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Wang Y, Wu X. SMOC1 silencing suppresses the angiotensin II-induced myocardial fibrosis of mouse myocardial fibroblasts via affecting the BMP2/Smad pathway. Oncol Lett 2018; 16:2903-2910. [PMID: 30127878 PMCID: PMC6096163 DOI: 10.3892/ol.2018.8989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/27/2018] [Indexed: 12/28/2022] Open
Abstract
SPARC-related modular calcium binding 1 (SMOC1) represents a vital member of the SPARC matricellular protein family that regulates cell matrix interaction through binding to cell-surface receptors. The present study aimed to investigate the roles and molecular mechanisms of SMOC1 silencing on the fibrosis of myocardial fibroblasts (MFBs). Cell Counting kit-8 and flow cytometry assays were performed to determine cell viability and reactive oxygen species (ROS) content, respectively. ELISA was performed to detect the expression of associated cytokines and matrix proteins. Western blot analysis and reverse transcription-quantitative polymerase chain reaction assays were used to evaluate the expression of associated proteins and mRNAs, respectively. The results revealed that SMOC1 silencing suppressed the cell viability of angiotensin II (Ang II)-treated MFBs. SMOC1 silencing reduced the ROS content and oxidative stress in MFBs in response to Ang II. Furthermore, SMOC1 silencing downregulated the expression levels of fibrosis-associated proteins in Ang II-treated MFBs. SMOC1 silencing affected the bone morphogenetic protein 2 (BMP2)/Smad signaling pathway in Ang II-treated MFBs. In conclusion, the results of the present study suggested that SMOC1 silencing suppressed the Ang II-induced myocardial fibrosis of mouse MFBs through affecting the BMP2/Smad signaling pathway.
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Affiliation(s)
- Yize Wang
- Department of Cardiology, Yiyang Central Hospital, Yiyang, Hunan 413000, P.R. China
| | - Xianming Wu
- Department of Cardiology, Yiyang Central Hospital, Yiyang, Hunan 413000, P.R. China
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102
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Liu L, Yin X, Chen M, Jia H, Eisen HJ, Hofman A. Geographic Variation in Heart Failure Mortality and Its Association With Hypertension, Diabetes, and Behavioral-Related Risk Factors in 1,723 Counties of the United States. Front Public Health 2018; 6:132. [PMID: 29868540 PMCID: PMC5950547 DOI: 10.3389/fpubh.2018.00132] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/18/2018] [Indexed: 01/15/2023] Open
Abstract
Background and objectives Studies that examined geographic variation in heart failure (HF) and its association with risk factors at county and state levels were limited. This study aimed to test a hypothesis that HF mortality is disproportionately distributed across the United States, and this variation is significantly associated with the county- and state-level prevalence of high blood pressure (HBP), diabetes, obesity and physical inactivity. Methods Data from 1,723 counties in 51 states (including District of Columbia as a state) on the age-adjusted prevalence of obesity, physical inactivity, HBP and diabetes in 2010, and age-adjusted HF mortality in 2013–2015 are examined. Geographic variations in risk factors and HF mortality are analyzed using spatial autocorrelation analysis and mapped using Geographic Information System techniques. The associations between county-level HF mortality and risk factors (level 1) are examined using multilevel hierarchical regression models, taking into consideration of their variations accounted for by states (level 2). Results There are significant variations in HF mortality, ranging from the lowest 11.7 (the state of Vermont) to highest 85.0 (Mississippi) per 100,000 population among the 51 states. Age-adjusted prevalence of obesity, physical inactivity, HBP, and diabetes are positively and significantly associated with HF mortality. Multilevel analysis indicates that county-level HF mortality rates remain significantly associated with diabetes (β = 2.7, 95% CI: 1.7–3.7, p < 0.0001), HBP (β = 3.6, 2.1–5.0, p < 0.0001), obesity (β = 0.9, 0.6–1.3, p < 0.0001), and physical inactivity (β = 1.2, 0.8–1.5, p < 0.0001) after controlling for gender, race/ethnicity, and poverty index. After further controlling obesity and physical inactivity in diabetes and HBP models, the effects of diabetes (β = 1.0, −0.3 to 2.3, p = 0.12) and HBP (β = 2.4, 0.9–3.9, p = 0.003) on HF mortality had a considerable reduction. Conclusion HF mortality disproportionately affects the counties and states across the nation. The geographic variations in HF morality are significantly explained by the variations in the prevalence of obesity, physical inactivity, diabetes, and HBP.
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Affiliation(s)
- Longjian Liu
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, United States.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Xiaoyan Yin
- Division of Endocrinology, Diabetes and Metabolism, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, United States
| | - Ming Chen
- Department of Cardiology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hong Jia
- Department of Epidemiology and Biostatistics, Southwest Medical University School of Public Health, Luzhou, Sichuan, China
| | - Howard J Eisen
- Division of Cardiology, Department of Medicine, Drexel University College of Medicine, Philadelphia, PA, United States
| | - Albert Hofman
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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103
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McQuillan RF, Lok CE. Does peritoneal dialysis have a role in urgent-start end-stage kidney disease? Semin Dial 2018; 31:325-331. [PMID: 29676003 DOI: 10.1111/sdi.12700] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Despite its many positive attributes, peritoneal dialysis remains underutilized, particularly in the United States. Urgent-start peritoneal dialysis (PD) has been proposed as a method of increasing PD prevalence. Urgent-start PD has been shown to be safe, feasible, and effective. However, urgent-start PD is also accompanied by several multidimensional challenges. This article is intended to equip the reader with a practical sense of whether an urgent-start PD program would be appropriate in his or her own clinical context and if appropriate, what factors would be necessary for such a program to flourish. As such, we summarize latent factors, which are necessary to consider before instituting an urgent-start PD. Then, using a series of clinical vignettes, highlight the component parts of a successful urgent-start PD program and the patient population who stand to benefit most from this strategy. The discussion is then balanced by presenting limitations to consider in the urgent-start PD approach.
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Affiliation(s)
- Rory F McQuillan
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
| | - Charmaine E Lok
- Division of Nephrology, Department of Medicine, University Health Network and The University of Toronto, Toronto, Ontario, Canada
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104
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LaMonte MJ. Physical Activity and Heart Failure: Taking Steps to Control a Major Public Health Burden. Am J Lifestyle Med 2018; 14:555-570. [PMID: 33110401 DOI: 10.1177/1559827618769609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome that is increasingly prevalent among US adults and accounts for substantial burden of healthcare costs and morbidity. HF is commonly associated with prior myocardial infarction as well as prolonged exposure to hypertension, diabetes, and coronary atherosclerosis. Exercise training is becoming established in the management of HF because of its beneficial effect on both central (cardiac) and peripheral (skeletal muscle) HF mechanisms. The role of habitual physical activity in the primary prevention of HF is less clear. Recent prospective observational studies suggest there is lower risk of developing HF in adults who are more physically activity and have higher cardiorespiratory fitness compared with their less active and fit peers. This article reviews the published evidence on physical activity and HF prevention, discusses potential mechanisms for this benefit, and suggests areas where further research is needed to establish recommendations on the type, amount, and intensity of physical activity required to prevent occurrence of HF.
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Affiliation(s)
- Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo-SUNY, Buffalo, New York
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105
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Cirelli MA, Lacerda MS, Lopes CT, de Lima Lopes J, de Barros ALBL. Correlations between stress, anxiety and depression and sociodemographic and clinical characteristics among outpatients with heart failure. Arch Psychiatr Nurs 2018; 32:235-241. [PMID: 29579518 DOI: 10.1016/j.apnu.2017.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
Abstract
UNLABELLED Aim To describe and investigate correlations among anxiety, stress and depression and identify their relationship with sociodemographic and clinical characteristics of patients with heart failure. METHODS This is an analytical cross-sectional study. Sociodemographic and clinical characteristics were collected, along with levels of anxiety, stress and depression from 309 outpatients. RESULTS The mean levels of stress, anxiety and depression were correlated but low. Time since diagnosis, the disease's functional class, family income, and smoking influenced stress. Functional class and Chagas disease influenced anxiety and depression. Being unemployed and smoking influenced anxiety, while being a homeowner influenced depression. CONCLUSION These findings should be considered when planning nursing interventions.
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Affiliation(s)
- Melissa Alves Cirelli
- Paulista Nursing School, Federal University of São Paulo, 754 Napoleão de Barros St, 04024-002 São Paulo, SP, Brazil.
| | - Marianna Sobral Lacerda
- Paulista Nursing School, Federal University of São Paulo, 754 Napoleão de Barros St, 04024-002 São Paulo, SP, Brazil
| | - Camila Takao Lopes
- Paulista Nursing School, Federal University of São Paulo, 754 Napoleão de Barros St, 04024-002 São Paulo, SP, Brazil
| | - Juliana de Lima Lopes
- Paulista Nursing School, Federal University of São Paulo, 754 Napoleão de Barros St, 04024-002 São Paulo, SP, Brazil
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Nimmon L, Bates J, Kimel G, Lingard L. Patients with heart failure and their partners with chronic illness: interdependence in multiple dimensions of time. J Multidiscip Healthc 2018; 11:175-186. [PMID: 29588596 PMCID: PMC5858542 DOI: 10.2147/jmdh.s146938] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background Informal caregivers play a vital role in supporting patients with heart failure (HF). However, when both the HF patient and their long-term partner suffer from chronic illness, they may equally suffer from diminished quality of life and poor health outcomes. With the focus on this specific couple group as a dimension of the HF health care team, we explored this neglected component of supportive care. Materials and methods From a large-scale Canadian multisite study, we analyzed the interview data of 13 HF patient-partner couples (26 participants). The sample consisted of patients with advanced HF and their long-term, live-in partners who also suffer from chronic illness. Results The analysis highlighted the profound enmeshment of the couples. The couples' interdependence was exemplified in the ways they synchronized their experience in shared dimensions of time and adapted their day-to-day routines to accommodate each other's changing health status. Particularly significant was when both individuals were too ill to perform caregiving tasks, which resulted in the couples being in a highly fragile state. Conclusion We conclude that the salience of this couple group's oscillating health needs and their severe vulnerabilities need to be appreciated when designing and delivering HF team-based care.
