51
|
Li J, Zhao Z, Jiang H, Jiang M, Yu G, Li X. Predictive value of elevated alanine aminotransferase for in-hospital mortality in patients with acute myocardial infarction. BMC Cardiovasc Disord 2021; 21:82. [PMID: 33563221 PMCID: PMC7874605 DOI: 10.1186/s12872-021-01903-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/07/2021] [Indexed: 12/28/2022] Open
Abstract
Background and aims Liver enzymes, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), are markers of hepatic dysfunction and fatty liver disease. Although ALT and AST have been suggested as risk factors for cardiovascular disease, their role as predictors of mortality after acute myocardial infarction (AMI) has not been established. The objective of this study was to investigate the predictive value of ALT and AST for mortality in patients with AMI. Methods We analyzed records of 712 patients with AMI and no known liver disease treated at the Department of Cardiovascular Center in the First Hospital of Jilin University. The primary outcome was all-cause in-hospital mortality. Relationships between primary outcome and various risk factors, including serum transaminase levels, were assessed using multivariate logistic regression analysis. Results Age (P < 0.001), hypertension (P = 0.034), prior myocardial infarction (P < 0.001), AST (P < 0.001), ALT (P < 0.001), creatinine (P = 0.007), blood urea nitrogen (P = 0.006), and troponin I (P < 0.001) differed significantly between ST-segment elevation myocardial infarction (STEMI) and non-STEMI. The following factors were associated with an increased risk of in-hospital all-cause mortality in patients with AMI: ALT ≥ 2ULN (adjusted odds ratio [AOR] 2.240 [95% confidence interval (CI), 1.331–3.771]; P = 0.002); age ≥ 65 year (AOR 4.320 [95% CI 2.687–6.947]; P < 0.001); increased fasting plasma glucose (FPG) (AOR 2.319 [95% CI 1.564–3.438]; P < 0.001); elevated D-dimer (AOR 2.117 [95% CI 1.407–3.184]; P < 0.001); elevated fibrinogen (AOR 1.601 [95% CI 1.077–2.380]; P = 0.20); and reduced estimated glomerular filtration rate (eGFR) (AOR 2.279 [95% CI 1.519–3.419]; P < 0.001). Conclusions Our findings demonstrated that elevated ALT was independently associated with increased in-hospital all-cause mortality in patients with AMI. Other risk factors were increased age, FPG, D-dimer, and fibrinogen and decreased eGFR.
Collapse
Affiliation(s)
- Jian Li
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Zhuo Zhao
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - Hui Jiang
- Medical Oncology Department, Jilin Cancer Hospital, Changchun, Jilin, China
| | - Minjie Jiang
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Ge Yu
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China
| | - Xu Li
- Department of Hepatology, The First Hospital of Jilin University, No. 71, Xinmin Street, Changchun, Jilin, China.
| |
Collapse
|
52
|
Kawahira M, Tamaki S, Yamada T, Watanabe T, Morita T, Furukawa Y, Kawasaki M, Kikuchi A, Kawai T, Seo M, Nakamura J, Kayama K, Kimura T, Ueda K, Sakamoto D, Kogame T, Ito S, Chang Y, Fukunami M. Prognostic value of impaired hepato-renal function and liver fibrosis in patients admitted for acute heart failure. ESC Heart Fail 2021; 8:1274-1283. [PMID: 33472273 PMCID: PMC8006618 DOI: 10.1002/ehf2.13195] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 12/28/2022] Open
Abstract
AIMS Cardiohepatic interactions have been a focus of attention in heart failure (HF). The model for end-stage liver disease excluding international normalized ratio (MELD-XI) score has been shown to be useful for predicting poor outcomes in patients with acute decompensated HF (ADHF). Furthermore, the fibrosis-4 (FIB-4) index, a simple marker to assess liver fibrosis, predicts adverse prognoses in patients with HF as well. However, there is little information available on the prognostic significance of the combination of the MELD-XI score and FIB-4 index in patients with ADHF and its association with left ventricular ejection fraction (LVEF) subgroup. METHODS AND RESULTS We prospectively studied 466 consecutive patients who were admitted for ADHF [HF with reduced LVEF (LVEF < 40%): n = 164, HF with mid-range LVEF (40% ≤ LVEF < 50%): n = 104, and HF with preserved LVEF (LVEF ≥ 50%): n = 198]. We calculated the MELD-XI score and FIB-4 indices at discharge. The primary endpoint was all-cause death (ACD). During the mean follow-up period of 2.8 years, 143 patients had ACD. In the multivariate Cox analysis, the MELD-XI score and FIB-4 index were independently associated with ACD. Patients were stratified into the following three groups according to the median value of MELD-XI score (=11) and FIB-4 index (=2.13): Group 1 had both a low MELD-XI score and a low FIB-4 index; Group 2 had either a high MELD-XI score (MELD-XI score ≥11) or a high FIB-4 index (FIB-4 index ≥2.13); and Group 3 had both a high MELD-XI score and a high FIB-4 index. Kaplan-Meier analysis revealed that Group 2 and Group 3 had a significantly greater risk of ACD than Group 1 [Group 2 vs. Group 1: adjusted hazard ratio, 2.48 (95% confidence interval: 1.75-3.53), P < 0.0001; Group 3 vs. Group 1: adjusted hazard ratio, 7.03 (95% confidence interval: 3.95-13.7), P < 0.0001]. In addition, the patients with both a higher MELD-XI score and FIB-4 index showed a significantly higher risk of ACD also in the patients with HF with reduced LVEF, HF with mid-range LVEF, and HF with preserved LVEF (all P < 0.0001). CONCLUSIONS The combination of MELD-XI score and FIB-4 index may be useful for stratifying patients at risk for ACD in patients with ADHF, irrespective of LVEF.
Collapse
Affiliation(s)
- Masatsugu Kawahira
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Shunsuke Tamaki
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takahisa Yamada
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Tetsuya Watanabe
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takashi Morita
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Yoshio Furukawa
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masato Kawasaki
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Atsushi Kikuchi
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Tsutomu Kawai
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masahiro Seo
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Jun Nakamura
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Kiyomi Kayama
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takanari Kimura
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Kunpei Ueda
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Daisuke Sakamoto
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Takehiro Kogame
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Shota Ito
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Yongchol Chang
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| | - Masatake Fukunami
- Division of CardiologyOsaka General Medical Center3‐1‐56, Mandai‐Higashi, Sumiyoshi‐kuOsaka558‐8558Japan
| |
Collapse
|
53
|
Mangoni AA, Jarmuzewska EA. Incorporating pharmacokinetic data into personalised prescribing for older people: challenges and opportunities. Eur Geriatr Med 2021; 12:435-442. [PMID: 33417165 DOI: 10.1007/s41999-020-00437-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 12/09/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE We discuss the known age-associated changes in drug metabolism and elimination, the potential use of this information when selecting specific therapeutic strategies in older patients, and the steps required to fill the knowledge gap in this field. METHODS We conducted a narrative review that encapsulates the current knowledge regarding the main age-associated changes in drug metabolism and elimination and discusses their possible inclusion in current and future personalised prescribing tools for the older patient population. RESULTS Despite some progress in this field, the lack of specific information regarding the impact of frailty, pharmacogenomics, and drug-drug, drug-disease, and organ-organ interactions, particularly in subjects > 80 years, currently prevents the routine incorporation of pharmacokinetic data, barring measures of renal function, into personalised prescribing tools. CONCLUSIONS The incorporation of pharmacokinetic data into personalised prescribing, an approach based on the consideration of a number of patient's characteristics when selecting the right drug(s) and dose regimen(s) to maximize effectiveness and limit toxicity, remains a hypothetical construct in geriatric care. Pending the inclusion of frail and complex older patients in pre- and post-marketing studies, a better understanding of the key pharmacokinetic alterations of common medications in "real-life" patients, together with the implementation of effective strategies tackling inappropriate prescribing, is likely to improve clinical outcomes and reduce healthcare utilization in the older population.
Collapse
Affiliation(s)
- Arduino A Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University and Flinders Medical Centre, Bedford Park, SA, 5042, Australia. .,Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Elzbieta A Jarmuzewska
- Department of Internal Medicine, Polyclinic IRCCS, Ospedale Maggiore, University of Milan, Milan, Italy
| |
Collapse
|
54
|
March DT, Marshall K, Swan G, Gerlach T, Smith H, Blyde D, Ariel E, Christidis L, Kelaher BP. The use of echocardiography as a health assessment tool in green sea turtles (Chelonia mydas). Aust Vet J 2020; 99:46-54. [PMID: 33227826 DOI: 10.1111/avj.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/25/2020] [Indexed: 12/13/2022]
Abstract
There are limited techniques available to assess the health of sea turtles as physical examination has little correlation to clinical findings, and blood reference intervals are broad and provide limited prognostic significance. Advances in the portability of ultrasound machines allow echocardiography to be increasingly used in the health assessments of wild animals. This study performed blood analysis and echocardiograms on 11 green sea turtles upon admission to a rehabilitation clinic and six animals before release. Significant differences were seen between groups, with admission animals having significantly smaller diameters of the cavum arteriosum at systole and diastole, smaller E-waves and an increased fractional shortening. Pre-release animals displayed significant increases in the maximum blood velocities of both the pulmonary artery and the left aorta. Significant negative correlations were seen between fractional shortening and uric acid and between the velocity time integral of the pulmonary artery and urea. The pulmonary artery velocity time integral was also significantly correlated to the E wave. Furthermore, there was asynchrony between the cavum arteriosum and the cavum pulmonale and the detection of a parasitic granuloma in the ventricular outflow tract of one animal. Overall, the results suggest that cardiac function in stranded green sea turtles is significantly impaired and that echocardiography has applications in the health assessments of green sea turtles.
Collapse
Affiliation(s)
- D T March
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia.,Dolphin Marine Rescue, Veterinary Department, Coffs Harbour, New South Wales, Australia
| | - K Marshall
- Dolphin Marine Rescue, Veterinary Department, Coffs Harbour, New South Wales, Australia
| | - G Swan
- Mid North Coast Cardiac Services, Medical Imaging Department, Coffs Harbour, New South Wales, Australia
| | - T Gerlach
- Veterinary Specialty Centre, Cardiology Department, Chicago, Illinois, USA
| | - H Smith
- Massey University, College of Sciences, Palmerston North, New Zealand
| | - D Blyde
- Veterinary Department, Sea World, Sea World Drive, Gold Coast, Queensland, Australia
| | - E Ariel
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - L Christidis
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia
| | - B P Kelaher
- National Marine Science Centre, School of Environment, Science and Engineering, Southern Cross University, Coffs Harbour, New South Wales, Australia
| |
Collapse
|
55
|
Lu Z, Ma G, Chen L. De-Ritis Ratio Is Associated with Mortality after Cardiac Arrest. DISEASE MARKERS 2020; 2020:8826318. [PMID: 33204363 PMCID: PMC7657697 DOI: 10.1155/2020/8826318] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The aim of our study was to explore the associations of the aspartate transaminase/alanine transaminase (De-Ritis) ratio with outcomes after cardiac arrest (CA). METHODS This retrospective study included 374 consecutive adult cardiac arrest patients. Information on the study population was obtained from the Dryad Digital Repository. Patients were divided into tertiles based on their De-Ritis ratio. The logistic regression hazard analysis was used to assess the independent relationship between the De-Ritis ratio and mortality. The Kaplan-Meier method and log-rank test were used to estimate the survival of different groups. Receiver operating characteristic (ROC) curve analysis was utilized to compare the prognostic ability of biomarkers. A model combining the De-Ritis ratio was established, and its performance was evaluated using the Akaike information criterion (AIC). RESULTS Of the 374 patients who were included in the study, 194 patients (51.9%) died in the intensive care unit (ICU), 213 patients (57.0%) died during hospitalization, and 226 patients (60.4%) had an unfavorable neurologic outcome. Logistic regression analysis including potentially confounding factors showed that the De-Ritis ratio was independently associated with mortality, yielding a more than onefold risk of ICU mortality (OR 1.455; 95% CI 1.088-1.946; p = 0.011) and hospital mortality (OR 1.378; 95% CI 1.031-1.842; p = 0.030). Discriminatory performance assessed by ROC curves showed an area under the curve of 0.611 (95% CI 0.553-0.668) for ICU mortality and 0.625 (0.567-0.682) for hospital mortality. Further, the likelihood ratio test (LRT) analysis showed that the model combining the De-Ritis ratio had a smaller AIC and higher likelihood ratio χ 2 score than the model without the De-Ritis ratio. The Kaplan-Meier curves showed that the CA patients in the De-Ritis ratio tertile 3 group clearly had a significantly higher incidence of ICU mortality (log - rank = 0.007). CONCLUSION An elevated De-Ritis ratio on admission was significantly associated with ICU mortality and hospital mortality after CA. Assessment of the De-Ritis ratio might help identify groups at high risk for mortality.
