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Grymyr LMD, Mellgren G, McCann A, Gerdts E, Meyer K, Nadirpour S, Fernø J, Nedrebø BG, Cramariuc D. Preoperative risk factors associated with left ventricular dysfunction after bariatric surgery. Sci Rep 2024; 14:2173. [PMID: 38273044 PMCID: PMC10810803 DOI: 10.1038/s41598-024-52623-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 01/22/2024] [Indexed: 01/27/2024] Open
Abstract
A large proportion of patients with severe obesity remain with left ventricular (LV) dysfunction after bariatric surgery. We assessed whether preoperative evaluation by echocardiography and inflammatory proteins can identify this high-risk group. In the Bariatric Surgery on the West Coast of Norway study, 75 patients (44 ± 10 years, body mass index [BMI] 41.5 ± 4.7 kg/m2) were prospectively evaluated by echocardiography and inflammatory proteins (high-sensitivity C-reactive protein [hsCRP], serum amyloid A [SAA] and calprotectin) before and one year after Roux-en-Y gastric bypass surgery. LV mechanics was assessed by the midwall shortening (MWS) and global longitudinal strain (GLS). Bariatric surgery improved BMI and GLS, and lowered hsCRP, calprotectin and SAA (p < 0.05). MWS remained unchanged and 35% of patients had impaired MWS at 1-year follow-up. A preoperative risk index including sex, hypertension, ejection fraction (EF) and high hsCRP (index 1) or SAA (index 2) predicted low 1-year MWS with 81% sensitivity/71% specificity (index 1), and 77% sensitivity/77% specificity (index 2) in ROC analyses (AUC 0.80 and 0.79, p < 0.001). Among individuals with severe obesity, women and patients with hypertension, increased serum levels of inflammatory proteins and reduced EF are at high risk of impaired LV midwall mechanics 1 year after bariatric surgery.ClinicalTrials.gov identifier NCT01533142 February 15, 2012.
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Affiliation(s)
- Lisa M D Grymyr
- Department of Heart Disease, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gunnar Mellgren
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | | | - Eva Gerdts
- Center for Research on Cardiac Disease in Women, Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Saied Nadirpour
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Johan Fernø
- Mohn Nutrition Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway
- Hormone Laboratory, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway
| | - Bjørn G Nedrebø
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Dana Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Jonas Liesvei 65, 5021, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
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Rauf A, Ullah A, Rathi U, Ashfaq Z, Ullah H, Ashraf A, Kumar J, Faraz M, Akhtar W, Mehmoodi A, Malik J. Predicting stroke and mortality in mitral stenosis with atrial flutter: A machine learning approach. Ann Noninvasive Electrocardiol 2023; 28:e13078. [PMID: 37545120 PMCID: PMC10475890 DOI: 10.1111/anec.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Our study hypothesized that an intelligent gradient boosting machine (GBM) model can predict cerebrovascular events and all-cause mortality in mitral stenosis (MS) with atrial flutter (AFL) by recognizing comorbidities, electrocardiographic and echocardiographic parameters. METHODS The machine learning model was used as a statistical analyzer in recognizing the key risk factors and high-risk features with either outcome of cerebrovascular events or mortality. RESULTS A total of 2184 patients with their chart data and imaging studies were included and the GBM analysis demonstrated mitral valve area (MVA), right ventricular systolic pressure, pulmonary artery pressure (PAP), left ventricular ejection fraction (LVEF), New York Heart Association (NYHA) class, and surgery as the most significant predictors of transient ischemic attack (TIA/stroke). MVA, PAP, LVEF, creatinine, hemoglobin, and diastolic blood pressure were predictors for all-cause mortality. CONCLUSION The GBM model assimilates clinical data from all diagnostic modalities and significantly improves risk prediction performance and identification of key variables for the outcome of MS with AFL.