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Affiliation(s)
- Laura Nimmon
- Centre for Health Education Scholarship.,Department of Occupational Science and Occupational Therapy
| | - Joanna Bates
- Centre for Health Education Scholarship.,Department of Family Practice, Faculty of Medicine, University of British Columbia
| | - Gil Kimel
- Palliative Care Program, St Paul's Hospital.,Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, BC
| | - Lorelei Lingard
- Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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107
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Vaidya GN, Abramov D. Echocardiographic Evaluation of Diastolic Function Is of Limited Value in the Diagnosis and Management of HFpEF. J Card Fail 2018; 24:392-396. [PMID: 29499321 DOI: 10.1016/j.cardfail.2018.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/13/2017] [Accepted: 02/20/2018] [Indexed: 12/19/2022]
Affiliation(s)
| | - Dmitry Abramov
- Department of Cardiology, Loma Linda University Hospital, Loma Linda, California.
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108
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The relationship between serum fibrosis markers and restrictive ventricular filling in patients with heart failure with reduced ejection fraction: A technetium-99m radionuclide ventriculography study. Oncotarget 2018; 8:2381-2390. [PMID: 27924061 PMCID: PMC5356808 DOI: 10.18632/oncotarget.13795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 11/24/2016] [Indexed: 12/11/2022] Open
Abstract
Myocardial fibrosis leads to a restrictive diastolic filling pattern of the left ventricle which is associated with a poor prognosis in patients with heart failure. We investigated the relationship between cardiac fibrosis and restrictive filling pattern of the left ventricle measured by Tc99m left ventriculography in patients with chronic symptomatic heart failure. Serum cardiac extracellular matrix markers including type I and III aminoterminal propeptide of procollagen (PINP and PIIINP), matrix metalloproteinase-2,9 (MMP-2,9), and tissue inhibitor of MMP-1 (TIMP-1) were analyzed. Fifty-one (39 males) patients were enrolled. Their median age was 51.8 years, and median left ventricular ejection fraction was 31.9%. Time to peak filling rate of the left ventricle was significantly correlated with serum levels of the three cardiac extracellular matrix markers (TIMP-1, PIIINP, and MMP-2). The patients with a restrictive diastolic filling pattern of the left ventricle (time to peak filling rate ≤ 154 ms) had significantly higher levels of these extracellular matrix markers. In receiver operating characteristic curve analysis, areas under the curve of PIIINP, TIMP-1, and MMP-2 were 0.758, 0.695, and 0.751 to predict the presence of a restrictive pattern. In C-statistics, all three cardiac extracellular matrix markers significantly increased the area under the curve after adding creatinine. In net reclassification improvement and integrated discrimination improvement models, PIIINP and MMP-2 significantly improved the predictive power of age, creatinine and brain natriuretic peptide. In conclusion, serum extracellular matrix markers are significantly correlated with restrictive diastolic filling pattern of the left ventricle in patients with heart failure.
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Stamp KD, Prasun M, Lee CS, Jaarsma T, Piano MR, Albert NM. Nursing research in heart failure care: a position statement of the american association of heart failure nurses (AAHFN). Heart Lung 2018; 47:169-175. [PMID: 29397988 DOI: 10.1016/j.hrtlng.2018.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heart Failure (HF) is a public health problem globally affecting approximately 6 million in the United States. OBJECTIVES A tailored position statement was developed by the American Association of Heart Failure Nurses (AAHFN) and their Research Consortium to assist researchers, funding institutions and policymakers with improving HF clinical advancements and outcomes. METHODS A comprehensive review was conducted using multiple search terms in various combinations to describe gaps in HF nursing science. Based on gaps described in the literature, the AAHFN made recommendations for future areas of research in HF. RESULTS Nursing has made positive contributions through disease management interventions, however, quality, rigorous research is needed to improve the lives of patients and families while advancing nursing science. CONCLUSIONS Advancing HF science is critical to managing and improving patient outcomes while promoting the nursing profession. Based on this review, the AAHFN is putting forth a call to action for research designs that promote validity, sustainability, and funding of future nursing research.
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Affiliation(s)
- Kelly D Stamp
- School of Nursing University of North Carolina at Greensboro, 218 Moore Building, P.O. Box 26170, Greensboro, NC 27420, USA.
| | - Marilyn Prasun
- Heart Failure Disease Management Program, Memorial Medical Center & Clinical Associate Professor, University of Illinois at Chicago, Chicago, IL, USA
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Chestnut Hill, MA, USA
| | - Tiny Jaarsma
- Department of Nursing, Linkoping University, Linkoping, Sweden
| | - Mariann R Piano
- School of Nursing, Vanderbilt University, Nashville, TN, USA
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Fonseca C, Brás D, Araújo I, Ceia F. Heart failure in numbers: Estimates for the 21st century in Portugal. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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111
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Insuficiência cardíaca em números: estimativas para o século XXI em Portugal. Rev Port Cardiol 2018; 37:97-104. [DOI: 10.1016/j.repc.2017.11.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 11/11/2017] [Indexed: 12/27/2022] Open
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112
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Avaldi VM, Lenzi J, Urbinati S, Molinazzi D, Descovich C, Campagna A, Taglioni M, Fioritti A, Fantini MP. Effect of cardiologist care on 6-month outcomes in patients discharged with heart failure: results from an observational study based on administrative data. BMJ Open 2017; 7:e018243. [PMID: 29101146 PMCID: PMC5695401 DOI: 10.1136/bmjopen-2017-018243] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/08/2017] [Accepted: 09/29/2017] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To evaluate the effect of cardiologist care on adherence to evidence-based secondary prevention medications, mortality and readmission within 6 months of discharge in patients with heart failure (HF). DESIGN Retrospective observational study based on administrative data. SETTING Local Healthcare Authority (LHA) of Bologna, one of the largest LHAs of Italy with ~870 000 inhabitants. PARTICIPANTS All patients residing in the LHA of Bologna discharged from hospital with a diagnosis of HF between 1 January 2015 and 31 December 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Multivariable regression analysis was used to assess the association of inpatient and outpatient cardiologist care with adherence to evidence-based medications, all-cause mortality and hospital readmission (including emergency room visits) within 6 months of discharge. RESULTS The study population included 2650 patients (mean age 82.3 years). 340 (12.8%) patients were discharged from cardiology wards, while 635 (24.0%) were seen by a cardiologist during follow-up. Inpatient and outpatient cardiologist care was associated with an increased likelihood of adherence to ACE inhibitors/angiotensin receptor blockers (ACEIs/ARBs), β-blockers and aldosterone antagonists after discharge. The risk of mortality was significantly lower among patients adherent to ACEIs/ARBs and/or β-blockers (-53% and -28%, respectively); the risk of hospital readmission was significantly lower among patients adherent to ACEIs/ARBs (-28%). CONCLUSIONS Compared with non-specialist care, cardiologist care improves patient adherence to evidence-based medications and might thus favourably affect mortality and readmission following HF.
