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Li R, Zhu L, Wu M, Tao C, Lu Y, Zhao Y, Jiang X, Zhang C, Wan L. Serum Pharmacochemistry Combined with Network Pharmacology-Based Mechanism Prediction and Pharmacological Validation of Zhenwu Decoction on Alleviating Isoprenaline-Induced Heart Failure Injury in Rats. ACS OMEGA 2023; 8:37233-37247. [PMID: 37841161 PMCID: PMC10568591 DOI: 10.1021/acsomega.3c05055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/13/2023] [Indexed: 10/17/2023]
Abstract
Zhenwu decoction (ZWD) is a famous classical formula in the treatment of heart failure (HF) with significant clinical effects. Owing to the complex material basis of ZWD, it is challenging to elucidate the pharmacodynamic substances and pharmacological mechanisms of ZWD against HF. Therefore, an ultrahigh-performance liquid chromatography system coupled with a high-resolution orbitrap mass spectrometry method was used to profile the chemical components and the absorbed prototype constituents in ISO-induced HF rat serum after oral administration of ZWD, and 33 out of 115 compounds were identified. In the in vivo study, ZWD could improve cardiac function and reduce the content of serum biochemical indexes, which are heart failure markers. With the help of network pharmacology and molecular docking simulation analysis, 112 ZWD targets oriented by HF were obtained, with STAT3, TNF, AKT1, VEGFA, and ALB as the core targets. Furthermore, we found that paeoniflorin and its derivatives may play a bigger role than other serum migrant components. Enriched pathway analysis yielded multiple HF-related signaling pathways, which indicated that ZWD may attenuate HF through the effect of PI3K-Akt, and MAPK pathways by regulating key targets such as STAT3, TNF, and AKT1. Finally, STAT3/MAPK pathways were experimentally validated in the anti-HF effect of ZWD. The phosphorylation levels of p38, JNK, ERK, and STAT3 were significantly increased in the ISO group and reversed by ZWD intervention. The results provided a reasonable strategy for the rapid screening of bioactive components in ZWD and a reference for quality control and further mechanism study of ZWD.
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Affiliation(s)
- Ruiyu Li
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
- Sichuan
Engineering Technology Research Centre for Injection of Traditional
Chinese Medicines, China Resources Sanjiu
(Yaan) Pharmaceutical Co., Ltd., Yaan, Sichuan 625000, P. R. China
| | - Lv Zhu
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
| | - Mengyao Wu
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
| | - Chengtian Tao
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
| | - Yang Lu
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
| | - Yunyan Zhao
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
| | - Xiaofeng Jiang
- Sichuan
Engineering Technology Research Centre for Injection of Traditional
Chinese Medicines, China Resources Sanjiu
(Yaan) Pharmaceutical Co., Ltd., Yaan, Sichuan 625000, P. R. China
| | - Chi Zhang
- Sichuan
Engineering Technology Research Centre for Injection of Traditional
Chinese Medicines, China Resources Sanjiu
(Yaan) Pharmaceutical Co., Ltd., Yaan, Sichuan 625000, P. R. China
| | - Li Wan
- State
Key Laboratory of Southwestern Chinese Medicine Resources, School
of pharmacy, Chengdu University of Traditional
Chinese Medicine, Chengdu, Sichuan 611137, P. R. China
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Spilias N, Martyn T, Denby KJ, Harb SC, Popovic ZB, Kapadia SR. Left Ventricular Systolic Dysfunction in Aortic Stenosis: Pathophysiology, Diagnosis, Management, and Future Directions. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100089. [PMID: 37288060 PMCID: PMC10242576 DOI: 10.1016/j.shj.2022.100089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Degenerative calcific aortic stenosis (AS) is the most common valvular heart disease and often co-exists with left ventricular (LV) systolic dysfunction at the time of diagnosis. Impaired LV systolic function has been associated with worse outcomes in the setting of AS, even after successful aortic valve replacement (AVR). Myocyte apoptosis and myocardial fibrosis are the 2 key mechanisms responsible for the transition from the initial adaptation phase of LV hypertrophy to the phase of heart failure with reduced ejection fraction. Novel advanced imaging methods, based on echocardiography and cardiac magnetic resonance imaging, can detect LV dysfunction and remodeling at an early and reversible stage, with important implications for the optimal timing of AVR especially in patients with asymptomatic severe AS. Furthermore, the advent of transcatheter AVR as a first-line treatment for AS with excellent procedural outcomes, and evidence that even moderate AS portends worse prognosis in heart failure with reduced ejection fraction patients, has raised the question of early valve intervention in this patient population. With this review, we describe the pathophysiology and outcomes of LV systolic dysfunction in the setting of AS, present imaging predictors of LV recovery after AVR, and discuss future directions in the treatment of AS extending beyond the traditional indications defined in the current guidelines.