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Affiliation(s)
- Amer Rauf
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | - Asif Ullah
- Department of CardiologyKMU Institute of Medical SciencesKohatPakistan
| | | | - Zainab Ashfaq
- Department of MedicineCMH Lahore Medical CollegeLahorePakistan
| | - Hidayat Ullah
- Department of CardiologyPakistan Atomic Energy Commission HospitalIslamabadPakistan
| | - Amna Ashraf
- Department of MedicineMilitary Hospital RawalpindiRawalpindiPakistan
| | - Jateesh Kumar
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | - Maria Faraz
- Department of Business DevelopmentBahria UniversityIslamabadPakistan
| | - Waheed Akhtar
- Department of CardiologyAbbas Institute of Medical SciencesMuzaffarabadPakistan
| | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Jahanzeb Malik
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
- Department of Cardiovascular ResearchCardiovascular Analytics GroupRawalpindiPakistan
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3
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Zhou J, Lee S, Liu Y, Chan JSK, Li G, Wong WT, Jeevaratnam K, Cheng SH, Liu T, Tse G, Zhang Q. Predicting Stroke and Mortality in Mitral Regurgitation: A Machine Learning Approach. Curr Probl Cardiol 2023; 48:101464. [PMID: 36261105 DOI: 10.1016/j.cpcardiol.2022.101464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 01/04/2023]
Abstract
We hypothesized that an interpretable gradient boosting machine (GBM) model considering comorbidities, P-wave and echocardiographic measurements, can better predict mortality and cerebrovascular events in mitral regurgitation (MR). Patients from a tertiary center were analyzed. The GBM model was used as an interpretable statistical approach to identify the leading indicators of high-risk patients with either outcome of CVAs and all-cause mortality. A total of 706 patients were included. GBM analysis showed that age, systolic blood pressure, diastolic blood pressure, plasma albumin levels, mean P-wave duration (PWD), MR regurgitant volume, left ventricular ejection fraction (LVEF), left atrial dimension at end-systole (LADs), velocity-time integral (VTI) and effective regurgitant orifice were significant predictors of TIA/stroke. Age, sodium, urea and albumin levels, platelet count, mean PWD, LVEF, LADs, left ventricular dimension at end systole (LVDs) and VTI were significant predictors of all-cause mortality. The GBM demonstrates the best predictive performance in terms of precision, sensitivity c-statistic and F1-score compared to logistic regression, decision tree, random forest, support vector machine, and artificial neural networks. Gradient boosting model incorporating clinical data from different investigative modalities significantly improves risk prediction performance and identify key indicators for outcome prediction in MR.
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Affiliation(s)
- Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China
| | - Sharen Lee
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Yingzhi Liu
- Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
| | - Jeffrey Shi Kai Chan
- Heart Failure and Structural Heart Disease Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China
| | - Guoliang Li
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, China
| | | | - Shuk Han Cheng
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, Kent, UK.
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, China.
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Remmelzwaal S, Beulens JWJ, Elders PJM, Stehouwer CDA, Handoko ML, Appelman Y, van Empel V, Heymans SRB, van Ballegooijen AJ. Sex-specific associations of body composition measures with cardiac function and structure after 8 years of follow-up. Sci Rep 2021; 11:21046. [PMID: 34702868 PMCID: PMC8548503 DOI: 10.1038/s41598-021-00541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022] Open
Abstract
We investigated the prospective associations of body composition with cardiac structure and function and explored effect modification by sex and whether inflammation was a mediator in these associations. Total body (BF), trunk (TF) and leg fat (LF), and total lean mass (LM) were measured at baseline by a whole body DXA scan. Inflammatory biomarkers and echocardiographic measures were determined both at baseline and follow-up in the Hoorn Study (n = 321). We performed linear regression analyses with body composition measures as determinant and left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) or left atrial volume index (LAVI) at follow-up as outcome. Additionally, we performed mediation analysis using inflammation at follow-up as mediator. The study population was 67.7 ± 5.2 years and 50% were female. After adjustment, BF, TF and LF, and LM were associated with LVMI with regression coefficients of 2.9 (0.8; 5.1)g/m2.7, 2.3 (0.6; 4.0)g/m2.7, 2.0 (0.04; 4.0)g/m2.7 and − 2.9 (− 5.1; − 0.7)g/m2.7. Body composition measures were not associated with LVEF or LAVI. These associations were not modified by sex or mediated by inflammation. Body composition could play a role in the pathophysiology of LV hypertrophy. Future research should focus on sex differences in regional adiposity in relation with diastolic dysfunction.