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Affiliation(s)
- Vera Maria Avaldi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
| | - Stefano Urbinati
- Department of Cardiology, Bellaria Hospital, Bologna, Emilia-Romagna, Italy
| | - Dario Molinazzi
- Department of Management Control and Administrative Data, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Carlo Descovich
- Department of Clinical Governance and Quality, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Anselmo Campagna
- Regional Agency for Health and Social Care of Emilia-Romagna, Bologna, Emilia-Romagna, Italy
| | - Martina Taglioni
- Department of Clinical Governance and Quality, St Orsola-Malpighi Hospital, Bologna, Emilia-Romagna, Italy
| | - Angelo Fioritti
- Medical Directorate, Bologna Local Healthcare Authority, Bologna, Emilia-Romagna, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Emilia-Romagna, Italy
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Moretti HD, Colucci VJ, Berry BD. Vitamin D 3 repletion versus placebo as adjunctive treatment of heart failure patient quality of life and hormonal indices: a randomized, double-blind, placebo-controlled trial. BMC Cardiovasc Disord 2017; 17:274. [PMID: 29084522 PMCID: PMC5663043 DOI: 10.1186/s12872-017-0707-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 10/18/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Vitamin D status may influence heart failure (HF) patient outcomes by affecting b-type natriuretic peptide (BNP), parathyroid hormone (PTH), and enhancing cardiac contractility. Vitamin D deficiency is associated with morbidity and mortality in HF patients. The objective of this study was to determine if vitamin D3 at a comparatively high dose would replete 25-hydroxyvitamin D (25(OH)D) stores, improve BNP, PTH, cardiopulmonary function, reduce inflammatory markers, and improve quality of life (QOL) in HF patients. METHODS This was a 6 month, parallel group, double-blind, placebo-controlled, single clinic center, randomized trial of supplemental vitamin D3 using a dose of 10,000 IU daily or placebo in 40 vitamin D deficient or insufficient (25(OH)D level ≤ 32 ng/ml) patients with stable New York Heart Association Class II-III HF in a specialty cardiology clinic. All variables were measured at baseline and 6 months. Values between the two treatment groups were assessed using Student's t-test or Mann-Whitney Test. Univariate analysis of covariance was conducted to adjust for variance in baseline 25(OH)D. RESULTS All results were adjusted for baseline 25(OH)D. The change in BNP from baseline was ∆ +30 ± 950 pg/ml for treatment vs. placebo ∆ +400 ± 1900 pg/ml, p = 0.003. 25(OH)D serum levels rose by 49 ± 32 ng/ml in the treatment group vs 4 ± 10 ng/ml in the placebo group, p < 0.001. PTH and exercise chronotropic response index improved in the treatment group vs placebo group, respectively, but both were attenuated by adjustment ((∆-20 ± 20 pg/ml vs ∆ + 7 ± 53 pg/ml respectively (p = 0.01, adjusted p = 0.07)) and (∆ + 0.13 ± 0.26 vs. ∆-0.03 ± 02.9 respectively, p < 0.01, adjusted p = 0.17)). Other measured cardiopulmonary parameters remained unchanged. High sensitivity C-reactive protein (hsCRP) remained unchanged for women, but improved for men (∆-2 ± 4 treatment versus ∆2 ± 5 mg/L placebo, p = 0.05). QOL scores, including composite overall and clinical summary scores significantly improved in treatment compared to placebo (∆ + 10 ± 15 versus -6 ± 15, p < 0.01 and ∆ + 8 ± 14 versus -8 ± 18, p = 0.01, respectively). CONCLUSIONS Repletion of 25(OH)D may improve QOL in HF patients and may help to normalize BNP, PTH, and hsCRP. TRIAL REGISTRATION Clinicaltrials.gov, Trial Registration Number: NCT01636570 , First registered 3 July 2012.
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Affiliation(s)
- Heidi D. Moretti
- Providence Saint Patrick Hospital, 500 W. Broadway St, Missoula, MT 59802 USA
| | - Vincent J. Colucci
- International Heart Institute of Montana, 500 W. Broadway, Missoula, MT 59802 USA
- University of Montana, 32 Campus Drive, Missoula, MT 59812 USA
| | - Bradley D. Berry
- Providence Saint Patrick Hospital, 500 W. Broadway St, Missoula, MT 59802 USA
- International Heart Institute of Montana, 500 W. Broadway, Missoula, MT 59802 USA
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115
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Mahmoudi M, Yu M, Serpooshan V, Wu JC, Langer R, Lee RT, Karp JM, Farokhzad OC. Multiscale technologies for treatment of ischemic cardiomyopathy. NATURE NANOTECHNOLOGY 2017; 12:845-855. [PMID: 28875984 PMCID: PMC5717755 DOI: 10.1038/nnano.2017.167] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 07/13/2017] [Indexed: 05/02/2023]
Abstract
The adult mammalian heart possesses only limited capacity for innate regeneration and the response to severe injury is dominated by the formation of scar tissue. Current therapy to replace damaged cardiac tissue is limited to cardiac transplantation and thus many patients suffer progressive decay in the heart's pumping capacity to the point of heart failure. Nanostructured systems have the potential to revolutionize both preventive and therapeutic approaches for treating cardiovascular disease. Here, we outline recent advancements in nanotechnology that could be exploited to overcome the major obstacles in the prevention of and therapy for heart disease. We also discuss emerging trends in nanotechnology affecting the cardiovascular field that may offer new hope for patients suffering massive heart attacks.
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Affiliation(s)
- Morteza Mahmoudi
- Center for Nanomedicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 13169-43551, Iran
| | - Mikyung Yu
- Center for Nanomedicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Vahid Serpooshan
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Joseph C. Wu
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, California 94305, USA
- Department of Medicine, Division of Cardiology, Stanford University School of Medicine, Stanford, California 94305, USA
- Institute of Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California 94305, USA
| | - Robert Langer
- The David H. Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts 02139, USA
| | - Richard T. Lee
- Department of Stem Cell and Regenerative Biology, Harvard University, Harvard Stem Cell Institute, Cambridge, Massachusetts 02138, USA
- Department of Medicine, Division of Cardiology, Brigham and Women’s Hospital and Harvard Medical School, Cambridge, Massachusetts 02138, USA
| | - Jeffrey M. Karp
- Center for Nanomedicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts 02139, USA
- Division of Engineering in Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Harvard Stem Cell Institute, Cambridge, Massachusetts 02138, USA
| | - Omid C. Farokhzad
- Center for Nanomedicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Department of Anesthesiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
- Nanotechnology Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran 13169-43551, Iran
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116
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Wagenaar KP, Rutten FH, Klompstra L, Bhana Y, Sieverink F, Ruschitzka F, Seferovic PM, Lainscak M, Piepoli MF, Broekhuizen BD, Strömberg A, Jaarsma T, Hoes AW, Dickstein K. ‘heartfailurematters.org’, an educational website for patients and carers from the Heart Failure Association of the European Society of Cardiology: objectives, use and future directions. Eur J Heart Fail 2017; 19:1447-1454. [DOI: 10.1002/ejhf.917] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 05/16/2017] [Accepted: 05/22/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Kim P. Wagenaar
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Frans H. Rutten
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Leonie Klompstra
- Department of Social and Welfare Studies; Linköping University; Linköping Sweden
| | | | - Floor Sieverink
- Centre for eHealth & Welbeing Research; University of Twente; Enschede the Netherlands
| | - Frank Ruschitzka
- Department of Cardiology; University Hospital Zurich; Zurich Switzerland
| | - Petar M. Seferovic
- Department of Internal Medicine; Belgrade University School of Medicine; Belgrade Serbia
- Heart Failure Centre; Belgrade University Medical Centre; Belgrade Serbia
| | - Mitja Lainscak
- Department of Cardiology; General Hospital Celje; Celje Slovenia
| | - Massimo F. Piepoli
- Cardiac Department; Guglielmo da Saliceto Polichirurgico Hospital AUSL Piacenza; Piacenza Italy
| | - Berna D.L. Broekhuizen
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Anna Strömberg
- Department of Social and Welfare Studies; Linköping University; Linköping Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies; Linköping University; Linköping Sweden
| | - Arno W. Hoes
- Julius Centre for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| | - Kenneth Dickstein
- Department of Cardiology; Stavanger University Hospital, University of Bergen; Stavanger Norway
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Abstract
Heart failure is the quintessential cardiovascular syndrome of aging that results from common cardiovascular conditions in older adults in conjunction with age-associated changes in cardiovascular structure and function. To a large extent, heart failure is a geriatric syndrome in much the same way that dementia, falls, and frailty are geriatric syndromes. The incidence and prevalence of heart failure increase strikingly with age and make heart failure the most common reason for hospitalization among older adults. Although outcomes for older adults with heart failure have improved over time, mortality, hospitalization, and rehospitalization rates remain high.
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Affiliation(s)
- Kumar Dharmarajan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Yale University School of Medicine, 1 Church Street, Suite 200, New Haven, CT 06510, USA.
| | - Michael W Rich
- Division of Cardiology, Department of Internal Medicine, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St Louis, MO 63110, USA
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118
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Mogle J, Buck H, Zambroski C, Alvaro R, Vellone E. Cross-Validation of the Minnesota Living With Heart Failure Questionnaire. J Nurs Scholarsh 2017; 49:513-520. [PMID: 28755434 DOI: 10.1111/jnu.12318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 01/10/2023]
Abstract
PURPOSE The Minnesota Living With Heart Failure Questionnaire (MLHFQ) is the leading method for assessing quality of life in patients with heart failure (HF) around the world. However, unique, culture-specific variations in factorial structure have been identified. The current study examined the cross-cultural equivalence of an Italian version of the MLHFQ. DESIGN Cross-sectional assessment as part of an HF study in Italy. Patients (n = 1,192; mean age = 72 years, SD = 11) completed demographics, the MLHFQ, and the Short-Form 12 (SF-12). METHODS A series of exploratory and confirmatory factor analyses were used to develop an appropriate factor model in the current sample. FINDINGS We initially fit a confirmatory factor analysis based on published psychometric work validating the MLHFQ. This did not provide adequate fit, and the sample was then randomly split into equivalent subsets to conduct factor analyses with cross-validation. In the first subsample, an exploratory factor analysis uncovered slight modifications to the proposed factor structure that resulted in much improved model fit. The final model included a higher order factor and three subscales: physical, emotional, and social. A cross-validation confirmatory factor analysis using this structure was conducted in the remaining subset to ensure broader applicability of the results. Correlations with the SF-12 were consistent with previous work using these measures. CONCLUSIONS Some items of the MLHFQ are sensitive to differences across cultures, and factor structures vary based on where the scale is administered. In spite of these differences, the total score remains a valid and reliable indicator of quality of life in HF patients across cultures. CLINICAL RELEVANCE Cultural influences on quality of life are important to consider when assessing patients' well-being in HF.