Collapse
Affiliation(s)
- Zhengri Lu
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Genshan Ma
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Lijuan Chen
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| |
Collapse
|
56
|
Controlling Nutritional Status Score As a Predictive Marker for Patients With Implantable Left Ventricular Assist Device. ASAIO J 2020; 66:166-172. [PMID: 30913100 DOI: 10.1097/mat.0000000000000972] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Although a correlation between the nutritional status and the prognosis of patients with heart failure has been suggested, a correlation between the nutritional status and outcomes after the left ventricular assist device (LVAD) implantation remains unclear. We aimed to investigate the efficacy of the Controlling Nutritional Status (CONUT) score (range 0-12, including serum albumin, total cholesterol, and lymphocytes) as a nutritional index in speculating the prognosis of patients undergoing LVAD implantation. We examined 63 consecutive patients who underwent the continuous-flow LVAD implantation. Using the preoperative CONUT score, patients were categorized into two groups: lower CONUT score (0-4: normal to mild malnutrition) and higher CONUT score (5-12: moderate to severe malnutrition). We compared for the backgrounds and the clinical events after LVAD implantation. The higher CONUT group exhibited a significantly higher mean right atrial pressure (10.9 ± 4.7 vs. 7.3 ± 4.1 mmHg; p = 0.0019). In that group, the mortality rate was significantly higher (25% vs. 2.6%; p = 0.0059) and the Kaplan-Meier analysis showed lower survival rate. Furthermore, more bleeding events significantly occurred in the higher CONUT group. The preoperative CONUT score may reflect systemic venous congestion and offer a useful prognostic index of clinical courses after LVAD implantation.
Collapse
|
57
|
Omar AS, Taha A, Al-Khulaifi A. High Transaminases Following Cardiac Surgery: A Narrative Review. JOURNAL OF CARDIAC CRITICAL CARE TSS 2020. [DOI: 10.1055/s-0040-1715931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractElevation of liver enzymes after cardiac surgery is encountered infrequently. Acute heart failure during and after surgery may be the culprit responsible for liver dysfunction. However, it may create clinical confusion whether acute liver dysfunction could induce some sort of cardiac dysfunction through mechanisms similar to those encountered in chronic liver disease. We searched through the Medline, Cochrane, and Embase databases up to January 2018. We included review articles, meta-analyses, and original trials on the elevation of liver enzymes after cardiac surgery, and combined the following MESH terms: “intensive care, “cardiac surgery,” “high liver enzymes,” “ischemia,” “left ventricular dysfunction,” and “critical illness.” Case reports were excluded. Language restrictions were not applied. References were examined for other potentially useful articles. We did not find any articles that supported the cardiac decompensation phenomenon after acute liver injury. In contrast, low-hepatic flow, hypoxemia, or pump-induced inflammation could induce hepatic dysfunction in acute settings after cardiac surgery. In conclusion, a rise in the transaminases following cardiac surgery would favor an ischemic etiology for the condition.
Collapse
Affiliation(s)
- Amr S. Omar
- Department of Cardiothoracic Surgery/Cardiac Anesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
- Department of Critical Care Medicine, Beni Suef University, Beni Suef, Egypt
- Department of Clinical Medicine, Weill Cornell Medical College, Qatar
| | - Adel Taha
- Department of Critical Care Medicine, King Khaled Specialized Hospital, Dammam, KSA
| | - Abdulaziz Al-Khulaifi
- Department of Cardiothoracic Surgery/Cardiac Anesthesia and ICU, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
58
|
Prognostic Value of Lactate Dehydrogenase for Mid-Term Mortality in Acute Decompensated Heart Failure: A Comparison to Established Biomarkers and Brain Natriuretic Peptide. Heart Lung Circ 2020; 29:1318-1327. [DOI: 10.1016/j.hlc.2019.11.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 10/08/2019] [Accepted: 11/10/2019] [Indexed: 11/23/2022]
|
59
|
Al Busaidi A, Al Balushi M, Al Busaidi N. Pulmonary Embolism Presenting as Abdominal Pain and Asystole. Cureus 2020; 12:e9123. [PMID: 32789064 PMCID: PMC7417130 DOI: 10.7759/cureus.9123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Pulmonary embolism (PE) is a life-threatening condition that mandates prompt identification and management. The protean and atypical symptomatology of PE can mislead the physician and pose a diagnostic dilemma. Abdominal pain is one such rare symptom that is not commonly encountered in the clinical setting. With the limited availability of literature describing abdominal pain as a symptom of this acute disease, it is pivotal that healthcare workers are aware of this presentation. Herewith, we report a 36-year-old man with no co-morbidities who presented with abdominal pain and subsequent cardiac arrest. He was diagnosed and managed in the emergency department and made a complete recovery.
Collapse
|
60
|
Oh PC, Eom YS, Moon J, Jang HJ, Kim TH, Suh J, Kong MG, Park SD, Kwon SW, Choe JY, Suh SY, Lee K, Han SH, Ahn T, Kang WC. Prognostic impact of the combination of serum transaminase and alkaline phosphatase determined in the emergency room in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. PLoS One 2020; 15:e0233286. [PMID: 32442225 PMCID: PMC7244093 DOI: 10.1371/journal.pone.0233286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 05/01/2020] [Indexed: 02/07/2023] Open
Abstract
Background Elevated serum transaminase or alkaline phosphatase (ALP) has been proposed as a novel prognosticator for ST-segment elevation myocardial infarction (STEMI). We evaluated the combined prognostic impact of elevated serum transaminases and ALP on admission in STEMI patients who underwent primary percutaneous coronary intervention (PCI). Methods A total of 1176 patients with STEMI undergoing primary PCI were retrospectively enrolled from the INTERSTELLAR registry. Hypoxic liver injury (HLI) was defined as serum transaminase > twice the upper limit of normal. The cut-off value of high ALP was set at the median level (73 IU/L). Patients were divided into four groups according to their serum transaminase and ALP levels. The primary endpoint was major adverse cardiac or cerebrovascular events (MACCE), defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization. Results Median follow-up duration was 25 months (interquartile range, 10–39 months). The rate of MACCE was highest in patients with HLI (+) and high ALP (25.9%), compared to those in the other groups (8.2% in HLI [-] and low ALP, 11.8% in HLI [-] and high ALP, and 15.0% in HLI [+] and low ALP). Each of HLI or high ALP was an independent predictor for MACCE (HR 1.807, 95% CI 1.191–2.741; HR 1.721, 95% CI 1.179–2.512, respectively). Combined HLI and high ALP was associated with the worst prognosis (HR 3.145, 95% CI 1.794–5.514). Conclusions Combined HLI and high ALP on admission is associated with poor clinical outcomes in patients with STEMI who have undergone primary PCI.
Collapse
Affiliation(s)
- Pyung Chun Oh
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Young Sil Eom
- Endocrinology and Metabolism, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Ho-Jun Jang
- Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Tae-Hoon Kim
- Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Jon Suh
- Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Min Gyu Kong
- Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sang-Don Park
- Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Jae Yeol Choe
- Department of Medicine, Gachon University School of Medicine, Incheon, Republic of Korea
| | - Soon Yong Suh
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Seung Hwan Han
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Taehoon Ahn
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
| | - Woong Chol Kang
- Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon, Republic of Korea
- * E-mail:
| |
Collapse
|
61
|
Borovac JA, Glavas D, Susilovic Grabovac Z, Supe Domic D, Stanisic L, D’Amario D, Duplancic D, Bozic J. Right Ventricular Free Wall Strain and Congestive Hepatopathy in Patients with Acute Worsening of Chronic Heart Failure: A CATSTAT-HF Echo Substudy. J Clin Med 2020; 9:jcm9051317. [PMID: 32370248 PMCID: PMC7290588 DOI: 10.3390/jcm9051317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/25/2020] [Accepted: 04/27/2020] [Indexed: 12/20/2022] Open
Abstract
Right ventricular (RV) function is an important predictor of prognosis in patients with heart failure. However, the relationship of the RV free wall longitudinal strain (RV FWS) and the degree of hepatic dysfunction during the acute worsening of heart failure (AWHF) is unknown. We sought to determine associations of RV FWS with laboratory liver function tests and parameters of RV function including tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (RV FAC), maximal tricuspid jet velocity (TR Vmax), RV S′ velocity, and estimated RV systolic pressure (RVSP). A total of 42 AWHF patients from the CATSTAT-HF study were stratified in two groups by the RV FWS median (−16.5%). Patients < RV FWS median had significantly prolonged international normalized ratio (INR; p = 0.002), increased total bilirubin (p < 0.001) and alkaline phosphatase (ALP; p = 0.020), and decreased albumin (p = 0.005) and thrombocytes (p = 0.017) compared to patients > RV FWS median. RV FWS independently correlated to total bilirubin (β = 0.457, p = 0.004), ALP (β = 0.556, p = 0.002), INR (β = 0.392, p = 0.022), albumin (β = −0.437, p = 0.013), and thrombocytes (β = −404, p = 0.038). Similarly, TAPSE, RV FAC, and RV S′ significantly correlated with RV FWS. In conclusion, RV impairment, reflected in reduced RV FWS, is independently associated with a higher degree of hepatic dysfunction among patients with AWHF (CATSTAT-HF ClinicalTrials gov number, NCT03389386).
Collapse
Affiliation(s)
- Josip A. Borovac
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia;
- Institute of Emergency Medicine of Split-Dalmatia County, Spinciceva 1, 21000 Split, Croatia
- Clinic for Cardiovascular Diseases, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.G.); (Z.S.G.); (D.D.)
| | - Duska Glavas
- Clinic for Cardiovascular Diseases, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.G.); (Z.S.G.); (D.D.)
- Department of Internal Medicine, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Zora Susilovic Grabovac
- Clinic for Cardiovascular Diseases, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.G.); (Z.S.G.); (D.D.)
| | - Daniela Supe Domic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.S.D.); (L.S.)
- Department of Health Studies, University of Split, Rudjera Boskovica 35 P.P. 464, 21000 Split, Croatia
| | - Lada Stanisic
- Department of Medical Laboratory Diagnostics, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.S.D.); (L.S.)
- Department of Health Studies, University of Split, Rudjera Boskovica 35 P.P. 464, 21000 Split, Croatia
| | - Domenico D’Amario
- Department of Cardiovascular and Thoracic Sciences, IRCCS Fondazione Policlinico A. Gemelli, Università Cattolica Sacro Cuore, Largo Francesco Vito 1, 00168 Rome, Italy;
| | - Darko Duplancic
- Clinic for Cardiovascular Diseases, University Hospital of Split, Spinciceva 1, 21000 Split, Croatia; (D.G.); (Z.S.G.); (D.D.)
- Department of Internal Medicine, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, Soltanska 2, 21000 Split, Croatia;
- Correspondence: ; Tel.: +385-21-557-871
| |
Collapse
|
62
|
Castelhano J, Ribeiro B, Sanches M, Graça B, Saraiva J, Oliveiros B, Neves C, Rodrigues T, Sereno J, Gonçalves S, Ferreira MJ, Seiça R, Matafome P, Castelo-Branco M. A rat model of enhanced glycation mimics cardiac phenotypic components of human type 2 diabetes : A translational study using MRI. J Diabetes Complications 2020; 34:107554. [PMID: 32122788 DOI: 10.1016/j.jdiacomp.2020.107554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/22/2020] [Accepted: 01/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The success of translational research depends on how well animal models mimic the pathophysiology of the human phenotype, and on the identification of disease mechanisms such as enhanced glycation. METHODS Here, we studied cardiac MRI and metabolic phenotypes in human type 2 diabetes (N = 106; 55 patients+51 controls) and animal models with distinct levels of fat diet and end glycation products, to model the role of these factors in the cardiac phenotype. We included four groups of rats, designed to evaluate the role of lipid load and glucotoxicity in cardiac function and to correlate these with the cardiac phenotype observed in humans. We also aimed to assess into which extent phenotypes were related to specific risk factors. RESULTS Stroke Volume (SV) and Peak Filling Rate (PFR) measures were similarly discriminative both in humans and animal models, particularly when enhanced glycation was present. Factorial analysis showed that reduction of multidimensionality into common main explanatory factors, in humans and animals, revealed components that equally explained the variance of cardiac phenotypes (87.62% and 83.75%, respectively). One of the components included, both in humans and animals, SV, PFR and peak ejection rate (PER). The other components included in both humans and animals are the following: ESV (end systolic volume), left ventricular mass (LVM) and ejection fraction (EF). These components were useful for between group discrimination. CONCLUSIONS We conclude that animal models of enhanced glycation and human type 2 diabetes share a striking similarity of cardiac phenotypic components and relation with metabolic changes, independently of fact content in the diet, which reinforces the role of glucose dysmetabolism in left ventricular dysfunction and provides a potentially useful approach for translational research in diabetes, in particular when testing new therapies early on during the natural history of this condition.
