between July 2007 and July 2008, we enrolled patients aged ≥40 years who had hypertension with or without type 2 diabetes mellitus and unknown history of coronary artery disease who applied to 7.–8. internal medicine polyclinics of Goztepe Education and Training Hospital. Transthoracic echocardiography was used to assess the diastolic function. If patients with positive treadmill exercise test and/or EF ≤%50 in transthoracic echocardiography were excluded from the study. A total of 110 patients (males, n=42 38.2%, and females, n=68; 61.8%) with a mean age of 60.78 (±10.627) years were included in the study. For statistical analysis, SPSS 12.0 program and for the comparison of data chi-square test was used. RESULTS: Diastolic dysfunction was significantly more prevalent in diabetes (81.25%) than those without diabetes group (62.9%) (p<0.05). In men, 35.9% in the DM(+) group and 41.1% in the DM(-) group had diastolic dysfunction. In women, 64.1% in the DM(+) group and 58.29% in the DM(-) group had diastolic dysfunction. In the evaluation based on gender, the difference male and female patients was not significant (p>0.05). CONCLUSION: Diabetes in association with hypertension has a negative effect on left ventricular diastolic function. This effect appears similar in men and women.
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64
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Leung M, Wong VW, Durmush E, Phan V, Xie M, Leung DY. Cardiac dysfunction in type II diabetes: a bittersweet, weighty problem, or both? Acta Diabetol 2017; 54:91-100. [PMID: 27696068 PMCID: PMC5263192 DOI: 10.1007/s00592-016-0911-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 09/01/2016] [Indexed: 11/30/2022]
Abstract
AIMS Weight loss in obese patients leads to improved left ventricular (LV) function. It is unclear whether improving glycaemic control has additional benefits to weight loss alone in patients with type 2 diabetes, or if benefits of weight loss are mediated through improving glycaemic control. This case-control study examined the incremental impact of these approaches on LV function. METHODS Three groups of age, gender, and baseline HbA1c-matched patients with type 2 diabetes and suboptimal glycaemic control were followed-up for 12 months. Group 1 patients did not improve HbA1c ≥ 1 % (10.9 mmol/mol) or lose weight. Group 2 improved HbA1c ≥ 1 % but did not lose weight. Group 3 improved HbA1c ≥ 1 % (10.9 mmol/mol) and lost weight. All patients underwent transthoracic echocardiogram at baseline and at follow-up. RESULTS At baseline, three groups were comparable in all clinical and metabolic parameters except Group 3 had highest body mass index. The three groups had similar echocardiographic parameters except Group 3 had the worst LV systolic function [global longitudinal strain (GLS)]. At follow-up, LV ejection fraction and diastolic function improved with a reduction in filling pressures in Group 2 and more so in Group 3. LV filling pressures in Group 1 increased. There was a significant improvement in GLS in Group 2 and more so in Group 3. Despite GLS being the worst in Group 3 at baseline, this was comparable between Groups 2 and 3 at follow-up. CONCLUSIONS In overweight patients with type 2 diabetes, weight loss and improved glycaemic control had additive beneficial effects on improving LV systolic and diastolic function.
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Affiliation(s)
- Melissa Leung
- Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Leiden University Medical Centre, Leiden, The Netherlands.
| | - Vincent W Wong
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
- Liverpool Diabetes Collaborative Research Unit, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
| | | | - Victoria Phan
- Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Mikey Xie
- Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
| | - Dominic Y Leung
- Department of Cardiology, Liverpool Hospital, South Western Sydney Clinical School, University of New South Wales, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Mishra PK, Ying W, Nandi SS, Bandyopadhyay GK, Patel KK, Mahata SK. Diabetic Cardiomyopathy: An Immunometabolic Perspective. Front Endocrinol (Lausanne) 2017; 8:72. [PMID: 28439258 PMCID: PMC5384479 DOI: 10.3389/fendo.2017.00072] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/27/2017] [Indexed: 12/12/2022] Open
Abstract
The heart possesses a remarkable inherent capability to adapt itself to a wide array of genetic and extrinsic factors to maintain contractile function. Failure to sustain its compensatory responses results in cardiac dysfunction, leading to cardiomyopathy. Diabetic cardiomyopathy (DCM) is characterized by left ventricular hypertrophy and reduced diastolic function, with or without concurrent systolic dysfunction in the absence of hypertension and coronary artery disease. Changes in substrate metabolism, oxidative stress, endoplasmic reticulum stress, formation of extracellular matrix proteins, and advanced glycation end products constitute the early stage in DCM. These early events are followed by steatosis (accumulation of lipid droplets) in cardiomyocytes, which is followed by apoptosis, changes in immune responses with a consequent increase in fibrosis, remodeling of cardiomyocytes, and the resultant decrease in cardiac function. The heart is an omnivore, metabolically flexible, and consumes the highest amount of ATP in the body. Altered myocardial substrate and energy metabolism initiate the development of DCM. Diabetic hearts shift away from the utilization of glucose, rely almost completely on fatty acids (FAs) as the energy source, and become metabolically inflexible. Oxidation of FAs is metabolically inefficient as it consumes more energy. In addition to metabolic inflexibility and energy inefficiency, the diabetic heart suffers from impaired calcium handling with consequent alteration of relaxation-contraction dynamics leading to diastolic and systolic dysfunction. Sarcoplasmic reticulum (SR) plays a key role in excitation-contraction coupling as Ca2+ is transported into the SR by the SERCA2a (sarcoplasmic/endoplasmic reticulum calcium-ATPase 2a) during cardiac relaxation. Diabetic cardiomyocytes display decreased SERCA2a activity and leaky Ca2+ release channel resulting in reduced SR calcium load. The diabetic heart also suffers from marked downregulation of novel cardioprotective microRNAs (miRNAs) discovered recently. Since immune responses and substrate energy metabolism are critically altered in diabetes, the present review will focus on immunometabolism and miRNAs.
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Affiliation(s)
- Paras K. Mishra
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, USA
- *Correspondence: Paras K. Mishra, ; Sushil K. Mahata,
| | - Wei Ying
- Department of Medicine, Metabolic Physiology and Ultrastructural Biology Laboratory, University of California San Diego, La Jolla, CA, USA
| | - Shyam Sundar Nandi
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gautam K. Bandyopadhyay
- Department of Medicine, Metabolic Physiology and Ultrastructural Biology Laboratory, University of California San Diego, La Jolla, CA, USA
| | - Kaushik K. Patel
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sushil K. Mahata
- Department of Medicine, Metabolic Physiology and Ultrastructural Biology Laboratory, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, Metabolic Physiology and Ultrastructural Biology Laboratory, VA San Diego Healthcare System, San Diego, CA, USA
- *Correspondence: Paras K. Mishra, ; Sushil K. Mahata,
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de Gonzalo-Calvo D, Kenneweg F, Bang C, Toro R, van der Meer RW, Rijzewijk LJ, Smit JW, Lamb HJ, Llorente-Cortes V, Thum T. Circulating long-non coding RNAs as biomarkers of left ventricular diastolic function and remodelling in patients with well-controlled type 2 diabetes. Sci Rep 2016; 6:37354. [PMID: 27874027 PMCID: PMC5118808 DOI: 10.1038/srep37354] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/26/2016] [Indexed: 12/15/2022] Open
Abstract
Contractile dysfunction is underdiagnosed in early stages of diabetic cardiomyopathy. We evaluated the potential of circulating long non-coding RNAs (lncRNAs) as biomarkers of subclinical cardiac abnormalities in type 2 diabetes. Forty-eight men with well-controlled type 2 diabetes and 12 healthy age-matched volunteers were enrolled in the study. Left ventricular (LV) parameters were measured by magnetic resonance imaging. A panel of lncRNAs was quantified in serum by RT-qPCR. No differences in expression levels of lncRNAs were observed between type 2 diabetes patients and healthy volunteers. In patients with type 2 diabetes, long intergenic non-coding RNA predicting cardiac remodeling (LIPCAR) was inversely associated with diastolic function, measured as E/A peak flow (P < 0.050 for all linear models). LIPCAR was positively associated with grade I diastolic dysfunction (P < 0.050 for all logistic models). Myocardial infarction-associated transcript (MIAT) and smooth muscle and endothelial cell-enriched migration/differentiation-associated long noncoding RNA (SENCR) were directly associated with LV mass to LV end-diastolic volume ratio, a marker of cardiac remodelling (P < 0.050 for all linear models). These findings were validated in a sample of 30 patients with well-controlled type 2 diabetes. LncRNAs are independent predictors of diastolic function and remodelling in patients with type 2 diabetes.
