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Abstract
Peripartum cardiomyopathy is a potentially life-threatening pregnancy-associated disease that typically arises in the peripartum period and is marked by left ventricular dysfunction and heart failure. The disease is relatively uncommon, but its incidence is rising. Women often recover cardiac function, but long-lasting morbidity and mortality are not infrequent. Management of peripartum cardiomyopathy is largely limited to the same neurohormonal antagonists used in other forms of cardiomyopathy, and no proven disease-specific therapies exist yet. Research in the past decade has suggested that peripartum cardiomyopathy is caused by vascular dysfunction, triggered by late-gestational maternal hormones. Most recently, information has also indicated that many cases of peripartum cardiomyopathy have genetic underpinnings. We review here the known epidemiology, clinical presentation, and management of peripartum cardiomyopathy, as well as the current knowledge of the pathophysiology of the disease.
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Affiliation(s)
- Zolt Arany
- From Perelman School of Medicine, University of Pennsylvania, Philadelphia (Z.A.); and Department of Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles (U.E.).
| | - Uri Elkayam
- From Perelman School of Medicine, University of Pennsylvania, Philadelphia (Z.A.); and Department of Medicine, Division of Cardiovascular Medicine and Department of Obstetrics and Gynecology, University of Southern California, Los Angeles (U.E.)
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252
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Elkayam U, Goland S, Pieper PG, Silversides CK. High-Risk Cardiac Disease in Pregnancy. J Am Coll Cardiol 2016; 68:502-516. [DOI: 10.1016/j.jacc.2016.05.050] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/03/2016] [Indexed: 02/09/2023]
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253
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Seno A, Takeda Y, Matsui M, Okuda A, Nakano T, Nakada Y, Kumazawa T, Nakagawa H, Nishida T, Onoue K, Somekawa S, Watanabe M, Kawata H, Kawakami R, Okura H, Uemura S, Saito Y. Suppressed Production of Soluble Fms-Like Tyrosine Kinase-1 Contributes to Myocardial Remodeling and Heart Failure. Hypertension 2016; 68:678-87. [PMID: 27480835 DOI: 10.1161/hypertensionaha.116.07371] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/26/2016] [Indexed: 01/17/2023]
Abstract
Soluble fms-like tyrosine kinase-1 (sFlt-1), an endogenous inhibitor of vascular endothelial growth factor and placental growth factor, is involved in the pathogenesis of cardiovascular disease. However, the significance of sFlt-1 in heart failure has not been fully elucidated. We found that sFlt-1 is decreased in renal failure and serves as a key molecule in atherosclerosis. In this study, we aimed to investigate the role of the decreased sFlt-1 production in heart failure, using sFlt-1 knockout mice. sFlt-1 knockout mice and wild-type mice were subjected to transverse aortic constriction and evaluated after 7 days. The sFlt-1 knockout mice had significantly higher mortality (52% versus 15%; P=0.0002) attributable to heart failure and showed greater cardiac hypertrophy (heart weight to body weight ratio, 8.95±0.45 mg/g in sFlt-1 knockout mice versus 6.60±0.32 mg/g in wild-type mice; P<0.0001) and cardiac dysfunction, which was accompanied by a significant increase in macrophage infiltration and cardiac fibrosis, than wild-type mice after transverse aortic constriction. An anti-placental growth factor-neutralizing antibody prevented pressure overload-induced cardiac hypertrophy, fibrosis, and cardiac dysfunction. Moreover, monocyte chemoattractant protein-1 expression was significantly increased in the hypertrophied hearts of sFlt-1 knockout mice compared with wild-type mice. Monocyte chemoattractant protein-1 inhibition with neutralizing antibody ameliorated maladaptive cardiac remodeling in sFlt-1 knockout mice after transverse aortic constriction. In conclusion, decreased sFlt-1 production plays a key role in the aggravation of cardiac hypertrophy and heart failure through upregulation of monocyte chemoattractant protein-1 expression in pressure-overloaded heart.
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Affiliation(s)
- Ayako Seno
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yukiji Takeda
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Masaru Matsui
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Aya Okuda
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Tomoya Nakano
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yasuki Nakada
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Takuya Kumazawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hitoshi Nakagawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Taku Nishida
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Kenji Onoue
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Satoshi Somekawa
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Makoto Watanabe
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hiroyuki Kawata
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Rika Kawakami
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Hiroyuki Okura
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Shiro Uemura
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.)
| | - Yoshihiko Saito
- From the First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan (A.S., Y.T., M.M., A.O., T. Nakano, Y.N., T.K., H.N., T. Nishida, K.O., S.S., M.W., H.K., R.K., H.O., S.U., Y.S.); and Department of Regulatory Medicine for Blood Pressure, Kashihara, Nara, Japan (T.K., Y.S.).
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254
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Abstract
Vascular endothelial growth factors (VEGFs) and their receptors (VEGFRs) are uniquely required to balance the formation of new blood vessels with the maintenance and remodelling of existing ones, during development and in adult tissues. Recent advances have greatly expanded our understanding of the tight and multi-level regulation of VEGFR2 signalling, which is the primary focus of this Review. Important insights have been gained into the regulatory roles of VEGFR-interacting proteins (such as neuropilins, proteoglycans, integrins and protein tyrosine phosphatases); the dynamics of VEGFR2 endocytosis, trafficking and signalling; and the crosstalk between VEGF-induced signalling and other endothelial signalling cascades. A clear understanding of this multifaceted signalling web is key to successful therapeutic suppression or stimulation of vascular growth.
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255
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Kechele DO, Dunworth WP, Trincot CE, Wetzel-Strong SE, Li M, Ma H, Liu J, Caron KM. Endothelial Restoration of Receptor Activity-Modifying Protein 2 Is Sufficient to Rescue Lethality, but Survivors Develop Dilated Cardiomyopathy. Hypertension 2016; 68:667-77. [PMID: 27402918 DOI: 10.1161/hypertensionaha.116.07191] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/03/2016] [Indexed: 12/20/2022]
Abstract
RAMPs (receptor activity-modifying proteins) serve as oligomeric modulators for numerous G-protein-coupled receptors, yet elucidating the physiological relevance of these interactions remains complex. Ramp2 null mice are embryonic lethal, with cardiovascular developmental defects similar to those observed in mice null for canonical adrenomedullin/calcitonin receptor-like receptor signaling. We aimed to genetically rescue the Ramp2(-/-) lethality in order to further delineate the spatiotemporal requirements for RAMP2 function during development and thereby enable the elucidation of an expanded repertoire of RAMP2 functions with family B G-protein-coupled receptors in adult homeostasis. Endothelial-specific expression of Ramp2 under the VE-cadherin promoter resulted in the partial rescue of Ramp2(-/-) mice, demonstrating that endothelial expression of Ramp2 is necessary and sufficient for survival. The surviving Ramp2(-/-) Tg animals lived to adulthood and developed spontaneous hypotension and dilated cardiomyopathy, which was not observed in adult mice lacking calcitonin receptor-like receptor. Yet, the hearts of Ramp2(-/-) Tg animals displayed dysregulation of family B G-protein-coupled receptors, including parathyroid hormone and glucagon receptors, as well as their downstream signaling pathways. These data suggest a functional requirement for RAMP2 in the modulation of additional G-protein-coupled receptor pathways in vivo, which is critical for sustained cardiovascular homeostasis. The cardiovascular importance of RAMP2 extends beyond the endothelium and canonical adrenomedullin/calcitonin receptor-like receptor signaling, in which future studies could elucidate novel and pharmacologically tractable pathways for treating cardiovascular diseases.
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Affiliation(s)
- Daniel O Kechele
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - William P Dunworth
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Claire E Trincot
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Sarah E Wetzel-Strong
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Manyu Li
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Hong Ma
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Jiandong Liu
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill
| | - Kathleen M Caron
- From the Department of Cell Biology and Physiology (D.O.K., S.E.W.-S., M.L., K.M.C.), Curriculum in Genetics and Molecular Biology (W.P.D., C.E.T., K.M.C.), Department of Pathology and Laboratory Medicine (H.M., J.L.), and McAllister Heart Institute (H.M., J.L., K.M.C.), The University of North Carolina, Chapel Hill.
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256
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Abstract
Peripartum cardiomyopathy (PPCM) is a rare, but life-threatening condition that occurs during the peripartum period in previously healthy women. Although its etiology remains unknown, potential risk factors include hypertensive disorders during pregnancy, such as preeclampsia, advanced maternal age, multiparity, multiple gestation, and African descent. Several cohort studies of PPCM revealed that the prevalence of these risk factors was quite similar. Clinically, approximately 40% of PPCM patients are complicated with hypertensive disorders during pregnancy. Because PPCM is a diagnosis of exclusion, heterogeneity is a common element in its pathogenesis. Recent genetic research has given us new aspects of the disease. PPCM and dilated cardiomyopathy (DCM) share genetic predisposition: 15% of PPCM patients were found to have genetic mutations that have been associated with DCM, and they showed a lower recovery rate. Other basic research using PPCM model mice suggests that predisposition genes related to both hypertensive and cardiac disorders via angiogenic imbalance may explain common elements of hypertensive disorders and PPCM. Furthermore, hypertensive disorders during pregnancy are now found to be a risk factor of not only PPCM, but also cardiomyopathy in the future. Understanding genetic variations allows us to stratify PPCM patients and to guide therapy. (Circ J 2016; 80: 1684-1688).