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Affiliation(s)
- Jacqueline Mogle
- Assistant Professor, College of Nursing, Pennsylvania State University, University Park, PA, USA
| | - Harleah Buck
- Associate Professor, Coordinator of Chronic Illness Initiatives, College of Nursing, University of South Florida, Tampa, FL, USA
| | - Cheryl Zambroski
- Associate Professor and Director, College of Nursing, University of South Florida, Tampa, FL, USA
| | - Rosaria Alvaro
- Associate Professor in Nursing Science, Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
| | - Ercole Vellone
- Assistant Professor in Nursing Science, Department of Biomedicine and Prevention, University of Rome "Tor Vergata,", Rome, Italy
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119
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Sidney S, Quesenberry CP, Jaffe MG, Sorel M, Go AS, Rana JS. Heterogeneity in national U.S. mortality trends within heart disease subgroups, 2000-2015. BMC Cardiovasc Disord 2017; 17:192. [PMID: 28720073 PMCID: PMC5516392 DOI: 10.1186/s12872-017-0630-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 07/12/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The long-term downward national U.S. trend in heart disease-related mortality slowed substantially during 2011-2014 before turning upward in 2015. Examining mortality trends in the major subgroups of heart disease may provide insight into potentially more targeted and effective prevention and treatment approaches to promote favorable trajectories. We examined national trends between 2000 and 2015 in mortality attributed to major heart disease subgroups including ischemic heart disease, heart failure, and all other types of heart disease. METHODS Using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER) data system, we determined national trends in age-standardized mortality rates attributed to ischemic heart disease, heart failure, and other heart diseases from January 1, 2000, to December 31, 2011, and from January 1, 2011, to December 31, 2015. Annual rate of changes in mortality attributed to ischemic heart disease, heart failure, and other heart diseases for 2000-2011 and 2011-2015 were compared. RESULTS Death attributed to ischemic heart disease declined from 2000 to 2015, but the rate of decline slowed from 4.96% (95% confidence interval 4.77%-5.15%) for 2000-2011 to 2.66% (2.00%-3.31%) for 2011-2015. In contrast, death attributed to heart failure and all other causes of heart disease declined from 2000 to 2011 at annual rates of 1.94% (1.77%-2.11%) and 0.64% (0.44%-0.82%) respectively, but increased from 2011 to 2015 at annual rates of 3.73% (3.21% 4.26%) and 1.89% (1.33-2.46%). Differences in 2000-2011 and 2011-2015 decline rates were statistically significant for all 3 endpoints overall, by sex, and all race/ethnicity groups except Asian/Pacific Islanders (heart failure only significant) and American Indian/Alaskan Natives. CONCLUSIONS While the long-term decline in death attributed to heart disease slowed between 2011 and 2014 nationally before turning upward in 2015, heterogeneity existed in the trajectories attributed to heart disease subgroups, with ischemic heart disease mortality continuing to decline while death attributed to heart failure and other heart diseases switched from a downward to upward trend. While systematic efforts to prevent and treat ischemic heart disease continue to be effective, urgent attention is needed to address the challenge of heart failure.
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Affiliation(s)
- Stephen Sidney
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Charles P. Quesenberry
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Marc G. Jaffe
- Department of Endocrinology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, CA USA
| | - Michael Sorel
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, San Francisco, CA USA
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA USA
| | - Jamal S. Rana
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA 94612 USA
- Department of Cardiology, Kaiser Permanente Oakland Medical Center, Oakland, CA USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA USA
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120
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Ruiz M, Labarthe F, Fortier A, Bouchard B, Thompson Legault J, Bolduc V, Rigal O, Chen J, Ducharme A, Crawford PA, Tardif JC, Des Rosiers C. Circulating acylcarnitine profile in human heart failure: a surrogate of fatty acid metabolic dysregulation in mitochondria and beyond. Am J Physiol Heart Circ Physiol 2017; 313:H768-H781. [PMID: 28710072 DOI: 10.1152/ajpheart.00820.2016] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 07/07/2017] [Accepted: 07/07/2017] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) is associated with metabolic perturbations, particularly of fatty acids (FAs), which remain to be better understood in humans. This study aimed at testing the hypothesis that HF patients with reduced ejection fraction display systemic perturbations in levels of energy-related metabolites, especially those reflecting dysregulation of FA metabolism, namely, acylcarnitines (ACs). Circulating metabolites were assessed using mass spectrometry (MS)-based methods in two cohorts. The main cohort consisted of 72 control subjects and 68 HF patients exhibiting depressed left ventricular ejection fraction (25.9 ± 6.9%) and mostly of ischemic etiology with ≥2 comorbidities. HF patients displayed marginal changes in plasma levels of tricarboxylic acid cycle-related metabolites or indexes of mitochondrial or cytosolic redox status. They had, however, 22-79% higher circulating ACs, irrespective of chain length (P < 0.0001, adjusted for sex, age, renal function, and insulin resistance, determined by shotgun MS/MS), which reflects defective mitochondrial β-oxidation, and were significantly associated with levels of NH2-terminal pro-B-type natriuretic peptide levels, a disease severity marker. Subsequent extended liquid chromatography-tandem MS analysis of 53 plasma ACs in a subset group from the primary cohort confirmed and further substantiated with a comprehensive lipidomic analysis in a validation cohort revealed in HF patients a more complex circulating AC profile. The latter included dicarboxylic-ACs and dihydroxy-ACs as well as very long chain (VLC) ACs or sphingolipids with VLCFAs (>20 carbons), which are proxies of dysregulated FA metabolism in peroxisomes. Our study identified alterations in circulating ACs in HF patients that are independent of biological traits and associated with disease severity markers. These alterations reflect dysfunctional FA metabolism in mitochondria but also beyond, namely, in peroxisomes, suggesting a novel mechanism contributing to global lipid perturbations in human HF.NEW & NOTEWORTHY Mass spectrometry-based profiling of circulating energy metabolites, including acylcarnitines, in two cohorts of heart failure versus control subjects revealed multiple alterations in fatty acid metabolism in peroxisomes in addition to mitochondria, thereby highlighting a novel mechanism contributing to global lipid perturbations in heart failure.Listen to this article's corresponding podcast at http://ajpheart.podbean.com/e/acylcarnitines-in-human-heart-failure/.
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Affiliation(s)
- Matthieu Ruiz
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Research Center, Montreal, Quebec, Canada
| | - François Labarthe
- CHRU de Tours, Université François Rabelais, Institut National de la Santé et de la Recherche Médicale U1069, Nutrition, Croissance et Cancer, Tours, France
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Montreal, Quebec, Canada
| | - Bertrand Bouchard
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Research Center, Montreal, Quebec, Canada
| | - Julie Thompson Legault
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada.,Montreal Heart Institute, Research Center, Montreal, Quebec, Canada
| | - Virginie Bolduc
- Montreal Heart Institute, Research Center, Montreal, Quebec, Canada
| | - Odile Rigal
- Laboratoire de Biochimie, Hôpital R. Debré, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jane Chen
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; and
| | - Anique Ducharme
- Montreal Heart Institute, Research Center, Montreal, Quebec, Canada.,Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Peter A Crawford
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri; and
| | | | - Christine Des Rosiers
- Department of Nutrition, Université de Montréal, Montreal, Quebec, Canada; .,Montreal Heart Institute, Research Center, Montreal, Quebec, Canada
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121
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Kruzliak P, Berezin A, Kremzer A, Samura T, Benacka R, Mozos I, Egom E, Rodrigo L. Global Longitudinal Strain and Strain Rate in Type Two Diabetes Patients with Chronic Heart Failure: Relevance to Osteoprotegerin. Folia Med (Plovdiv) 2017; 58:164-173. [PMID: 27760011 DOI: 10.1515/folmed-2016-0021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 05/31/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Biomechanical stress and inflammatory biomarkers relate to global contractility dysfunction; however, adding these biomarkers into a risk model constructed on clinical data does not improve its prediction value in chronic heart failure (CHF). AIM The aim of this study was to evaluate whether biomarkers predict declining of left ventricular global contractility function in diabetic patients with ischemia-induced CHF. PATIENTS AND METHODS The study retrospectively evolved 54 diabetic patients who had systolic or diastolic ischemia-induced CHF that was defined as left-ventricular ejection fraction (LVEF) ≤45% or 46-55% respectively assessed by quantitative echocardiography and other conventional criteria according to current clinical guidelines. Two-dimensional transthoracic echocardiography and tissue Doppler imaging were performed according to a conventional method. Radial, longitudinal, and circumferential strain and strain rate values were obtained by speckle-tracking Imaging analysis of both LV short axis and long axis views. Serum adiponectin, NT-pro brain natriuretic peptide (BNP), osteoprotegerin, and hs- C-reactive protein (CRP) were determined at baseline by ELISA. RESULTS We found lower global longitudinal strain and strain rate in diabetic patients with LVEF <45% than these in diabetic patients that did not have LVEF (Р=0.001 for all cases). Multivariate logistic regression analysis showed that NT-proBNP (r=0.432; P=0.001 and r=0.402; P=0.001, respectively), osteoprotegerin (r=0.422; P=0.001 and r=0.401; P=0.001, respectively), hs-CRP (r=0.408; P=0.001 and r=0.404; P=0.001, respectively) were independently inversely associated with global longitudinal strain and strain rate in CHF patients. CONCLUSION We suggest that osteoprotegerin may be useful in improving the NT-proBNP based model as predictor of decreased global contractility function in diabetic patients with CHF.