Collapse
Affiliation(s)
| | - Bruno Ribeiro
- CIBIT/ICNAS, University of Coimbra, Coimbra, Portugal
| | | | - Bruno Graça
- Coimbra University Hospital (CHUC), Coimbra, Portugal
| | - Joana Saraiva
- Coimbra University Hospital (CHUC), Coimbra, Portugal
| | - Bárbara Oliveiros
- Laboratório de Bioestatística e Informática Médica, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Christian Neves
- Laboratory of Physiology, Faculty of Medicine, University of Coimbra, Portugal
| | - Tiago Rodrigues
- Laboratory of Physiology, Faculty of Medicine, University of Coimbra, Portugal
| | - José Sereno
- CIBIT/ICNAS, University of Coimbra, Coimbra, Portugal
| | | | - Maria João Ferreira
- CIBIT/ICNAS, University of Coimbra, Coimbra, Portugal; Laboratório de Bioestatística e Informática Médica, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Raquel Seiça
- Laboratory of Physiology, Faculty of Medicine, University of Coimbra, Portugal
| | - Paulo Matafome
- Laboratory of Physiology, Faculty of Medicine, University of Coimbra, Portugal.; Instituto Politécnico de Coimbra, Coimbra Health School (ESTeSC), Department of Complementary Sciences, Coimbra, Portugal
| | - Miguel Castelo-Branco
- CIBIT/ICNAS, University of Coimbra, Coimbra, Portugal; Laboratório de Bioestatística e Informática Médica, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| |
Collapse
|
63
|
Kramer F, Voss S, Roessig L, Igl BW, Butler J, Lam CSP, Maggioni AP, Shah SJ, Pieske B. Evaluation of high-sensitivity C-reactive protein and uric acid in vericiguat-treated patients with heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 22:1675-1683. [PMID: 32216011 PMCID: PMC7687153 DOI: 10.1002/ejhf.1787] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The effects of vericiguat vs. placebo on high‐sensitivity C‐reactive protein (hsCRP) and serum uric acid (SUA) were assessed in patients with heart failure with reduced ejection fraction (HFrEF) in the Phase 2 SOCRATES‐REDUCED study (NCT01951625). Methods and results Changes from baseline hsCRP and SUA values at 12 weeks with placebo and vericiguat (1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg, respectively) were assessed. The probability of achieving an hsCRP value of ≤3.0 mg/L or SUA value of <7.0 mg/dL at week 12 was tested. Median baseline hsCRP and SUA levels were 3.68 mg/L [interquartile range (IQR) 1.41–8.41; n = 335] and 7.80 mg/dL (IQR 6.40–9.33; n = 348), respectively. Baseline‐adjusted mean percentage changes in hsCRP were 0.2%, −19.5%, −24.3%, −25.7% and −31.9% in the placebo and vericiguat 1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg groups, respectively; significance vs. placebo was observed in the vericiguat 10.0 mg group (P = 0.035). Baseline‐adjusted mean percentage changes in SUA were 5.0%, −1.3%, −1.1%, −3.5% and −5.3% in the placebo, and vericiguat 1.25 mg, 2.5 mg, 5.0 mg and 10.0 mg groups, respectively; significance vs. placebo was observed in the 5.0 mg and 10.0 mg groups (P = 0.0202 and P = 0.004, respectively). Estimated probability for an end‐of‐treatment hsCRP value of ≤3.0 mg/L and SUA value of <7.0 mg/dL was higher with vericiguat compared with placebo. The effect was dose‐dependent, with the greatest effect observed in the 10.0 mg group. Conclusions Vericiguat treatment for 12 weeks was associated with reductions in hsCRP and SUA, and a higher likelihood of achieving an hsCRP value of ≤3.0 mg/L and SUA value of <7.0 mg/dL.
Collapse
Affiliation(s)
- Frank Kramer
- Medical Devices and eHealth Clinical, Bayer AG, Wuppertal, Germany
| | | | | | | | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Carolyn S P Lam
- National Heart Centre and Duke University-National University of Singapore, Singapore, Singapore.,University Medical Centre Groningen, Groningen, the Netherlands.,The George Institute for Global Health, Sydney, NSW, Australia
| | - Aldo P Maggioni
- Italian Association of Hospital Cardiologists (ANMCO) Research Centre, Florence, Italy
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Centre Berlin (DHZB), Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| |
Collapse
|
64
|
Maeda D, Sakane K, Ito T, Kanzaki Y, Sohmiya K, Hoshiga M. Fibrosis-4 index reflects right-sided filling pressure in patients with heart failure. Heart Vessels 2020; 35:376-383. [PMID: 31529178 DOI: 10.1007/s00380-019-01505-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/06/2019] [Indexed: 12/20/2022]
Abstract
The fibrosis-4 index (FIB-4 index) is a marker of liver fibrosis. It has been reported that the FIB-4 index in compensated phase is associated with estimated right-sided filling pressure and poor prognosis in patients with heart failure. However, the relationship with invasively obtained right-sided cardiac pressures has been unclear. Hemodynamic status was evaluated by right heart catheterization in 189 heart failure patients who were in a clinically compensated phase between January 2015 and September 2017. Patients were assigned to two groups based on a median FIB-4 index of 2.15, then hemodynamic parameters and event rates were compared. Endpoint was defined as a composite of all-cause death, readmission for heart failure, or left ventricular-assist device implantation. Then, we also investigated correlations between the FIB-4 index and clinical factors, including hemodynamic parameters. Patients with a high FIB-4 index were significantly older (76 [IQR, 63-80] vs. 65 [IQR, 56-74] years, P < 0.001) and had higher right atrial pressure (RAP; 7 [IQR, 5-11] vs. 4 [IQR, 1-6] mmHg, P < 0.001) and pulmonary capillary wedge pressure (16 [IQR, 12-22] vs. 12 [IQR, 8-19] mmHg, P = 0.011) than those with a low FIB-4 index. The FIB-4 index correlated more strongly with parameters of right-sided than left-sided HF (RAP, R = 0.41, P < 0.001; inferior vena cava diameter, R = 0.44, P < 0.001; pulmonary capillary wedge pressure, R = 0.15, P = 0.038; brain natriuretic peptide, R = 0.14, P = 0.29). Multiple regression analysis showed that the FIB-4 index independently correlated with RAP. In conclusion, the FIB-4 index can non-invasively reflect right-sided filling pressure, which might explain why it is associated with a poor prognosis, among patients with heart failure.
Collapse
Affiliation(s)
- Daichi Maeda
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Kazushi Sakane
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Takahide Ito
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Yumiko Kanzaki
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Koichi Sohmiya
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan
| | - Masaaki Hoshiga
- Department of Cardiology, Osaka Medical College, 2-7 Daigakumachi, Takatsuki, Osaka, 569-8686, Japan.
| |
Collapse
|
65
|
El Hadi H, Di Vincenzo A, Vettor R, Rossato M. Relationship between Heart Disease and Liver Disease: A Two-Way Street. Cells 2020; 9:cells9030567. [PMID: 32121065 PMCID: PMC7140474 DOI: 10.3390/cells9030567] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/23/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022] Open
Abstract
In clinical practice, combined heart and liver dysfunctions coexist in the setting of the main heart and liver diseases because of complex cardiohepatic interactions. It is becoming increasingly crucial to identify these interactions between heart and liver in order to ensure an effective management of patients with heart or liver disease to provide an improvement in overall prognosis and therapy. In this review, we aim to summarize the cross-talk between heart and liver in the setting of the main pathologic conditions affecting these organs. Accordingly, we present the clinical manifestation, biochemical profiles, and histological findings of cardiogenic ischemic hepatitis and congestive hepatopathy due to acute and chronic heart failure, respectively. In addition, we discuss the main features of cardiac dysfunction in the setting of liver cirrhosis, nonalcoholic fatty liver disease, and those following liver transplantation.
Collapse
Affiliation(s)
- Hamza El Hadi
- Internal Medicine 3, Department of Medicine—DIMED, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (H.E.H.); (A.D.V.); (R.V.)
- Department of Medicine, Klinikum Rheine, 48431 Rheine, Germany
| | - Angelo Di Vincenzo
- Internal Medicine 3, Department of Medicine—DIMED, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (H.E.H.); (A.D.V.); (R.V.)
| | - Roberto Vettor
- Internal Medicine 3, Department of Medicine—DIMED, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (H.E.H.); (A.D.V.); (R.V.)
| | - Marco Rossato
- Internal Medicine 3, Department of Medicine—DIMED, University of Padova, Via Giustiniani 2, 35100 Padova, Italy; (H.E.H.); (A.D.V.); (R.V.)
- Correspondence: ; Tel.: +39-049-8218747; Fax: +39049-8213332
| |
Collapse
|
66
|
Cardiogenic Shock: Reflections at the Crossroad Between Perfusion, Tissue Hypoxia, and Mitochondrial Function. Can J Cardiol 2020; 36:184-196. [PMID: 32036863 DOI: 10.1016/j.cjca.2019.11.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 11/19/2019] [Accepted: 11/19/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiogenic shock is classically defined by systemic hypotension with evidence of hypoperfusion and end organ dysfunction. In modern practice, however, these metrics often incompletely describe cardiogenic shock because patients present with more advanced cardiovascular disease and greater degrees of multiorgan dysfunction. Understanding how perfusion, congestion, and end organ dysfunction contribute to hypoxia at the cellular level are central to the diagnosis and management of cardiogenic shock. Although, in clinical practice, increased lactate level is often equated with hypoxia, several other factors might contribute to an elevated lactate level including mitochondrial dysfunction, impaired hepatic and renal clearance, as well as epinephrine use. To this end, we present the evidence underlying the value of lactate to pyruvate ratio as a potential discriminator of cellular hypoxia. We will then discuss the physiological implications of hypoxia and congestion on hepatic, intestinal, and renal physiology. Organ-specific susceptibility to hypoxia is presented in the context of their functional architecture. We discuss how the concepts of contractile reserve, fluid responsiveness, tissue oxygenation, and cardiopulmonary interactions can help personalize the management of cardiogenic shock. Finally, we highlight the limitations of using lactate for tailoring therapy in cardiogenic shock.
Collapse
|
67
|
Huang CY, Nithiyanantham S, Liao JY, Lin WT. Bioactive peptides attenuate cardiac hypertrophy and fibrosis in spontaneously hypertensive rat hearts. J Food Drug Anal 2019; 28:94-102. [PMID: 31883612 DOI: 10.1016/j.jfda.2019.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 11/05/2019] [Accepted: 11/11/2019] [Indexed: 12/26/2022] Open
Abstract
Alcalase potato protein hydrolysate (APPH), a nutraceutical food, might an have important role in anti-obesity activity. Recent studies from our lab indicated that APPH treatment had lipolysis stimulating activity and identified was an efficient anti-obesity diet ingredient. In this study we aim to investigate the beneficial effects of pure peptide amino acid sequences (DIKTNKPVIF (DI) and IF) from APPH supplement in the regulation of cardiac hypertrophy and fibrosis on spontaneously hypertensive rats (SHR). We examined hematoxylin and eosin staining, Masson's trichrome staining, echocardiographic parameters, serum parameters, hypertrophy, inflammation and fibrotic marker expression to demonstrate efficacy of bioactive peptides in a SHR model. There was a significant upregulation between SHR and bioactive peptides treated groups in left heart weight (LHW), LHW/WHW, LHW/Tibia, LVIDd, and LVd mass. In addition, the bioactive peptides repress the protein expression of hypertrophy markers (BNP, MYH7), inflammation (TLR-4, p-NFkB, TNF-α, IL-6), and fibrotic markers (uPA, MMP-2, TIMP1, CTGF). In summary, these results indicate that DI and IF bioactive peptides from APPH attenuate cardiac hypertrophy, inflammation and fibrosis in the SHR model.