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Affiliation(s)
- Chizuko A Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center
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257
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Bauersachs J, Arrigo M, Hilfiker-Kleiner D, Veltmann C, Coats AJ, Crespo-Leiro MG, De Boer RA, van der Meer P, Maack C, Mouquet F, Petrie MC, Piepoli MF, Regitz-Zagrosek V, Schaufelberger M, Seferovic P, Tavazzi L, Ruschitzka F, Mebazaa A, Sliwa K. Current management of patients with severe acute peripartum cardiomyopathy: practical guidance from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2016; 18:1096-105. [DOI: 10.1002/ejhf.586] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/27/2016] [Accepted: 05/08/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- Johann Bauersachs
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Mattia Arrigo
- Department of Cardiology, AP-HP; Lariboisière University Hospital; Paris France
- Department of Cardiology; University Heart Center, University Hospital Zurich; Zurich Switzerland
| | | | - Christian Veltmann
- Department of Cardiology and Angiology; Medical School Hannover; Hannover Germany
| | - Andrew J.S. Coats
- Monash-Warwick Alliance; Monash University, Australia, and University of Warwick; UK
| | | | - Rudolf A. De Boer
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Peter van der Meer
- Department of Cardiology; University Medical Center Groningen; Groningen The Netherlands
| | - Christoph Maack
- Klinik für Innere Medizin III; Universitätsklinikum des Saarlandes; Homburg Germany
| | | | - Mark C. Petrie
- Department of Cardiology; Golden Jubilee National Hospital and Glasgow University; Glasgow UK
| | - Massimo F. Piepoli
- Department of Cardiology; Guglielmo da Saliceto Hospital; Piacenza Italy
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine; Charité Universitaetsmedizin Berlin, and German Center for Cardiovascular Research; Berlin Germany
| | - Maria Schaufelberger
- Section of Acute and Cardiovascular Medicine, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy; University of Gothenburg, Sahlgrenska University Hospital/Östra; Gothenburg Sweden
| | | | - Luigi Tavazzi
- Maria Cecilia Hospital, Gruppo Villa Maria Care and Research; Ettore Sansavini Health Science Foundation Cotignola Italy
| | - Frank Ruschitzka
- Department of Cardiology; University Heart Center, University Hospital Zurich; Zurich Switzerland
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP; Saint Louis Lariboisière University Hospitals; Paris France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa & IDM, Inter-Cape Heart Group, Medical Research Council South Africa, Department of Medicine; University of Cape Town; Cape Town South Africa
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258
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Affiliation(s)
- James D. Fett
- Hospital Albert Schweitzer, Adult Medicine, Deschapelles, Haiti
- Peripartum Cardiomyopathy Network, Cardiovascular Institute, Coordinating Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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259
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Shimizu I, Minamino T. Physiological and pathological cardiac hypertrophy. J Mol Cell Cardiol 2016; 97:245-62. [PMID: 27262674 DOI: 10.1016/j.yjmcc.2016.06.001] [Citation(s) in RCA: 614] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 05/10/2016] [Accepted: 06/01/2016] [Indexed: 12/24/2022]
Abstract
The heart must continuously pump blood to supply the body with oxygen and nutrients. To maintain the high energy consumption required by this role, the heart is equipped with multiple complex biological systems that allow adaptation to changes of systemic demand. The processes of growth (hypertrophy), angiogenesis, and metabolic plasticity are critically involved in maintenance of cardiac homeostasis. Cardiac hypertrophy is classified as physiological when it is associated with normal cardiac function or as pathological when associated with cardiac dysfunction. Physiological hypertrophy of the heart occurs in response to normal growth of children or during pregnancy, as well as in athletes. In contrast, pathological hypertrophy is induced by factors such as prolonged and abnormal hemodynamic stress, due to hypertension, myocardial infarction etc. Pathological hypertrophy is associated with fibrosis, capillary rarefaction, increased production of pro-inflammatory cytokines, and cellular dysfunction (impairment of signaling, suppression of autophagy, and abnormal cardiomyocyte/non-cardiomyocyte interactions), as well as undesirable epigenetic changes, with these complex responses leading to maladaptive cardiac remodeling and heart failure. This review describes the key molecules and cellular responses involved in physiological/pathological cardiac hypertrophy.
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Affiliation(s)
- Ippei Shimizu
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan; Division of Molecular Aging and Cell Biology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan.
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260
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Melo MAME, Carvalho JS, Feitosa FEDL, Araujo Júnior E, Peixoto AB, Costa Carvalho FH, Carvalho RCM. Peripartum Cardiomyopathy Treatment with Dopamine Agonist and Subsequent Pregnancy with a Satisfactory Outcome. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2016; 38:308-13. [PMID: 27399926 PMCID: PMC10374231 DOI: 10.1055/s-0036-1584567] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022] Open
Abstract
Pathophysiological mechanisms of peripartum cardiomyopathy are not yet completely defined, although there is a strong association with various factors that are already known, including pre-eclampsia. Peripartum cardiomyopathy treatment follows the same recommendations as heart failure with systolic dysfunction. Clinical and experimental studies suggest that products of prolactin degradation can induce this cardiomyopathy. The pharmacological suppression of prolactin production by D2 dopamine receptor agonists bromocriptine and cabergoline has demonstrated satisfactory results in the therapeutic response to the treatment. Here we present a case of an adolescent patient in her first gestation with peripartum cardiomyopathy that evolved to the normalized left ventricular function after cabergoline administration, which was used as an adjuvant in cardiac dysfunction treatment. Subsequently, despite a short interval between pregnancies, the patient exhibited satisfactory progress throughout the entire gestation or puerperium in a new pregnancy without any cardiac alterations. Dopamine agonists that are orally used and are affordable in most tertiary centers, particularly in developing countries, should be considered when treating peripartum cardiomyopathy cases.
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Affiliation(s)
- Maria Adélia Medeiros e Melo
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | - Jordão Sousa Carvalho
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Edward Araujo Júnior
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Alberto Borges Peixoto
- Department of Obstetrics, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Regina Coeli Marques Carvalho
- Fetal Medicine Service, Maternidade-Escola Assis Chateaubriand, Universidade Federal do Ceará, Fortaleza, CE, Brazil
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261
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Affiliation(s)
- S. Ananth Karumanchi
- From the Center for Vascular Biology, Departments of Medicine, Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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262
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Shahul S, Medvedofsky D, Wenger JB, Nizamuddin J, Brown SM, Bajracharya S, Salahuddin S, Thadhani R, Mueller A, Tung A, Lang RM, Arany Z, Talmor D, Karumanchi SA, Rana S. Circulating Antiangiogenic Factors and Myocardial Dysfunction in Hypertensive Disorders of Pregnancy. Hypertension 2016; 67:1273-80. [PMID: 27113052 DOI: 10.1161/hypertensionaha.116.07252] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 03/13/2016] [Indexed: 12/13/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) are associated with subclinical changes in cardiac function. Although the mechanism underlying this finding is unknown, elevated levels of soluble antiangiogenic proteins such as soluble fms-like tyrosine kinase-1 (sFlt1) and soluble endoglin (sEng) are associated with myocardial dysfunction and may play a role. We hypothesized that these antiangiogenic proteins may contribute to the development of cardiac dysfunction in HDP. We prospectively studied 207 pregnant women with HDP and nonhypertensive controls and evaluated whether changes in global longitudinal strain (GLS) observed on echocardiography is specific for HDP and whether these changes correlate with HDP biomarkers, sFlt1 and sEng. A total of 62 (30%) patients were diagnosed with preeclampsia (group A), 105 (51%) did not have an HDP (group B), and 40 (19%) were diagnosed with chronic or gestational hypertension (group C). Blood was drawn and sFlt1 and sEng levels measured using enzyme-linked immunosorbent assay. Comprehensive echocardiograms, including measurement of GLS, were performed on all patients. Overall, GLS was worse in women in group A (preeclampsia) than those in group B or C. Increasing sFlt1 and sEng levels correlated with worsening GLS (r=0.44 for sFlt1 and r=0.46 for sEng, both P<0.001), which remained significant after multivariable analysis (r=0.18 and r=0.22, both P≤0.01). Increasing levels also correlated with increasing left ventricular mass index, which also remained significant after multivariable analysis (r=0.20 for sFlt1 and 0.19 for sEng, both P=0.01). Elevated circulating levels of antiangiogenic proteins in HDP correlate with and may contribute to myocardial dysfunction as measured by GLS.
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Affiliation(s)
- Sajid Shahul
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.).
| | - Diego Medvedofsky
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Julia B Wenger
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Junaid Nizamuddin
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Samuel M Brown
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Surichhya Bajracharya
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Saira Salahuddin
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Ravi Thadhani
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Ariel Mueller
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Avery Tung
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Roberto M Lang
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Zoltan Arany
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Daniel Talmor
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - S Ananth Karumanchi
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
| | - Sarosh Rana
- From the Department of Anesthesia and Critical Care (S.S., J.N., A.T.), Section of Cardiology, Department of Medicine (D.M., R.M.L.), and Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology (S.R.), University of Chicago, IL; Division of Nephrology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston (J.B.W., R.T.); Center for Humanizing Critical Care, Intermountain Healthcare, Department of Medicine, University of Utah, Salt Lake City (S.M.B.); Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA (S.B., S.A.K., S.R.); Center for Vascular Biology, Department of Medicine (S.S., S.A.K.) and Department of Anesthesia, Critical Care and Pain Medicine (A.M., D.T.), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA; and Department of Medicine, Cardiovascular Institute, University of Pennsylvania, Philadelphia (Z.A.)