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Affiliation(s)
- Peter Kruzliak
- Laboratory of Structural Biology and Proteomics, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Alexander Berezin
- Department of Internal Medicine, State Medical University, Zaporozhye, Ukraine
| | - Alexander Kremzer
- Department of Clinical Pharmacology, State Medical University, Zaporozhye, Ukraine
| | - Tatyana Samura
- Department of Clinical Pharmacology, State Medical University, Zaporozhye, Ukraine
| | | | - Ioana Mozos
- Department of Functional Sciences, Victor Babes University of Medicine and Pharmacy, Timișoara, Romania
| | - Emmanuel Egom
- Department of Clinical Medicine, Education Division, Trinity College, University of Dublin, Dublin, Ireland
| | - Luis Rodrigo
- Central University Hospital of Asturia, University of Oviedo, Oviedo, Spain
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122
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Abstract
LCZ696, a first-in-class angiotensin receptor neprilysin inhibitor (ARNI), is comprised of the angiotensin receptor blocker valsartan and the neprilysin inhibitor pro-drug sacubitril (AHU377). After oral administration, AHU377 is rapidly metabolized to the active neprilysin inhibitor LBQ657. LCZ696 exerts its effects of diuresis, natriuresis, vasodilation and aldosterone secretion inhibition through simultaneous renin-angiotensin-aldosterone system (RAAS) blockade and natriuretic peptides system (NPS) enhancement. Powerful evidence including PARAMETER and PRARDIGM-HF trials have shown that LCZ696 outperforms RAAS inhibition in treating patients with hypertension and heart failure with reduced ejection fraction (HFrEF), and is well tolerated. In addition, accumulating evidence also suggests its potential use in heart failure with preserved ejection fraction (HFpEF), chronic kidney disease (CKD), post-myocardium infarction (post-MI) and stroke. Both the FDA and CHMP have approved LCZ696 for treatment of HFrEF. Despite all this, some special issues (e.g. use in specific subgroups, adverse events, contraindications and cost-effectiveness analysis) should be considered before its implementation in clinical practice.
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123
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The Role of Cardiologists in the Management of Patients with Heart Failure. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1067:133-144. [PMID: 29188455 DOI: 10.1007/5584_2017_120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Heart failure is a complex clinical syndrome with a remarkable impact on health care systems in terms of patients' morbidity and mortality, as well as direct and indirect costs. It is essential to redesign models of care for patients with heart failure that are tailored on personalized health care needs and carried out in the most appropriate setting. There is some debate about the role of cardiologists in the management of patients with heart failure. Indeed, results regarding the inclination of cardiologists' patients to achieve better outcomes are controversial, given the heterogeneity of studies in terms of study design, population, setting and variables considered. The aim of this chapter is to describe and synthesize the current state of knowledge about the role of specialists in the management of patient with heart failure, and to assess whether there is a type of patients for which cardiologists demonstrate the greatest value or a setting of care where they add more benefit.
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124
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Hošková L, Málek I, Kopkan L, Kautzner J. Pathophysiological mechanisms of calcineurin inhibitor-induced nephrotoxicity and arterial hypertension. Physiol Res 2016; 66:167-180. [PMID: 27982677 DOI: 10.33549/physiolres.933332] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Solid organ transplantation is an established treatment modality in patients with end-stage organ damage in cases where other therapeutic options fail. The long-term outcomes of solid organ transplant recipients have improved considerably since the introduction of the first calcineurin inhibitor (CNI) - cyclosporine. In 1984, the potent immunosuppressive properties of another CNI, tacrolimus, were discovered. The immunosuppressive effects of CNIs result from the inhibition of interleukin-2 synthesis and reduced proliferation of T cells due to calcineurin blockade. The considerable side effects that are associated with CNIs therapy include arterial hypertension and nephrotoxicity. The focus of this article was to review the available literature on the pathophysiological mechanisms of CNIs that induce chronic nephrotoxicity and arterial hypertension. CNIs lead to activation of the major vasoconstriction systems, such as the renin-angiotensin and endothelin systems, and increase sympathetic nerve activity. On the other hand, CNIs are known to inhibit NO synthesis and NO-mediated vasodilation and to increase free radical formation. Altogether, these processes cause endothelial dysfunction and contribute to the impairment of organ function. A better insight into the mechanisms underlying CNI nephrotoxicity could assist in developing more targeted therapies of arterial hypertension or preventing CNI nephrotoxicity in organ transplant recipients, including heart transplantation.
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Affiliation(s)
- L Hošková
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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125
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Bachmann BJ, Bernardi L, Loosli C, Marschewski J, Perrini M, Ehrbar M, Ermanni P, Poulikakos D, Ferrari A, Mazza E. A Novel Bioreactor System for the Assessment of Endothelialization on Deformable Surfaces. Sci Rep 2016; 6:38861. [PMID: 27941901 PMCID: PMC5150819 DOI: 10.1038/srep38861] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/15/2016] [Indexed: 12/28/2022] Open
Abstract
The generation of a living protective layer at the luminal surface of cardiovascular devices, composed of an autologous functional endothelium, represents the ideal solution to life-threatening, implant-related complications in cardiovascular patients. The initial evaluation of engineering strategies fostering endothelial cell adhesion and proliferation as well as the long-term tissue homeostasis requires in vitro testing in environmental model systems able to recapitulate the hemodynamic conditions experienced at the blood-to-device interface of implants as well as the substrate deformation. Here, we introduce the design and validation of a novel bioreactor system which enables the long-term conditioning of human endothelial cells interacting with artificial materials under dynamic combinations of flow-generated wall shear stress and wall deformation. The wall shear stress and wall deformation values obtained encompass both the physiological and supraphysiological range. They are determined through separate actuation systems which are controlled based on validated computational models. In addition, we demonstrate the good optical conductivity of the system permitting online monitoring of cell activities through live-cell imaging as well as standard biochemical post-processing. Altogether, the bioreactor system defines an unprecedented testing hub for potential strategies toward the endothelialization or re-endothelialization of target substrates.
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Affiliation(s)
- Björn J. Bachmann
- ETH Zurich, Laboratory of Thermodynamics in Emerging Technologies, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Laura Bernardi
- ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092 Zurich, Switzerland
| | - Christian Loosli
- ETH Zurich, Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering, Tannenstrasse 3, CH-8092 Zurich, Switzerland
| | - Julian Marschewski
- ETH Zurich, Laboratory of Thermodynamics in Emerging Technologies, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Michela Perrini
- ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092 Zurich, Switzerland
- University Hospital Zurich, Department of Obstetrics, Zurich, Switzerland
| | - Martin Ehrbar
- University Hospital Zurich, Department of Obstetrics, Zurich, Switzerland
| | - Paolo Ermanni
- ETH Zurich, Laboratory of Composite Materials and Adaptive Structures, Department of Mechanical and Process Engineering, Tannenstrasse 3, CH-8092 Zurich, Switzerland
| | - Dimos Poulikakos
- ETH Zurich, Laboratory of Thermodynamics in Emerging Technologies, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Aldo Ferrari
- ETH Zurich, Laboratory of Thermodynamics in Emerging Technologies, Sonneggstrasse 3, 8092 Zurich, Switzerland
| | - Edoardo Mazza
- ETH Zurich, Institute for Mechanical Systems, Leonhardstrasse 21, 8092 Zurich, Switzerland
- Empa, Swiss Federal Laboratories for Materials Science & Technology, Überlandstr. 129, 8600 Dübendorf, Switzerland
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126
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van den Berge JC, Akkerhuis MK, Constantinescu AA, Kors JA, van Domburg RT, Deckers JW. Temporal trends in long-term mortality of patients with acute heart failure: Data from 1985–2008. Int J Cardiol 2016; 224:456-460. [DOI: 10.1016/j.ijcard.2016.09.062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/26/2016] [Accepted: 09/15/2016] [Indexed: 12/28/2022]
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127
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Guo LY, Liu B, Sun ZC, Sun Y, Li JX, He Z. Miraculous Recovery of a Dilated Heart after Usage of Supramaximal Titrated Valsartan for 8 Months. Chin Med J (Engl) 2016; 129:2771-2772. [PMID: 27824018 PMCID: PMC5126177 DOI: 10.4103/0366-6999.193448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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128
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Carga de enfermedad de la insuficiencia cardiaca en América Latina: revisión sistemática y metanálisis. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2016.04.045] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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129
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Li XL, Zeng D, Chen Y, Ding L, Li WJ, Wei T, Ou DB, Yan S, Wang B, Zheng QS. Role of alpha- and beta-adrenergic receptors in cardiomyocyte differentiation from murine-induced pluripotent stem cells. Cell Prolif 2016; 50. [PMID: 27790820 DOI: 10.1111/cpr.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Induced pluripotent stem cell (iPSC)-derived cardiomyocytes are a promising source of cells for regenerative heart disease therapies, but progress towards their use has been limited by their low differentiation efficiency and high cellular heterogeneity. Previous studies have demonstrated expression of adrenergic receptors (ARs) in stem cells after differentiation; however, roles of ARs in fate specification of stem cells, particularly in cardiomyocyte differentiation and development, have not been characterized. MATERIALS AND METHODS Murine-induced pluripotent stem cells (miPSCs) were cultured in hanging drops to form embryoid bodies, cells of which were then differentiated into cardiomyocytes. To determine whether ARs regulated miPSC differentiation into cardiac lineages, effects of the AR agonist, epinephrine (EPI), on miPSC differentiation and underlying signalling mechanisms, were evaluated. RESULTS Treatment with EPI, robustly enhanced miPSC cardiac differentiation, as indicated by increased expression levels of cardiac-specific markers, GATA4, Nkx2.5 and Tnnt2. Although β-AR signalling is the foremost signalling pathway in cardiomyocytes, EPI-enhanced cardiac differentiation depended more on α-AR signalling than β-AR signalling. In addition, selective activation of α1 -AR signalling with specific agonists induced vigorous cardiomyocyte differentiation, whereas selective activation of α2 - or β-AR signalling induced no or less differentiation, respectively. EPI- and α1 -AR-dependent cardiomyocyte differentiation from miPSCs occurred through specific promotion of CPC proliferation via the MEK-ERK1/2 pathway and regulation of miPS cell-cycle progression. CONCLUSIONS These results demonstrate that activation of ARs, particularly of α1 -ARs, promoted miPSC differentiation into cardiac lineages via MEK-ERK1/2 signalling.