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Affiliation(s)
- D de Gonzalo-Calvo
- Cardiovascular Research Center (CSIC-ICCC), Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - F Kenneweg
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - C Bang
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany
| | - R Toro
- Department of Medicine, University of Cádiz, Cádiz, Spain
| | - R W van der Meer
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - L J Rijzewijk
- Department of Medicine, Kantonsspital Baden AG, Baden, Switzerland
| | - J W Smit
- Department of Internal Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - V Llorente-Cortes
- Cardiovascular Research Center (CSIC-ICCC), Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - T Thum
- Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, Hannover Medical School, Hannover, Germany.,Excellence Cluster REBIRTH, Hannover Medical School, Hannover, Germany.,National Heart and Lung Institute, Imperial College, London, UK
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67
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Georgievska-Ismail L, Zafirovska P, Hristovski Z. Evaluation of the role of left atrial strain using two-dimensional speckle tracking echocardiography in patients with diabetes mellitus and heart failure with preserved left ventricular ejection fraction. Diab Vasc Dis Res 2016; 13:384-394. [PMID: 27407084 DOI: 10.1177/1479164116655558] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To evaluate additional role of left atrial two-dimensional speckle tracking echocardiography in patients with diabetes mellitus type 2, 218 patients with heart failure with preserved left ventricular ejection fraction divided according to the presence of diabetes mellitus (108 with and 110 without) were enrolled in the study. METHODS Traditional parameters using two-dimensional echocardiography and Doppler imaging were measured as expressions of left ventricular diastolic function as well as peak atrial longitudinal strain and peak atrial contraction strain were measured using two-dimensional speckle tracking echocardiography. RESULTS Global average peak atrial longitudinal strain and peak atrial contraction strain were significantly lower in patients with diabetes mellitus (p = 0.002 and p = 0.001, respectively) and its reduced values were significantly associated with higher prevalence of diabetes mellitus (p = 0.002 and p = 0.001, respectively), its greater severity (p = 0.002 and p = 0.016, respectively) and longer duration only for global average peak atrial longitudinal strain (p = 0.030). Multiple linear regression analysis demonstrated that the presence of diabetes mellitus appeared as independent predictor of reduced global peak atrial longitudinal strain [B = -2.173; 95% confidence interval: -3.870 to (-0.477); p = 0.012] as well of reduced global peak atrial contraction strain [B = -1.30; 95% confidence interval: -2.234 to (-0.366); p = 0.007]. CONCLUSION Two-dimensional speckle tracking echocardiography appeared as a useful additional tool for detection of left atrial dysfunction in patients with heart failure who have preserved left ventricular ejection fraction and diabetes mellitus who are especially prone to develop cardiovascular complications.
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Affiliation(s)
| | - Planinka Zafirovska
- Special Hospital for Surgical Diseases 'Filip II', Skopje, Republic of Macedonia
| | - Zarko Hristovski
- Clinical Hospital 'Acibadem Sistina', Skopje, Republic of Macedonia
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Abstract
PURPOSE OF REVIEW It is well known that patients with heart failure also suffer from a large number of comorbid conditions, which confound their heart failure management and adversely affect the prognosis. The purpose of this review is to evaluate the latest developments of these conditions. RECENT FINDINGS Chronic lung disease commonly coexists with heart failure. It is more prevalent and worsens prognosis more in patients with preserved (heart failure with preserved ejection fraction) than with reduced ejection fraction (heart failure with reduced ejection fraction). Patients with diabetes have increased risk of incident heart failure, and as a comorbid condition it adversely affects prognosis. The relative impact on mortality and heart failure hospitalization remains controversial. Renal dysfunction is also common in patients with heart failure, with similar prevalence among those with preserved ejection fraction and those with reduced ejection fraction. The prognosis seems mainly related to long-term changes in kidney function, rather than to short-term changes in serum creatinine. Anemia and iron deficiency have a similar profile in terms of prevalence and impact on prognosis. Recent data suggest a benefit of intravenous iron infusion in patients who are iron deficient. SUMMARY As patients with comorbid conditions are frequently excluded from clinical trials, future clinical trials should recruit these patients and include endpoints that will be reflective of these conditions.
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69
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Markus MRP, Dörr M. Relation of Early and Late Stages of Glucose Metabolism Disturbances With Left Ventricular Geometry and Function: Are Sugar Kisses Bad for the Heart? Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.005625. [PMID: 27729372 DOI: 10.1161/circimaging.116.005625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marcello Ricardo Paulista Markus
- From the Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M.) and Department of Internal Medicine B - Cardiology (M.D.), University Medicine Greifswald, Germany; DZD (German Center for Diabetes Research), partner site Greifswald, Germany (M.R.P.M.); and DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany (M.R.P.M., M.D.)
| | - Marcus Dörr
- From the Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M.) and Department of Internal Medicine B - Cardiology (M.D.), University Medicine Greifswald, Germany; DZD (German Center for Diabetes Research), partner site Greifswald, Germany (M.R.P.M.); and DZHK (German Centre for Cardiovascular Research), partner site Greifswald, Germany (M.R.P.M., M.D.).
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Leung M, Wong VW, Hudson M, Leung DY. Impact of Improved Glycemic Control on Cardiac Function in Type 2 Diabetes Mellitus. Circ Cardiovasc Imaging 2016; 9:e003643. [PMID: 26962125 DOI: 10.1161/circimaging.115.003643] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus are at risk of heart failure. Specific therapeutic interventions for diabetic heart disease are still elusive. We aimed to examine the impact of improved glycemic control on left ventricular (LV) function in these patients. METHODS AND RESULTS A total of 105 subjects with type 2 diabetes mellitus (aged 54±10 years) and poor glycemic control received optimization of treatment for blood glucose, blood pressure, and cholesterol to recommended targets for 12 months. LV systolic and diastolic function, measured by LV global longitudinal strain (GLS) and septal e' velocities, were compared before and after optimization. At baseline, patients had impaired LV systolic (GLS -14.9±3.2%) and diastolic function (e' 6.2±1.7 cm/s). After 12 months, glycated hemoglobin (HbA1c) decreased from 10.3±2.4% to 8.3±2.0%, which was associated with significant relative improvement in GLS of 21% and septal e' of 24%. There was a progressively greater improvement in GLS as patients achieved a lower final HbA1c. Patients achieving an HbA1c of <7.0% had the largest improvement. The 15 patients whose HbA1c worsened experienced a decline in GLS. Patients who improved their HbA1c by ≥1.0% had a significantly higher relative improvement in e' than those who did not (32% versus 8%; P=0.003). Baseline GLS, decrease in body mass index, and treatment with metformin were additional independent predictors of GLS improvement. CONCLUSIONS Improvements in glycemic control over a 12-month period led to improvements in LV systolic and diastolic function. This may have long-term prognostic implications.
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Affiliation(s)
- Melissa Leung
- From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.).
| | - Vincent W Wong
- From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.)
| | - Malcolm Hudson
- From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.)
| | - Dominic Y Leung
- From the Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia (M.L., D.Y.L.); University of New South Wales, Sydney, New South Wales, Australia (M.L., V.W.W., D.Y.L.); Liverpool Diabetes Collaborative Research Unit, Ingham Institute, Liverpool, Sydney, New South Wales, Australia (V.W.W.); Department of Statistics, Macquarie University, Sydney, New South Wales, Australia (M.H.); and NHMRC CTC, University of Sydney, Sydney, New South Wales, Australia (M.H.)
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Hensel KO. Non-ischemic diabetic cardiomyopathy may initially exhibit a transient subclinical phase of hyperdynamic myocardial performance. Med Hypotheses 2016; 94:7-10. [PMID: 27515189 DOI: 10.1016/j.mehy.2016.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/02/2016] [Indexed: 01/14/2023]
Abstract
Cardiovascular complications are the key cause for mortality in diabetes mellitus. Besides ischemia-related cardiac malfunction there is growing evidence for non-ischemic diabetes-associated heart failure in both type 1 and type 2 diabetes mellitus. The underlying pathophysiology of non-ischemic diabetic cardiomyopathy (NIDC) is poorly understood and data on myocardial mechanics in early stages of the disease are rare. However, several studies in both human and experimental animal settings have reported prima facie unexplained features indicating myocardial hyperdynamics early in the course of the disease. The new hypothesis is that - other than previously thought - NIDC may be non-linear and initially feature an asymptomatic subclinical phase of myocardial hypercontractility that precedes the long-term development of diabetes-associated cardiac dysfunction and ultimately heart failure. Diabetes-induced metabolic imbalances may lead to a paradoxic inotropic increase and inefficient myocardial mechanics that finally result in a gradual deterioration of myocardial performance. In conclusion, diabetic patients should be screened regularly and early in the course of the disease utilizing ultra-sensitive myocardial deformation imaging in order to identify patients at risk for diabetes-associated heart failure. Moreover, hyperdynamic myocardial deformation might help distinguish non-ischemic from ischemic diabetic cardiomyopathy. Further studies are needed to illuminate the underlying pathophysiological mechanisms, the exact spatiotemporal evolvement of diabetic cardiomyopathy and its long-term relation to clinical outcome parameters.
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Affiliation(s)
- Kai O Hensel
- HELIOS University Hospital Wuppertal, Department of Pediatrics, Center for Clinical and Translational Research (CCTR), Witten/Herdecke University, Faculty of Health, Germany.