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263
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Bellinger AM, Arteaga CL, Force T, Humphreys BD, Demetri GD, Druker BJ, Moslehi JJ. Cardio-Oncology: How New Targeted Cancer Therapies and Precision Medicine Can Inform Cardiovascular Discovery. Circulation 2016; 132:2248-58. [PMID: 26644247 DOI: 10.1161/circulationaha.115.010484] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Cardio-oncology (the cardiovascular care of cancer patients) has developed as a new translational and clinical field based on the expanding repertoire of mechanism-based cancer therapies. Although these therapies have changed the natural course of many cancers, several may also lead to cardiovascular complications. Many new anticancer drugs approved over the past decade are "targeted" kinase inhibitors that interfere with intracellular signaling contributing to tumor progression. Unexpected cardiovascular and cardiometabolic effects of patient treatment with these inhibitors have provided unique insights into the role of kinases in human cardiovascular biology. Today, an ever-expanding number of cancer therapies targeting novel kinases and other specific cellular and metabolic pathways are being developed and tested in oncology clinical trials. Some of these drugs may affect the cardiovascular system in detrimental ways and others perhaps in beneficial ways. We propose that the numerous ongoing oncology clinical trials are an opportunity for closer collaboration between cardiologists and oncologists to study the cardiovascular and cardiometabolic changes caused by the modulation of these pathways in patients. In this regard, cardio-oncology represents an opportunity and a novel platform for basic and translational investigation and can serve as a potential avenue for optimization of anticancer therapies and for cardiovascular research and drug discovery.
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Affiliation(s)
- Andrew M Bellinger
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - Carlos L Arteaga
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - Thomas Force
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - Benjamin D Humphreys
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - George D Demetri
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - Brian J Druker
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.)
| | - Javid J Moslehi
- From Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.M.B., G.D.D.); Vanderbilt-Ingram Cancer Center (C.L.A., J.M.), Cardiovascular Division (T.F., J.J.M.), and Cardio-Oncology Program (C.L.A., T.F., J.J.M.), Vanderbilt University School of Medicine, Nashville, TN; Department of Medicine, Washington University Medical Center, St. Louis, MO (B.D.H., J.M.); Dana-Farber Cancer Institute and Ludwig Center at Harvard, Harvard Medical School, Boston, MA (G.D.D.); and Knight Cancer Institute, Oregon Health & Science University and Howard Hughes Medical Institute, Portland, OR (B.J.D.).
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264
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Affiliation(s)
- Eliyahu V Khankin
- From the Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K.); and Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Z.A.).
| | - Zoltan Arany
- From the Division of Nephrology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.V.K.); and Cardiovascular Institute, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (Z.A.)
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265
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Murata K, Ishida J, Ishimaru T, Mizukami H, Hamada J, Saito C, Fukamizu A. Lactation Is a Risk Factor of Postpartum Heart Failure in Mice with Cardiomyocyte-specific Apelin Receptor (APJ) Overexpression. J Biol Chem 2016; 291:11241-51. [PMID: 27033703 DOI: 10.1074/jbc.m115.699009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Indexed: 11/06/2022] Open
Abstract
The G protein-coupled receptor APJ and its ligand apelin are highly expressed in cardiovascular tissues and are associated with the regulation of blood pressure and cardiac function. Although accumulating evidence suggests that APJ plays a crucial role in the heart, it remains unclear whether up-regulation of APJ affects cardiac function. Here we generated cardiomyocyte-specific APJ-overexpressing (APJ-TG) mice and investigated the cardiac phenotype in APJ-TG mice. Male and non-pregnant APJ-TG mice showed cardiac hypertrophy, contractile dysfunction, and elevation of B-type natriuretic peptide gene expression in the heart but not cardiac fibrosis and symptoms of heart failure, including breathing abnormality and pleural effusion. We further examined the influence of APJ overexpression in response to physiological stress induced by pregnancy and lactation in the heart. Interestingly, repeating pregnancy and lactation (pregnancy-lactation cycle) exacerbated cardiac hypertrophy and systolic dysfunction and induced cardiac fibrosis, lung congestion, pleural effusion, and abnormal breathing in APJ-TG mice. These data indicate that female APJ-TG mice develop postpartum cardiomyopathy. We showed that lactation, but not parturition, was critical for the onset of postpartum cardiomyopathy in APJ-TG mice. Furthermore, we found that lactating APJ-TG mice showed impaired myocardial angiogenesis and imbalance of pro- and antiangiogenic gene expression in the heart. These results demonstrate that overexpression of APJ in cardiomyocytes has adverse effects on cardiac function in male and non-pregnant mice and that lactation contributes to the development of postpartum cardiomyopathy in the heart with APJ overexpression.
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Affiliation(s)
- Kazuya Murata
- From the Life Science Center, Tsukuba Advanced Research Alliance, and
| | - Junji Ishida
- From the Life Science Center, Tsukuba Advanced Research Alliance, and Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba, Ibaraki 305-8577, Japan
| | - Tomohiro Ishimaru
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba, Ibaraki 305-8577, Japan
| | - Hayase Mizukami
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba, Ibaraki 305-8577, Japan
| | - Juri Hamada
- From the Life Science Center, Tsukuba Advanced Research Alliance, and
| | - Chiaki Saito
- Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba, Ibaraki 305-8577, Japan
| | - Akiyoshi Fukamizu
- From the Life Science Center, Tsukuba Advanced Research Alliance, and Graduate School of Life and Environmental Sciences, University of Tsukuba, 1-1-1 Ten-noudai, Tsukuba, Ibaraki 305-8577, Japan
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266
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Abstract
Applying federalist principles to networked health record data could facilitate realization of the potential of shared health data.
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Affiliation(s)
- Kenneth D Mandl
- Boston Children's Hospital, Boston and Harvard Medical School, Boston, Massachusetts, USA
| | - Isaac S Kohane
- Boston Children's Hospital, Boston and Harvard Medical School, Boston, Massachusetts, USA
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267
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Damp J, Givertz MM, Semigran M, Alharethi R, Ewald G, Felker GM, Bozkurt B, Boehmer J, Haythe J, Skopicki H, Hanley-Yanez K, Pisarcik J, Halder I, Gorcsan J, Rana S, Arany Z, Fett JD, McNamara DM. Relaxin-2 and Soluble Flt1 Levels in Peripartum Cardiomyopathy: Results of the Multicenter IPAC Study. JACC-HEART FAILURE 2016; 4:380-8. [PMID: 26970832 DOI: 10.1016/j.jchf.2016.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/28/2015] [Accepted: 01/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study explored the association of vascular hormones with myocardial recovery and clinical outcomes in peripartum cardiomyopathy (PPCM). BACKGROUND PPCM is an uncommon disorder with unknown etiology. Angiogenic imbalance may contribute to its pathophysiology. METHODS In 98 women with newly diagnosed PPCM enrolled in the Investigation in Pregnancy Associated Cardiomyopathy study, serum was obtained at baseline for analysis of relaxin-2, prolactin, soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF). Left ventricular ejection fraction (LVEF) was assessed by echocardiography at baseline and 2, 6, and 12 months. RESULTS Mean age was 30 ± 6 years, with a baseline of LVEF 0.35 ± 0.09. Relaxin-2, prolactin, and sFlt1 were elevated in women presenting early post-partum, but decreased rapidly and were correlated inversely with time from delivery to presentation. In tertile analysis, higher relaxin-2 was associated with smaller left ventricular systolic diameter (p = 0.006) and higher LVEF at 2 months (p = 0.01). This was particularly evident in women presenting soon after delivery (p = 0.02). No relationship was evident for myocardial recovery and prolactin, sFlt1 or VEGF levels. sFlt1 levels were higher in women with higher New York Heart Association functional class (p = 0.01) and adverse clinical events (p = 0.004). CONCLUSIONS In women with newly diagnosed PPCM, higher relaxin-2 levels soon after delivery were associated with myocardial recovery at 2 months. In contrast, higher sFlt1 levels correlated with more severe symptoms and major adverse clinical events. Vascular mediators may contribute to the development of PPCM and influence subsequent myocardial recovery. (Investigation in Pregnancy Associate Cardiomyopathy [IPAC]; NCT01085955).