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Affiliation(s)
- Sharon Remmelzwaal
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vanessa van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.,Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, bus 911, 3000, Leuven, Belgium
| | - A Johanne van Ballegooijen
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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5
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On the association between body fat and left ventricular mass. J Hypertens 2019; 37:1699-1704. [PMID: 31058795 DOI: 10.1097/hjh.0000000000002095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES As intervention studies have shown a reduction in body weight to be paralleled with a reduction in left ventricular mass (LVM), we quantified a hypothesized causal relationship between fat mass and LVM, and how much of these effects that was mediated by blood pressure (BP), diabetes and adipokines. Also visceral and subcutaneous adipose tissue (VAT and SAT) were explored in the same fashion. METHODS In the Prospective Study of the Vasculature in Uppsala Seniors study (n = 1016, 50% women, all aged 70 years), LVM was measured by echocardiography (indexed for lean mass, LVMI), fat and lean mass by dual-energy X-ray. VAT and SAT were measured by abdominal MRI (in n = 275). RESULTS In a structural equation model adjusting for sex, the total effect of fat mass on LVMI was large (standardized coefficient 0.280, P = 3.2 × 10, 95% confidence interval 0.210-0.349). Out of the total effect of fat mass on LVMI, 29.0% was mediated by BP and glucose (P = 2.4 × 10). The BP pathway was most important, mediating 24.4% of the total effect of fat mass on LVMI (P = 4.6 × 10), while the glucose pathway accounted for 4.6% (P = 0.033). The association of VAT with LVMI (0.202, P = 2.4 × 10) was slightly weaker than that of SAT with LVMI (0.283, P = 1.0 × 10). Of several measured adipokines, leptin was a significant mediator of the effect of fat mass on LVMI (P = 3.0 × 10). CONCLUSION One-third of the hypothesized association between body fat and LVMI was mediated by BP and glucose in this population-based cohort. Leptin was also an important mediator. Visceral adipose tissue was not more closely related to LVMI than subcutaneous abdominal fat.
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6
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Liu X, Zhao Y, Li Q, Dang S, Yan H. Equation-derived body fat percentage indicates metabolic abnormalities among normal-weight adults in a rural Chinese population. Am J Hum Biol 2017; 29. [PMID: 28161896 DOI: 10.1002/ajhb.22964] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/02/2016] [Accepted: 12/23/2016] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Obesity classification using body mass index (BMI) may miss subjects with elevated body fat percentage (BF%) and related metabolic risk factors. We aimed to evaluate whether BF% calculated by equations could provide more information about metabolic risks, in addition to BMI classification, in a cross-sectional rural Chinese population. METHODS A total of 2,990 men and women aged 18-80 years were included in this study. BF% was calculated using previously validated Chinese-specific equations. Metabolic syndrome was defined according to the updated National Cholesterol Education Program Panel III criteria for Asian Americans. RESULTS In total, 33.6% men and 32.9% women were overweight/obese according to BMI classification. Among those within the normal BMI range, 25.4% men and 54.7% women were indicated as overweight or obese given their elevated BF% (men: BF% ≥ 20%; women: BF% ≥ 30%). In both men and women, compared with those with normal BMI and BF% (NBB), subjects with normal BMI but elevated BF% (NBOB) were more likely to carry abnormal serum lipid profile and to have higher risks of metabolic syndrome. The multivariable adjusted odds ratios (95% confidence intervals) for metabolic syndrome were 5.45 (2.37-9.53, P < 0.001) and 5.65 (3.36-9.52, P < 0.001) for men and women, respectively. Moreover, the women with NBOB also showed higher blood pressure and serum uric acid than women with NBB. CONCLUSIONS Our study suggested that high BF% based on equations may indicate adverse metabolic profiles among rural Chinese adults with a normal BMI.