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72
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Dubó S, Gallegos D, Cabrera L, Sobrevia L, Zúñiga L, González M. Cardiovascular Action of Insulin in Health and Disease: Endothelial L-Arginine Transport and Cardiac Voltage-Dependent Potassium Channels. Front Physiol 2016; 7:74. [PMID: 27014078 PMCID: PMC4791397 DOI: 10.3389/fphys.2016.00074] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 02/15/2016] [Indexed: 12/19/2022] Open
Abstract
Impairment of insulin signaling on diabetes mellitus has been related to cardiovascular dysfunction, heart failure, and sudden death. In human endothelium, cationic amino acid transporter 1 (hCAT-1) is related to the synthesis of nitric oxide (NO) and insulin has a vascular effect in endothelial cells through a signaling pathway that involves increases in hCAT-1 expression and L-arginine transport. This mechanism is disrupted in diabetes, a phenomenon potentiated by excessive accumulation of reactive oxygen species (ROS), which contribute to lower availability of NO and endothelial dysfunction. On the other hand, electrical remodeling in cardiomyocytes is considered a key factor in heart failure progression associated to diabetes mellitus. This generates a challenge to understand the specific role of insulin and the pathways involved in cardiac function. Studies on isolated mammalian cardiomyocytes have shown prolongated action potential in ventricular repolarization phase that produces a long QT interval, which is well explained by attenuation in the repolarizing potassium currents in cardiac ventricles. Impaired insulin signaling causes specific changes in these currents, such a decrease amplitude of the transient outward K(+) (Ito) and the ultra-rapid delayed rectifier (IKur) currents where, together, a reduction of mRNA and protein expression levels of α-subunits (Ito, fast; Kv 4.2 and IKs; Kv 1.5) or β-subunits (KChIP2 and MiRP) of K(+) channels involved in these currents in a MAPK mediated pathway process have been described. These results support the hypothesis that lack of insulin signaling can produce an abnormal repolarization in cardiomyocytes. Furthermore, the arrhythmogenic potential due to reduced Ito current can contribute to an increase in the incidence of sudden death in heart failure. This review aims to show, based on pathophysiological models, the regulatory function that would have insulin in vascular system and in cardiac electrophysiology.
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Affiliation(s)
- Sebastián Dubó
- Department of Kinesiology, Faculty of Medicine, Universidad de Concepción Concepción, Chile
| | - David Gallegos
- Vascular Physiology Laboratory, Department of Physiology, Faculty of Biological Sciences, Universidad de Concepción Concepción, Chile
| | - Lissette Cabrera
- Vascular Physiology Laboratory, Department of Physiology, Faculty of Biological Sciences, Universidad de ConcepciónConcepción, Chile; Department of Morphophysiology, Faculty of Medicine, Universidad Diego PortalesSantiago, Chile
| | - Luis Sobrevia
- Cellular and Molecular Physiology Laboratory (CMPL), Division of Obstetrics and Gynecology, Faculty of Medicine, School of Medicine, Pontificia Universidad Católica de ChileSantiago, Chile; Department of Physiology, Faculty of Pharmacy, Universidad de SevillaSeville, Spain; Faculty of Medicine and Biomedical Sciences, University of Queensland Centre for Clinical Research (UQCCR), University of QueenslandHerston, QLD, Queensland, Australia
| | - Leandro Zúñiga
- Centro de Investigaciones Médicas, Escuela de Medicina, Universidad de Talca Talca, Chile
| | - Marcelo González
- Vascular Physiology Laboratory, Department of Physiology, Faculty of Biological Sciences, Universidad de ConcepciónConcepción, Chile; Group of Research and Innovation in Vascular Health (GRIVAS-Health)Chillán, Chile
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Meo M, Meste O, Signore S, Sorrentino A, Cannata A, Zhou Y, Matsuda A, Luciani M, Kannappan R, Goichberg P, Leri A, Anversa P, Rota M. Reduction in Kv Current Enhances the Temporal Dispersion of the Action Potential in Diabetic Myocytes: Insights From a Novel Repolarization Algorithm. J Am Heart Assoc 2016; 5:e003078. [PMID: 26896476 PMCID: PMC4802457 DOI: 10.1161/jaha.115.003078] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 01/02/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Diabetes is associated with prolongation of the QT interval of the electrocardiogram and enhanced dispersion of ventricular repolarization, factors that, together with atherosclerosis and myocardial ischemia, may promote the occurrence of electrical disorders. Thus, we tested the possibility that alterations in transmembrane ionic currents reduce the repolarization reserve of myocytes, leading to action potential (AP) prolongation and enhanced beat-to-beat variability of repolarization. METHODS AND RESULTS Diabetes was induced in mice with streptozotocin (STZ), and effects of hyperglycemia on electrical properties of whole heart and myocytes were studied with respect to an untreated control group (Ctrl) using electrocardiographic recordings in vivo, ex vivo perfused hearts, and single-cell patch-clamp analysis. Additionally, a newly developed algorithm was introduced to obtain detailed information of the impact of high glucose on AP profile. Compared to Ctrl, hyperglycemia in STZ-treated animals was coupled with prolongation of the QT interval, enhanced temporal dispersion of electrical recovery, and susceptibility to ventricular arrhythmias, defects observed, in part, in the Akita mutant mouse model of type I diabetes. AP was prolonged and beat-to-beat variability of repolarization was enhanced in diabetic myocytes, with respect to Ctrl cells. Density of Kv K(+) and L-type Ca(2+) currents were decreased in STZ myocytes, in comparison to cells from normoglycemic mice. Pharmacological reduction of Kv currents in Ctrl cells lengthened AP duration and increased temporal dispersion of repolarization, reiterating features identified in diabetic myocytes. CONCLUSIONS Reductions in the repolarizing K(+) currents may contribute to electrical disturbances of the diabetic heart.
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Affiliation(s)
- Marianna Meo
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Olivier Meste
- Laboratoire d'Informatique, Signaux et Systèmes de Sophia Antipolis (I3S), Université Nice Sophia Antipolis, CNRS, Nice, France
| | - Sergio Signore
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Andrea Sorrentino
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Antonio Cannata
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yu Zhou
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Alex Matsuda
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Fondazione Cardiocentro Ticino, University of Zurich, Lugano, Switzerland
| | - Marco Luciani
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ramaswamy Kannappan
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Polina Goichberg
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Annarosa Leri
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Fondazione Cardiocentro Ticino, University of Zurich, Lugano, Switzerland
| | - Piero Anversa
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Fondazione Cardiocentro Ticino, University of Zurich, Lugano, Switzerland
| | - Marcello Rota
- Division of Cardiovascular Medicine, Departments of Anesthesia and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA Department of Physiology, New York Medical College, Valhalla, NY
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Hensel KO, Grimmer F, Roskopf M, Jenke AC, Wirth S, Heusch A. Subclinical Alterations of Cardiac Mechanics Present Early in the Course of Pediatric Type 1 Diabetes Mellitus: A Prospective Blinded Speckle Tracking Stress Echocardiography Study. J Diabetes Res 2016; 2016:2583747. [PMID: 26839891 PMCID: PMC4709644 DOI: 10.1155/2016/2583747] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 10/21/2015] [Accepted: 10/27/2015] [Indexed: 01/14/2023] Open
Abstract
Diabetic cardiomyopathy substantially accounts for mortality in diabetes mellitus. The pathophysiological mechanism underlying diabetes-associated nonischemic heart failure is poorly understood and clinical data on myocardial mechanics in early stages of diabetes are lacking. In this study we utilize speckle tracking echocardiography combined with physical stress testing in order to evaluate whether left ventricular (LV) myocardial performance is altered early in the course of uncomplicated type 1 diabetes mellitus (T1DM). 40 consecutive asymptomatic normotensive children and adolescents with T1DM (mean age 11.5 ± 3.1 years and mean disease duration 4.3 ± 3.5 years) and 44 age- and gender-matched healthy controls were assessed using conventional and quantitative echocardiography (strain and strain rate) during bicycle ergometer stress testing. Strikingly, T1DM patients had increased LV longitudinal (p = 0.019) and circumferential (p = 0.016) strain rate both at rest and during exercise (p = 0.021). This was more pronounced in T1DM patients with a longer disease duration (p = 0.038). T1DM patients with serum HbA1c > 9% showed impaired longitudinal (p = 0.008) and circumferential strain (p = 0.005) and a reduced E/A-ratio (p = 0.018). In conclusion, asymptomatic T1DM patients have signs of hyperdynamic LV contractility early in the course of the disease. Moreover, poor glycemic control is associated with early subclinical LV systolic and diastolic impairment.
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Affiliation(s)
- Kai O. Hensel
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
- *Kai O. Hensel:
| | - Franziska Grimmer
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Markus Roskopf
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Andreas C. Jenke
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Stefan Wirth
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Andreas Heusch
- Department of Pediatrics, HELIOS Medical Center Wuppertal, Centre for Clinical & Translational Research (CCTR), Centre for Biomedical Education & Research (ZBAF), Faculty of Health, Witten/Herdecke University, Heusnerstraße 40, 42283 Wuppertal, Germany
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Felício JS, Koury CC, Carvalho CT, Abrahão Neto JF, Miléo KB, Arbage TP, Silva DD, de Oliveira AF, Peixoto AS, Figueiredo AB, Ribeiro Dos Santos ÂKC, Yamada ES, Zanella MT. Present Insights on Cardiomyopathy in Diabetic Patients. Curr Diabetes Rev 2016; 12:384-395. [PMID: 26364799 PMCID: PMC5101638 DOI: 10.2174/1573399812666150914120529] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 08/27/2015] [Accepted: 09/14/2015] [Indexed: 12/22/2022]
Abstract
The pathogenesis of diabetic cardiomyopathy (DCM) is partially understood and is likely to be multifactorial, involving metabolic disturbances, hypertension and cardiovascular autonomic neuropathy (CAN). Therefore, an important need remains to further delineate the basic mechanisms of diabetic cardiomyopathy and to apply them to daily clinical practice. We attempt to detail some of these underlying mechanisms, focusing in the clinical features and management. The novelty of this review is the role of CAN and reduction of blood pressure descent during sleep in the development of DCM. Evidence has suggested that CAN might precede left ventricular hypertrophy and diastolic dysfunction in normotensive patients with type 2 diabetes, serving as an early marker for the evaluation of preclinical cardiac abnormalities. Additionally, a prospective study demonstrated that an elevation of nocturnal systolic blood pressure and a loss of nocturnal blood pressure fall might precede the onset of abnormal albuminuria and cardiovascular events in hypertensive normoalbuminuric patients with type 2 diabetes. Therefore, existing microalbuminuria could imply the presence of myocardium abnormalities. Considering that DCM could be asymptomatic for a long period and progress to irreversible cardiac damage, early recognition and treatment of the preclinical cardiac abnormalities are essential to avoid severe cardiovascular outcomes. In this sense, we recommend that all type 2 diabetic patients, especially those with microalbuminuria, should be regularly submitted to CAN tests, Ambulatory Blood Pressure Monitoring and echocardiography, and treated for any abnormalities in these tests in the attempt of reducing cardiovascular morbidity and mortality.