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Affiliation(s)
- Julie Damp
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Michael M Givertz
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marc Semigran
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Alharethi
- Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah
| | - Gregory Ewald
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Biykem Bozkurt
- Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - John Boehmer
- Division of Cardiology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer Haythe
- Division of Cardiology, Columbia University, New York, New York
| | - Hal Skopicki
- Division of Cardiology, Stony Brook Medical Center, Stony Brook, New York
| | - Karen Hanley-Yanez
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Pisarcik
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Zoltan Arany
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Fett
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
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268
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Analysis of changes in maternal circulating angiogenic factors throughout pregnancy for the prediction of preeclampsia. J Perinatol 2016; 36:172-7. [PMID: 26583938 DOI: 10.1038/jp.2015.170] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 10/07/2015] [Accepted: 10/09/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess whether changes in maternal angiogenic factors throughout pregnancy predict the development of preeclampsia. STUDY DESIGN Placental growth factor (PlGF) and soluble fms-like tyrosine kinase 1 receptor (sFlt-1) were measured in 2355 women at 10, 18, 26 and 35 weeks gestation. Receiver operator characteristic analysis was used to calculate test characteristics for changes in analytes between time points. Linear mixed-effects models generated slopes of analytes throughout pregnancy, which in turn were used as predictors in adjusted logistic regression models. RESULT Changes in analytes yielded positive predictive values of 9 to 19% and negative predictive values of 93 to 97%. Individuals with lowest quartile slopes in PlGF had sixfold greater odds (95% confidence interval (CI): 3.5, 10.2) of preeclampsia compared with individuals in the highest quartile. With respect to sFlt-1, the highest quartile had 5.1 times greater odds (95% CI: 3.1, 8.4) than the lowest quartile. CONCLUSION Measuring the trend in PlGF and sFlt-1 across pregnancy segregates women at increased risk of preeclampsia. However, changes in these factors throughout pregnancy lack clinically useful predictive power.
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269
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Li W, Li H, Long Y. Clinical Characteristics and Long-term Predictors of Persistent Left Ventricular Systolic Dysfunction in Peripartum Cardiomyopathy. Can J Cardiol 2016; 32:362-8. [DOI: 10.1016/j.cjca.2015.07.733] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 12/29/2022] Open
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Characteristics and In-Hospital Outcomes of Peripartum Cardiomyopathy Diagnosed During Delivery in the United States From the Nationwide Inpatient Sample (NIS) Database. J Card Fail 2016; 22:512-9. [PMID: 26923643 DOI: 10.1016/j.cardfail.2016.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 02/11/2016] [Accepted: 02/19/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is associated with advanced maternal age, African-American race, hypertensive disorders of pregnancy, and multiple-gestation pregnancies. Less is known regarding racial differences in risk factors and predictors of adverse in-hospital outcomes. METHODS AND RESULTS A total of 1,337 women with PPCM were identified with the use of the Nationwide Inpatient Sample (2004-2011). Clinical profiles and maternal outcomes in delivering mothers with and without PPCM were compared and stratified by race. In multivariate analysis, established risk factors for PPCM were confirmed. Anemia (odds ratio [OR] 2.0, 95% confidence interval [CI] 1.6-2.5; P < .0001), asthma (OR 2.2, 95% CI 1.5-3.2; P = .0002), smoking (OR 33.6, 95% CI 9.3-159.4; P < .0001), and thyroid disease (OR 5.9; 95% CI 1.5-21.3; P = .01) were associated with PPCM. Risk factors significant in whites, African Americans, and Hispanics were hypertension during pregnancy and anemia. Patients with PPCM had higher rates of in-hospital adverse outcomes (P < .0001), but no differences in race or comorbidities predicted adverse events. CONCLUSIONS Hypertensive disorders during pregnancy and anemia were associated with PPCM in whites, African Americans, and Hispanics, providing further evidence that vascular stress may play a role in the pathogenesis of PPCM. Thyroid disorders may represent a novel risk factor for PPCM.
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271
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Chung E, Kim Y, Usen O. Associations Between Parity, Obesity, and Cardiovascular Risk Factors Among Middle-Aged Women. J Womens Health (Larchmt) 2016; 25:818-25. [PMID: 26886718 DOI: 10.1089/jwh.2015.5581] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Several studies have demonstrated an association between parity and the risk of developing cardiovascular disease (CVD) in middle-aged women; however, some inconsistencies still remain in the literature after accounting for obesity. The purpose of this study was to examine the association between parity and the risk factors of CVD while accounting for current obesity status in middle-aged women. METHOD Data for this study came from the National Health and Nutrition Examination Survey 2007-2012. The final analytic sample included 2024 middle-aged women (40-60 years old). General linear models predicting CVD risk factors based on parity (nulliparous, 1, 2, 3, and ≥4) were established after controlling for study covariates. Least square adjusted means of CVD risk factors and associated 95% confidence intervals were estimated across parity and body mass index (BMI) levels. RESULTS Women with ≥4 parity (8.34%; standard error [SE] = 0.84) showed significantly distinct demographic characteristics and health conditions, including obesity (49.08%; SE = 3.55). There were no significant associations between parity and CVD risk factors after controlling for covariates. Follow-up analyses showed consistent results across parity; however, CVD risk factors were significantly increased with higher BMI levels, regardless of parity status. CONCLUSIONS Our results suggest that parity is not a significant predictor of CVD risk factors in middle-aged women, whereas current overweight or obesity status is more important when explaining the risk of the development of CVD.
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Affiliation(s)
- Eunhee Chung
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
| | - Youngdeok Kim
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
| | - Oduware Usen
- Department of Kinesiology and Sport Management, Texas Tech University , Lubbock, Texas
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272
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Khan SG, Melikian N, Mushemi-Blake S, Dennes W, Jouhra F, Monaghan M, Shah AM. Physiological Reduction in Left Ventricular Contractile Function in Healthy Postpartum Women: Potential Overlap with Peripartum Cardiomyopathy. PLoS One 2016; 11:e0147074. [PMID: 26859567 PMCID: PMC4747599 DOI: 10.1371/journal.pone.0147074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 12/27/2015] [Indexed: 01/04/2023] Open
Abstract
Aims Peripartum cardiomyopathy is a potentially life-threatening cause of heart failure, commoner in Afro-Caribbean than Caucasian women. Its diagnosis can be challenging due to physiological changes in cardiac function that also occur in healthy women during the early postpartum period. This study aimed to (i) establish the overlap between normal cardiac physiology in the immediate postpartum period and pathological changes in peripartum cardiomyopathy ii) identify any ethnicity-specific changes in cardiac function and cardiac biomarkers in healthy postpartum women. Methods and Results We conducted a cross-sectional study of 58 healthy postpartum women within 48 hours of delivery and 18 matched non-pregnant controls. Participants underwent cardiac assessment by echocardiography and strain analysis, including 3D echocardiography in 40 postpartum women. Results were compared with 12 retrospectively studied peripartum cardiomyopathy patients. Healthy postpartum women had significantly higher left ventricular volumes and mass, and lower ejection fraction and global longitudinal strain than non-pregnant controls. These parameters were significantly more impaired in peripartum cardiomyopathy patients but with overlapping ranges of values. Healthy postpartum women had higher levels of adrenomedullin, placental growth factor (PlGF) and soluble fms-like tyrosine kinase-1 (sFlt1) compared to controls. The postpartum state, adrenomedullin, sFlt1 and the sFlt1:PlGF ratio were independent predictors of LV remodelling and function in healthy postpartum women. Conclusion Healthy postpartum women demonstrate several echocardiographic indicators of left ventricular remodelling and reduced function, which are associated with altered levels of angiogenic and cardiac biomarkers.
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MESH Headings
- Adult
- Biomarkers/metabolism
- Cardiomyopathy, Dilated/diagnostic imaging
- Cardiomyopathy, Dilated/metabolism
- Cardiomyopathy, Dilated/pathology
- Cardiomyopathy, Dilated/physiopathology
- Female
- Humans
- Myocardial Contraction
- Peripartum Period/metabolism
- Peripartum Period/physiology
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnostic imaging
- Pregnancy Complications, Cardiovascular/metabolism
- Pregnancy Complications, Cardiovascular/pathology
- Pregnancy Complications, Cardiovascular/physiopathology
- Retrospective Studies
- Stroke Volume
- Ultrasonography
- Ventricular Dysfunction, Left
- Ventricular Function, Left
- Ventricular Remodeling
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Affiliation(s)
- Sitara G. Khan
- Department of Cardiology, King’s College London British Heart Foundation Centre, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Narbeh Melikian
- Department of Cardiology, King’s College London British Heart Foundation Centre, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Sitali Mushemi-Blake
- Department of Cardiology, King’s College London British Heart Foundation Centre, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - William Dennes
- Department of Obstetrics and Gynaecology, King’s College Hospital, London, United Kingdom
| | - Fadi Jouhra
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Mark Monaghan
- Department of Cardiology, King’s College London British Heart Foundation Centre, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
| | - Ajay M. Shah
- Department of Cardiology, King’s College London British Heart Foundation Centre, London, United Kingdom
- Department of Cardiology, King’s College Hospital, London, United Kingdom
- * E-mail:
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273
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Chou MH, Huang HH, Lai YJ, Hwang KS, Wang YC, Su HY. Cardiac arrest during emergency cesarean section for severe pre-eclampsia and peripartum cardiomyopathy. Taiwan J Obstet Gynecol 2016; 55:125-7. [DOI: 10.1016/j.tjog.2015.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2014] [Indexed: 11/28/2022] Open
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274
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Wickramasinghe CD, Nguyen KL, Watson KE, Vorobiof G, Yang EH. Concepts in cardio-oncology: definitions, mechanisms, diagnosis and treatment strategies of cancer therapy-induced cardiotoxicity. Future Oncol 2016; 12:855-70. [PMID: 26829050 DOI: 10.2217/fon.15.349] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There has been considerable improvement in cancer survival rates, primarily through improved preventive strategies and novel anticancer drugs. Cancer is now becoming a chronic illness and as such both short and long-term cardiotoxic effects of cancer therapy are becoming more apparent. This has led to the emergence of a new multidisciplinary specialty known as cardio-oncology, with the purpose of identifying patients who are at a higher risk for developing cardiotoxicity so that appropriate surveillance, treatment and follow-up strategies may be instituted early. The mechanisms of cardiotoxicity caused by commonly used anticancer agents are reviewed, along with the latest advances in diagnostic and preventative strategies, with the overall objective of allowing cancer patients to continue both lifesaving and palliative treatments for their malignancy.