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Affiliation(s)
- Xiao-Li Li
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Di Zeng
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Yan Chen
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China.,Department of Emergency, Chinese PLA No.401 Hospital, Qingdao, 266071, China
| | - Lu Ding
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Wen-Ju Li
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Ting Wei
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Dong-Bo Ou
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Song Yan
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Bin Wang
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
| | - Qiang-Sun Zheng
- Department of Cardiology, Tangdu Hospital, The Fourth Military Medical University, Xi'an, 710038, China
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Kumari K, Ganesh V, Jayant A, Dhawan R, Banayan J. Perioperative Hypertension and Diastolic Dysfunction. J Cardiothorac Vasc Anesth 2016; 31:1487-1496. [PMID: 28041811 DOI: 10.1053/j.jvca.2016.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Kamesh Kumari
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Venkata Ganesh
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aveek Jayant
- Department of Anesthesia and Intensive Care, Nehru Hospital (Level 4), Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Richa Dhawan
- Department of Anesthesia, Swedish Covenant Hospital, Chicago, IL
| | - Jennifer Banayan
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
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El-Menyar A, Sulaiman K, AlSadawi A, AlSheikh-Ali AA, AlMahameed W, Bazargani N, AlMotarreb A, Amin H, Asaad N, Al Habib K, Ridha M, Al-Jarallah M, Al-Thani H, AlFaleh H, Singh R, Panduranga P, Al Suwaidi J. Implications of a History of Syncope in Patients Hospitalized With Heart Failure. Angiology 2016; 68:196-206. [PMID: 27255265 DOI: 10.1177/0003319716647320] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed the frequency and implications of a history of syncope of up to 1 year prior to hospitalization with acute heart failure (AHF) between February and November 2012. Data were collected for 5005 patients hospitalized with AHF and analyzed and compared according to the absence/presence of a history of syncope (group 1 vs group 2). Prior syncope among patients with heart failure was 5.3%. Age, gender, hypertension, atrial fibrillation, bundle branch block, left ventricular ejection fraction (LVEF), and obstructed coronary vessels were comparable in the 2 groups. Group 2 patients were more likely to smoke or have diabetes mellitus, stroke, and cardiac arrest. Group 2 patients frequently required aggressive treatment and had more worse in-hospital and 1-year outcomes compared to group 1. After adjustment for age, sex, ethnicity, and LVEF, multivariate regression analysis showed that history of syncope predicted in-hospital mortality (odds ratio: 2.61; 95% confidence interval: 1.707-4.002). History of syncope during the year prior to the index admission with AHF is a marker of worse outcomes regardless of patient age and LVEF. Further studies are required to confirm this observation and its clinical implications.
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Affiliation(s)
- Ayman El-Menyar
- 1 Clinical Medicine, Weill Cornel Medical College, Doha, Qatar.,2 Clinical Research, Hamad General Hospital, Doha, Qatar
| | | | - Ali AlSadawi
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alawi A AlSheikh-Ali
- 5 Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Wael AlMahameed
- 6 Cardiology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Nooshin Bazargani
- 7 Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Ahmed AlMotarreb
- 8 Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | - Haitham Amin
- 9 Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Nidal Asaad
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Al Habib
- 10 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mustafa Ridha
- 11 Department of Cardiology, Adan Hospital, Hadiya, Kuwait
| | | | | | - Husam AlFaleh
- 10 Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Rajvir Singh
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Jassim Al Suwaidi
- 4 Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Ciapponi A, Alcaraz A, Calderón M, Matta MG, Chaparro M, Soto N, Bardach A. Burden of Heart Failure in Latin America: A Systematic Review and Meta-analysis. ACTA ACUST UNITED AC 2016; 69:1051-1060. [PMID: 27553287 DOI: 10.1016/j.rec.2016.04.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 04/22/2016] [Indexed: 02/07/2023]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure is a major public health concern. The aim of this review was to estimate the burden of heart failure in Latin America. METHODS Systematic review and meta-analysis following a search in MEDLINE, EMBASE, LILACS, and CENTRAL for articles published between January 1994 and June 2014, with no language restrictions. We included experimental and observational studies with at least 50 participants aged ≥ 18 years. RESULTS In total, 143 of the 4792 references retrieved were included in the study. Most studies had been conducted in South America (92%), and mainly in Brazil (64%). The mean age of the patients was 60 ± 9 years, and mean ejection fraction was 36% ± 9%. The incidence of heart failure in the single population study providing this information was 199 cases per 100000 person-years. The prevalence of heart failure was 1% (95% confidence interval [95%CI], 0.1%-2.7%); hospital readmission rates were 33%, 28%, 31%, and 35% at 3, 6, 12, and 24 to 60 months of follow-up, respectively; and the median duration of hospitalization was 7.0 days. The 1-year mortality rate was 24.5% (95%CI, 19.4%-30.0%). In-hospital mortality was 11.7% (95%CI, 10.4%-13.0%), and the rate was higher in patients with a reduced ejection fraction, ischemic heart disease, or Chagas disease. CONCLUSIONS Few studies have evaluated the incidence and prevalence of heart failure in Latin America. High mortality and hospitalization rates were found, and the main limitation was heterogeneity between studies. The results presented provide useful epidemiologic information for decision-making related to this disease. Further studies with standardized methods and representative populations are needed in this line.
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Affiliation(s)
- Agustín Ciapponi
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina.
| | - Andrea Alcaraz
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - María Calderón
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - María Gabriela Matta
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Martin Chaparro
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Natalie Soto
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Ariel Bardach
- Departamento de Revisiones Sistemáticas, Evaluación de Tecnologías Sanitarias y Evaluaciones Económicas, Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
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Smit J, Adelborg K, Thomsen RW, Søgaard M, Schønheyder HC. Chronic heart failure and mortality in patients with community-acquired Staphylococcus aureus bacteremia: a population-based cohort study. BMC Infect Dis 2016; 16:227. [PMID: 27225712 PMCID: PMC4880885 DOI: 10.1186/s12879-016-1570-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
Background Patients with chronic heart failure (CHF) may experience higher mortality of Staphylococcus aureus bacteremia (SAB) than patients without CHF due to insufficient cardiovascular responses during systemic infection. We investigated 90-day mortality in SAB patients with and without CHF. Methods Using population-based medical databases, we conducted a cohort study of all adult patients with community-acquired SAB (CA-SAB) in Northern Denmark, 2000-2011. Ninety-day mortality after SAB for patients with and without CHF was estimated by the Kaplan-Meier method. Based on Cox regression analysis, we computed hazard ratios as estimates of mortality rate ratios (MRRs) overall and stratified by CHF-related conditions (e.g., cardiomyopathy and valvular heart disease), CHF severity (defined by daily dosage of loop-diuretics), and CHF duration while adjusting for potential confounders. Results Among 2638 SAB patients, 390 (14.8 %) had a history of CHF. Ninety-day mortality was 45 % in patients with CHF and 30 % in patients without CHF, which yielded an adjusted MRR (aMRR) of 1.24 (95 % CI, 1.04-1.48). Compared to patients without CHF, the excess risk of death was most pronounced among patients with valvular heart disease (aMRR = 1.73 (95 % CI, 1.26–2.38)), patients with daily loop-diuretic dosages of 81–159 mg/day (aMRR = 1.55 (95 % CI, 1.11–2.14)) and ≥160 mg/day (aMRR = 1.62 (95 % CI, 1.21–2.18)), and among patients with <3 years of CHF duration (aMRR = 1.43 (95 % CI, 1.14–1.78)). Conclusion CA-SAB patients with CHF experienced increased 90-day mortality compared to patients without CHF. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1570-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jesper Smit
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark. .,Department of Infectious Diseases, Aalborg University Hospital, Mølleparkvej 4, P.O. Box 365, DK-9100, Aalborg, Denmark. .,Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark.
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark
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Abstract
PURPOSE OF REVIEW Heart failure prevention is an important public health goal. Increased physical activity and exercise may help to prevent heart failure, as they are associated with reduced heart failure incidence and potentially act through a variety of mechanisms to slow disease progression. RECENT FINDINGS Increased physical activity, higher cardiorespiratory fitness, and lower sedentary time are associated with reduced heart failure incidence. These associations are consistent for occurrence of heart failure with both preserved and reduced ejection fraction, the common subphenotypes of the condition. Physiologic cardiac and vascular remodeling occurs across the normal range of physical activity in the community, and regular exercise (four to five sessions per week) is necessary to mitigate age-associated reductions in ventricular compliance and cardiac mass. SUMMARY Greater physical activity, less sedentary time, and improved cardiorespiratory fitness are associated with reductions in heart failure risk. Various mechanisms may explain these findings, including: reducing the prevalence of standard and novel cardiovascular risk factors, inhibiting pathologic cardiovascular remodeling, promoting physiologic remodeling, and improving cardiac, neurohormonal, skeletal muscle, pulmonary, renal, and vascular performance. Future research is needed to elucidate the optimal timing, duration, and modality of physical activity and exercise training necessary to prevent the development of heart failure.