Collapse
Affiliation(s)
- Chih Yang Huang
- Graduate Institute of Biomedical Science, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan; Center of General Education, Buddhist Tzu Chi Medical Foundation, Tzu Chi University of Science and Technology, Hualien, Taiwan; Cardiovascular and Mitochondrial Related Diseases Research Center, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | | | - Jia Ying Liao
- Department of Hospitality Management, College of Agriculture, Tunghai University, Taichung, Taiwan
| | - Wan Teng Lin
- Department of Hospitality Management, College of Agriculture, Tunghai University, Taichung, Taiwan.
| |
Collapse
|
68
|
Sezgin G, Li L, Wilson R, Westbrook JI, Lindeman R, Vecellio E, Georgiou A. Laboratory Test Utilization and Repeat Testing for Inpatients of Age 80 and Over in Australia: A Retrospective Observational Study. J Appl Lab Med 2019; 4:143-151. [DOI: 10.1373/jalm.2019.029025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 03/12/2019] [Indexed: 02/02/2023]
Abstract
Abstract
Introduction
Repeat laboratory testing is often necessary in hospitals. However, frequent blood draws can be harmful to older patients. The objective of this study was to identify the most frequently ordered laboratory tests and repeat testing rates for these tests among older inpatients.
Methods
A retrospective observational study of inpatients of age 80 years and over in 4 public hospitals in New South Wales, Australia, was conducted between 2008 and 2013. Proportions of laboratory tests and proportions of repeated tests among the most frequently used tests were reported.
Results
There were 42739 patients with 108003 admissions (56.2% women; 43.2% of ages 80–84). Of these admissions, 95.9% had a laboratory test, with 3012577 tests recorded. Five tests accounted for 62% of all tests and were present in 98.5% of admissions: electrolytes urea and creatinine (EUC; 18% of all tests ordered), complete blood count (CBC; 16.7%), calcium magnesium phosphate (CaMgPhos; 10.2%), liver function test (LFT; 9.0%), and C-reactive protein (CRP; 8.0%). Proportions of repeat tests for this group performed outside recommended minimum repeat intervals were 10.3% EUC, 8.9% CBC, 41.5% CRP, 68.2% CaMgPhos, and 65.2% LFT tests. An exponential increase in repeat testing for all 5 tests was observed around 24 h after a previous test.
Conclusion
Compliance with guidelines on repeat testing intervals among older patients is variable. A better understanding of the underlying reasons for repeat testing would allow targeting of interventions, including decision support, to improve laboratory use for older inpatients.
Collapse
Affiliation(s)
- Gorkem Sezgin
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Ling Li
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Roger Wilson
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Johanna I Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| | - Robert Lindeman
- New South Wales Health Pathology, Chatswood, New South Wales, Australia
| | - Elia Vecellio
- New South Wales Health Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Faculty of Health and Medical Sciences, Macquarie University, New South Wales, Australia
| |
Collapse
|
69
|
Correale M, Tricarico L, Leopizzi A, Mallardi A, Mazzeo P, Tucci S, Grazioli D, Di Biase M, Brunetti ND. Liver disease and heart failure. Panminerva Med 2019; 62:26-37. [PMID: 31670498 DOI: 10.23736/s0031-0808.19.03768-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Several systemic conditions, inflammatory disease, infections and alcoholism, may affect both the heart and the liver. Common conditions, such as the non-alcoholic fatty liver disease (NAFLD), may increase the risk of cardiac dysfunction. Patients with acute decompensated HF (ADHF) may develop acute ischemic hepatitis and, chronic HF patients may develop congestive hepatopathy (CH). EVIDENCE ACQUISITION Laboratory anomalies of hepatic function may predict the outcome of patients with advanced HF and the evaluation of both cardiac and hepatic function is very important in the management of these patients. In clinically apparent ischemic hepatitis more than 90% of patients have some right-sided HF. There are systemic disorders characterized by the accumulation of metals or by metabolism defects that may affect primarily the liver but also the heart leading to symptomatic hypertrophic cardiomyopathy (HCM). EVIDENCE SYNTHESIS Abnormal LFTs indicate the mechanism of liver injury: liver congestion or liver ischemia. In AHF, it's important an adequate evaluation of heart and liver function in order to choose the treatment in order to ensure stable hemodynamic as well as optimal liver function. CONCLUSIONS Measurements of LFTs should be recommended in the early phase of ADHF management. Physicians with interest in HF should be trained in the evaluation of LFTs. It's very important for cardiologists to know the systemic diseases affecting both heart and liver and the first imaging or laboratory findings useful for a diagnosis. it is very important for internists, nephrologists, cardiologists, primary physicians and any physicians with interest in treating HF to recognize such signs and symptoms belong to rare diseases and liver diseases that could be mistaken for HF.
Collapse
Affiliation(s)
- Michele Correale
- Unit of Cardiology, Ospedali Riuniti University Hospital of Foggia, Foggia, Italy -
| | - Lucia Tricarico
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alessandra Leopizzi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Adriana Mallardi
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro Mazzeo
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Salvatore Tucci
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | | | | | - Natale D Brunetti
- Unit of Cardiology, Ospedali Riuniti University Hospital of Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| |
Collapse
|
70
|
Shea CM, Price GM, Liu G, Sarno R, Buys ES, Currie MG, Masferrer JL. Soluble guanylate cyclase stimulator praliciguat attenuates inflammation, fibrosis, and end-organ damage in the Dahl model of cardiorenal failure. Am J Physiol Renal Physiol 2019; 318:F148-F159. [PMID: 31608671 DOI: 10.1152/ajprenal.00247.2019] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Reduced nitric oxide (NO) and a decrease in cGMP signaling mediated by soluble guanylate cyclase (sGC) has been linked to the development of several cardiorenal diseases. Stimulation of sGC is a potential means for enhancing cGMP production in conditions of reduced NO bioavailability. The purpose of our studies was to determine the effects of praliciguat, a clinical-stage sGC stimulator, in a model of cardiorenal failure. Dahl salt-sensitive rats fed a high-salt diet to induce hypertension and organ damage were treated with the sGC stimulator praliciguat to determine its effects on hemodynamics, biomarkers of inflammation, fibrosis, tissue function, and organ damage. Praliciguat treatment reduced blood pressure, improved cardiorenal damage, and attenuated the increase in circulating markers of inflammation and fibrosis. Notably, praliciguat affected markers of renal damage at a dose that had minimal effect on blood pressure. In addition, liver fibrosis and circulating markers of tissue damage were attenuated in praliciguat-treated rats. Stimulation of the NO-sGC-cGMP pathway by praliciguat attenuated or normalized indicators of chronic inflammation, fibrosis, and tissue dysfunction in the Dahl salt-sensitive rat model. Stimulation of sGC by praliciguat may present an effective mechanism for treating diseases linked to NO deficiency, particularly those associated with cardiac and renal failure. Praliciguat is currently being evaluated in patients with diabetic nephropathy and heart failure with preserved ejection fraction.
Collapse
Affiliation(s)
| | | | - Guang Liu
- Cyclerion Therapeutics, Cambridge, Massachusetts
| | - Renee Sarno
- Cyclerion Therapeutics, Cambridge, Massachusetts
| | | | | | | |
Collapse
|
71
|
Ajayi EIO, Molehin OR, Oloyede OI, Kumar V, Amara VR, Kaur J, Karpe P, Tikoo K. Liver mitochondrial membrane permeability modulation in insulin-resistant, uninephrectomised male rats by Clerodendrum volubile P. Beauv and Manihot esculenta Crantz. CLINICAL PHYTOSCIENCE 2019. [DOI: 10.1186/s40816-019-0124-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AbstractBackgroundNon-alcoholic fatty liver disease, which occurs in people who are not alcohol drinkers, describes some of the pathogenic conditions that may be in the least characterized by simple steatosis or can be as serious as non-alcoholic steatohepatitis and cirrhosis. Its mechanistic pathogenesis has been said to arise from insulin resistance and oxidative stress, which may be compounded by obesity. An experimental model showing, systemic insulin resistance, obesity and accumulated hepatic fatty acids was created in adult male rats using high-fat diet manipulation and surgical removal of the left kidney (uninephrectomy). This study sought to identify the impact of these multiple burdens on the liver mitochondrial membrane permeability transition pore opening, and the possible in vitro effects of the extracts ofClerodendrum volubileandManihot esculentaleaves on the membrane permeabilization.ResultsThe results indicated that the methanolic extract ofClerodendrum volubileleaf inhibited mitochondrial membrane pore opening in the insulin resistance condition or when it is followed by uni-nephrectomy, while the ethanolic extract ofManihot esculentaleaf does the same in the insulin resistance condition both prior to and following uni-nephrectomy.ConclusionSince the vegetable extracts were able to abrogate mitochondrial pore opening at low concentrations, the structural integrity of the mitochondria can possibly be restored over time if treated by the vegetable extracts. Research efforts should, therefore, be made to harness the drugability of the bioactives of these vegetables for use in the treatment of non-alcoholic fatty liver disease arising from insulin resistance and renal failure.
Collapse
|
72
|
Vishram-Nielsen JKK, Deis T, Balling L, Sabbah M, Boesgaard S, Rossing K, Wolsk E, Gustafsson F. Relationship between invasive hemodynamics and liver function in advanced heart failure. SCAND CARDIOVASC J 2019; 53:235-246. [PMID: 31327253 DOI: 10.1080/14017431.2019.1646972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective. To examine how liver function (LF) relates to invasive hemodynamics cross-sectionally and longitudinally, in advanced heart failure (AHF) patients treated with maximally tolerated medical HF therapy. Design. A retrospective study of 309 consecutive AHF patients with a left ventricular ejection fraction < 45% treated with maximally tolerated medical HF therapy who were referred for AHF therapies. All patients underwent right heart catheterization (RHC) using Swan-Ganz catheters. Cardiac output was measured using thermodilution. Measurements of pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), cardiac index (CI) and mean arterial pressure (MAP) were obtained. RHC and evaluation of LF were repeated (median (IQR) = 186.5 (150-208) days) in 33 patients. Results. Mean (SD) age was 50 (±13) years, and 239 (77%) were men. Only 22 (7%) were treated with inotropes, and none were receiving mechanical circulatory support. Median (IQR) plasma alanine transaminase (ALT) was 32 (22-53) U/l, alkaline phosphatase (ALP) 82 (63-122) U/l, bilirubin 14 (9-22) µmol/l, albumin 39 (35-43) g/l, lactate dehydrogenase 212 (175-275) U/l, and the prothrombin time/International Normalized Ratio (PT/INR) 1.1 (1.0-1.3). In multivariate analyses significant associations between LF tests and hemodynamics were seen for CVP: ALP (β = 0.031, p = .0002), bilirubin (β = 0.027, p = .004), and INR (β = 0.013, p = .002). PCWP (β = 0.020, p = .002) and CI (β = -0.17, p = .005) were also associated with bilirubin. Over time, changes in bilirubin correlated positively with changes in CVP (β = 1.496, p = .005). Conclusion. In optimally treated AHF patients, CVP was associated with both markers of biliary excretion and liver synthesis function, whereas changes in CVP were associated with changes in markers of biliary excretion. Decongestion may improve measures of LF in AHF.