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Affiliation(s)
- Chanaka D Wickramasinghe
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Kim-Lien Nguyen
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Karol E Watson
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Gabriel Vorobiof
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Eric H Yang
- Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
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275
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Kirbas A, Kirbas O, Daglar K, Inal HA, Kurmus O, Kara O, Timur H, Gencosmanoglu G, Danisman N. Novel indexes of arrhythmogenesis in preeclampsia: QT dispersion, Tp-e interval, and Tp-e/QT ratio. Pregnancy Hypertens 2016; 6:38-41. [PMID: 26955770 DOI: 10.1016/j.preghy.2016.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 01/19/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE There is increasing evidence that preeclampsia (PE) may also be a risk factor for future cardiovascular diseases (CVDs), including arrhythmia. In this study we aimed to evaluate the association between PE and ventricular repolarization using novel electrocardiogram markers: QT interval duration, Tp-e interval, and Tp-e/QT ratio. MATERIALS AND METHODS In this controlled cross-sectional study sixty-four pregnant women with PE (31 with mild and 33 with severe disease) and 32 healthy women with uncomplicated pregnancies in the third trimester were compared by measuring QT parameters, Tp-e interval, and Tp-e/QT ratio. RESULTS Tp-e interval and Tp-e/QT ratio values were significantly higher in both the mild and severe PE groups compared to the healthy pregnant group. CONCLUSION Prevention of CVD requires that patients be aware of their risk factors, be educated about their risk, and perhaps most importantly perceive them to be at risk. In this study, we documented that PE has a significant effect on ventricular repolarization. This alteration could, in part, explain the increased cardiovascular risk in women with a history of PE. This important association can be used to screen women for increased risk in order to better target counseling regarding lifestyle modifications and to follow up and manage women with a history of hypertensive disease of pregnancy more closely.
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Affiliation(s)
- Ayse Kirbas
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | - Ozgur Kirbas
- Department of Cardiology, Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey.
| | - Korkut Daglar
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | - Hasan Ali Inal
- Department of Obstetrics and Gynecology, Konya Education and Research Hospital, Konya, Turkey.
| | - Ozge Kurmus
- Department of Cardiology, Mersin State Hospital, Mersin, Turkey.
| | - Ozgur Kara
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | - Hakan Timur
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | - Gulenay Gencosmanoglu
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
| | - Nuri Danisman
- Department of Perinatology, Zekai Tahir Burak Women's Health Education and Research Hospital, Ankara, Turkey.
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276
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Ware JS, Li J, Mazaika E, Yasso CM, DeSouza T, Cappola TP, Tsai EJ, Hilfiker-Kleiner D, Kamiya CA, Mazzarotto F, Cook SA, Halder I, Prasad SK, Pisarcik J, Hanley-Yanez K, Alharethi R, Damp J, Hsich E, Elkayam U, Sheppard R, Kealey A, Alexis J, Ramani G, Safirstein J, Boehmer J, Pauly DF, Wittstein IS, Thohan V, Zucker MJ, Liu P, Gorcsan J, McNamara DM, Seidman CE, Seidman JG, Arany Z. Shared Genetic Predisposition in Peripartum and Dilated Cardiomyopathies. N Engl J Med 2016; 374:233-41. [PMID: 26735901 PMCID: PMC4797319 DOI: 10.1056/nejmoa1505517] [Citation(s) in RCA: 376] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Peripartum cardiomyopathy shares some clinical features with idiopathic dilated cardiomyopathy, a disorder caused by mutations in more than 40 genes, including TTN, which encodes the sarcomere protein titin. Methods In 172 women with peripartum cardiomyopathy, we sequenced 43 genes with variants that have been associated with dilated cardiomyopathy. We compared the prevalence of different variant types (nonsense, frameshift, and splicing) in these women with the prevalence of such variants in persons with dilated cardiomyopathy and with population controls. Results We identified 26 distinct, rare truncating variants in eight genes among women with peripartum cardiomyopathy. The prevalence of truncating variants (26 in 172 [15%]) was significantly higher than that in a reference population of 60,706 persons (4.7%, P=1.3×10(-7)) but was similar to that in a cohort of patients with dilated cardiomyopathy (55 of 332 patients [17%], P=0.81). Two thirds of identified truncating variants were in TTN, as seen in 10% of the patients and in 1.4% of the reference population (P=2.7×10(-10)); almost all TTN variants were located in the titin A-band. Seven of the TTN truncating variants were previously reported in patients with idiopathic dilated cardiomyopathy. In a clinically well-characterized cohort of 83 women with peripartum cardiomyopathy, the presence of TTN truncating variants was significantly correlated with a lower ejection fraction at 1-year follow-up (P=0.005). Conclusions The distribution of truncating variants in a large series of women with peripartum cardiomyopathy was remarkably similar to that found in patients with idiopathic dilated cardiomyopathy. TTN truncating variants were the most prevalent genetic predisposition in each disorder.
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Affiliation(s)
- James S Ware
- From the Department of Genetics, Harvard Medical School (J.S.W., E.M., C.M.Y., C.E.S., J.G.S.), the Howard Hughes Medical Institute (C.E.S.), and the Cardiovascular Division, Brigham and Women's Hospital (J.S.W., E.M., C.E.S., J.G.S.) - all in Boston; the Cardiovascular Institute and the Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia (J.L., T.D., T.P.C., Z.A.), the Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh (I.H., J.P., K.H.-Y., J.G., D.M.M.), and Penn State Hershey Medical Center, Hershey (J.B.) - all in Pennsylvania; the National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit (J.S.W., F.M., S.K.P.) and the National Heart and Lung Institute (J.S.W., F.M., S.A.C., S.K.P.), Imperial College London, London; the Division of Cardiology, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York (E.J.T.), and the University of Rochester, Rochester (J.A.) - both in New York; the Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany (D.H.-K.); the Department of Perinatology and Gynecology, the National Cerebral and Cardiovascular Center, Osaka, Japan (C.A.K.); the National Heart Center and Duke-National University of Singapore, Singapore (S.A.C.); the Intermountain Medical Center, Murray, Utah (R.A.); Vanderbilt University, Nashville (J.D.); Cleveland Clinic, Cleveland (E.H.); University of Southern California, Los Angeles (U.E.); McGill University and Jewish General Hospital, Montreal (R.S.), University of Calgary, Calgary, AB (A.K.), and University of Toronto, Toronto (P.L.) - all in Canada; University of Maryland, College Park (G.R.), and Johns Hopkins Hospital, Baltimore (I.S.W.) - both in Maryland; Morristown Hospital, Morristown (J.S.), and Newark Beth Israel Medical Center, Newark (M.J.Z.) - both in New Jersey; Truman Medical Center, University of Missouri, Kansas City (D.F.P.); and Wa
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Stojanovska V, Scherjon SA, Plösch T. Preeclampsia As Modulator of Offspring Health. Biol Reprod 2016; 94:53. [PMID: 26792940 DOI: 10.1095/biolreprod.115.135780] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 01/15/2016] [Indexed: 02/01/2023] Open
Abstract
A balanced intrauterine homeostasis during pregnancy is crucial for optimal growth and development of the fetus. The intrauterine environment is extremely vulnerable to multisystem pregnancy disorders such as preeclampsia, which can be triggered by various pathophysiological factors, such as angiogenic imbalance, immune responses, and inflammation. The fetus adapts to these conditions by a mechanism known as developmental programming that can lead to increased risk of chronic noncommunicable diseases in later life. This is shown in a substantial number of epidemiological studies that associate preeclampsia with increased onset of cardiovascular and metabolic diseases in the later life of the offspring. Furthermore, animal models based predominantly on one of the pathophysiological mechanism of preeclampsia, for example, angiogenic imbalance, immune response, or inflammation, do address the susceptibility of the preeclamptic offspring to increased maternal blood pressure and disrupted metabolic homeostasis. Accordingly, we extensively reviewed the latest research on the role of preeclampsia on the offspring's metabolism and cardiovascular phenotype. We conclude that future research on the pathophysiological changes during preeclampsia and methods to intervene in the harsh intrauterine environment will be essential for effective therapies.