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Affiliation(s)
- Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Yaling Zhao
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Qiang Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Shaonong Dang
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, People's Republic of China.,Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, Shaanxi, 710061, People's Republic of China
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7
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Markus MRP, Werner N, Schipf S, Siewert-Markus U, Bahls M, Baumeister SE, Völzke H, Felix SB, Ittermann T, Dörr M. Changes in Body Weight and Composition Are Associated With Changes in Left Ventricular Geometry and Function in the General Population. Circ Cardiovasc Imaging 2017; 10:e005544. [DOI: 10.1161/circimaging.116.005544] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
Background—
The different effects of total body weight (TBW), fat-free mass (FFM), and fat mass (FM) on left ventricular (LV) geometry and function are complex. We investigated the associations of changes over time in TBW, FM, and FFM with changes in LV geometry and function.
Methods and Results—
We analyzed data from 1189 subjects (694 women), aged 44 to 86 years, from the baseline and the 5-year follow-up examination of the population-based SHIP (Study of Health in Pomerania). TBW was measured, and FFM and FM were calculated based on height-weight models derived from bioelectrical impedance studies. Echocardiographic measurements of LV geometry and function were performed according to the guidelines of the American Society of Echocardiography. Changes in body composition measures were associated with changes in LV geometry and function by multivariable-adjusted linear regression models. A 1-kg increase/decrease in TBW or FM was associated, respectively, with an increase/decrease of 0.89 g or 1.84 g in LV mass, whereas there was no such association on changes in FFM. Moreover, an increase in FM was associated with LV concentric remodeling and impairment of systolic and diastolic function parameters, whereas an increase in FFM was associated with LV eccentric remodeling and improved systolic and diastolic functional variables.
Conclusions—
Our findings indicate that changes in LV morphology and function depend on the type of body mass composition. Prospective data need to address whether specific changes in body composition over time may affect the risk for heart dysfunction more precisely than the change in TBW.
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Nicole Werner
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sabine Schipf
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Ulrike Siewert-Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Martin Bahls
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sebastian Edgar Baumeister
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Henry Völzke
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Stephan Burkhard Felix
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Till Ittermann
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Marcus Dörr
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
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8
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Affiliation(s)
- Brian D. Hoit
- From the Department of Medicine, Case Western Reserve University, Cleveland, OH; and Harrington Heart and Vascular Center, University Hospitals Cleveland Medical Center, Cleveland, OH
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9
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Schlabritz-Loutsevitch N, Apostolakis-Kyrus K, Krutilina R, Hubbard G, Kocak M, Janjetovic Z, Sathanandam S, Slominski AT, Mari G, Dick E. Pregnancy-driven cardiovascular maternal miR-29 plasticity in obesity. J Med Primatol 2016; 45:297-303. [PMID: 27627870 DOI: 10.1111/jmp.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Obesity in pregnancy (MO) is a risk factor for maternal and/or fetal cardiovascular system disorders. This study evaluated maternal CVS expression of microRNA-29 family and its target molecules in MO to test the hypotheses: CVS miR-29 concentrations are increased in pregnancy and decreased in MO. METHODS Non-pregnant (n=4), pregnant obese (POb, n=4), and pregnant non-obese (PnOb, n=4) baboons (Papio spp.) were studied. Maternal left ventricle (LV), left atrium (LA), and aortic arch (AA) were collected at the end of gestation. Expression of MiR-29 and elastin (ELN) mRNA were quantified. RESULTS LA miR-29 (a, c) expression was highest in PnOb. In the LV, miR-29b expression trended lower (P=.059) for PnOb animals. ELN mRNA expression correlated positively with miR-29b expression in AA (r=.76, P=.03). CONCLUSION Maternal obesity diminishes miR-29 adaptation to pregnancy. Pharmacologic, tissue-specific targeting of miRNA-29 may represent a strategy for prevention and treatment of MO complications.