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Affiliation(s)
| | | | | | | | | | - Samir R. Kapadia
- Address correspondence to: Samir Kapadia, MD, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Mail Code J2-3, 9500 Euclid Ave, Cleveland, OH 44195.
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Ito A, Izumiya Y, Iwata S, Ogawa M, Kim AT, Yahiro R, Kure Y, Yamaguchi T, Okai T, Takahashi Y, Shibata T, Yoshiyama M. Left atrial volume index predicts future improvement of B-type natriuretic peptide levels after transcatheter aortic valve replacement. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1463-1471. [PMID: 35133548 DOI: 10.1007/s10554-022-02538-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/23/2022] [Indexed: 11/05/2022]
Abstract
In patients with symptomatic severe aortic stenosis (AS), those who experienced readmission due to heart failure after transcatheter aortic valve replacement (TAVR) showed poor prognosis. Furthermore, poor B-type natriuretic peptide (BNP) improvement is associated with increased morbidity and mortality. However, little is known about the clinical parameters related to the change in BNP levels after TAVR procedure. This study population consisted of 127 consecutive patients of symptomatic severe AS with preserved ejection fraction (EF) who underwent transfemoral TAVR (TF-TAVR). Comprehensive transthoracic echocardiography was performed prior to the day of TF-TAVR. BNP was measured serially before and 1 year after TF-TAVR. The median BNP level was significantly decreased from 252.5 pg/ml to 146.8 pg/ml in all 127 patients 1 year after TF-TAVR (P < 0.01). However, the patients could be divided into 2 groups according to decrease (72%) or increase (28%) in plasma BNP level. Multivariate logistic regression analysis revealed that Aortic valve (AV) peak velocity, pre-procedural BNP, and larger left atrial volume index (LAVI) were found to be an independent predictor of increased BNP level 1 year after TAVR (OR 0.55, 95% CI 0.38-0.77; P < 0.01). LAVI were negatively correlated with the change in BNP level before and 1 year after TAVR (r = 0.47, P < 0.01). The ROC analysis demonstrated that 52.9 ml/m2 was the optimal cut-off value of LAVI for decreasing BNP 1 year after TAVR (area under the curve 0.69) with 64% sensitivity and 70% specificity. In addition to AV peak velocity and pre-procedural BNP, LAVI independently predicts future improvement of BNP levels 1 year after TAVR. Our findings indicate an additive predictive value of assessment of LAVI before TAVR procedure for risk stratification.
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Affiliation(s)
- Asahiro Ito
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Yasuhiro Izumiya
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Shinichi Iwata
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Mana Ogawa
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Andrew T Kim
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Ryosuke Yahiro
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yusuke Kure
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tomohiro Yamaguchi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Tsukasa Okai
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Minoru Yoshiyama
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abenoku, Osaka, 545-8585, Japan
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Sato K, Wang TKM, Desai MY, Kapadia SR, Krishnaswamy A, Rodriguez LL, Grimm RA, Griffin BP, Popović ZB. Physical and physiological effects of dobutamine stress echocardiography in low-gradient aortic stenosis. Am J Physiol Heart Circ Physiol 2022; 322:H94-H104. [PMID: 34860593 DOI: 10.1152/ajpheart.00183.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Dobutamine stress echocardiography (DSE) is a useful tool for assessing low-gradient significant aortic stenosis (AS) and contractile reserve (CR), but its prognostic utility has become controversial in recent studies. We evaluated the impact of DSE on aortic valve physiological, structural, and left ventricular parameters in low-gradient AS. Consecutive patients undergoing DSE for low-gradient AS evaluation from September 2010 to July 2016 were retrospectively studied, and DSE findings were divided into four groups: with and without severe AS and/or CR. Relationships between left ventricular chamber quantification, CR, aortic valve Doppler during DSE, and calcium score [by computerized tomography (CT)] were analyzed. There were 258 DSE studies performed on 243 patients, mean age 77.6 ± 10.8 yr and 183 (70.1%) were males. With increasing dobutamine dose, apart from systolic blood pressure, left ventricular ejection fraction, flow, cardiac power output, and longitudinal strain magnitude, along with aortic valve area and mean aortic gradient were all significantly increased (P < 0.05). Flow and mean gradient increased in both the presence and absence of CR, whereas stroke volume and aortic valve area increased mainly in those with CR only. The aortic valve area increased in both patients with low and high calcium scores; however, the baseline area was lower in those with a higher calcium score. During DSE, aortic valve area increases with increase in aortic valve gradient. Higher calcium score is associated with lower baseline aortic valve area, but the aortic valve area still increases with dobutamine even in presence of a high calcium score.NEW & NOTEWORTHY We show that even in most severe aortic stenosis, there is some residual valve pliability. This suggests that a complete loss of pliability is not compatible with survival.