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Affiliation(s)
- Violeta Stojanovska
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Sicco A Scherjon
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Torsten Plösch
- Department of Obstetrics and Gynecology, University of Groningen, University Medical Center Groningen, The Netherlands
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278
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Abstract
Heart disease is a common cause of morbidity and mortality during pregnancy. Symptoms and signs of heart failure in a pregnant woman are an indication for urgent assessment to establish a diagnosis and appropriate management. This is best accomplished through a multidisciplinary approach in which both cardiologists and obstetricians need to participate in order to provide expert counselling and care in pursuit of safe motherhood. Congenital heart disease, although common, once corrected is an unusual source of complications, which are more likely to develop as a consequence of ventricular failure, pulmonary hypertension and aortic arch disease. Rheumatic valvular heart disease is a challenge because of the need for anticoagulation during pregnancy and the risk of sepsis associated with childbirth. This review outlines a contemporary approach to heart failure presenting during pregnancy.
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Affiliation(s)
- John Anthony
- Division of Obstetrics and Gynaecology Groote Schuur Hospital, University of Cape Town,Cape Town, South Africa
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town,Cape Town, South Africa.,Soweto Cardiovascular Research Group University of theWitwatersrand, South Africa
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Hammadah M, Georgiopoulou VV, Kalogeropoulos AP, Weber M, Wang X, Samara MA, Wu Y, Butler J, Tang WHW. Elevated Soluble Fms-Like Tyrosine Kinase-1 and Placental-Like Growth Factor Levels Are Associated With Development and Mortality Risk in Heart Failure. Circ Heart Fail 2015; 9:e002115. [PMID: 26699385 DOI: 10.1161/circheartfailure.115.002115] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 11/18/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Vascular endothelial dysfunction may play an important role in the progression of heart failure (HF). We hypothesize that elevated levels of vascular markers, placental-like growth factor, and soluble Fms-like tyrosine kinase-1 (sFlt-1) are associated with adverse outcomes in patients with HF. We also assessed possible triggers of sFlt-1 elevation in animal HF models. METHODS AND RESULTS We measured plasma placental-like growth factor and sFlt-1 in 791 HF patients undergoing elective coronary angiogram. Median (interquartile range) placental-like growth factor and sFlt-1 levels were 24 (20-29) and 382 (277-953) pg/mL, respectively. After 5 years of follow-up, and after using receiver operator characteristic curves to determine optimal cutoffs, high levels of sFlt-1 (≥ 280 pg/mL; adjusted hazard ratio, 1.47; 95% confidence interval, 1.03-2.09; P=0.035) but not placental-like growth factor (≥ 25 pg/mL; adjusted hazard ratio, 1.26; 95% confidence interval, 0.94-1.71, P=0.12) were associated with adverse cardiovascular outcomes. In addition, significant elevation of sFlt-1 levels was observed in left anterior descending artery ligation and transverse aortic constriction HF mouse models after 4 and 8 weeks of follow-up, suggesting vascular stress and ischemia as triggers for sFlt-1 elevation in HF. CONCLUSIONS Circulating sFlt-1 is generated as a result of myocardial injury and subsequent HF development. Elevated levels of sFlt-1 are associated with adverse outcomes in stable patients with HF.
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Affiliation(s)
- Muhammad Hammadah
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Vasiliki V Georgiopoulou
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Andreas P Kalogeropoulos
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Malory Weber
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Xi Wang
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Michael A Samara
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Yuping Wu
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - Javed Butler
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.)
| | - W H Wilson Tang
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (M.H., W.H.W.T.), Department of Cellular and Molecular Medicine, Lerner Research Institute (M.W., X.W., W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Emory University, Atlanta, GA (M.H., V.V.G., A.P.K.); Department of Cardiology, Minneapolis Heart Institute, MN (M.A.S); Department of Mathematics, Cleveland State University, OH (Y.W.); Cardiovascular Division, Stony Brook University, NY (J.B.).
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281
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The Medical Treatment of New-Onset Peripartum Cardiomyopathy: A Systematic Review of Prospective Studies. Can J Cardiol 2015; 31:1421-6. [DOI: 10.1016/j.cjca.2015.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/08/2015] [Accepted: 04/28/2015] [Indexed: 11/23/2022] Open
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282
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Dinic V, Markovic D, Savic N, Kutlesic M, Jankovic RJ. Peripartum Cardiomyopathy in Intensive Care Unit: An Update. Front Med (Lausanne) 2015; 2:82. [PMID: 26636086 PMCID: PMC4655438 DOI: 10.3389/fmed.2015.00082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/02/2015] [Indexed: 11/17/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a systolic heart failure that occurs during the last month of pregnancy or within 5 months after delivery. It is an uncommon disease of unknown etiopathogenesis and has a very high rate of maternal mortality. Because of similarity between symptoms of PPCM and physiological discomforts during pregnancy, the early diagnosis of PPCM presents a major challenge. Since hemodynamic changes during PPCM can vitally jeopardize the mother and the fetus, patients with severe forms of PPCM require a multidisciplinary approach in intensive care units. This review summarizes the current state of knowledge about the diagnosis, monitoring, and the treatment of PPCM. Having reviewed the recent researches, it gives insight into the new treatment strategies of this rare disease.
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Affiliation(s)
- Vesna Dinic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Danica Markovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Nenad Savic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Marija Kutlesic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia
| | - Radmilo J Jankovic
- Center for Anesthesiology and Reanimatology, Clinical Center of Nis , Nis , Serbia ; Department for Anesthesiology and Intensive Care, School of Medicine, University of Nis , Nis , Serbia
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283
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McNamara DM, Elkayam U, Alharethi R, Damp J, Hsich E, Ewald G, Modi K, Alexis JD, Ramani GV, Semigran MJ, Haythe J, Markham DW, Marek J, Gorcsan J, Wu WC, Lin Y, Halder I, Pisarcik J, Cooper LT, Fett JD. Clinical Outcomes for Peripartum Cardiomyopathy in North America: Results of the IPAC Study (Investigations of Pregnancy-Associated Cardiomyopathy). J Am Coll Cardiol 2015; 66:905-14. [PMID: 26293760 DOI: 10.1016/j.jacc.2015.06.1309] [Citation(s) in RCA: 312] [Impact Index Per Article: 34.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 06/14/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) remains a major cause of maternal morbidity and mortality. OBJECTIVES This study sought to prospectively evaluate recovery of the left ventricular ejection fraction (LVEF) and clinical outcomes in the multicenter IPAC (Investigations of Pregnancy Associated Cardiomyopathy) study. METHODS We enrolled and followed 100 women with PPCM through 1 year post-partum. The LVEF was assessed by echocardiography at baseline and at 2, 6, and 12 months post-partum. Survival free from major cardiovascular events (death, transplantation, or left ventricular [LV] assist device) was determined. Predictors of outcome, particularly race, parameters of LV dysfunction (LVEF), and remodeling (left ventricular end-diastolic diameter [LVEDD]) at presentation, were assessed by univariate and multivariate analyses. RESULTS The cohort was 30% black, 65% white, 5% other; the mean patient age was 30 ± 6 years; and 88% were receiving beta-blockers and 81% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The LVEF at study entry was 0.35 ± 0.10, 0.51 ± 0.11 at 6 months, and 0.53 ± 0.10 at 12 months. By 1 year, 13% had experienced major events or had persistent severe cardiomyopathy with an LVEF <0.35, and 72% achieved an LVEF ≥0.50. An initial LVEF <0.30 (p = 0.001), an LVEDD ≥6.0 cm (p < 0.001), black race (p = 0.001), and presentation after 6 weeks post-partum (p = 0.02) were associated with a lower LVEF at 12 months. No subjects with both a baseline LVEF <0.30 and an LVEDD ≥6.0 cm recovered by 1 year post-partum, whereas 91% with both a baseline LVEF ≥0.30 and an LVEDD <6.0 cm recovered (p < 0.00001). CONCLUSIONS In a prospective cohort with PPCM, most women recovered; however, 13% had major events or persistent severe cardiomyopathy. Black women had more LV dysfunction at presentation and at 6 and 12 months post-partum. Severe LV dysfunction and greater remodeling at study entry were associated with less recovery. (Investigations of Pregnancy Associated Cardiomyopathy [IPAC]; NCT01085955).