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Affiliation(s)
- N Schlabritz-Loutsevitch
- Department of Obstetrics and Gynecology, Texas Tech University Health Sciences Center at the Permian Basin, Odessa, TX, USA
| | - K Apostolakis-Kyrus
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - R Krutilina
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - G Hubbard
- Department of Pathology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - M Kocak
- Division of Biostatistics and Epidemiology, Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Z Janjetovic
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - S Sathanandam
- Division of Pediatric Cardiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - A T Slominski
- Department of Dermatology, University of Alabama at Birmingham, Birmingham, AL, USA.,VA Medical Center, Birmingham AL, USA
| | - G Mari
- Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - E Dick
- Southwest National Primate Research Center, Texas Biomedical Research Institute, San Antonio, TX, USA
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10
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Youcef G, Olivier A, Nicot N, Muller A, Deng C, Labat C, Fay R, Rodriguez-Guéant RM, Leroy C, Jaisser F, Zannad F, Lacolley P, Vallar L, Pizard A. Preventive and chronic mineralocorticoid receptor antagonism is highly beneficial in obese SHHF rats. Br J Pharmacol 2016; 173:1805-19. [PMID: 26990406 DOI: 10.1111/bph.13479] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/17/2016] [Accepted: 02/23/2016] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE Mineralocorticoid receptor (MR) activation contributes to heart failure (HF) progression. Its overactivity in obesity is thought to accelerate cardiac remodelling and HF development. Given that MR antagonists (MRA) are beneficial in chronic HF patients, we hypothesized that early MRA treatment may target obesity-related disorders and consequently delay the development of HF. EXPERIMENTAL APPROACH Twenty spontaneously hypertensive HF dyslipidaemic obese SHHF(cp/cp) rats and 18 non-dyslipidaemic lean SHHF(+/+) controls underwent regular monitoring for their metabolic and cardiovascular phenotypes with or without MRA treatment [eplerenone (eple), 100 mg∙kg(-1) ∙day(-1) ] from 1.5 to 12.5 months of age. KEY RESULTS Eleven months of eple treatment in obese rats (SHHF(cp/cp) eple) reduced the obesity-related metabolic disorders observed in untreated SHHF(cp/cp) rats by reducing weight gain, triglycerides and total cholesterol levels and by preserving adiponectinaemia. The MRA treatment predominantly preserved diastolic and systolic functions in obese rats by alleviating the eccentric cardiac hypertrophy observed in untreated SHHF(cp/cp) animals and preserving ejection fraction (70 ± 1 vs. 59 ± 1%). The MRA also improved survival independently of these pressure effects. CONCLUSION AND IMPLICATIONS Early chronic eple treatment resulted in a delay in cardiac remodelling and HF onset in both SHHF(+/+) and SHHF(cp/cp) rats, whereas SHHF(cp/cp) rats further benefited from the MRA treatment through a reduction in their obesity and dyslipidaemia. These findings suggest that preventive MRA therapy may provide greater benefits in obese patients with additional risk factors of developing cardiovascular complications.
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Affiliation(s)
- G Youcef
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,Genomics Research Unit, Luxembourg Institute of Health, Luxembourg
| | - A Olivier
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Nancy, France
| | - N Nicot
- Genomics Research Unit, Luxembourg Institute of Health, Luxembourg
| | - A Muller
- Genomics Research Unit, Luxembourg Institute of Health, Luxembourg
| | - C Deng
- Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,UMR 7365 CNRS, Nancy, France
| | - C Labat
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France
| | - R Fay
- CHU Nancy, Nancy, France.,CIC 1433 Inserm, Pierre Drouin, Nancy, France
| | - R-M Rodriguez-Guéant
- Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Nancy, France.,U954 Inserm, Nancy, France
| | - C Leroy
- UMRS U1116 Inserm, Nancy, France.,CIC 1433 Inserm, Pierre Drouin, Nancy, France
| | - F Jaisser
- CHU Nancy, Nancy, France.,CIC 1433 Inserm, Pierre Drouin, Nancy, France
| | - F Zannad
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Nancy, France.,CIC 1433 Inserm, Pierre Drouin, Nancy, France
| | - P Lacolley
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Nancy, France
| | - L Vallar
- Genomics Research Unit, Luxembourg Institute of Health, Luxembourg
| | - A Pizard
- UMRS U1116 Inserm, Nancy, France.,Fédération de Recherche 3209, Nancy, France.,Université de Lorraine, Nancy, France.,CHU Nancy, Nancy, France.,CIC 1433 Inserm, Pierre Drouin, Nancy, France