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Affiliation(s)
- João Soares Felício
- Hospital Universitário João de Barros Barreto - Universidade Federal do Pará, Mundurucus Street, 4487 - Postal Code: 66073-000 - Guamá - Belém - PA - Brazil.
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76
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Gu H, Liu Y, Mei S, Wang B, Sun G, Wang X, Xiao Y, Staup M, Gregoire FM, Chng K, Wang YJ. Left ventricular diastolic dysfunction in nonhuman primate model of dysmetabolism and diabetes. BMC Cardiovasc Disord 2015; 15:141. [PMID: 26518730 PMCID: PMC4628306 DOI: 10.1186/s12872-015-0133-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes is one of the major risk factors for cardiomyopathy and heart failure with reduced ejection fraction (EF) and highly associated with left ventricular (LV) dysfunction in human. This study aimed 1) to noninvasively assess cardiac function using echocardiography; 2) to test the hypothesis that like diabetic human, cardiac function may also be compromised; in spontaneously developed obese, dysmetabolic and diabetic nonhuman primates (NHPs). METHODS Cardiovascular functions were measured by noninvasive echocardiography in 28 control, 20 dysmetabolic/pre-diabetic and 41 diabetic cynomolgus monkeys based on fasting blood glucose and other metabolic status. RESULTS The LV end-systolic volume (ESV) was higher while end-diastolic volume (EDV, 12 ± 5.7 mL) and EF (63 ± 12.8 %) significantly lower in the diabetic compared to control (14 ± 7 mL and 68 ± 9.8 %) group, respectively. The E/A ratio of LV trans-mitral peak flow rate during early (E) over late (A) diastole was significantly lower in the diabetic (1.19 ± 0.45) than control (1.44 ± 0.48) group. E-wave deceleration time (E DT) was prolonged in the diabetic (89 ± 41 ms) compared to control (78 ± 26 ms) group. Left atrial (LA) maximal dimension (LADmax) was significantly greater in the diabetic (1.3 ± 0.17 cm) than control (1.1 ± 0.16 cm) group. Biochemical tests showed that total cholesterol and LDL were significant higher in the diabetic (167 ± 63 and 69 ± 37 mg/dL) than both pre-diabetic (113 ± 37 and 41 ± 23 mg/dL) and control (120 ± 28 and 41 ± 17 mg/dL) groups, respectively. Multivariable logistic regression analysis demonstrated that LV systolic (reduced EF) and diastolic (abnormal E/A ratio) dysfunctions are significantly correlated with aging and hyperglycemia. Histopathology examination of the necropsy heart revealed inflammatory infiltration, cardiomyocyte hypertrophy and fragmentation, indicating the myocardial ischemia and remodeling which is consistent with the LV dysfunction phenotype. CONCLUSIONS Using noninvasive echocardiography, the present study demonstrated for the first time that dysmetabolic and diabetic NHPs are associated with LV systolic (increased ESV, decreased EF, etc.) and diastolic (decreased EDV and E/A ratio, prolonged E DT, etc.) dysfunctions, accompanied by LA hypertrophic remodeling (increased LADmax), the phenotypes similarly to those found in diabetic patients. Thus, spontaneously developed dysmetabolic and diabetic NHPs is a highly translatable model to human diseases not only in the pathogenic mechanisms but also can be used for testing novel therapies for cardiometabolic disorders.
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Affiliation(s)
- Haihua Gu
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Yongqiang Liu
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Shuang Mei
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Bingdi Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Guofeng Sun
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Xiaoli Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Yongfu Xiao
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Michael Staup
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China.
| | - Francine M Gregoire
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Keefe Chng
- Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
| | - Yixin Jim Wang
- Cardiovascular and metabolic diseases division, Crown Bioscience, Inc., 6 West Beijing road, Taicang, Jiangsu, China. .,Crown Bioscience, Inc. at David H. Murdoch Research Institute, 150 N Research Campus drive, Kannapolis, NC, USA.
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77
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Milwidsky A, Maor E, Kivity S, Berkovitch A, Zekry SB, Tenenbaum A, Fisman EZ, Erez A, Segev S, Sidi Y, Goldenberg I, Kuperstein R. Impaired fasting glucose and left ventricular diastolic dysfunction in middle-age adults: a retrospective cross-sectional analysis of 2971 subjects. Cardiovasc Diabetol 2015; 14:119. [PMID: 26369690 PMCID: PMC4570240 DOI: 10.1186/s12933-015-0282-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 08/27/2015] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction (LVDD) is a well-established and early echocardiographic characteristic of diabetic cardiomyopathy. However, there are limited data on the association between impaired fasting glucose (IFG) and LVDD. OBJECTIVE To determine whether IFG is associated with LVDD among middle age adults. METHODS Amongst 3781 subjects screened in an annual health survey program and referred for an echocardiogram, 2971 individuals without LV systolic dysfunction or valvular heart disease were selected. Mean age of study population was 59 ± 12 years and 75% were men. The subjects were categorized into three groups: euglycemia (N = 2025), IFG (N = 534) and diabetes mellitus (DM; N = 412). Doppler echocardiography readers were blinded to glycemic state. Subjects with impaired LV relaxation, pseudo-normal or restrictive filling patterns were defined as having LVDD. RESULTS LVDD was diagnosed in 574 (19 %) of subjects and it was more prevalent among patients with IFG and DM than in euglycemic individuals (27, 30 and 15%, respectively; p < 0.001). Patients with IFG and DM had lower ratios of early (E) to late (A) trans-mitral flow (0.9 ± 0.3 and 0.9 ± 0.3 vs. 1.1 ± 0.4, respectively, p < 0.001). LV hypertrophy (LVH) was also more prevalent among patients with IFG and DM (11 and 18%, respectively, vs. 9%; p < 0.001). Multivariate binary logistic regression model adjusted to age, gender, obesity, LVH, renal function, total, high and low density lipoprotein cholesterol, triglycerides, ischemic heart disease, hypertension and LV ejection fraction showed that patients with IFG were 43% more likely to have LVDD compared with euglycemic subjects (95% confidence interval 1.12-1.83, p = 0.004). CONCLUSIONS IFG is independently associated with a significant increase in the likelihood for the presence of LVDD in middle aged adults.
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Affiliation(s)
- Assi Milwidsky
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Elad Maor
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shaye Kivity
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Anat Berkovitch
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Sagit Ben Zekry
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
| | - Alexander Tenenbaum
- Cardiac Rehabilitation Institute, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Cardiovascular Diabetology Research Foundation, Holon, Israel.
| | - Enrique Z Fisman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. .,Cardiovascular Diabetology Research Foundation, Holon, Israel.
| | - Aharon Erez
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Shlomo Segev
- Institute for Medical Screening, Chaim Sheba Medical Center, Ramat Gan, Israel.
| | - Yechezkel Sidi
- Department of Internal Medicine C, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Ilan Goldenberg
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Department of Internal Medicine "E", Tel-Aviv Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel.
| | - Rafael Kuperstein
- Leviev Heart Center, Chaim Sheba Medical Center, Ramat Gan, Israel. .,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel.
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78
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Kawata T, Daimon M, Miyazaki S, Ichikawa R, Maruyama M, Chiang SJ, Ito C, Sato F, Watada H, Daida H. Coronary microvascular function is independently associated with left ventricular filling pressure in patients with type 2 diabetes mellitus. Cardiovasc Diabetol 2015; 14:98. [PMID: 26242308 PMCID: PMC4525728 DOI: 10.1186/s12933-015-0263-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/23/2015] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is known as an early marker of myocardial alterations in patients with diabetes. Because microvascular disease has been regarded as an important cause of heart failure or diastolic dysfunction in diabetic patients, we tested the hypothesis that coronary flow reserve (CFR), which reflects coronary microvascular function, is associated with LV diastolic dysfunction in patients with type 2 diabetes. METHODS We studied asymptomatic patients with type 2 diabetes but without overt heart failure. Transthoracic Doppler echocardiography was performed that included pulsed tissue Doppler of the mitral annulus and CFR of the left anterior descending artery (induced by adenosine 0.14 mg/kg/min). The ratio of mitral velocity to early diastolic velocity of the mitral annulus (E/e') was used as a surrogate marker of diastolic function. We also evaluated renal function, lipid profile, parameters of glycemic control and other clinical characteristics to determine their association with E/e'. Patients with LV ejection fraction <50%, atrial fibrillation, valvular disease, regional wall motion abnormality, renal failure (serum creatinine >2.0 mg/dl) or type 1 diabetes were excluded. Patients with a CFR <2.0 were also excluded based on the suspicion of significant coronary artery stenosis. RESULTS We included 67 asymptomatic patients with type 2 diabetes and 14 non-diabetic controls in the final study population. In univariate analysis, age, presence of hypertension, LV mass index, estimated glomerular filtration rate and CFR were significantly associated with E/e'. Multivariate analysis indicated that both LV mass index and CFR were independently associated with E/e'. In contrast, there were no significant associations between parameters of glycemic control and E/e'. CONCLUSIONS CFR was associated with LV filling pressure in patients with type 2 diabetes. This result suggests a possible link between coronary microvascular disease and LV diastolic function in these subjects.