Collapse
Affiliation(s)
- Julie K K Vishram-Nielsen
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Tania Deis
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Louise Balling
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Muhammad Sabbah
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Søren Boesgaard
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Kasper Rossing
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Emil Wolsk
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark
| | - Finn Gustafsson
- Centre for Cardiac, Vascular, Pulmonary and Infectious Diseases, Rigshospitalet, University Hospital of Copenhagen , Copenhagen , Denmark.,Department of Medicine, University of Copenhagen , Copenhagen , Denmark
| |
Collapse
|
73
|
Xu Y, Park SH, Yoon KN, Park SJ, Gye MC. Effects of citrate ester plasticizers and bis (2-ethylhexyl) phthalate in the OECD 28-day repeated-dose toxicity test (OECD TG 407). ENVIRONMENTAL RESEARCH 2019; 172:675-683. [PMID: 30878739 DOI: 10.1016/j.envres.2019.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 02/12/2019] [Accepted: 03/02/2019] [Indexed: 05/24/2023]
Abstract
Citrate esters are considered functional alternatives to phthalate plasticizers, but their toxicity remains poorly understood. The toxicity of citrate esters, including triethyl 2-acetylcitrate (ATEC) and trihexyl O-acetylcitrate (ATHC), were examined together with that of bis (2-ethylhexyl) phthalate (DEHP) using the Organization for Economic Co-operation and Development Test Guideline 407 (OECD TG407). Following 28-day oral administration, no significant differences in body weight or the weight of the brain, pituitary, heart, epididymis, seminal vesicles, or coagulating gland were found between the vehicle control and DEHP, ATEC or ATHC groups. In the 400 mg/kg day DEHP group, liver, adrenal, thymus, spleen, kidney, testis, and prostate weights were significantly increased. In the 400 mg/kg day ATHC group, kidney, adrenal, thymus, testis and prostate weights were significantly increased. In the 400 mg/kg day ATEC group, kidney, adrenal and testis weights were significantly increased. Hepatocyte size was significantly increased in the 400 mg/kg day DEHP group, suggestive of hepatotoxicity, but was not increased in the ATEC or ATHC groups. There were no significant differences in white blood cell, red blood cell or platelet counts, hemoglobin concentrations, hematocrit, mean corpuscular volume, fasting glucose, insulin, or testosterone concentrations between the vehicle control and DEHP, ATEC and ATHC groups. In the ATHC 400 mg/kg day group, T3 was decreased while T4 was increased, suggestive of disruption of thyroid function. The results of the OECD TG407 subacute repeated dosing toxicity test indicate ATEC is less toxic compared to ATHC or DEHP and could be recommended as an alternative to phthalate plasticizers.
Collapse
Affiliation(s)
- Yang Xu
- Department of Life Science and Institute for Natural Sciences, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Seung Hyun Park
- Department of Life Science and Institute for Natural Sciences, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Kyung Noh Yoon
- Department of Life Science and Institute for Natural Sciences, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Sun Jung Park
- Department of Life Science and Institute for Natural Sciences, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea
| | - Myung Chan Gye
- Department of Life Science and Institute for Natural Sciences, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
| |
Collapse
|
74
|
Abnormal Liver Enzymes. Gastroenterol Nurs 2019; 41:497-507. [PMID: 30418344 DOI: 10.1097/sga.0000000000000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Abnormal liver enzymes are frequently encountered in primary care offices and hospitals and may be caused by a wide variety of conditions, from mild and nonspecific to well-defined and life-threatening. Terms such as "abnormal liver chemistries" or "abnormal liver enzymes," also referred to as transaminitis, should be reserved to describe inflammatory processes characterized by elevated alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. Although interchangeably used with abnormal liver enzymes, abnormal liver function tests specifically denote a loss of synthetic functions usually evaluated by serum albumin and prothrombin time. We discuss the entities that most commonly cause abnormal liver enzymes, specific patterns of enzyme abnormalities, diagnostic modalities, and the clinical scenarios that warrant referral to a hepatologist.
Collapse
|
75
|
Shi M, Ellingsen Ø, Bathen TF, Høydal MA, Stølen T, Esmaeili M. The Effect of Exercise Training on Myocardial and Skeletal Muscle Metabolism by MR Spectroscopy in Rats with Heart Failure. Metabolites 2019; 9:metabo9030053. [PMID: 30893827 PMCID: PMC6468534 DOI: 10.3390/metabo9030053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/12/2019] [Accepted: 03/14/2019] [Indexed: 01/16/2023] Open
Abstract
The metabolism and performance of myocardial and skeletal muscle are impaired in heart failure (HF) patients. Exercise training improves the performance and benefits the quality of life in HF patients. The purpose of the present study was to determine the metabolic profiles in myocardial and skeletal muscle in HF and exercise training using MRS, and thus to identify targets for clinical MRS in vivo. After surgically establishing HF in rats, we randomized the rats to exercise training programs of different intensities. After the final training session, rats were sacrificed and tissues from the myocardial and skeletal muscle were extracted. Magnetic resonance spectra were acquired from these extracts, and principal component and metabolic enrichment analysis were used to assess the differences in metabolic profiles. The results indicated that HF affected myocardial metabolism by changing multiple metabolites, whereas it had a limited effect on skeletal muscle metabolism. Moreover, exercise training mainly altered the metabolite distribution in skeletal muscle, indicating regulation of metabolic pathways of taurine and hypotaurine metabolism and carnitine synthesis.
Collapse
Affiliation(s)
- Mingshu Shi
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
| | - Øyvind Ellingsen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
- Clinic of Cardiology, St Olavs Hospital, NO-7491 Trondheim, Norway.
| | - Tone Frost Bathen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
| | - Morten A Høydal
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
- Clinic of Cardiology, St Olavs Hospital, NO-7491 Trondheim, Norway.
- Clinic of Cardiothoracic Surgery, St Olavs Hospital, NO-7491 Trondheim, Norway.
| | - Tomas Stølen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
- Clinic of Cardiology, St Olavs Hospital, NO-7491 Trondheim, Norway.
- Clinic of Cardiothoracic Surgery, St Olavs Hospital, NO-7491 Trondheim, Norway.
| | - Morteza Esmaeili
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, NO-7491 Trondheim, Norway.
| |
Collapse
|
76
|
Xanthopoulos A, Starling RC, Kitai T, Triposkiadis F. Heart Failure and Liver Disease: Cardiohepatic Interactions. JACC-HEART FAILURE 2018; 7:87-97. [PMID: 30553904 DOI: 10.1016/j.jchf.2018.10.007] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 10/04/2018] [Indexed: 02/07/2023]
Abstract
Heart failure (HF) and liver disease often co-exist. This is because systemic disorders and diseases affect both organs (alcohol abuse, drugs, inflammation, autoimmunity, infections) and because of complex cardiohepatic interactions. The latter, which are the focus of this review, include the development of acute cardiogenic liver injury and congestive hepatopathy in HF as well as cardiac dysfunction and failure in the setting of liver cirrhosis, nonalcoholic fatty liver disease, and sequelae following liver transplantation. The emerging role of altered liver X receptor signaling in the pathogenesis of HF comorbidities as well as of the intestinal microbiome and its metabolites in HF and liver disease are fruitful areas for future research.
Collapse
Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Randall C Starling
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Kaufman Center for Heart Failure, Cleveland Clinic, Cleveland, Ohio
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | | |
Collapse
|
77
|
Cops J, Mullens W, Verbrugge FH, Swennen Q, De Moor B, Reynders C, Penders J, Achten R, Driessen A, Dendooven A, Rigo JM, Hansen D. Selective abdominal venous congestion induces adverse renal and hepatic morphological and functional alterations despite a preserved cardiac function. Sci Rep 2018; 8:17757. [PMID: 30532057 PMCID: PMC6288122 DOI: 10.1038/s41598-018-36189-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/16/2018] [Indexed: 12/13/2022] Open
Abstract
Venous congestion is an important contributor to worsening renal function in heart failure and the cardiorenal syndrome. In patients, it is difficult to study the effects of isolated venous congestion on organ function. In this study, the consequences of isolated abdominal venous congestion on morphology and function of the kidneys, liver and heart were studied in a rat model. Twelve sham-operated (SHAM) male Sprague Dawley rats were compared to eleven inferior vena cava-constricted (IVCc) rats for twenty-one weeks. Abdominal venous pressure was significantly higher in the IVCc versus SHAM group (p < 0.0001). Indices of liver and kidney weight, function and morphology, inflammation as well as collagen deposition were significantly increased in the IVCc compared to SHAM group, (p < 0.05). Echocardiographic and hemodynamic parameters were largely unaffected by abdominal venous congestion. In this rat model of isolated abdominal venous congestion, retrogradely conducted glomerular hypertension without a concomitant change in glomerular filtration rate was observed. Adverse short-term hepatic morphological alterations were developed which explain the observed organ function dysfunction. Importantly, cardiac function remained comparable between both groups. This study provides relevant insight in the pathophysiology of abdominal congestion on organ function.
Collapse
Affiliation(s)
- Jirka Cops
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium. .,Doctoral school for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.
| | - Wilfried Mullens
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Cardiology, Ziekenhuis Oost-limburg, Genk, Belgium
| | | | - Quirine Swennen
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Bart De Moor
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Nephrology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Joris Penders
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Clinical laboratory, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Ruth Achten
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Pathology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Ann Driessen
- Department of Pathology, Universitair Ziekenhuis Antwerpen, University of Antwerp, Edegem, Belgium
| | - Amélie Dendooven
- Department of Pathology, Universitair Ziekenhuis Antwerpen, University of Antwerp, Edegem, Belgium
| | - Jean-Michel Rigo
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dominique Hansen
- BIOMED - Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium.,REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| |
Collapse
|
78
|
Steininger M, Winter MP, Reiberger T, Koller L, El-Hamid F, Forster S, Schnaubelt S, Hengstenberg C, Distelmaier K, Goliasch G, Wojta J, Toma A, Niessner A, Sulzgruber P. De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction. J Clin Med 2018; 7:jcm7120474. [PMID: 30477196 PMCID: PMC6306912 DOI: 10.3390/jcm7120474] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 10/28/2018] [Accepted: 11/14/2018] [Indexed: 12/17/2022] Open
Abstract
Background: Recent evidence suggested levels of aspartate aminotransferase (AST), alanine transaminase (ALT), and AST/ALT ratio (De-Ritis ratio) were associated with a worse outcome after acute myocardial infarction (AMI). However, their value for predicting long-term prognosis remained unknown. Therefore, we investigated the prognostic potential of transaminases on patient outcome after AMI from a long-term perspective. Methods: Data of a large AMI registry including 1355 consecutive patients were analyzed. The Cox regression hazard analysis was used to assess the impact of transaminases and the De-Ritis ratio on long-term mortality. Results: The median De-Ritis ratio for the entire study population was 1.5 (interquartile range [IQR]: 1.0–2.6). After a median follow-up time of 8.6 years, we found that AST (crude hazard ratio (HR) of 1.19 per 1-SD [95% confidence interval (CI): 1.09–1.32; p < 0.001]) and De-Ritis ratio (crude HR of 1.31 per 1-SD [95% CI: 1.18–1.44; p < 0.001]), but not ALT (p = 0.827), were significantly associated with long-term mortality after AMI. After adjustment for confounders independently, the De-Ritis ratio remained a strong and independent predictor for long-term mortality in the multivariate model with an adjusted HR of 1.23 per 1-SD (95% CI: 1.07–1.42; p = 0.004). Moreover, the De-Ritis ratio added prognostic value beyond N-terminal pro-B-Type Natriuretic Peptide, Troponin T, and Creatine Kinase. Conclusion: The De-Ritis ratio is a strong and independent predictor for long-term mortality after AMI. As a readily available biomarker in clinical routine, it might be used to identify patients at risk for fatal cardiovascular events and help to optimize secondary prevention strategies after AMI.
Collapse
Affiliation(s)
- Matthias Steininger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Max-Paul Winter
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, 1090 Vienna, Austria.
- Vienna Hepatic Hemodynamic Laboratory, Medical University of Vienna, 1090 Vienna, Austria.
| | - Lorenz Koller
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Feras El-Hamid
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Stefan Forster
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Sebastian Schnaubelt
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria.
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Klaus Distelmaier
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Georg Goliasch
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Aurel Toma
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| | - Patrick Sulzgruber
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria.
| |
Collapse
|
79
|
Sridhara S, Lichtenwalter C, Mazdeh S, Yeneneh BT. Positive Murphy's Sign in Pericardial Hematoma from a Right Atrial Tear. Cureus 2018; 10:e3402. [PMID: 30533336 PMCID: PMC6279000 DOI: 10.7759/cureus.3402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A positive Murphy's sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy's sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure. The patient required an atrial tear repair to prevent a cardiac tamponade.