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11
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Shamszad P, Rossano JW, Marino BS, Lowry AW, Knudson JD. Obesity and Diabetes Mellitus Adversely Affect Outcomes after Cardiac Surgery in Children's Hospitals. CONGENIT HEART DIS 2016; 11:409-414. [PMID: 26887350 DOI: 10.1111/chd.12325] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess how obesity or diabetes mellitus impacts outcomes in patients undergoing cardiac surgery in pediatric hospitals. DESIGN A multi-institutional, matched case-control study of the Pediatric Health Information System database was performed. SETTING Tertiary children's hospitals in the United States. PATIENTS All cardiac surgical cases in patients with obesity or diabetes mellitus between 2004 and 2012 were included. Cases were matched to controls by age, sex, race, and Risk Adjustment for Congenital Heart Surgery score. OUTCOME MEASURES Mortality, surgical complications, and hospital utilization. Differences in outcome measures were assessed by chi-square and Mann-Whitney tests. P value < .05 was significant. RESULTS Six hundred twenty-nine cardiac surgical cases (median age 17 years [IQR 12-32]) with obesity or diabetes mellitus were matched to 629 controls. Cases demonstrated lower median household income than those in the control group ($38,031 [IQR $31,900-$48,844] vs. ($41,896 [IQR $32,854-$56,020], P < .001). Mortality was similar between cases and controls (22% vs. 1.9%, P =.692). Surgical complications occurred similarly between cases and controls (13.5% vs. 12.4%, P = .535). Cases had longer intensive care unit length of stay than controls (3 vs. 2 days, P = .001), resulting in longer overall hospital length of stay (5 vs. 4 days, P < .001). Cases also had a higher odds of undergoing mechanical ventilation for >96 hours (OR 2.0, 95% CI 1.1-3.7) and higher rate of total parenteral nutrition use (7.2% vs. 4.5%, P = .040). Median hospital charges were higher in cases (clinical: $6,696 vs. $5,872; laboratory: $14,168 vs. $12,251; pharmacy: $12,971 vs. $10,426; imaging: $6,259 vs. $5,660; P ≤ .030 for all). CONCLUSIONS The presence of obesity or diabetes mellitus was associated with increased postoperative morbidity, hospital utilization, and cost in patients undergoing cardiac surgery in pediatric hospitals.
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Affiliation(s)
- Pirouz Shamszad
- Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA.
| | - Joseph W Rossano
- Department of Pediatrics, The Cardiac Center, Perelman School of Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Penn, USA
| | - Bradley S Marino
- Department of Pediatrics, Divisions of Cardiology and Critical Care Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Ill, USA
| | - Adam W Lowry
- Department of Cardiology, Children's National Medical Center, Washington, DC, USA
| | - Jarrod D Knudson
- Department of Pediatrics, Children's Heart Center, Division of Critical Care, Children's of Mississippi, University of Mississippi Medical Center, Jackson, Miss, USA
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12
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Tadic M, Cuspidi C, Ilic I, Suzic-Lazić J, Zivanovic V, Jozika L, Celic V. The relationship between blood pressure variability, obesity and left atrial phasic function in hypertensive population. Int J Cardiovasc Imaging 2015; 32:603-12. [DOI: 10.1007/s10554-015-0822-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
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13
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Müller PDT, Domingos H, Patusco LAP, Rapello GVG. Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery. J Bras Pneumol 2015; 41:427-32. [PMID: 26578134 PMCID: PMC4635089 DOI: 10.1590/s1806-37132015000000031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. METHODS This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. RESULTS Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = -0.355 and r = -0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). CONCLUSIONS A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.
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Affiliation(s)
- Paulo de Tarso Müller
- Laboratório de Fisiopatologia Respiratória - LAFIR - Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
- Disciplina de Pneumologia, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
| | - Hamilton Domingos
- Disciplina de Cardiologia, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
| | - Luiz Armando Pereira Patusco
- Laboratório de Fisiopatologia Respiratória - LAFIR - Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
- Disciplina de Pneumologia, Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brasil
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