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Affiliation(s)
- Takayuki Kawata
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masao Daimon
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Sakiko Miyazaki
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Ryoko Ichikawa
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Masaki Maruyama
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Shuo-Ju Chiang
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Chiharu Ito
- Department of Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Fumihiko Sato
- Department of Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University School of Medicine, Tokyo, Japan.
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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Mellor KM, Brimble MA, Delbridge LM. Glucose as an agent of post-translational modification in diabetes — New cardiac epigenetic insights. Life Sci 2015; 129:48-53. [DOI: 10.1016/j.lfs.2014.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 03/11/2014] [Accepted: 03/17/2014] [Indexed: 01/07/2023]
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80
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Davidson MH. Potential Impact of Dipeptidyl Peptidase-4 Inhibitors on Cardiovascular Pathophysiology in Type 2 Diabetes Mellitus. Postgrad Med 2015; 126:56-65. [DOI: 10.3810/pgm.2014.05.2756] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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81
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Skali H, Shah A, Gupta DK, Cheng S, Claggett B, Liu J, Bello N, Aguilar D, Vardeny O, Matsushita K, Selvin E, Solomon S. Cardiac structure and function across the glycemic spectrum in elderly men and women free of prevalent heart disease: the Atherosclerosis Risk In the Community study. Circ Heart Fail 2015; 8:448-54. [PMID: 25759458 DOI: 10.1161/circheartfailure.114.001990] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND Individuals with diabetes mellitus and pre-diabetes mellitus are at particularly high risk of incident heart failure or death, even after accounting for known confounders. Nevertheless, the extent of impairments in cardiac structure and function in elderly individuals with diabetes mellitus and pre-diabetes mellitus is not well known. We aimed to assess the relationship between echocardiographic measures of cardiac structure and function and dysglycemia. METHODS AND RESULTS We assessed measures of cardiac structure and function in 4419 participants without prevalent coronary heart disease or heart failure who attended the Atherosclerosis Risk In the Community (ARIC) visit 5 examination (2011-2013) and underwent transthoracic echocardiography (age, 75±6 years; 61% women, 23% black). Subjects were grouped across the dysglycemia spectrum as normal (39%), pre-diabetes mellitus (31%), or diabetes mellitus (30%) based on medical history, antidiabetic medication use, and glycated hemoglobin levels. Glycemic status was related to measures of cardiac structure and function. Worsening dysglycemia was associated with increased left ventricular mass, worse diastolic function, and subtle reduction in left ventricular systolic function (P≤0.01 for all). For every 1% higher glycated hemoglobin, left ventricular mass was higher by 3.0 g (95% confidence interval, 1.5-4.6 g), E/E' by 0.5 (95% confidence interval, 0.4-0.7), and global longitudinal strain by 0.3% (95% confidence interval, 0.2-0.4) in multivariable analyses. CONCLUSIONS In a large contemporary biracial cohort of elderly subjects without prevalent cardiovascular disease or heart failure, dysglycemia was associated with subtle and subclinical alterations of cardiac structure, and left ventricular systolic and diastolic function. It remains unclear whether these are sufficient to explain the heightened risk of heart failure in individuals with diabetes mellitus.
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Affiliation(s)
- Hicham Skali
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.).
| | - Amil Shah
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Deepak K Gupta
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Susan Cheng
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Brian Claggett
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Jiankang Liu
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Natalie Bello
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - David Aguilar
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Orly Vardeny
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Kunihiro Matsushita
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Elizabeth Selvin
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
| | - Scott Solomon
- From the Brigham and Women's Hospital, Harvard Medical School, Boston, MA (H.S., A.S., S.C., B.C., J.L., S.S.); Vanderbilt University School of Medicine, Nashville, TN (D.K.G.); Columbia University Medical Center, New York, NY (N.B.); Baylor College of Medicine, Houston, TX (D.A.); University of Wisconsin School of Pharmacy, Madison (O.V.); and Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (K.M., E.S.)
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82
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Delbridge LMD, Mellor KM, Taylor DJR, Gottlieb RA. Myocardial autophagic energy stress responses--macroautophagy, mitophagy, and glycophagy. Am J Physiol Heart Circ Physiol 2015; 308:H1194-204. [PMID: 25747748 DOI: 10.1152/ajpheart.00002.2015] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/02/2015] [Indexed: 12/26/2022]
Abstract
An understanding of the role of autophagic processes in the management of cardiac metabolic stress responses is advancing rapidly and progressing beyond a conceptualization of the autophagosome as a simple cell recycling depot. The importance of autophagy dysregulation in diabetic cardiomyopathy and in ischemic heart disease - both conditions comprising the majority of cardiac disease burden - has now become apparent. New findings have revealed that specific autophagic processes may operate in the cardiomyocyte, specialized for selective recognition and management of mitochondria and glycogen particles in addition to protein macromolecular structures. Thus mitophagy, glycophagy, and macroautophagy regulatory pathways have become the focus of intensive experimental effort, and delineating the signaling pathways involved in these processes offers potential for targeted therapeutic intervention. Chronically elevated macroautophagic activity in the diabetic myocardium is generally observed in association with structural and functional cardiomyopathy; yet there are also numerous reports of detrimental effect of autophagy suppression in diabetes. Autophagy induction has been identified as a key component of protective mechanisms that can be recruited to support the ischemic heart, but in this setting benefit may be mitigated by adverse downstream autophagic consequences. Recent report of glycophagy upregulation in diabetic cardiomyopathy opens up a novel area of investigation. Similarly, a role for glycogen management in ischemia protection through glycophagy initiation is an exciting prospect under investigation.
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Affiliation(s)
- Lea M D Delbridge
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia;
| | - Kimberley M Mellor
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia; Department of Physiology, University of Auckland, New Zealand; and
| | - David J R Taylor
- Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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Cao N, Wong YG, Rosli S, Kiriazis H, Huynh K, Qin C, Du XJ, Kemp-Harper BK, Ritchie RH. Chronic administration of the nitroxyl donor 1-nitrosocyclo hexyl acetate limits left ventricular diastolic dysfunction in a mouse model of diabetes mellitus in vivo. Circ Heart Fail 2015; 8:572-81. [PMID: 25737497 DOI: 10.1161/circheartfailure.114.001699] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 02/24/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Nitroxyl (HNO), a redox congener of nitric oxide (NO·), is a novel regulator of cardiovascular function, combining concomitant positive inotropic, lusitropic, and vasodilator properties. Moreover, HNO exhibits myocardial antihypertrophic and superoxide-suppressing actions. Despite these favorable actions, the impact of chronic HNO administration has yet to be reported in the context of cardiomyopathy. Diabetic cardiomyopathy is characterized by early diastolic dysfunction and adverse left ventricular (LV) structural remodeling, with LV superoxide generation playing a major causal role. We tested the hypothesis that the HNO donor 1-nitrosocyclohexylacetate (1-NCA) limits cardiomyocyte hypertrophy and LV diastolic dysfunction in a mouse model of diabetes mellitus in vivo. METHODS AND RESULTS Diabetes mellitus was induced in male FVB/N mice using streptozotocin. After 4 weeks, diabetic and nondiabetic mice were allocated to 1-NCA therapy (83 mg/kg per day IP) or vehicle and followed up for a further 4 weeks. Diabetes mellitus-induced LV diastolic dysfunction was evident on echocardiography-derived E and A wave velocities, E:A ratio, deceleration, and isovolumic relaxation times; LV systolic function was preserved. Increased LV cardiomyocyte size, hypertrophic and profibrotic gene expression, and upregulation of LV superoxide were also evident. These characteristics of diabetic cardiomyopathy were largely prevented by 1-NCA treatment. Selectivity of 1-NCA as an HNO donor was demonstrated by sensitivity of acute 1-NCA to l-cysteine but not to hydroxocobalamin in the normal rat heart ex vivo. CONCLUSIONS Our studies provide the first evidence that HNO donors may represent a promising strategy for treatment of diabetic cardiomyopathy and implies therapeutic efficacy in settings of chronic heart failure.
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Affiliation(s)
- Nga Cao
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Yung George Wong
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Sarah Rosli
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Helen Kiriazis
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Karina Huynh
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Chengxue Qin
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Xiao-Jun Du
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Barbara K Kemp-Harper
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia
| | - Rebecca H Ritchie
- From the Departments of Heart Failure Pharmacology (N.C., Y.G.W., S.R., C.Q., R.H.R.) and Experimental Cardiology (H.K. X.J.D.), Baker IDI Heart & Diabetes Institute, Melbourne, Victoria, Australia; and Departments of Pharmacology (Y.G.W., B.K.K.-H.) and Medicine (K.H., X.-J.D., R.H.R.), Monash University, Clayton, Victoria, Australia.