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135
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Berezin AE. Prognostication in Different Heart Failure Phenotypes: The Role of Circulating Biomarkers. J Circ Biomark 2016; 5:6. [PMID: 28936254 PMCID: PMC5548324 DOI: 10.5772/62797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 03/02/2016] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) is multifactorial syndrome with high cardiovascular (CV) morbidity and mortality rates associated with an increasing prevalence worldwide. Measuring plasma levels of circulating biomarkers, i.e., natriuretic peptides, cardiac-specific troponins, metabolomic intermediates, Galectin-3, ST2, cardiotrophin-1, soluble endoglin and growth differentiation factor 15, may assist in the prognostication of HF development. However, the role of biomarker models in the prediction of an early stage of HF with a preserved ejection fraction (HFpEF) and HF with a reduced ejection fraction (HFrEF) is not still understood. This review explores the knowledge regarding the utility of cardiac biomarkers, aiming to reclassify patients with different phenotypes of HF. The review reports that several biomarkers reflected on subsequently alter collagen turnover, cardiac fibrosis and inflammation, which might have diagnostic and predictive value in HFpEF and HFrEF. The best candidates for determining the early stage of HF development were sST2, Galectin-3, CT-1 and GDF-15. However, increased plasma concentrations of these biomarkers were not specific to a distinct disease group of HFpEF and HFrEF. Finally, more investigations are required to determine the role of novel biomarkers in the prediction of HF and the determination of the early stages of HFpEF and HFrEF development.
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Turnbull IC, Eltoukhy AA, Fish KM, Nonnenmacher M, Ishikawa K, Chen J, Hajjar RJ, Anderson DG, Costa KD. Myocardial Delivery of Lipidoid Nanoparticle Carrying modRNA Induces Rapid and Transient Expression. Mol Ther 2016; 24:66-75. [PMID: 26471463 PMCID: PMC4754552 DOI: 10.1038/mt.2015.193] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 09/07/2015] [Indexed: 12/25/2022] Open
Abstract
Nanoparticle-based delivery of nucleotides offers an alternative to viral vectors for gene therapy. We report highly efficient in vivo delivery of modified mRNA (modRNA) to rat and pig myocardium using formulated lipidoid nanoparticles (FLNP). Direct myocardial injection of FLNP containing 1-10 μg eGFPmodRNA in the rat (n = 3 per group) showed dose-dependent enhanced green fluorescent protein (eGFP) mRNA levels in heart tissue 20 hours after injection, over 60-fold higher than for naked modRNA. Off-target expression, including lung, liver, and spleen, was <10% of that in heart. Expression kinetics after injecting 5 μg FLNP/eGFPmodRNA showed robust expression at 6 hours that reduced by half at 48 hours and was barely detectable at 2 weeks. Intracoronary administration of 10 μg FLNP/eGFPmodRNA also proved successful, although cardiac expression of eGFP mRNA at 20 hours was lower than direct injection, and off-target expression was correspondingly higher. Findings were confirmed in a pilot study in pigs using direct myocardial injection as well as percutaneous intracoronary delivery, in healthy and myocardial infarction models, achieving expression throughout the ventricular wall. Fluorescence microscopy revealed GFP-positive cardiomyocytes in treated hearts. This nanoparticle-enabled approach for highly efficient, rapid and short-term mRNA expression in the heart offers new opportunities to optimize gene therapies for enhancing cardiac function and regeneration.
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Affiliation(s)
- Irene C Turnbull
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ahmed A Eltoukhy
- David H Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kenneth M Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mathieu Nonnenmacher
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kiyotake Ishikawa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Daniel G Anderson
- David H Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kevin D Costa
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Jain S, Londono FJ, Segers P, Gillebert TC, De Buyzere M, Chirinos JA. MRI Assessment of Diastolic and Systolic Intraventricular Pressure Gradients in Heart Failure. Curr Heart Fail Rep 2016; 13:37-46. [DOI: 10.1007/s11897-016-0281-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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138
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Abstract
Heart failure (HF) is a major public health problem affecting more than 23 million patients worldwide. Incidence and prevalence rates vary significantly according to the source of data, but both increase with advancing age reaching, in the very elderly, prevalence rates that represent a challenge for the organization of medical care systems. Even if evidence-based treatments have improved prognosis in some patients with HF, patients with HF still need to be carefully characterized, described, and treated. Hospitalizations for acute HF are frequent and costly accounting for the vast majority of HF-related costs.
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Affiliation(s)
- Francesco Orso
- Department of Medicine and Geriatrics, Section of Geriatric Medicine and Cardiology, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.,ANMCO Research Center, Via La Marmora 34, 50121, Florence, Italy
| | - Gianna Fabbri
- ANMCO Research Center, Via La Marmora 34, 50121, Florence, Italy
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Inglis SC, Clark RA, Dierckx R, Prieto-Merino D, Cleland JGF. Structured telephone support or non-invasive telemonitoring for patients with heart failure. Cochrane Database Syst Rev 2015; 2015:CD007228. [PMID: 26517969 PMCID: PMC8482064 DOI: 10.1002/14651858.cd007228.pub3] [Citation(s) in RCA: 177] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Specialised disease management programmes for heart failure aim to improve care, clinical outcomes and/or reduce healthcare utilisation. Since the last version of this review in 2010, several new trials of structured telephone support and non-invasive home telemonitoring have been published which have raised questions about their effectiveness. OBJECTIVES To review randomised controlled trials (RCTs) of structured telephone support or non-invasive home telemonitoring compared to standard practice for people with heart failure, in order to quantify the effects of these interventions over and above usual care. SEARCH METHODS We updated the searches of the Cochrane Central Register of Controlled Trials (CENTRAL), Database of Abstracts of Reviews of Effects (DARE), Health Technology AsseFssment Database (HTA) on the Cochrane Library; MEDLINE (OVID), EMBASE (OVID), CINAHL (EBSCO), Science Citation Index Expanded (SCI-EXPANDED), Conference Proceedings Citation Index- Science (CPCI-S) on Web of Science (Thomson Reuters), AMED, Proquest Theses and Dissertations, IEEE Xplore and TROVE in January 2015. We handsearched bibliographies of relevant studies and systematic reviews and abstract conference proceedings. We applied no language limits. SELECTION CRITERIA We included only peer-reviewed, published RCTs comparing structured telephone support or non-invasive home telemonitoring to usual care of people with chronic heart failure. The intervention or usual care could not include protocol-driven home visits or more intensive than usual (typically four to six weeks) clinic follow-up. DATA COLLECTION AND ANALYSIS We present data as risk ratios (RRs) with 95% confidence intervals (CIs). Primary outcomes included all-cause mortality, all-cause and heart failure-related hospitalisations, which we analysed using a fixed-effect model. Other outcomes included length of stay, health-related quality of life, heart failure knowledge and self care, acceptability and cost; we described and tabulated these. We performed meta-regression to assess homogeneity (the null hypothesis) in each subgroup analysis and to see if the effect of the intervention varied according to some quantitative variable (such as year of publication or median age). MAIN RESULTS We include 41 studies of either structured telephone support or non-invasive home telemonitoring for people with heart failure, of which 17 were new and 24 had been included in the previous Cochrane review. In the current review, 25 studies evaluated structured telephone support (eight new studies, plus one study previously included but classified as telemonitoring; total of 9332 participants), 18 evaluated telemonitoring (nine new studies; total of 3860 participants). Two of the included studies trialled both structured telephone support and telemonitoring compared to usual care, therefore 43 comparisons are evident.Non-invasive telemonitoring reduced all-cause mortality (RR 0.80, 95% CI 0.68 to 0.94; participants = 3740; studies = 17; I² = 24%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.71, 95% CI 0.60 to 0.83; participants = 2148; studies = 8; I² = 20%, GRADE: moderate-quality evidence). Structured telephone support reduced all-cause mortality (RR 0.87, 95% CI 0.77 to 0.98; participants = 9222; studies = 22; I² = 0%, GRADE: moderate-quality evidence) and heart failure-related hospitalisations (RR 0.85, 95% CI 0.77 to 0.93; participants = 7030; studies = 16; I² = 27%, GRADE: moderate-quality evidence).Neither structured telephone support nor telemonitoring demonstrated effectiveness in reducing the risk of all-cause hospitalisations (structured telephone support: RR 0.95, 95% CI 0.90 to 1.00; participants = 7216; studies = 16; I² = 47%, GRADE: very low-quality evidence; non-invasive telemonitoring: RR 0.95, 95% CI 0.89 to 1.01; participants = 3332; studies = 13; I² = 71%, GRADE: very low-quality evidence).Seven structured telephone support studies reported length of stay, with one reporting a significant reduction in length of stay in hospital. Nine telemonitoring studies reported length of stay outcome, with one study reporting a significant reduction in the length of stay with the intervention. One telemonitoring study reported a large difference in the total number of hospitalisations for more than three days, but this was not an analysis of length of stay per hospitalisation. Nine of 11 structured telephone support studies and five of 11 telemonitoring studies reported significant improvements in health-related quality of life. Nine structured telephone support studies and six telemonitoring studies reported costs of the intervention or cost effectiveness. Three structured telephone support studies and one telemonitoring study reported a decrease in costs and two telemonitoring studies reported increases in cost, due both to the cost of the intervention and to increased medical management. Adherence was rated between 55.1% and 98.5% for those structured telephone support and telemonitoring studies which reported this outcome. Participant acceptance of the intervention was reported in the range of 76% to 97% for studies which evaluated this outcome. Seven of nine studies that measured these outcomes reported significant improvements in heart failure knowledge and self-care behaviours. AUTHORS' CONCLUSIONS For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations; these interventions also demonstrated improvements in health-related quality of life and heart failure knowledge and self-care behaviours. Studies also demonstrated participant satisfaction with the majority of the interventions which assessed this outcome.