Collapse
|
80
|
Xiang H, Han J, Ridley WE, Ridley LJ. Playboy bunny and moose head sign: Hepatic veins in congestive heart failure. J Med Imaging Radiat Oncol 2018; 62 Suppl 1:99-100. [PMID: 30309097 DOI: 10.1111/1754-9485.44_12784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hao Xiang
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | - Jason Han
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia
| | | | - Lloyd J Ridley
- Department of Radiology, Concord Repatriation General Hospital, Concord, New South Wales, Australia.,Medical Imaging, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
81
|
Simonavičius J, Knackstedt C, Brunner-La Rocca HP. Loop diuretics in chronic heart failure: how to manage congestion? Heart Fail Rev 2018; 24:17-30. [DOI: 10.1007/s10741-018-9735-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
82
|
Souza ACF, Bastos DSS, Santos FC, Sertorio MN, Ervilha LOG, Gonçalves RV, de Oliveira LL, Machado-Neves M. Arsenic aggravates oxidative stress causing hepatic alterations and inflammation in diabetic rats. Life Sci 2018; 209:472-480. [PMID: 30144451 DOI: 10.1016/j.lfs.2018.08.054] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 08/08/2018] [Accepted: 08/21/2018] [Indexed: 02/06/2023]
Abstract
AIMS Studies have shown that exposure to either environmental toxicants or hyperglycemia causes hepatic injuries. However, it is unclear the extent to which their combined exposure may influence liver functions. Therefore, we aimed to evaluate morphological and functional hepatic parameters in diabetic rats exposed to arsenic. METHODS Diabetes was induced in male rats by intraperitoneal streptozotocin injection. While healthy and diabetic animals received saline solution (negative control and diabetes control, respectively), other animals received 10 mg/L sodium arsenate (arsenic control and diabetes + arsenic groups, respectively) for 40 days in drinking water. Liver tissue was subjected to antioxidant enzymes analysis, cytokine assay, arsenic determination, and histopathological evaluation. Functional markers of hepatic damage were analyzed using serum samples. KEY FINDINGS Arsenate exposure reduced the antioxidant enzymes activity in healthy rats, and it worsened the reduction of GST in diabetic animals. Consequently, arsenate-exposed animals showed increased malondialdehyde and carbonyl protein levels, being this increase worsened in diabetes + arsenic animals. Arsenate-exposed groups also showed hepatic inflammatory process with high number of mast cells and TNF-α production mainly in diabetes + arsenic animals. Vascular alterations, such as congestion, bleeding, and hemosiderin deposition were intensified in diabetes + arsenic animals, whereas glycogen storage reduced in these animals. SIGNIFICANCE We concluded that arsenate exposure was able to intensify morphological and functional damages in liver tissue of diabetic animals.
Collapse
Affiliation(s)
| | - Daniel Silva Sena Bastos
- Department of General Biology, Federal University of Viçosa, Viçosa 36570-900, Minas Gerais, Brazil
| | - Felipe Couto Santos
- Department of General Biology, Federal University of Viçosa, Viçosa 36570-900, Minas Gerais, Brazil
| | | | | | | | | | - Mariana Machado-Neves
- Department of General Biology, Federal University of Viçosa, Viçosa 36570-900, Minas Gerais, Brazil.
| |
Collapse
|
83
|
Ruggiero SA, Huber JS, Murrant CL, Brunt KR, Simpson JA. Splenic blood-flow response following myocardial infarction in rat. Can J Physiol Pharmacol 2018; 96:1060-1068. [PMID: 30102865 DOI: 10.1139/cjpp-2018-0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
During physiological stress (e.g., exercise, hypoxia), blood flow is shunted to specific anatomical regions to protect critical organs; yet, splenic blood flow in these circumstances remains to be investigated. Despite being classically viewed as a non-critical organ, recent experimental and epidemiological evidence suggests the spleen plays a significant role in cardiovascular pathophysiology. We hypothesized that splenic blood flow is prioritized in the development of heart failure (i.e., chronic state of reduced cardiac output). Five-week-old male Wistar rats were randomized for either myocardial infarction (MI; n = 58) or sham (n = 56) surgery. At 2, 5, and 9 weeks post-surgery, Doppler ultrasound measurements of the splenic, left renal, left common carotid, and left femoral arteries were performed. Cardiac function was assessed at all time points using echocardiography and at 9 weeks post-surgery using invasive hemodynamic analysis. Splenic and cerebral blood flow was preferentially maintained at 9 weeks post-MI, whereas blood flow to the lower limb and kidney were reduced. Spleen size increased by 5 weeks post-MI and remained elevated. Splenic blood flow was maintained in conditions of decreased cardiac output, when other tissues showed decreased blood flow. The maintenance of blood flow in the face of decreased cardiac output indicates that splenic function is being prioritized during heart failure.
Collapse
Affiliation(s)
- Sara A Ruggiero
- a Department of Human Health and Nutritional Science, College of Biological Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Jason S Huber
- a Department of Human Health and Nutritional Science, College of Biological Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada.,b IMPART team Canada Investigator Network
| | - Coral L Murrant
- a Department of Human Health and Nutritional Science, College of Biological Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada
| | - Keith R Brunt
- b IMPART team Canada Investigator Network.,c Department of Pharmacology, Dalhousie Medicine New Brunswick, Dalhousie University, Saint John, NB E2K 5E2, Canada
| | - Jeremy A Simpson
- a Department of Human Health and Nutritional Science, College of Biological Sciences, University of Guelph, Guelph, ON N1G 2W1, Canada.,b IMPART team Canada Investigator Network
| |
Collapse
|
84
|
Valbusa F, Agnoletti D, Scala L, Grillo C, Arduini P, Bonapace S, Calabria S, Scaturro G, Mantovani A, Zoppini G, Turcato E, Maggioni AP, Arcaro G, Targher G. Non-alcoholic fatty liver disease and increased risk of all-cause mortality in elderly patients admitted for acute heart failure. Int J Cardiol 2018; 265:162-168. [DOI: 10.1016/j.ijcard.2018.04.129] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 04/15/2018] [Accepted: 04/30/2018] [Indexed: 12/12/2022]
|
85
|
Mercurio V, Palazzuoli A, Correale M, Lombardi C, Passantino A, Ravera A, Ruocco G, Sciatti E, Triggiani M, Lagioia R, Scrutinio D, Tocchetti CG, Nodari S. Right heart dysfunction: from pathophysiologic insights to therapeutic options: a translational overview. J Cardiovasc Med (Hagerstown) 2018; 19:613-623. [PMID: 30048301 DOI: 10.2459/jcm.0000000000000700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
: The right ventricle has become increasingly studied in cardiovascular research. In this article, we describe specific pathophysiological characteristics of the right ventricle, with special focus on functional and molecular modifications as well as therapeutic strategies in right ventricular dysfunction, underlining the differences with the left ventricle. Then we analyze the main imaging modalities to assess right ventricular function in different clinical settings. Finally, we acknowledge main therapeutic advances for treatment of right heart diseases.
Collapse
Affiliation(s)
- Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Alberto Palazzuoli
- Department of Internal Medicine, Cardiovascular Diseases Unit, University of Siena, Siena
| | | | - Carlo Lombardi
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Andrea Passantino
- Istituti Clinici Scientifici Maugeri. Istituto di Cassano delle Murge. I.R.C.C.S., Cassano Murge, Bari, Italy
| | - Alice Ravera
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Gaetano Ruocco
- Department of Internal Medicine, Cardiovascular Diseases Unit, University of Siena, Siena
| | - Edoardo Sciatti
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Marco Triggiani
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - Rocco Lagioia
- Istituti Clinici Scientifici Maugeri. Istituto di Cassano delle Murge. I.R.C.C.S., Cassano Murge, Bari, Italy
| | - Domenico Scrutinio
- Istituti Clinici Scientifici Maugeri. Istituto di Cassano delle Murge. I.R.C.C.S., Cassano Murge, Bari, Italy
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples
| | - Savina Nodari
- Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| |
Collapse
|
86
|
Mirtschink P, Jang C, Arany Z, Krek W. Fructose metabolism, cardiometabolic risk, and the epidemic of coronary artery disease. Eur Heart J 2018; 39:2497-2505. [PMID: 29020416 PMCID: PMC6037111 DOI: 10.1093/eurheartj/ehx518] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 07/16/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
Despite strong indications that increased consumption of added sugars correlates with greater risks of developing cardiometabolic syndrome (CMS) and cardiovascular disease (CVD), independent of the caloric intake, the worldwide sugar consumption remains high. In considering the negative health impact of overconsumption of dietary sugars, increased attention is recently being given to the role of the fructose component of high-sugar foods in driving CMS. The primary organs capable of metabolizing fructose include liver, small intestine, and kidneys. In these organs, fructose metabolism is initiated by ketohexokinase (KHK) isoform C of the central fructose-metabolizing enzyme KHK. Emerging data suggest that this tissue restriction of fructose metabolism can be rescinded in oxygen-deprived environments. In this review, we highlight recent progress in understanding how fructose metabolism contributes to the development of major systemic pathologies that cooperatively promote CMS and CVD, reference recent insights into microenvironmental control of fructose metabolism under stress conditions and discuss how this understanding is shaping preventive actions and therapeutic approaches.
Collapse
Affiliation(s)
- Peter Mirtschink
- Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Otto-Stern-Weg 7, Zurich, Switzerland
- Department of Clinical Pathobiochemistry, Institute of Clinical Chemistry and Laboratory Medicine, University Hospital Dresden, Fetscherstr. 74, Dresden, Germany
| | - Cholsoon Jang
- Department of Medicine, Cardiovascular Institute and Institute Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, 11th floor, Civic Blvd, Philadelphia, 19104 PA, USA
| | - Zoltan Arany
- Department of Medicine, Cardiovascular Institute and Institute Diabetes Obesity and Metabolism, Perelman School of Medicine, University of Pennsylvania, 11th floor, Civic Blvd, Philadelphia, 19104 PA, USA
| | - Wilhelm Krek
- Department of Biology, Institute of Molecular Health Sciences, ETH Zurich, Otto-Stern-Weg 7, Zurich, Switzerland
| |
Collapse
|
87
|
Intra-Abdominal Hemorrhage following Cardiopulmonary Resuscitation: A Report of Two Cases. Case Rep Emerg Med 2018; 2018:5243105. [PMID: 29974000 PMCID: PMC6008890 DOI: 10.1155/2018/5243105] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/01/2018] [Accepted: 04/22/2018] [Indexed: 01/17/2023] Open
Abstract
Cardiopulmonary resuscitation (CPR) represents an emergency procedure, consisting of chest compressions and artificial ventilation. Two rare cases of intra-abdominal bleeding following cardiac compressions are reported. The first case was a 29-year-old female with massive pulmonary embolism (PE). Following CPR due to cardiac arrest, she showed signs of intra-abdominal bleeding. A liver laceration was found and sutured. The patient passed away, due to massive PE. The second patient was a 62-year-old female, suffering from cardiac arrest due to drowning at sea. CPR was performed in situ. At presentation to the emergency department she showed signs of intra-abdominal bleeding. The origin of the hemorrhage was found to be vessels of the lesser curvature of the stomach, which were ligated. Regarding the first patient PE has already been described as a cause for liver lacerations in CPR due to stasis and liver enlargement. The second case is the first report of gastric vessel injury without gastric rupture/laceration and pneumoperitoneum. Complications of CPR should not represent a drawback to performing cardiac compressions. Parenchymatic injuries have been related to inappropriate technique of chest compressions during basic life support. Therefore, it is of utmost importance for the providers to refresh their knowledge of performing CPR.
Collapse
|
88
|
Hasanzadeh-Moghadam M, Khadem-Ansari MH, Farjah GH, Rasmi Y. Hepatoprotective effects of betaine on liver damages followed by myocardial infarction. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2018; 9:129-135. [PMID: 30065801 PMCID: PMC6047573 DOI: 10.30466/vrf.2018.30834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 02/21/2018] [Indexed: 12/20/2022]
Abstract
Myocardial infarction is commonly considered as a leading cause of cardiovascular disease taking the lives of seven million people annually. Liver dysfunction is associated with cardiac diseases. The profile of abnormal liver functions in heart failure is not clearly defined. This study was designed to investigate the protective effects of betaine on liver injury after myocardial infarction induced by isoprenaline in rats. Forty-eight male rats were divided into four groups: the control group received normal diet and the experimental groups received 50, 150, and 250 mg kg-1 body weight of betaine daily through gastric gavages for 60 days. All of experimental and control groups experienced myocardial infarction, induced by subcutaneous injection of 100 mg kg-1 isoprenaline in two consecutive doses )8:00 AM to 8:00 PM). Liver enzymes including aspartate transaminase (AST) and alanine transaminase (ALT) were significantly reduced in the groups treated with betaine, compared with the control group. The total antioxidant capacity in the experimental groups, treated with betaine, showed a significant increase, compared with the control group. In the control group, severe lesions were created in the liver tissue, while degenerative changes of liver tissue significantly reduced in groups treated with different doses of betaine, showing the repair of liver tissue. Betaine decreased apoptosis in the experimental groups in comparison with the control group. Betaine showed a protective effect against biochemical and histological changes in liver tissue caused by the induction of myocardial infarction via isoprenaline injection.