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Johnson EJ, Dieter BP, Marsh SA. Evidence for distinct effects of exercise in different cardiac hypertrophic disorders. Life Sci 2015; 123:100-6. [PMID: 25632833 PMCID: PMC4339313 DOI: 10.1016/j.lfs.2015.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/05/2014] [Accepted: 01/02/2015] [Indexed: 02/08/2023]
Abstract
Aerobic exercise training (AET) attenuates or reverses pathological cardiac remodeling after insults such as chronic hypertension and myocardial infarction. The phenotype of the pathologically hypertrophied heart depends on the insult; therefore, it is likely that distinct types of pathological hypertrophy require different exercise regimens. However, the mechanisms by which AET improves the structure and function of the pathologically hypertrophied heart are not well understood, and exercise research uses highly inconsistent exercise regimens in diverse patient populations. There is a clear need for systematic research to identify precise exercise prescriptions for different conditions of pathological hypertrophy. Therefore, this review synthesizes existing evidence for the distinct mechanisms by which AET benefits the heart in different pathological hypertrophy conditions, suggests strategic exercise prescriptions for these conditions, and highlights areas for future research.
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Affiliation(s)
- Emily J Johnson
- Graduate Program in Pharmaceutical Sciences, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - Brad P Dieter
- Graduate Program in Movement Sciences, College of Education, University of Idaho, Moscow, ID, USA; Section of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA
| | - Susan A Marsh
- Section of Experimental and Systems Pharmacology, College of Pharmacy, Washington State University, Spokane, WA, USA.
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85
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Hussein MF, Essa SI, Saleh AZ. Evaluation of Myocardial Performance in Hypertensive Patients with Type 2 Diabetes and Normal Ejection Fraction. Health (London) 2015. [DOI: 10.4236/health.2015.712187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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86
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Pham I, Cosson E, Nguyen MT, Banu I, Genevois I, Poignard P, Valensi P. Evidence for a Specific Diabetic Cardiomyopathy: An Observational Retrospective Echocardiographic Study in 656 Asymptomatic Type 2 Diabetic Patients. Int J Endocrinol 2015; 2015:743503. [PMID: 26074964 PMCID: PMC4444596 DOI: 10.1155/2015/743503] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/01/2015] [Accepted: 04/01/2015] [Indexed: 11/29/2022] Open
Abstract
Aim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 ± 8 years (359 men, 59.7 ± 8.7 years old, HbA1c 8.7 ± 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7-81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7-7907], p < 0.01), while HbA1c (OR 1.9 [1.1-3.2], p < 0.05) and body mass index (OR 1.6 [1.1-2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities.
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Affiliation(s)
- Isabelle Pham
- Department of Physiology, AP-HP, Jean Verdier Hospital, 93 143 Bondy, France
- Sorbonne Paris Cité-Université Paris 13, UFR SMBH, EA 23-63, 93 017 Bobigny, France
- *Isabelle Pham:
| | - Emmanuel Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Université Paris 13, CRNH-IdF, CINFO, 93 143 Bondy, France
- Sorbonne Paris Cité-Université Paris 13, UMR U1153 Inserm/U1125 Inra/Cnam, 93 017 Bobigny, France
| | - Minh Tuan Nguyen
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Université Paris 13, CRNH-IdF, CINFO, 93 143 Bondy, France
- Sorbonne Paris Cité-Université Paris 13, UMR U1153 Inserm/U1125 Inra/Cnam, 93 017 Bobigny, France
| | - Isabela Banu
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Université Paris 13, CRNH-IdF, CINFO, 93 143 Bondy, France
| | - Isabelle Genevois
- Department of Physiology, AP-HP, Jean Verdier Hospital, 93 143 Bondy, France
| | - Patricia Poignard
- Department of Physiology, AP-HP, Jean Verdier Hospital, 93 143 Bondy, France
| | - Paul Valensi
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Université Paris 13, CRNH-IdF, CINFO, 93 143 Bondy, France
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87
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Heschl S, Colantonio C, Pieske B, Toller W. [Perioperative care of patients with diastolic heart failure. Interface to anesthesia]. Anaesthesist 2014; 63:951-7. [PMID: 25501914 DOI: 10.1007/s00101-014-2404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diastolic heart failure leads to an increase in perioperative morbidity and mortality. The prevalence of this disease is rising and multiple risk factors have already been identified. Besides higher age and female gender, arterial hypertension, diabetes mellitus and coronary artery disease in particular have to be considered. Clinical examination and laboratory analyses are important for preoperative evaluation; however, echocardiography plays the most important role in the diagnostics of diastolic heart failure. The transmitral flow profile can be used to differentiate the grades of diastolic dysfunction using the ratio between early passive ventricular filling (E) and late active filling due to atrial contraction (A). Data concerning the ideal anesthesia technique are for the most part lacking; however, the application of thoracic epidural anesthesia seems to be beneficial. A great deal of attention has to be paid to the intraoperative volume status of patients with diastolic dysfunction as hypovolemia and hypervolemia can both have detrimental effects. Arrhythmias and major changes in blood pressure put this special group of patients at additional risks.
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Affiliation(s)
- S Heschl
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Klin. Abteilung für Herz-, Thorax-, Gefäßchirurgische Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
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88
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Noncardiac comorbidities in heart failure with reduced versus preserved ejection fraction. J Am Coll Cardiol 2014; 64:2281-93. [PMID: 25456761 DOI: 10.1016/j.jacc.2014.08.036] [Citation(s) in RCA: 383] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Revised: 08/19/2014] [Accepted: 08/28/2014] [Indexed: 01/09/2023]
Abstract
Heart failure patients are classified by ejection fraction (EF) into distinct groups: heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF). Although patients with heart failure commonly have multiple comorbidities that complicate management and may adversely affect outcomes, their role in the HFpEF and HFrEF groups is not well-characterized. This review summarizes the role of noncardiac comorbidities in patients with HFpEF versus HFrEF, emphasizing prevalence, underlying pathophysiologic mechanisms, and outcomes. Pulmonary disease, diabetes mellitus, anemia, and obesity tend to be more prevalent in HFpEF patients, but renal disease and sleep-disordered breathing burdens are similar. These comorbidities similarly increase morbidity and mortality risk in HFpEF and HFrEF patients. Common pathophysiologic mechanisms include systemic and endomyocardial inflammation with fibrosis. We also discuss implications for clinical care and future HF clinical trial design. The basis for this review was discussions between scientists, clinical trialists, and regulatory representatives at the 10th Global CardioVascular Clinical Trialists Forum.
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89
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Iida M, Yamamoto M, Ishiguro YS, Yamazaki M, Ueda N, Honjo H, Kamiya K. Urinary type IV collagen is related to left ventricular diastolic function and brain natriuretic peptide in hypertensive patients with prediabetes. J Diabetes Complications 2014; 28:824-30. [PMID: 25217792 DOI: 10.1016/j.jdiacomp.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/02/2014] [Accepted: 08/11/2014] [Indexed: 02/08/2023]
Abstract
AIM Urinary type IV collagen is an early biomarker of diabetic nephropathy. Concomitant prediabetes (the early stage of diabetes) was associated with left ventricular (LV) diastolic dysfunction and increased brain natriuretic peptide (BNP) in hypertensive patients. We hypothesized that urinary type IV collagen may be related to these cardiac dysfunctions. METHODS We studied hypertensive patients with early prediabetes (HbA1c <5.7% and fasting glucose >110, n=18), those with prediabetes (HbA1c 5.7-6.4, n=98), and those with diabetes (HbA1c>6.5 or on diabetes medications, n=92). The participants underwent echocardiography to assess left atrial volume/body surface area (BSA) and the ratio of early mitral flow velocity to mitral annular velocity (E/e'). Left ventricular diastolic dysfunction (LVDD) was defined if patients had E/e'≥15, or E/e'=9-14 accompanied by left atrial volume/BSA≥32ml/mm(2). Urinary samples were collected for type IV collagen and albumin, and blood samples were taken for BNP and HbA1c. RESULTS Urinary type IV collagen and albumin increased in parallel with the deterioration of glycemic status. In hypertensive patients with prediabetes, subjects with LVDD had higher levels of BNP and urinary type IV collagen than those without LVDD. In contrast, in hypertensive patients with diabetes, subjects with LVDD had higher urinary albumin and BNP than those without LVDD. Urinary type IV collagen correlated positively with BNP in hypertensive patients with prediabetes, whereas it correlated with HbA1c in those with diabetes. CONCLUSIONS In hypertensive patients with prediabetes, urinary type IV collagen was associated with LV diastolic dysfunction and BNP.