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Affiliation(s)
- Sally C Inglis
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Altara R, Gu YM, Struijker-Boudier HAJ, Thijs L, Staessen JA, Blankesteijn WM. Left Ventricular Dysfunction and CXCR3 Ligands in Hypertension: From Animal Experiments to a Population-Based Pilot Study. PLoS One 2015; 10:e0141394. [PMID: 26506526 PMCID: PMC4624781 DOI: 10.1371/journal.pone.0141394] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 09/01/2015] [Indexed: 01/14/2023] Open
Abstract
Detecting left ventricular (LV) dysfunction at an early stage is key in addressing the heart failure epidemic. In proteome profiling experiments in mice subjected either to aortic banding or sham, the circulating CXCR3 ligands monokine induced by interferon-γ (MIG) and interferon-γ inducible protein 10 (IP10) were 5 to 40 fold up-regulated at eight weeks. We assessed the diagnostic value of circulating NT-pro BNP and CXCR3 ligands (MIG, IP10, Interferon-inducible T-cell alpha chemo-attractant [I–TAC]) in patients with hypertension (≥140/90 mm Hg) associated with subclinical (n = 19) or symptomatic (n = 16) diastolic LV dysfunction on echocardiography and healthy controls. NT–pro BNP, MIG, IP10, I–TAC all increased (p ≤ 0.014) across the categories of worsening left ventricular dysfunction. In patients with symptomatic disease, MIG, IP10, and I–TAC increased 210% (p = 0.015), 140% (p = 0.007) and 120% (p = 0.035) more than NT-pro BNP. The optimal discrimination limits, obtained by maximizing Youden’s index were 246 pmol/L, 65 pg/mL, 93 pg/mL, and 24 pg/mL, respectively. The odds ratios associated with the four biomarkers were significant (p ≤ 0.010), ranging from 4.00 for IP10 to 9.69 for MIG. With adjustment for NT–pro BNP, the CXCR3 ligands retained significance (p ≤ 0.028). Adding optimized thresholds for the CXCR3 ligands to NT–pro BNP enhanced (p ≤ 0.014) the integrated discrimination improvement and the net reclassification improvement. In conclusion, congruent with the concept that inflammation plays a key role in the pathogenesis of LV dysfunction, MIG, IP10 and I–TAC add diagnostic accuracy over and beyond NT–pro BNP.
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Affiliation(s)
- Raffaele Altara
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Yu-Mei Gu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Harry A. J. Struijker-Boudier
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Lutgarde Thijs
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- VitaK Research and Development, Maastricht University, Maastricht, The Netherlands
| | - W. Matthijs Blankesteijn
- Department of Pharmacology and Toxicology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- * E-mail:
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141
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Berezin AE, Kremzer AA. Impaired phenotype of circulating endothelial microparticles in chronic heart failure patients: Relevance to body mass index. Diabetes Metab Syndr 2015; 9:230-236. [PMID: 26044504 DOI: 10.1016/j.dsx.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIMS The objective of the study was to investigate the relationship of circulating endothelial-derived microparticls (EMP) pattern with body mass index (BMI) in CHF patients. METHODS The study retrospectively evolved 153 patients (86 males) who were underwent multispiral contrast-enhanced computed tomography angiography or conventional angiographic examination of coronary arteries. Flowcytometry analysis for quantifying the number of EMPs was used at baseline. RESULTS Using C-statistics for models with CHF, BMI, and circulating biomarkers (NT-pro-BNP, OPG and adiponectin) as continuous variables we found that adding of BMI to the based model (NYHA class of CHF) improved the relative IDI by 12.5% for increased CD31+/annexin V+ EMPs to CD62E+ EMPs ratio. When we used other model constructed on entering variables IDI appears to be improved up to 5.8% for increased EMPs (available for NT-pro-BNP as continuous variable). Three biomarkers (NYHA class of CHF+NT-pro-BNP+OPG) and four biomarkers (NYHA class of CHF+NT-pro-BNP+OPG+adiponectin) could not significantly improve predictive model based on combination of BMI and NYHA class of CHF for increased CD31+/annexin V+ EMPs to CD62E+ EMPs ratio. CONCLUSION We suggested that lower BMI is significant predictor for impaired phenotype of circulating EMPs in CHF patients.
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Affiliation(s)
- Alexander E Berezin
- Internal Medicine Department, State Medical University, 26, Mayakovsky Av., Zaporozhye 69035, Ukraine.
| | - Alexander A Kremzer
- State Medical University, Clinical Pharmacology Department, Zaporozhye, Ukraine
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Metabolomic fingerprint of heart failure with preserved ejection fraction. PLoS One 2015; 10:e0124844. [PMID: 26010610 PMCID: PMC4444296 DOI: 10.1371/journal.pone.0124844] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 01/01/2023] Open
Abstract
Background Heart failure (HF) with preserved ejection fraction (HFpEF) is increasingly recognized as an important clinical entity. Preclinical studies have shown differences in the pathophysiology between HFpEF and HF with reduced ejection fraction (HFrEF). Therefore, we hypothesized that a systematic metabolomic analysis would reveal a novel metabolomic fingerprint of HFpEF that will help understand its pathophysiology and assist in establishing new biomarkers for its diagnosis. Methods and Results Ambulatory patients with clinical diagnosis of HFpEF (n = 24), HFrEF (n = 20), and age-matched non-HF controls (n = 38) were selected for metabolomic analysis as part of the Alberta HEART (Heart Failure Etiology and Analysis Research Team) project. 181 serum metabolites were quantified by LC-MS/MS and 1H-NMR spectroscopy. Compared to non-HF control, HFpEF patients demonstrated higher serum concentrations of acylcarnitines, carnitine, creatinine, betaine, and amino acids; and lower levels of phosphatidylcholines, lysophosphatidylcholines, and sphingomyelins. Medium and long-chain acylcarnitines and ketone bodies were higher in HFpEF than HFrEF patients. Using logistic regression, two panels of metabolites were identified that can separate HFpEF patients from both non-HF controls and HFrEF patients with area under the receiver operating characteristic (ROC) curves of 0.942 and 0.981, respectively. Conclusions The metabolomics approach employed in this study identified a unique metabolomic fingerprint of HFpEF that is distinct from that of HFrEF. This metabolomic fingerprint has been utilized to identify two novel panels of metabolites that can separate HFpEF patients from both non-HF controls and HFrEF patients. Clinical Trial Registration ClinicalTrials.gov NCT02052804
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Minguet J, Sutton G, Ferrero C, Gomez T, Bramlage P. LCZ696 : a new paradigm for the treatment of heart failure? Expert Opin Pharmacother 2015; 16:435-46. [PMID: 25597387 DOI: 10.1517/14656566.2015.1000300] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Heart failure (HF) represents a significant healthcare issue because of its ever-increasing prevalence, poor prognosis and complex pathophysiology. Currently, blockade of the renin-angiotensin-aldosterone system (RAAS) is the cornerstone of treatment; however, the combination of RAAS blockade with inhibition of neprilysin (NEP), an enzyme that degrades natriuretic peptides, has recently emerged as a potentially superior treatment strategy. AREAS COVERED Following the results of the recent Phase III Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure clinical trial in patients with chronic HF with reduced ejection fraction (HF-REF), this review focuses on LCZ696 , a first-in-class angiotensin receptor NEP inhibitor. This drug consists of a supramolecular complex containing the angiotensin receptor inhibitor valsartan in combination with the NEP inhibitor prodrug, AHU377. Following oral administration, the LCZ696 complex dissociates and the NEP inhibitor component is metabolized to the active form (LBQ657). Aspects of the trial that might be relevant to clinical practice are also discussed. EXPERT OPINION Speculation that LCZ696 will pass the scrutiny of regulatory agencies for HF-REF appears to be justified, and it is likely to become a core therapeutic component in the near future. Replication of the eligibility criteria and titration protocol used in the PARADIGM-HF trial would be valuable in clinical practice and may minimize the risk of adverse events. Although long-term data remain to be generated, the promising results regarding hypertension are likely to expedite acceptance of the drug for HF-REF.
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Affiliation(s)
- Joan Minguet
- Institute for Research and Medicine Advancement (IRMEDICA) , Barcelona , Spain
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Abstract
Heart failure (HF) represents the quintessential disorder of cardiovascular aging, reflecting the convergence of age-related changes in the cardiovascular system and other organ systems and the increasing prevalence of cardiovascular diseases at older age. The prevalence and incidence of HF increase progressively with advancing age, and HF imposes an enormous burden on society in mortality, morbidity, and associated health care costs. Despite major advances in treatment of HF over the last 25 years, the prognosis remains poor, with median survival rates of less than 5 years in older adults. As the population ages, it is anticipated that the number of older people with HF will increase dramatically over the next several decades.
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Affiliation(s)
- Sabu Thomas
- Washington University School of Medicine, St. Louis, MO 63110, USA
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