Collapse
Affiliation(s)
| | | | - Gholam Hossein Farjah
- Department of Anatomy, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran.,Neurophysiology Research Center, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rasmi
- Department of Clinical Biochemistry, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| |
Collapse
|
89
|
Butler DC, Lewin DN, Batalis NI. Differential Diagnosis of Hepatic Necrosis Encountered at Autopsy. Acad Forensic Pathol 2018; 8:256-295. [PMID: 31240042 DOI: 10.1177/1925362118782056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/13/2018] [Indexed: 12/13/2022]
Abstract
The liver is subject to a variety of extrinsic and intrinsic insults that manifest with both specific and nonspecific patterns of necrosis. In the autopsy setting, these patterns are often encountered as incidental findings or even causes of death. There are several etiologies of hepatic necrosis, including toxins, drug injuries, viral infections, ischemic injuries, and metabolic disease, all of which possess overlapping gross and histologic presentations. Nonetheless, patterned necrosis in the context of clinical and demographic history allows for the forensic pathologist to develop a differential diagnosis, which may then be pruned into a specific or likely cause. The aim of the following review is to elucidate these patterns in the context of the liver diseases from which they arise with the goal developing a differential diagnosis and ultimate determination of etiology. Acad Forensic Pathol. 2018 8(2): 256-295.
Collapse
|
90
|
Lysek-Gladysinska M, Wieczorek A, Walaszczyk A, Jelonek K, Jozwik A, Pietrowska M, Dörr W, Gabrys D, Widlak P. Long-term effects of low-dose mouse liver irradiation involve ultrastructural and biochemical changes in hepatocytes that depend on lipid metabolism. RADIATION AND ENVIRONMENTAL BIOPHYSICS 2018; 57:123-132. [PMID: 29470638 DOI: 10.1007/s00411-018-0734-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/16/2018] [Indexed: 06/08/2023]
Abstract
The aim of the study was to investigate long-term effects of radiation on the (ultra)structure and function of the liver in mice. The experiments were conducted on wild-type C57BL/6J and apolipoprotein E knock-out (ApoE-/-) male mice which received a single dose (2 or 8 Gy) of X-rays to the heart with simultaneous exposure of liver to low doses (no more than 30 and 120 mGy, respectively). Livers were collected for analysis 60 weeks after irradiation and used for morphological, ultrastructural, and biochemical studies. The results show increased damage to mitochondrial ultrastructure and lipid deposition in hepatocytes of irradiated animals as compared to non-irradiated controls. Stronger radiation-related effects were noted in ApoE-/- mice than wild-type animals. In contrast, radiation-related changes in the activity of lysosomal hydrolases, including acid phosphatase, β-glucuronidase, N-acetyl-β-D-hexosaminidase, β-galactosidase, and α-glucosidase, were observed in wild type but not in ApoE-deficient mice, which together with ultrastructural picture suggests a higher activity of autophagy in ApoE-proficient animals. Irradiation caused a reduction of plasma markers of liver damage in wild-type mice, while an increased level of hepatic lipase was observed in plasma of ApoE-deficient mice, which collectively indicates a higher resistance of hepatocytes from ApoE-proficient animals to radiation-mediated damage. In conclusion, liver dysfunctions were observed as late effects of irradiation with an apparent association with malfunction of lipid metabolism.
Collapse
Affiliation(s)
- Malgorzata Lysek-Gladysinska
- Department of Cell Biology and Electron Microscopy, Institute of Biology, University of Jan Kochanowski, Swietokrzyska 15, 25-406, Kielce, Poland.
| | - Anna Wieczorek
- Department of Cell Biology and Electron Microscopy, Institute of Biology, University of Jan Kochanowski, Swietokrzyska 15, 25-406, Kielce, Poland
| | - Anna Walaszczyk
- Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Karol Jelonek
- Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Artur Jozwik
- Institute of Genetics and Animal Breeding, Polish Academy of Sciences, 05-552, Jastrzebiec, Poland
| | - Monika Pietrowska
- Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Wolfgang Dörr
- Department of Radiotherapy and Radiation Oncology, Medical Faculty Carl Gustav Carus, University of Technology, Dresden, Germany
- Department of Radiation Oncology, ATRAB, Applied and Translational Radiobiology, Medical University Vienna, Vienna, Austria
| | - Dorota Gabrys
- Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| | - Piotr Widlak
- Maria Sklodowska-Curie Institute, Oncology Center, Gliwice Branch Wybrzeze Armii Krajowej 15, 44-101, Gliwice, Poland
| |
Collapse
|
91
|
Relation of High Serum Bilirubin to Short-Term Mortality Following a Myocardial Infarction Complicated by Left Ventricular Systolic Dysfunction (from the High-Risk Myocardial Infarction Database Initiative). Am J Cardiol 2018; 121:1015-1020. [PMID: 29631805 DOI: 10.1016/j.amjcard.2018.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 01/09/2018] [Accepted: 01/15/2018] [Indexed: 11/21/2022]
Abstract
Higher serum bilirubin has been associated with poorer prognosis in patients with heart failure (HF). We examined the association between serum bilirubin and clinical outcomes in patients with clinical signs of HF and/or left ventricular systolic dysfunction after acute myocardial infarction (MI). A total of 7,467 patients from the High-Risk Myocardial Infarction Database Initiative with an available baseline total bilirubin concentration were studied. The association between baseline bilirubin concentrations and the composite outcome of cardiovascular mortality (CVM), nonfatal stroke, nonfatal MI or hospitalization for HF, CVM, and all-cause mortality were assessed using Cox proportional hazards models. An interaction with time was observed with associations present only in the first 90 days after randomization. The median (percentile25-75) baseline total bilirubin concentration was 11 (8 to 14) µmol/L and was above the "normal" range (>17.1 µmol/L) in 1,053 (14.1%) patients. In multivariable analysis, with adjustment for baseline characteristics (demographic, co-morbidities, Killip score, left ventricular ejection fraction, and laboratory variables), patients with a bilirubin concentration of >17.1 µmol/L had a significantly higher risk of all the studied outcomes at 90 days (e.g., CVM: adjusted hazard ratio 1.45, 95% confidence interval 1.14 to 1.86, p = 0.003). The addition of bilirubin to a validated survival model modestly improved the risk reclassification to predict 90-day events (continuous net reclassification improvement for CVM 6.4%, 95% confidence interval 0.7% to 9.6%, p = 0.04). In patients with MI complicated with HF and/or systolic dysfunction, bilirubin concentration is an independent predictor of mortality and may improve risk stratification.
Collapse
|
92
|
Wadowski PP, Hülsmann M, Schörgenhofer C, Lang IM, Wurm R, Gremmel T, Koppensteiner R, Steinlechner B, Schwameis M, Jilma B. Sublingual functional capillary rarefaction in chronic heart failure. Eur J Clin Invest 2018; 48. [PMID: 29178250 DOI: 10.1111/eci.12869] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/21/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Microcirculatory changes contribute to clinical symptoms and disease progression in chronic heart failure (CHF). A depression of coronary flow reserve is associated with a lower myocardial capillary density in biopsies. We hypothesized that changes in cardiac microcirculation might also be reflected by a systemic reduction in capillaries and visualized by sublingual videomicroscopy. The aim was to study in vivo capillary density and glycocalyx dimensions in patients with CHF vs healthy controls. METHODS Fifty patients with ischaemic and nonischaemic CHF and standard treatment were compared to 35 healthy age-matched subjects in a prospective cross-sectional study. Sublingual microcirculation was visualized using a sidestream darkfield videomicroscope. Functional and perfused total capillary densities were compared between patients and controls. A reduced glycocalyx thickness was measured by an increased perfused boundary region (PBR). RESULTS Median functional and total perfused capillary densities were 30% and 45% lower in patients with CHF (both P < .001). Intake of oral vitamin K antagonists was associated with significantly lower capillary densities (P < .05), but not independent of NT-proBNP. Dimensions of the glycocalyx were marginally lower in CHF patients than in healthy controls (<7% difference). However, PBR correlated significantly with inflammation markers (fibrinogen: r = .58; C-reactive protein: r = .42), platelet counts (r = .36) and inversely with measures of liver/renal function such as bilirubin (r = -.38) or estimated glomerular filtration rate (r = -.34) in CHF patients. CONCLUSION CHF patients have got a markedly lower functional and total perfused capillary density in sublingual microvasculature when compared to controls, indicating a systemic decrease in microcirculation.
Collapse
Affiliation(s)
- Patricia P Wadowski
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.,Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Irene M Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Raphael Wurm
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Thomas Gremmel
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Renate Koppensteiner
- Division of Angiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Barbara Steinlechner
- Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna, Austria
| | - Michael Schwameis
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Bernd Jilma
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
93
|
Correale M, Tarantino N, Petrucci R, Tricarico L, Laonigro I, Di Biase M, Brunetti ND. Liver disease and heart failure: Back and forth. Eur J Intern Med 2018; 48:25-34. [PMID: 29100896 DOI: 10.1016/j.ejim.2017.10.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 10/04/2017] [Accepted: 10/23/2017] [Indexed: 12/18/2022]
Abstract
In their clinical practice, physicians can face heart diseases (chronic or acute heart failure) affecting the liver and liver diseases affecting the heart. Systemic diseases can also affect both heart and liver. Therefore, it is crucial in clinical practice to identify complex interactions between heart and liver, in order to provide the best treatment for both. In this review, we sought to summarize principal evidence explaining the mechanisms and supporting the existence of this complicate cross-talk between heart and liver. Hepatic involvement after heart failure, its pathophysiology, clinical presentation (congestive and ischemic hepatopathy), laboratory and echocardiographic prognostic markers are discussed; likewise, hepatic diseases influencing cardiac function (cirrhotic cardiomyopathy). Several clinical conditions (congenital, metabolic and infectious causes) possibly affecting simultaneously liver and heart have been also discussed. Cardiovascular drug therapy may present important side effects on the liver and hepato-biliary drug therapy on heart and vessels; post-transplantation immunosuppressive drugs may show reciprocal cardio-hepatotoxicity. A heart-liver axis is drafted by inflammatory reactants from the heart and the liver, and liver acts a source of energy substrates for the heart.
Collapse
Affiliation(s)
| | - Nicola Tarantino
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Rossella Petrucci
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Lucia Tricarico
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | - Irma Laonigro
- Ospedali Riuniti University Hospital, Foggia, Italy.
| | - Matteo Di Biase
- Department of Medical & Surgical Sciences, University of Foggia, Italy.
| | | |
Collapse
|
94
|
Pal S, Sarkar K, Nath PP, Mondal M, Khatun A, Paul G. Bisphenol S impairs blood functions and induces cardiovascular risks in rats. Toxicol Rep 2017; 4:560-565. [PMID: 29152460 PMCID: PMC5671619 DOI: 10.1016/j.toxrep.2017.10.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/16/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022] Open
Abstract
Bisphenol S alters blood homeostasis. Bisphenol S is probably a cardiac risk augmenting chemical. Bisphenol S is a haemolysis promoting chemical.
Bisphenol S (BPS) is an industrial chemical which is recently used to replace the potentially toxic Bisphenol A (BPA) in making polycarbonate plastics, epoxy resins and thermal receipt papers. The probable toxic effects of BPS on the functions of haemopoietic and cardiovascular systems have not been reported till to date. We report here that BPS depresses haematological functions and induces cardiovascular risks in rat. Adult male albino rats of Sprague-Dawley strain were given BPS at a dose level of 30, 60 and 120 mg/kg BW/day respectively for 30 days. Red blood cell (RBC) count, white blood cell (WBC) count, Hb concentration, and clotting time have been shown to be significantly (*P < 0.05) reduced in a dose dependent manner in all exposed groups of rats comparing to the control. It has also been shown that BPS increases total serum glucose and protein concentration in the exposed groups of rats. We have observed that BPS increases serum total cholesterol, triglyceride, glycerol free triglyceride, low density lipoprotein (LDL) and very low density lipoprotein (VLDL) concentration, whereas high density lipoprotein (HDL) concentration has been found to be reduced in the exposed groups. BPS significantly increases serum aspartate aminotransferase (AST), alanine aminotransferase (ALT) and alkaline phosphatase (ALP) activities dose dependently. Moreover, serum calcium, bilirubin and urea concentration have been observed to be increased in all exposed groups. In conclusion, BPS probably impairs the functions of blood and promotes cardiovascular risks in rats.