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Affiliation(s)
- Masato Iida
- Department of Cardiology, Mitsubishi Nagoya Hospital, Nagoya, Japan.
| | - Mitsuru Yamamoto
- Department of Cardiology, Mitsubishi Nagoya Hospital, Nagoya, Japan
| | - Yuko S Ishiguro
- Department of Cardiology, Mitsubishi Nagoya Hospital, Nagoya, Japan
| | | | - Norihiro Ueda
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Haruo Honjo
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Kaichirou Kamiya
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
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90
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Senni M, Paulus WJ, Gavazzi A, Fraser AG, Díez J, Solomon SD, Smiseth OA, Guazzi M, Lam CSP, Maggioni AP, Tschöpe C, Metra M, Hummel SL, Edelmann F, Ambrosio G, Stewart Coats AJ, Filippatos GS, Gheorghiade M, Anker SD, Levy D, Pfeffer MA, Stough WG, Pieske BM. New strategies for heart failure with preserved ejection fraction: the importance of targeted therapies for heart failure phenotypes. Eur Heart J 2014; 35:2797-815. [PMID: 25104786 PMCID: PMC4204003 DOI: 10.1093/eurheartj/ehu204] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 04/01/2014] [Accepted: 04/29/2014] [Indexed: 12/21/2022] Open
Abstract
The management of heart failure with reduced ejection fraction (HF-REF) has improved significantly over the last two decades. In contrast, little or no progress has been made in identifying evidence-based, effective treatments for heart failure with preserved ejection fraction (HF-PEF). Despite the high prevalence, mortality, and cost of HF-PEF, large phase III international clinical trials investigating interventions to improve outcomes in HF-PEF have yielded disappointing results. Therefore, treatment of HF-PEF remains largely empiric, and almost no acknowledged standards exist. There is no single explanation for the negative results of past HF-PEF trials. Potential contributors include an incomplete understanding of HF-PEF pathophysiology, the heterogeneity of the patient population, inadequate diagnostic criteria, recruitment of patients without true heart failure or at early stages of the syndrome, poor matching of therapeutic mechanisms and primary pathophysiological processes, suboptimal study designs, or inadequate statistical power. Many novel agents are in various stages of research and development for potential use in patients with HF-PEF. To maximize the likelihood of identifying effective therapeutics for HF-PEF, lessons learned from the past decade of research should be applied to the design, conduct, and interpretation of future trials. This paper represents a synthesis of a workshop held in Bergamo, Italy, and it examines new and emerging therapies in the context of specific, targeted HF-PEF phenotypes where positive clinical benefit may be detected in clinical trials. Specific considerations related to patient and endpoint selection for future clinical trials design are also discussed.
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Affiliation(s)
- Michele Senni
- Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Walter J Paulus
- Institute for Cardiovascular Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Antonello Gavazzi
- Cardiovascular Department, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Alan G Fraser
- Wales Heart Research Institute, Cardiff University, Cardiff, UK
| | - Javier Díez
- Division of Cardiovascular Sciences Centre for Applied Medical Research and Department of Cardiology and Cardiac Surgery, University of Navarra Clinic, University of Navarra, Pamplona, Spain
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Otto A Smiseth
- Institute for Surgical Research, Department of Cardiology, and Center for Cardiological Innovation, University of Oslo, Oslo, Norway
| | - Marco Guazzi
- Heart Failure Unit, Department of Biomedical Sciences for Health, IRCCS Policlinico San Donato, University of Milano, Milan, Italy
| | | | | | - Carsten Tschöpe
- Department of Cardiology and Pneumology, Charité-University Medicine Berlin, Campus Benjamin Franklin, Germany
| | - Marco Metra
- Cardiology, Department of Experimental and Applied Medicine, University of Brescia, Brescia, Italy
| | - Scott L Hummel
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA Section of Cardiology, Ann Arbor Veterans Affairs Medical Center, Ann Arbor, MI, USA
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Giuseppe Ambrosio
- Division of Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | | | | | - Mihai Gheorghiade
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stefan D Anker
- Department of Innovative Clinical Trials, University Medical Centre Gottingen, Gottingen, Germany Applied Cachexia Research, Department of Cardiology, Charite, Campus CVK, Berlin, Germany
| | - Daniel Levy
- Framingham Heart Study, Framingham, MA, USA Division of Cardiology, Boston University School of Medicine, Boston, MA, USA Center for Population Studies, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Wendy Gattis Stough
- Department of Clinical Research, Campbell University College of Pharmacy and Health Sciences, North Carolina, USA
| | - Burkert M Pieske
- Department of Cardiology, Medical University Graz, Ludwig-Boltzmann-Institute for Heart Failure Research, Auenbruggerplatz 15, 8010 Graz, Austria
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Schilling JD, Mann DL. Diabetic Cardiomyopathy: Distinct and Preventable Entity or Inevitable Consequence? CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0417-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Iwakura K, Ito H, Ishii K, Date M, Nakamura F, Nagano T, Takiuchi S. Changes in left ventricular relaxation after azelnidipine treatment in hypertensive patients with diabetes: subanalysis of a prospective single-arm multicentre study. BMJ Open 2014; 4:e006136. [PMID: 25270860 PMCID: PMC4179422 DOI: 10.1136/bmjopen-2014-006136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We previously demonstrated that a calcium channel blocker, azelnidipine, improves left ventricular relaxation in patients with hypertension and diastolic dysfunction in a multicentre, Clinical impact of Azelnidipine on Left VentricuLar diastolic function and OutComes in patients with hypertension (CALVLOC) trial. The objectives of the present subanalysis were to investigate the differences in diastolic function in hypertensive patients with and without diabetes, and the efficacy of azelnidipine on diastolic function among them. DESIGN Subanalysis of a prospective single-arm multicentre study. PARTICIPANTS 228 hypertensive patients with normal ejection fraction and impaired left ventricular relaxation (septal e' velocity<8 cm/s on echocardiography) enrolled for CALVLOC trial. They were divided into two groups based on presence or absence of diabetes. INTERVENTIONS Administration of 16 mg of azelnidipine for 8 months (range 6-10 months). MAIN OUTCOME MEASURES Septal e' velocity before and at the end of the study. RESULTS Whereas patients with diabetes (n=53, 23.2%) had lower systolic blood pressure (BP) than patients without diabetes (155±17 vs 161±16 mm Hg, p=0.03), they had lower e' velocity (5.7±1.5 vs 6.1±1.4 cm/s, p=0.04) at baseline. Azelnidipine decreased BP and heart rate, and increased e' velocity similarly in patients with diabetes (5.7±1.5 to 6.3±1.5 cm/s, p=0.0003) and without diabetes (6.1±1.4 to 6.9±1.4 cm/s, p<0.0001). Increase in e' velocity was not influenced by presence of diabetes, and patients with diabetes still had lower e' velocity after treatment (p=0.006). There was a significant correlation between increase in e' velocity and decrease in systolic BP (R=0.25, p=0.0001), which was not influenced by diabetes. CONCLUSIONS Comorbid diabetes could impair left ventricular relaxation independently in patients with hypertension, which might not be improved solely by BP lowering.
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Affiliation(s)
- Katsuomi Iwakura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Okayama, Japan
| | - Katsuhisa Ishii
- Division of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Motoo Date
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | - Toshihiko Nagano
- Department of Internal Medicine, Iwasa Dai-ichi Hospital, Gifu, Japan
| | - Shin Takiuchi
- Department of Cardiology, Higashi-Takarazuka Satoh Hospital, Takarazuka, Japan
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Bodiga VL, Eda SR, Bodiga S. Advanced glycation end products: role in pathology of diabetic cardiomyopathy. Heart Fail Rev 2014; 19:49-63. [PMID: 23404649 DOI: 10.1007/s10741-013-9374-y] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Increasing evidence demonstrates that advanced glycation end products (AGEs) play a pivotal role in the development and progression of diabetic heart failure, although there are numerous other factors that mediate the disease response. AGEs are generated intra- and extracellularly as a result of chronic hyperglycemia. Then, following the interaction with receptors for advanced glycation end products (RAGEs), a series of events leading to vascular and myocardial damage are elicited and sustained, which include oxidative stress, increased inflammation, and enhanced extracellular matrix accumulation resulting in diastolic and systolic dysfunction. Whereas targeting glycemic control and treating additional risk factors, such as obesity, dyslipidemia, and hypertension, are mandatory to reduce chronic complications and prolong life expectancy in diabetic patients, drug therapy tailored to reducing the deleterious effects of the AGE-RAGE interactions is being actively investigated and showing signs of promise in treating diabetic cardiomyopathy and associated heart failure. This review shall discuss the formation of AGEs in diabetic heart tissue, potential targets of glycation in the myocardium, and underlying mechanisms that lead to diabetic cardiomyopathy and heart failure along with the use of AGE inhibitors and breakers in mitigating myocardial injury.
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Affiliation(s)
- Vijaya Lakshmi Bodiga
- Department of Biotechnology, Krishna University, Machilipatnam, Andhra Pradesh, India
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94
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Dei Cas A, Fonarow GC, Gheorghiade M, Butler J. Concomitant diabetes mellitus and heart failure. Curr Probl Cardiol 2014; 40:7-43. [PMID: 25499908 DOI: 10.1016/j.cpcardiol.2014.09.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The prevalence of patients with concomitant diabetes mellitus (DM) and heart failure (HF) is growing exponentially. Patients with HF and DM show specific metabolic, neurohormonal, and structural heart abnormalities, which potentially contribute to worse HF outcomes than seen in patients without comorbid DM. Subgroup analysis of recent trials suggest that patients with HF and DM may respond differently to standard therapy, and data are emerging on the possible increase in the risk of hospitalizations for HF in patients with DM treated with specific class of antidiabetic agents, pointing to the need of developing specific medications to be tested in dedicated future studies to address the unique metabolic and hemodynamic alterations seen in these patients.
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Vasiliadis I, Kolovou G, Mavrogeni S, Nair DR, Mikhailidis DP. Sudden cardiac death and diabetes mellitus. J Diabetes Complications 2014; 28:573-9. [PMID: 24666923 DOI: 10.1016/j.jdiacomp.2014.02.003] [Citation(s) in RCA: 30] [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: 12/27/2013] [Revised: 02/07/2014] [Accepted: 02/10/2014] [Indexed: 01/11/2023]
Abstract
Sudden cardiac death (SCD) affects a significant percentage of diabetic patients. SCD in these patients can be due to several factors, such as diastolic dysfunction, heart failure, altered platelet function, inflammation, sympathetic nervous stimulation and other factors. In the present review, we discuss the association between diabetes mellitus and SCD.