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Affiliation(s)
| | - Uri Elkayam
- University of Southern California, Los Angeles, California
| | | | - Julie Damp
- Vanderbilt University, Nashville, Tennessee
| | | | | | - Kalgi Modi
- Louisiana State University Health Sciences Center, Shreveport, Louisiana
| | - Jeffrey D Alexis
- University of Rochester School of Medicine and Dentistry, Rochester, New York
| | | | - Marc J Semigran
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Josef Marek
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - John Gorcsan
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wen-Chi Wu
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Yan Lin
- University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart, Lung, Blood and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Pisarcik
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - James D Fett
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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284
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Evidence of autoantibodies against cardiac troponin I and sarcomeric myosin in peripartum cardiomyopathy. Basic Res Cardiol 2015; 110:60. [PMID: 26519371 DOI: 10.1007/s00395-015-0517-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 10/21/2015] [Indexed: 10/22/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a major cause of pregnancy-related maternal heart failure that develops towards the end of pregnancy or in the months following delivery. In small retrospective case series, autoimmune responses in the pathogenesis of PPCM have been proposed upon identification of autoantibodies (AABs) to cardiac antigens. However, their clinical and prognostic relevance still remain unclear. In this study, we evaluated the presence of circulating AABs against cardiac sarcomeric myosin (MHC) and troponin I (TnI) in the sera of PPCM patients and in relation to clinical presentation. In this case-control study, 70 patients diagnosed with PPCM and 50 pregnancy-matched healthy women with normal cardiac function were enrolled. Clinical assessment, echocardiography and blood tests were performed at baseline and at 6 ± 2 months follow-up. The presence of serum AABs against MHC (anti-MHC) and TnI (anti-TnI) was determined with a custom-made enzyme-linked immunosorbent assay (ELISA). The seropositivity for these AABs was correlated with the severity of LV dysfunction and the occurrence of pericardial effusion indicative of perimyocardial inflammation at baseline. Potential impact of these AABs on disease progression was evaluated with regard to functional (left ventricular ejection fraction) and clinical improvement at follow-up. Either anti-MHC or anti-TnI or both AABs were detected in the serum of 46 % of PPCM patients and in 8 % of healthy controls. In PPCM the presence of either one of these AABs was associated with significantly lower baseline LVEF and lower rate of full cardiac recovery at follow-up. Patients who were seropositive for anti-TnI AABs showed more frequently pericardial effusion indicative of a more pronounced immune response of the peri-/myocardium in these patients. Further studies are required to clarify cellular and molecular circuits leading to elevated levels of AABs and their pathophysiological relevance for disease initiation and progression in PPCM.
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285
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Bouabdallaoui N, Mouquet F, Lebreton G, Demondion P, Le Jemtel TH, Ennezat PV. Current knowledge and recent development on management of peripartum cardiomyopathy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:359-366. [PMID: 26474841 DOI: 10.1177/2048872615612465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Heart failure with left ventricular dysfunction occurring during pregnancy or during the post-partum period in patients without history of cardiovascular disease defines peripartum cardiomyopathy (PPCM). PPCM carries a high morbidity and mortality rate as well as the possibility of recovery ad integrum. Its incidence shows ethnic variations, with a greater prevalence of the disease among women with African descent. Pathogenesis of PPCM remains poorly understood. Both "oxidative stress-prolactin axis" and "anti-angiogenic-signaling excess" hypotheses are currently being investigated. Novel diagnostic strategies and biomarkers are currently being evaluated. Besides conventional treatment of heart failure, targeted therapies such as pharmacological prolactin blockade are under evaluation. The aim of this short review is to highlight current management as targeted therapy has far been disappointing.
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Affiliation(s)
| | | | - Guillaume Lebreton
- 1 Cardio-Thoracic Surgery Department, Pitié-Salpétrière Hospital, France
| | - Pierre Demondion
- 1 Cardio-Thoracic Surgery Department, Pitié-Salpétrière Hospital, France
| | | | - Pierre V Ennezat
- 4 Department of Cardiology, Centre Hospitalier Universitaire de Grenoble, France
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286
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Brown SA, Sandhu N, Herrmann J. Systems biology approaches to adverse drug effects: the example of cardio-oncology. Nat Rev Clin Oncol 2015; 12:718-31. [PMID: 26462128 DOI: 10.1038/nrclinonc.2015.168] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Increased awareness of the cardiovascular toxic effects of chemotherapy has led to the emergence of cardio-oncology (or onco-cardiology), which focuses on screening, monitoring and treatment of patients with cardiovascular dysfunctions resulting from chemotherapy. Anthracyclines, such as doxorubicin, and HER2 inhibitors, such as trastuzumab, both have cardiotoxic effects. The biological rationale, mechanisms of action and cardiotoxicity profiles of these two classes of drugs, however, are completely different, suggesting that cardiotoxic effects can occur in a range of different ways. Advances in genomics and proteomics have implicated several genomic variants and biological pathways that can influence the susceptibility to cardiotoxicity from these, and other drugs. Established pathways include multidrug resistance proteins, energy utilization pathways, oxidative stress, cytoskeletal regulation and apoptosis. Gene-expression profiles that have revealed perturbed pathways have vastly increased our knowledge of the complex processes involved in crosstalk between tumours and cardiac function. Utilization of mathematical and computational modelling can complement pharmacogenomics and improve individual patient outcomes. Such endeavours should enable identification of variations in cardiotoxicity, particularly in those patients who are at risk of not recovering, even with the institution of cardioprotective therapy. The application of systems biology holds substantial potential to advance our understanding of chemotherapy-induced cardiotoxicity.
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Affiliation(s)
- Sherry-Ann Brown
- Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Nicole Sandhu
- Division of General Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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287
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Davis MB. Pregnancy and Heart Disease Updates: Current Knowledge and Future Directions. CURRENT CARDIOVASCULAR RISK REPORTS 2015. [DOI: 10.1007/s12170-015-0478-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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288
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Kamiya CA, Yoshimatsu J. Editorial: How do genetic components play a role in peripartum cardiomyopathy? J Cardiol Cases 2015; 12:104-105. [PMID: 30546568 PMCID: PMC6281868 DOI: 10.1016/j.jccase.2015.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chizuko A. Kamiya
- Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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289
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Gallardo Arozena M, de Ganzo Suárez T, Contreras González B, Bernaldo de Quirós Huguet I, Sierra Medina N, Méndez Mora D. La miocardiopatía periparto como causa de insuficiencia cardiaca en el embarazo y el puerperio. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.pog.2015.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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290
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Hod T, Cerdeira AS, Karumanchi SA. Molecular Mechanisms of Preeclampsia. Cold Spring Harb Perspect Med 2015; 5:cshperspect.a023473. [PMID: 26292986 DOI: 10.1101/cshperspect.a023473] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Preeclampsia is a pregnancy-specific disease characterized by new onset hypertension and proteinuria after 20 wk of gestation. It is a leading cause of maternal and fetal morbidity and mortality worldwide. Exciting discoveries in the last decade have contributed to a better understanding of the molecular basis of this disease. Epidemiological, experimental, and therapeutic studies from several laboratories have provided compelling evidence that an antiangiogenic state owing to alterations in circulating angiogenic factors leads to preeclampsia. In this review, we highlight the role of key circulating antiangiogenic factors as pathogenic biomarkers and in the development of novel therapies for preeclampsia.
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Affiliation(s)
- Tammy Hod
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214
| | - Ana Sofia Cerdeira
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Gulbenkian Program for Advanced Medical Education, 1067-001 Lisbon, Portugal
| | - S Ananth Karumanchi
- Department of Medicine, Obstetrics & Gynecology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts 02214 Howard Hughes Medical Institute, Chevy Chase, Maryland 20815
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291
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Bello NA, Arany Z. Molecular mechanisms of peripartum cardiomyopathy: A vascular/hormonal hypothesis. Trends Cardiovasc Med 2015; 25:499-504. [PMID: 25697684 PMCID: PMC4797326 DOI: 10.1016/j.tcm.2015.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 02/06/2023]
Abstract
Peripartum cardiomyopathy (PPCM) is characterized by the development of systolic heart failure in the last month of pregnancy or within the first 5 months postpartum. The disease affects between 1:300 and 1:3000 births worldwide. Heart failure can resolve spontaneously but often does not. Mortality rates, like incidence, vary widely based on location, ranging from 0% to 25%. The consequences of PPCM are thus often devastating for an otherwise healthy young woman and her newborn. The cause of PPCM remains elusive. Numerous hypotheses have been proposed, with mixed supporting evidence. Recent work has suggested that PPCM is a vascular disease, triggered by the profound hormonal changes of late gestation. We focus here on these new mechanistic findings, and their potential implication for understanding and treating PPCM.
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Affiliation(s)
- Natalie A Bello
- Division of Cardiology, Columbia University Medical Center, New York, NY
| | - Zoltan Arany
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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292
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Abstract
The peripartum cardiomyopathy is a rare form of dilated cardiomyopathy resulting from alteration of angiogenesis toward the end of pregnancy. The diagnosis is based on the association of clinical heart failure and systolic dysfunction assessed by echocardiography or magnetic resonance imaging. Diagnoses to rule out are myocardial infarction, amniotic liquid embolism, myocarditis, inherited cardiomyopathy, and history of treatment by anthracycline. Risk factors are advance maternal age (>30), multiparity, twin pregnancy, African origin, obesity, preeclampsia, gestational hypertension, and prolonged tocolytic therapy. Treatment of acute phase is identical to usual treatment of acute systolic heart failure. After delivery, VKA treatment should be discussed in case of systolic function <25% because of higher risk of thrombus. A specific treatment by bromocriptine can be initiated on a case-by-case basis. Complete recovery of systolic function is observed in 50% of cases. The mortality risk is low. Subsequent pregnancy should be discouraged, especially if systolic function did not recover.