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Affiliation(s)
- Kimi Sato
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Tom Kai Ming Wang
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Section of Invasive and Interventional Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Section of Invasive and Interventional Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - L Leonardo Rodriguez
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
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White M, Baral R, Ryding A, Tsampasian V, Ravindrarajah T, Garg P, Koskinas KC, Clark A, Vassiliou VS. Biomarkers Associated with Mortality in Aortic Stenosis: A Systematic Review and Meta-Analysis. Med Sci (Basel) 2021; 9:medsci9020029. [PMID: 34067808 PMCID: PMC8163007 DOI: 10.3390/medsci9020029] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 12/15/2022] Open
Abstract
The optimal timing of aortic valve replacement (AVR) remains controversial. Several biomarkers reflect the underlying pathophysiological processes in aortic stenosis (AS) and may be of use as mortality predictors. The aim of this systematic review and meta-analysis is to evaluate the blood biomarkers utilised in AS and assess whether they associate with mortality. PubMed and Embase were searched for studies reporting baseline biomarker level and mortality outcomes in patients with AS. A total of 83 studies met the inclusion criteria and were systematically reviewed. Of these, 21 reporting brain natriuretic peptide (BNP), N-terminal pro B-type natriuretic peptide (NT-proBNP), Troponin and Galectin-3 were meta-analysed. Pooled analysis demonstrated that all-cause mortality was significantly associated with elevated baseline levels of BNP (HR 2.59; 95% CI 1.95–3.44; p < 0.00001), NT-proBNP (HR 1.73; 95% CI 1.45–2.06; p = 0.00001), Troponin (HR 1.65; 95% CI 1.31–2.07; p < 0.0001) and Galectin-3 (HR 1.82; 95% CI 1.27–2.61; p < 0.001) compared to lower baseline biomarker levels. Elevated levels of baseline BNP, NT-proBNP, Troponin and Galectin-3 were associated with increased all-cause mortality in a population of patients with AS. Therefore, a change in biomarker level could be considered to refine optimal timing of intervention. The results of this meta-analysis highlight the importance of biomarkers in risk stratification of AS, regardless of symptom status.
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Affiliation(s)
- Madeline White
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Ranu Baral
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Alisdair Ryding
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | - Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
- Correspondence:
| | - Thuwarahan Ravindrarajah
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Pankaj Garg
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
| | | | - Allan Clark
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich NR4 7UQ, UK; (M.W.); (R.B.); (A.R.); (T.R.); (P.G.); (A.C.); (V.S.V.)
- Norfolk and Norwich University Hospital, Norwich NR4 7UQ, UK
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Metabolic Modulation and Potential Biomarkers of the Prognosis Identification for Severe Aortic Stenosis after TAVR by a Metabolomics Study. Cardiol Res Pract 2020; 2020:3946913. [PMID: 33204525 PMCID: PMC7649585 DOI: 10.1155/2020/3946913] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 09/23/2020] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the metabolic profile in patients with aortic stenosis (AS) after transcatheter aortic valve replacement (TAVR) and explore the potential biomarkers to predict prognosis after TAVR based on metabolomics. Methods and Results Fifty-nine consecutive AS patients were prospectively recruited. Blood samples from the ascending aorta, coronary sinus, and peripheral vein at before and after TAVR were collected, respectively. Liquid chromatography-mass spectrometry and gas chromatography-mass spectrometry were performed to analyze the metabolic profile before and after TAVR. Influential metabolites were identified by integrating the univariate test, multivariate analysis, and weighted gene coexpression network analysis (WGCNA) algorithm. PLS-DA analysis revealed a significant extremely early (within 30 minutes after TAVR) alterations of metabolites in the ascending aorta, coronary sinus, and peripheral vein. The early (within 7 days after TAVR) changed metabolites in the peripheral vein were involved in purine metabolism, primary bile acid biosynthesis, glycerolipid metabolism, amino sugar and nucleotide sugar metabolism, one carbon pool by folate and alanine, and the aspartate and glutamate metabolism pathway. We used volcano plots to find that the cardiac-specific changed metabolites were enriched to the sphingolipid metabolism pathway after TAVR. Besides, WGCNA algorithm was performed to reveal that arginine and proline metabolites could reflect left ventricle regression to some extent. Conclusion This is the first study to reveal systemic and cardiac metabolites changed significantly in patients with AS after TAVR. Some altered metabolites involved in the arginine and proline metabolism pathway in the peripheral vein could predict left ventricle regression, which merited further study.