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MESH Headings
- Animals
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/therapy
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/therapy
- Diabetic Angiopathies/complications
- Diabetic Angiopathies/physiopathology
- Diabetic Angiopathies/prevention & control
- Diabetic Angiopathies/therapy
- Diabetic Cardiomyopathies/complications
- Diabetic Cardiomyopathies/physiopathology
- Diabetic Cardiomyopathies/prevention & control
- Diabetic Cardiomyopathies/therapy
- Disease Progression
- Evidence-Based Medicine
- Humans
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Affiliation(s)
- I Vasiliadis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom; Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - G Kolovou
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - S Mavrogeni
- Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - D R Nair
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom
| | - D P Mikhailidis
- Department of Clinical Biochemistry (Vascular Prevention Clinic), Royal Free Campus, University College London Medical School, University College London (UCL), London, United Kingdom.
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96
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Tapp RJ, Venn A, Huynh QL, Raitakari OT, Ukoumunne OC, Dwyer T, Magnussen CG. Impact of adiposity on cardiac structure in adult life: the Childhood Determinants of Adult Health (CDAH) study. BMC Cardiovasc Disord 2014; 14:79. [PMID: 24980215 PMCID: PMC4090182 DOI: 10.1186/1471-2261-14-79] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/28/2014] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND We have examined the association between adiposity and cardiac structure in adulthood, using a life course approach that takes account of the contribution of adiposity in both childhood and adulthood. METHODS The Childhood Determinants of Adult Health study (CDAH) is a follow-up study of 8,498 children who participated in the 1985 Australian Schools Health and Fitness Survey (ASHFS). The CDAH follow-up study included 2,410 participants who attended a clinic examination. Of these, 181 underwent cardiac imaging and provided complete data. The measures were taken once when the children were aged 9 to 15 years, and once in adult life, aged 26 to 36 years. RESULTS There was a positive association between adult left ventricular mass (LVM) and childhood body mass index (BMI) in males (regression coefficient (β) 0.41; 95% confidence interval (CI): 0.14 to 0.67; p = 0.003), and females (β = 0.53; 95% CI: 0.34 to 0.72; p < 0.001), and with change in BMI from childhood to adulthood (males: β = 0.27; 95% CI: 0.04 to 0.51; p < 0.001, females: β = 0.39; 95% CI: 0.20 to 0.58; p < 0.001), after adjustment for confounding factors (age, fitness, triglyceride levels and total cholesterol in adulthood). After further adjustment for known potential mediating factors (systolic BP and fasting plasma glucose in adulthood) the relationship of LVM with childhood BMI (males: β = 0.45; 95% CI: 0.19 to 0.71; p = 0.001, females: β = 0.49; 95% CI: 0.29 to 0.68; p < 0.001) and change in BMI (males: β = 0.26; 95% CI: 0.04 to 0.49; p = 0.02, females: β = 0.40; 95% CI: 0.20 to 0.59; p < 0.001) did not change markedly. CONCLUSIONS Adiposity and increased adiposity from childhood to adulthood appear to have a detrimental effect on cardiac structure.
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Affiliation(s)
- Robyn J Tapp
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Australia
- Department of Optometry and Vision Sciences, The University of Melbourne, 4th Floor │ Alice Hoy Building (Blg 162), Monash Road │, Melbourne, Australia
| | - Alison Venn
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Quan L Huynh
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
| | - Olli T Raitakari
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, and the Department of Clinical Physiology AND NUCLEAR MEDICINE, Turku University Hospital, Turku, Finland
| | - Obioha C Ukoumunne
- PenCLAHRC, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Terence Dwyer
- Murdoch Children’s Research Institute, Royal Children’s Hospital Parkville, Melbourne, Australia
| | - Costan G Magnussen
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia
- The Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, and the Department of Clinical Physiology AND NUCLEAR MEDICINE, Turku University Hospital, Turku, Finland
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97
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Kasznicki J, Drzewoski J. Heart failure in the diabetic population - pathophysiology, diagnosis and management. Arch Med Sci 2014; 10:546-56. [PMID: 25097587 PMCID: PMC4107260 DOI: 10.5114/aoms.2014.43748] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 10/14/2013] [Accepted: 11/04/2013] [Indexed: 01/08/2023] Open
Abstract
Evidence from clinical trials repeatedly confirms the association of diabetes with heart failure, independent of hypertension, atherosclerosis, coronary artery disease and valvular heart disease. However, the importance of coexistence of diabetes and heart failure is not universally recognized, despite the fact that it may significantly contribute to morbidity and mortality of the diabetic population. It seems that prevention of heart failure, early diagnosis, and appropriate management could improve the outcome. Unfortunately, the etiology of heart failure in diabetic patients is still to be elucidated. It is multifactorial in nature and several cellular, molecular and metabolic factors are implicated. Additionally, there are still no definite guidelines on either the diagnosis and treatment of heart failure in diabetic patients or on the therapy of diabetes in subjects with heart failure. This review focuses on the pathophysiology, diagnosis, and prevention of heart failure in the diabetic population as well as management of both comorbidities.
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Affiliation(s)
- Jacek Kasznicki
- Department of Internal Disease, Diabetology and Clinical Pharmacology, Medical University of Lodz, Poland
| | - Jozef Drzewoski
- Department of Internal Disease, Diabetology and Clinical Pharmacology, Medical University of Lodz, Poland
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98
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Menard CE, Durston M, Zherebitskaya E, Smith DR, Freed D, Glazner GW, Tian G, Fernyhough P, Arora RC. Temporal dystrophic remodeling within the intrinsic cardiac nervous system of the streptozotocin-induced diabetic rat model. Acta Neuropathol Commun 2014; 2:60. [PMID: 24894521 PMCID: PMC4229951 DOI: 10.1186/2051-5960-2-60] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 05/19/2014] [Indexed: 01/20/2023] Open
Abstract
Introduction The pathogenesis of heart failure (HF) in diabetic individuals, called “diabetic cardiomyopathy”, is only partially understood. Alterations in the cardiac autonomic nervous system due to oxidative stress have been implicated. The intrinsic cardiac nervous system (ICNS) is an important regulatory pathway of cardiac autonomic function, however, little is known about the alterations that occur in the ICNS in diabetes. We sought to characterize morphologic changes and the role of oxidative stress within the ICNS of diabetic hearts. Cultured ICNS neuronal cells from the hearts of 3- and 6-month old type 1 diabetic streptozotocin (STZ)-induced diabetic Sprague-Dawley rats and age-matched controls were examined. Confocal microscopy analysis for protein gene product 9.5 (PGP 9.5) and amino acid adducts of (E)-4-hydroxy-2-nonenal (4-HNE) using immunofluorescence was undertaken. Cell morphology was then analyzed in a blinded fashion for features of neuronal dystrophy and the presence of 4-HNE adducts. Results At 3-months, diabetic ICNS neuronal cells exhibited 30% more neurite swellings per area (p = 0.01), and had a higher proportion with dystrophic appearance (88.1% vs. 50.5%; p = <0.0001), as compared to control neurons. At 6-months, diabetic ICNS neurons exhibited more features of dystrophy as compared to controls (74.3% vs. 62.2%; p = 0.0448), with 50% more neurite branching (p = 0.0015) and 50% less neurite outgrowth (p = <0.001). Analysis of 4-HNE adducts in ICNS neurons of 6-month diabetic rats demonstrated twice the amount of reactive oxygen species (ROS) as compared to controls (p = <0.001). Conclusion Neuronal dystrophy occurs in the ICNS neurons of STZ-induced diabetic rats, and accumulates temporally within the disease process. In addition, findings implicate an increase in ROS within the neuronal processes of ICNS neurons of diabetic rats suggesting an association between oxidative stress and the development of dystrophy in cardiac autonomic neurons.
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99
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Su W, Wang P, Chen H, Li H. Role of protein kinase C β₂ in relaxin-mediated inhibition of cardiac fibrosis. J Endocrinol Invest 2014; 37:559-64. [PMID: 24729283 DOI: 10.1007/s40618-014-0068-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/05/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Relaxin is a pleiotropic hormone owing endogenous antifibrosis effect on numerous organs. We demonstrated relaxin's inhibitive effect on cardiac fibrosis previously. OBJECTIVE The aim of this study was to investigate the role of protein kinase C (PKC) β2 in relaxin's action under high glucose conditions. METHODS AND RESULTS Cardiac fibroblasts (CFs) were isolated, exposed to high glucose and incubated with recombinant human relaxin (rhRLX). Western blot analysis revealed a relaxin-mediated decrease in total expression and translocation of PKCβ2, showing downregulation of PKCβ2 is involved in relaxin's action. Blocking PKCβ2 pathway with ruboxistaurin accelerated rhRLX-mediated inhibition in both proliferation of CFs and deposition of collagen. CONCLUSION In conclusion, relaxin can inhibit high glucose-associated cardiac fibrosis partly through PKCβ2 pathway. Further work should be done to fully understand intracellular mechanisms of relaxin's action to accelerate its clinical use.
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Affiliation(s)
- W Su
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95, Yongan Road, Xicheng District, Beijing, 100050, People's Republic of China
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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