Collapse
Key Words
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- BPA, bisphenol A
- BPS, bisphenol S
- Bisphenol S
- Cardiovascular risks
- Clotting time
- DMSO, dimethyl sulphoxide
- HDL cholesterol
- HDL, high density lipoprotein
- Hb, hemoglobin
- LDL cholesterol
- LDL, low density lipoprotein
- MCH, mean corpuscular hemoglobin
- RBC, red blood cells
- Red blood cell count
- VLDL, very low density lipoprotein
- WBC, white blood cells
- White blood cell count
Collapse
Affiliation(s)
- Sanghamitra Pal
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| | - Kaushik Sarkar
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| | - Partha Pratim Nath
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| | - Mukti Mondal
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| | - Ashma Khatun
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| | - Goutam Paul
- Molecular Neurotoxicology Laboratory, Department of Physiology, University of Kalyani, Kalyani, West Bengal- 741235, India
| |
Collapse
|
95
|
Khosravi Y, Salimi A, Pourahmad J, Naserzadeh P, Seydi E. Inhalation exposure of nano diamond induced oxidative stress in lung, heart and brain. Xenobiotica 2017; 48:860-866. [DOI: 10.1080/00498254.2017.1367974] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Yahya Khosravi
- Research Center for Health, Safety and Environment (RCHSE), Alborz University of Medical Sciences, Karaj, Iran,
- Department of Occupational Health Engineering, Alborz University of Medical Sciences, Karaj, Iran,
| | - Ahmad Salimi
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran,
| | - Jalal Pourahmad
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and
| | - Parvaneh Naserzadeh
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran, and
- Students Research Committee, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Enayatollah Seydi
- Research Center for Health, Safety and Environment (RCHSE), Alborz University of Medical Sciences, Karaj, Iran,
- Department of Occupational Health Engineering, Alborz University of Medical Sciences, Karaj, Iran,
| |
Collapse
|
96
|
So-Armah KA, Lim JK, Re VL, Tate JP, Chang CCH, Butt AA, Gibert CL, Rimland D, Marconi VC, Goetz MB, Rodriguez-Barradas MC, Budoff MJ, Tindle HA, Samet JH, Justice AC, Freiberg MS. FIB-4 stage of liver fibrosis predicts incident heart failure among HIV-infected and uninfected patients. Hepatology 2017; 66:1286-1295. [PMID: 28543215 PMCID: PMC5609079 DOI: 10.1002/hep.29285] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/10/2017] [Accepted: 05/19/2017] [Indexed: 12/13/2022]
Abstract
UNLABELLED Liver fibrosis is common, particularly in individuals who are infected with human immunodeficiency virus (HIV). HIV-infected individuals have excess congestive heart failure (CHF) risk compared with uninfected people. It remains unknown whether liver fibrosis stage influences the CHF risk or if HIV or hepatitis C virus (HCV) infection modifies this association. Our objectives were to assess whether 1) stage of liver fibrosis is independently associated with incident CHF and 2) the association between stage of liver fibrosis and incident CHF is modified by HIV/HCV status. Participants alive on or after April 1, 2003, in the Veterans Aging Cohort Study were included. Those without prevalent cardiovascular disease were followed until their first CHF event, death, last follow-up date, or December 31, 2011. Liver fibrosis was measured using the fibrosis 4 index (FIB-4), which is calculated using age, aminotransferases, and platelets. Cox proportional hazards regression models were adjusted for cardiovascular disease risk factors. Among 96,373 participants over 6.9 years, 3844 incident CHF events occurred. FIB-4 between 1.45 and 3.25 (moderate fibrosis) and FIB-4 > 3.25 (advanced fibrosis/cirrhosis) were associated with CHF (hazard ratio [95% confidence interval], 1.17 [1.07-1.27] and 1.65 [1.43-1.92], respectively). The association of advanced fibrosis/cirrhosis and incident CHF persisted regardless of HIV/HCV status. CONCLUSION Moderate and advanced liver fibrosis/cirrhosis are associated with an increased risk of CHF. The association for advanced fibrosis/cirrhosis persists even among participants without hepatitis C and/or HIV infection. Assessing liver health may be important for reducing the risk of future CHF events, particularly among HIV and hepatitis C infected people among whom cardiovascular disease risk is elevated and liver disease is common. (Hepatology 2017;66:1286-1295).
Collapse
Affiliation(s)
| | - Joseph K. Lim
- Yale University School of Medicine, New Haven, CT, USA
| | - Vincent Lo Re
- Philadelphia VA Medical Center; University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Janet P. Tate
- VA Connecticut Healthcare System, West Haven, CT,Yale University School of Medicine, New Haven, CT, USA
| | - Chung-Chou H. Chang
- University of Pittsburgh Schools of Medicine and Public Health, Pittsburgh, PA, USA
| | - Adeel A. Butt
- Weill Cornell Medical College, NY, USA,VA Pittsburgh Healthcare System, PA, USA,Hamad Healthcare Quality Institute, Hamad Medical Corporation, Doha, Qatar
| | - Cynthia L. Gibert
- VA Medical Center & George Washington University School of Medicine and Public Health, Washington, DC, USA
| | - David Rimland
- Atlanta VA Medical Center & Emory University School of Medicine, Atlanta, GA
| | - Vincent C. Marconi
- Atlanta VA Medical Center; Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA
| | - Matthew B. Goetz
- VA Greater Los Angeles Healthcare System and the David Geffen School of Medicine at the University of California, Los Angeles, CA 90073, USA
| | | | - Matthew J. Budoff
- Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Los Angeles, CA, USA
| | | | - Jeffrey H. Samet
- Boston University Schools of Medicine and Public Health, Boston Medical Center, Boston, MA, USA
| | - Amy C. Justice
- VA Connecticut Healthcare System, West Haven, CT,Yale University Schools of Medicine and Public Health, New Haven, CT, USA
| | - Matthew S. Freiberg
- Vanderbilt University School of Medicine; Nashville Veterans Affairs Medical Center, Tennessee Valley Healthcare System, Nashville, TN, USA
| | | |
Collapse
|
97
|
Koehne de Gonzalez AK, Lefkowitch JH. Heart Disease and the Liver: Pathologic Evaluation. Gastroenterol Clin North Am 2017; 46:421-435. [PMID: 28506373 DOI: 10.1016/j.gtc.2017.01.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Liver injury due to acute and chronic heart failure has long been recognized. This article discusses the concepts of acute cardiogenic liver injury (ACLI) and cardiac or congestive hepatopathy (CH) along with their clinical manifestations and sequelae. Histologically, ACLI manifests as centrilobular hepatocellular necrosis, whereas CH is associated with centrilobular hepatocyte atrophy, dilated sinusoids, and perisinusoidal fibrosis, progressing to bridging fibrosis and ultimately cirrhosis. ACLI is associated with marked increases in aminotransferase levels, whereas CH is associated with a cholestatic pattern of laboratory tests. Certain cardiac medications have also been implicated as a cause of liver fibrosis.
Collapse
Affiliation(s)
- Anne Knoll Koehne de Gonzalez
- Department of Pathology and Cell Biology, Columbia University, 630 West 168th Street, PH 15 West, Rm 1574, New York, NY 10032-3725, USA
| | - Jay H Lefkowitch
- Department of Pathology and Cell Biology, Columbia University, 630 West 168th Street, PH 15 West, Rm 1574, New York, NY 10032-3725, USA.
| |
Collapse
|
98
|
Chou MH, Chen YC, Hwang KS, Yu MH, Su HY. Myocardial infarction and ischemic hepatitis complicated by postpartum hemorrhage. Taiwan J Obstet Gynecol 2017; 55:437-40. [PMID: 27343332 DOI: 10.1016/j.tjog.2016.04.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2014] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To present a rare case of life-threatening postpartum hemorrhage due to uterine atony complicated by acute myocardial infarction and ischemic hepatitis. CASE REPORT A 37-year-old parturient, gravida 1 para 0, presented with symptoms and signs of shock due to postpartum hemorrhage after delivery. Ischemic hepatitis, pulmonary edema, and adult respiratory distress syndrome developed the following morning. On the 7(th) postpartum day, she developed chest pain and was subsequently diagnosed with acute inferior myocardial infarction based on serial changes on the electrocardiogram (ECG) and myocardial enzymes. The clinical condition improved after a series of resuscitative efforts and percutaneous transluminal coronary angioplasty. CONCLUSION The presented case demonstrated that when hypovolemic shock develops with complications of pulmonary edema or ischemic hepatitis, the possibility of cardiovascular disease should be immediately investigated and preventive measures initiated.
Collapse
Affiliation(s)
- Meng-Han Chou
- Department of General Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Ying-Chieh Chen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Kwei-Shuai Hwang
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Mu-Hsien Yu
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Her-Young Su
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan.
| |
Collapse
|
99
|
Jang HJ, Oh PC, Moon J, Suh J, Park HW, Park SD, Lee K, Kim JS, Lee HJ, Choi RK, Choi YJ, Kang WC, Kwon SW, Kim TH. Prognostic Impact of Combined Dysglycemia and Hypoxic Liver Injury on Admission in Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (from the INTERSTELLAR Cohort). Am J Cardiol 2017; 119:1179-1185. [PMID: 28214004 DOI: 10.1016/j.amjcard.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/03/2017] [Accepted: 01/03/2017] [Indexed: 12/22/2022]
Abstract
Dysglycemia on admission is known to predict the prognosis of ST-segment elevation myocardial infarction (STEMI). Recently, hypoxic liver injury (HLI) has been proposed as a novel prognosticator for STEMI. We evaluated the prognostic impact of combined dysglycemia and HLI at the time of presentation in patients with STEMI who underwent primary percutaneous coronary intervention. From 2007 to 2014, 1,525 consecutive patients (79% men, mean age 61 years) who underwent primary percutaneous coronary intervention for STEMI in the INTERSTELLAR (Incheon-Bucheon Cohort of Patients Undergoing Primary PCI for Acute ST-Elevation Myocardial Infarction) cohort were analyzed retrospectively. Dysglycemia was defined as either hypoglycemia (serum glucose <90 mg/dl) or hyperglycemia (serum glucose >250 mg/dl). HLI was defined as more than twofold increase of any serum aminotransferases above the upper normal limit. Patients were divided into 4 groups according to their dysglycemia and HLI status on admission: group 1, normoglycemia without HLI; group 2, dysglycemia without HLI; group 3, normoglycemia with HLI; and group 4, dysglycemia with HLI. Primary end point was inhospital death and secondary end point was all-cause mortality at 12 months after the index procedure. Of the 1,525 patients, there were 87 inhospital deaths (5.7%) and 113 all-cause deaths (7.4%) at 12 months after the index procedure. Both dysglycemia and HLI on admission were independent predictors of inhospital death. Inhospital mortality rate was the highest in group 4 (32.1%), followed by groups 2 and 3. Kaplan-Meier survival analysis at 12 months showed similar trends among the 4 groups. In conclusion, combined dysglycemia and HLI on admission predicts early prognosis for STEMI.
Collapse
Affiliation(s)
- Ho-Jun Jang
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Pyung Chun Oh
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jeonggeun Moon
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Jon Suh
- Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Hyun Woo Park
- Division of Cardiology, Soon Chun Hyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Kyounghoon Lee
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Je Sang Kim
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Hyun Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Rak Kyeong Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Young-Jin Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Woong Chol Kang
- Division of Cardiology, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Sung Woo Kwon
- Division of Cardiology, Inha University Hospital, Incheon, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea.
| |
Collapse
|
100
|
Domingos Nunes GF, Fatela N, Ramalho F. Long-evolution ascites in a patient with constrictive pericarditis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2017. [PMID: 26219528 DOI: 10.17235/reed.2015.3728/2015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Constrictive pericarditis (CP) is an uncommon disease resulting from chronic pericardial inflammation, fibrosis and calcification. Once there are atypical forms of presentation, with subtle or nonexistent cardiorespiratory symptoms, diagnosis may be challenging and difficult. Recurrent ascites in patients with congestive hepatopathy due to constrictive pericarditis is common and, in most cases, reversible after pericardiectomy. Nevertheless, development of persistent liver dysfunction may be a long-term complication. The present work describes a 23 years old man with growth delay, dyspnoea and long evolution ascites, whose exhaustive etiological investigation led to diagnosis. Afterwards the patient underwent elective surgery with symptom and general condition improvement. Ascites differential diagnosis and its association with constrictive pericarditis are briefly reviewed in this article.
Collapse
|