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Elbaz-Greener G, Ghanim D, Kusniec F, Rabin A, Sudarsky D, Carasso S, Czeiger T, Shoan-Dayan M, Sakhnini A, Grosman-Rimon L, Strauss BH, Wijeysundra HC, Amir O. Pre- and Post-Transcatheter Aortic Valve Replacement Serum Brain Natriuretic Peptide Levels and All-Cause Mortality. Cardiology 2020; 145:813-821. [PMID: 33070124 DOI: 10.1159/000509857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Risk stratification in patients post-transcatheter aortic valve replacement (TAVR) is limited to and is based on clinical judgment and surgical scoring systems. Serum natriuretic peptides are used for general risk stratification in patients with aortic stenosis, reflecting the increase in their afterload and thereby stressing the need for valve intervention. The objective of this study was to determine the predictive value of pre- and post-procedural serum brain natriuretic peptide (BNP) on 1-year all-cause mortality in patients who underwent TAVR. METHODS In this population-based study, we included 148 TAVR patients treated at the Poriya Medical Center between June 1, 2015, and May 31, 2018. Routine blood samples for serum BNP levels (pg/mL) were taken just before the TAVR and 24 h post-TAVR. Our primary clinical outcome was defined as 1-year all-cause mortality. We used backward regression models and included all variables that had a p value <0.1 in the univariable analysis. A receiver-operating characteristic curve was calculated for the prediction of all-cause mortality by serum BNP levels using the median as the cut-off point. RESULTS In this study cohort, BNP levels 24 h post-TAVR higher than the cohort median versus lower than the cohort median (387.5 pg/mL; IQR 195-817.6) were the strongest predictor of 1-year mortality (hazard ratio 9; 95% CI 2.72-30.16; p < 0.001). The statistically significant relationship was seen in the unadjusted regression model as well as after the adjustment for clinical variables. CONCLUSIONS Serum BNP levels 24 h post-procedure were found to be a meaningful marker in predicting 1-year all-cause mortality in patients after TAVR procedure.
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Affiliation(s)
- Gabby Elbaz-Greener
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel, .,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel, .,Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel, .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel,
| | - Diab Ghanim
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Fabio Kusniec
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Asaf Rabin
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Doron Sudarsky
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Shemy Carasso
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Tal Czeiger
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Mirit Shoan-Dayan
- The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Ali Sakhnini
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Liza Grosman-Rimon
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Bradley H Strauss
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Harindra C Wijeysundra
- Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Offer Amir
- Cardiovascular Institute, Baruch Padeh Medical Center, Poriya, Israel.,The Azrieli Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel.,Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Gallo G, Presta V, Volpe M, Rubattu S. Molecular and clinical implications of natriuretic peptides in aortic valve stenosis. J Mol Cell Cardiol 2019; 129:266-271. [DOI: 10.1016/j.yjmcc.2019.03.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/06/2019] [Accepted: 03/11/2019] [Indexed: 11/16/2022]
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9
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Sato K, Kumar A, Krishnaswamy A, Mick S, Desai MY, Griffin BP, Kapadia SR, Popović ZB. B-type natriuretic peptide is associated with remodeling and exercise capacity after transcatheter aortic valve replacement for aortic stenosis. Clin Cardiol 2018; 42:270-276. [PMID: 30565264 PMCID: PMC6712326 DOI: 10.1002/clc.23138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/12/2018] [Accepted: 12/15/2018] [Indexed: 01/07/2023] Open
Abstract
Background We aimed to assess longitudinal changes of B‐type natriuretic peptide (BNP) in aortic stenosis (AS) patients treated by transcatheter aortic valve replacement (TAVR). Methods From our TAVR database, we identified 193 consecutive patients with severe symptomatic AS who underwent TAVR and were prospectively followed using serial BNP levels and echocardiography. Patients were divided into subgroups according to type of left ventricular (LV) remodeling as having normal LV mass and relative wall thickness, or showing concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Results At baseline, 30 patients (16%) had EH, 115 (60%) had CH, 37 (19%) had CR, and 11 (6%) had normal LV geometry. After TAVR, BNP decreased in the first 30 days, with further improvement during follow‐up. Patients with EH had higher BNP at baseline (P < 0.01) and a greater subsequent decrease (P < 0.001). During the median follow‐up of 1331 days (interquartile range: 632‐1678), 119 (62%) patients died. BNP showed a time‐dependent association with all‐cause mortality both in a univariable (hazards ratio [HR] 1.24, 95% confidence interval [CI]: 1.04‐1.47, P = 0.017), and in a multivariable model with Society of Thoracic Surgeons score and baseline BNP forced into the analysis (HR 1.32, 95% CI: 1.001‐1.73, P = 0.049). Elevated BNP was associated with a larger LV end‐diastolic volume index (P < 0.001) and shorter 6‐minute walk test distance (P = 0.013) throughout follow‐up. Conclusion In patients with AS, BNP was associated with LV remodeling phenotypes and functional status before and after TAVR. Elevated BNP levels were associated with poor prognosis.
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Affiliation(s)
- Kimi Sato
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Arnav Kumar
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie Mick
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Milind Y Desai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Brian P Griffin
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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