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Affiliation(s)
- Frédéric Mouquet
- Polyclinique du Bois, soins intensifs et cardiologie, 59000 Lille, France; Institut pasteur de Lille, Inserm UMR 1011, 59000 Lille, France.
| | - Nadia Bouabdallaoui
- AP-HP, université Pierre-et-Marie-Curie, Paris VI, hôpital de la Pitié-Salpêtrière, département de chirurgie thoracique et cardovasculaire, 75013 Paris, France
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293
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Regulation of neovascularization by S-glutathionylation via the Wnt5a/sFlt-1 pathway. Biochem Soc Trans 2015; 42:1665-70. [PMID: 25399587 DOI: 10.1042/bst20140213] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
S-glutathionylation occurs when reactive oxygen or nitrogen species react with protein-cysteine thiols. Glutaredoxin-1 (Glrx) is a cytosolic enzyme which enzymatically catalyses the reduction in S-glutathionylation, conferring reversible signalling function to proteins with redox-sensitive thiols. Glrx can regulate vascular hypertrophy and inflammation by regulating the activity of nuclear factor κB (NF-κB) and actin polymerization. Vascular endothelial growth factor (VEGF)-induced endothelial cell (EC) migration is inhibited by Glrx overexpression. In mice overexpressing Glrx, blood flow recovery, exercise function and capillary density were significantly attenuated after hindlimb ischaemia (HLI). Wnt5a and soluble Fms-like tyrosine kinase-1 (sFlt-1) were enhanced in the ischaemic-limb muscle and plasma respectively from Glrx transgenic (TG) mice. A Wnt5a/sFlt-1 pathway had been described in myeloid cells controlling retinal blood vessel development. Interestingly, a Wnt5a/sFlt-1 pathway was found also to play a role in EC to inhibit network formation. S-glutathionylation of NF-κB components inhibits its activation. Up-regulated Glrx stimulated the Wnt5a/sFlt-1 pathway through enhancing NF-κB signalling. These studies show a novel role for Glrx in post-ischaemic neovascularization, which could define a potential target for therapy of impaired angiogenesis in pathological conditions including diabetes.
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294
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Davis M, Duvernoy C. Peripartum Cardiomyopathy: Current Knowledge and Future Directions. WOMENS HEALTH 2015; 11:565-73. [DOI: 10.2217/whe.15.15] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Peripartum cardiomyopathy is a form of heart failure occurring at the end of pregnancy or early in the postpartum period. Women may recover, have persistent cardiac dysfunction or suffer complications and death. Women who are African-American, older, hypertensive or have multiple gestation pregnancies have increased risk. Diagnosis and treatment may be delayed due to similarities between symptoms of normal pregnancy and heart failure. Echocardiography is essential for the diagnosis, and B-type natriuretic peptide can be helpful. Treatment for systolic heart failure must be adjusted during pregnancy, and anticoagulation may be indicated. Even after recovery, subsequent pregnancy confers substantial risk of worsening heart failure. Further investigations into the etiology, duration of treatment and risks for relapse are needed.
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Affiliation(s)
- Melinda Davis
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA
| | - Claire Duvernoy
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, 1500 E Medical Center Drive, SPC 5853, Ann Arbor, MI 48109-5853, USA
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295
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Abstract
Preeclamptic twin pregnancy with larger gestational weight gain (GWG) is suggested to have a higher risk of peripartum cardiomyopathy (PPCM). This was true in a 5-year experience at a single center. A primiparous woman with twins and prepregnancy weight of 51.0 kg exhibited hypertension at gestational week (GW) 32−6/7 and GWG of 18.3 kg (6.0 kg and 2.9 kg during the last four weeks and one week of gestation, resp.) concomitant with generalized edema, gave birth at GW 34−4/7, developed proteinuria, cough, and dyspnea postpartum, and was diagnosed with preeclampsia and PPCM showing left ventricular ejection fraction of 34% and plasma BNP level of 1530 pg/mL. This was the only case of PPCM among 101 (12 with preeclampsia) and 3266 women with twin and singleton pregnancies, respectively. Thus, PPCM occurred significantly more often in women with preeclamptic twin pregnancies than in women with singleton pregnancies (8.3% [1/12] versus 0.0% [0/3266], P = 0.0355). This patient showed the greatest weight gain of 6.0 kg during the last four weeks of gestation and the greatest weight loss of 19.2 kg during one month postpartum among 90 women with twin deliveries at GW ≥ 32.
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296
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Goveia J, Stapor P, Carmeliet P. Principles of targeting endothelial cell metabolism to treat angiogenesis and endothelial cell dysfunction in disease. EMBO Mol Med 2015; 6:1105-20. [PMID: 25063693 PMCID: PMC4197858 DOI: 10.15252/emmm.201404156] [Citation(s) in RCA: 140] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The endothelium is the orchestral conductor of blood vessel function. Pathological blood vessel formation (a process termed pathological angiogenesis) or the inability of endothelial cells (ECs) to perform their physiological function (a condition known as EC dysfunction) are defining features of various diseases. Therapeutic intervention to inhibit aberrant angiogenesis or ameliorate EC dysfunction could be beneficial in diseases such as cancer and cardiovascular disease, respectively, but current strategies have limited efficacy. Based on recent findings that pathological angiogenesis and EC dysfunction are accompanied by EC-specific metabolic alterations, targeting EC metabolism is emerging as a novel therapeutic strategy. Here, we review recent progress in our understanding of how EC metabolism is altered in disease and discuss potential metabolic targets and strategies to reverse EC dysfunction and inhibit pathological angiogenesis.
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Affiliation(s)
- Jermaine Goveia
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center VIB, Leuven, Belgium
| | - Peter Stapor
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center VIB, Leuven, Belgium
| | - Peter Carmeliet
- Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center, Department of Oncology, University of Leuven, Leuven, Belgium Laboratory of Angiogenesis and Neurovascular Link, Vesalius Research Center VIB, Leuven, Belgium
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297
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Weber GM. Federated queries of clinical data repositories: Scaling to a national network. J Biomed Inform 2015; 55:231-6. [PMID: 25957825 DOI: 10.1016/j.jbi.2015.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2015] [Revised: 04/26/2015] [Accepted: 04/28/2015] [Indexed: 10/23/2022]
Abstract
Federated networks of clinical research data repositories are rapidly growing in size from a handful of sites to true national networks with more than 100 hospitals. This study creates a conceptual framework for predicting how various properties of these systems will scale as they continue to expand. Starting with actual data from Harvard's four-site Shared Health Research Information Network (SHRINE), the framework is used to imagine a future 4000 site network, representing the majority of hospitals in the United States. From this it becomes clear that several common assumptions of small networks fail to scale to a national level, such as all sites being online at all times or containing data from the same date range. On the other hand, a large network enables researchers to select subsets of sites that are most appropriate for particular research questions. Developers of federated clinical data networks should be aware of how the properties of these networks change at different scales and design their software accordingly.
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Affiliation(s)
- Griffin M Weber
- Center for Biomedical Informatics, Harvard Medical School, Boston, MA 02115, United States; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, United States.
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298
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Dalzell JR, Cannon JA, Simpson J, Gardner RS, Petrie MC. Improving outcomes in peripartum cardiomyopathy. Expert Rev Cardiovasc Ther 2015; 13:665-71. [DOI: 10.1586/14779072.2015.1040767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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299
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Goland S, Elkayam U. "Of mice and (wo)men": The need to confirm results of animal experimentations with solid clinical data. Trends Cardiovasc Med 2015; 25:505-7. [PMID: 25908533 DOI: 10.1016/j.tcm.2015.03.009] [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] [Received: 03/14/2015] [Revised: 03/21/2015] [Accepted: 03/22/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Sorel Goland
- Heart Institute, Kaplan Medical Center, Rehovot, affiliated to the Hebrew University, Jerusalem, Israel.
| | - Uri Elkayam
- Department of Medicine, Division of Cardiology, and the Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA
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300
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Soluble Flt-1 links microvascular disease with heart failure in CKD. Basic Res Cardiol 2015; 110:30. [PMID: 25893874 DOI: 10.1007/s00395-015-0487-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/29/2015] [Accepted: 04/13/2015] [Indexed: 01/17/2023]
Abstract
Chronic kidney disease (CKD) is associated with an increased risk of heart failure (HF). Elevated plasma concentrations of soluble Flt-1 (sFlt-1) have been linked to cardiovascular disease in CKD patients, but whether sFlt-1 contributes to HF in CKD is still unknown. To provide evidence that concludes a pathophysiological role of sFlt-1 in CKD-associated HF, we measured plasma sFlt-1 concentrations in 586 patients with angiographically documented coronary artery disease and renal function classified according to estimated glomerular filtration rate (eGFR). sFlt-1 concentrations correlated negatively with eGFR and were associated with signs of heart failure, based on New York Heart Association functional class and reduced left ventricular ejection fraction (LVEF), and early mortality. Additionally, rats treated with recombinant sFlt-1 showed a 15 % reduction in LVEF and a 29 % reduction in cardiac output compared with control rats. High sFlt-1 concentrations were associated with a 15 % reduction in heart capillary density (number of vessels/cardiomyocyte) and a 24 % reduction in myocardial blood volume. Electron microscopy and histological analysis revealed mitochondrial damage and interstitial fibrosis in the hearts of sFlt-1-treated, but not control rats. In 5/6-nephrectomised rats, an animal model of CKD, sFlt-1 antagonism with recombinant VEGF121 preserved heart microvasculature and significantly improved heart function. Overall, these findings suggest that a component of cardiovascular risk in CKD patients could be directly attributed to sFlt-1. Assessment of patients with CKD confirmed that sFlt-1 concentrations were inversely correlated with renal function, while studies in rats suggested that sFlt-1 may link microvascular disease with HF in CKD.
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