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Bjerregaard CL, Olsen FJ, Skaarup KG, Jørgensen PG, Galatius S, Pedersen S, Iversen A, Biering-Sørensen T. Association between cardiac time intervals and incident heart failure after acute coronary syndrome. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03206-8. [PMID: 39096406 DOI: 10.1007/s10554-024-03206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Cardiac time intervals are sensitive markers of myocardial dysfunction that predispose to heart failure (HF). We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS). METHODS This study included 386 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination a median of two days after PCI. Cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and systolic ejection time (ET), and myocardial performance index (MPI) were obtained by tissue Doppler echocardiography. The outcome was incident HF. RESULTS During follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, IVRT was not associated with HF (HR 1.02 (0.95-1.10), p = 0.61, per 10ms increase), and neither was IVCT (HR 0.07 (0.95-1.22), p = 0.26, per 10ms increase). Increasing MPI was associated with a higher risk of HF (HR 1.20 (1.08-1.34), P = 0.001, per 0.1 increase), and so was decreasing ET (HR 1.13 (1.07-1.18), P < 0.001 per 10ms decrease). After multivariable adjustment for cardiovascular risk factors, MPI (HR 1.13 (1.01-1.27), P = 0.034) and ET (HR 1.09 (1.01-1.17), P = 0.025) remained significantly associated with incident HF. LVEF modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF in patients with LVEF ≥ 36% (HR = 1.15 (1.06-1.24), P = 0.001, per 10ms decrease). CONCLUSION In patients admitted with ACS, shortened ET and higher MPI were independently associated with an increased risk of incident HF. Additionally, ET was associated with incident HF in patients with LVEF above 36%.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark.
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Liu YY, Tien TY, Hung CL, Wu YJ, Su CH, Yeh HI. Transdermal Nicotine Patch Increases the Number and Function of Endothelial Progenitor Cells in Young Healthy Nonsmokers without Adverse Hemodynamic Effects. Clin Pharmacol Ther 2024; 116:128-135. [PMID: 38529793 DOI: 10.1002/cpt.3249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/03/2024] [Indexed: 03/27/2024]
Abstract
Transdermal nicotine patches (TNPs), administering nicotine into the bloodstream through skin, have been widely used as nicotine replacement therapy, and exposure to nicotine can be detected by measurement of plasma cotinine concentration. In animal studies, nicotine treatment could increase the number of endothelial progenitor cells (EPCs), but the effect of TNPs on circulating EPCs and their activity in humans remained unclear. This study aimed to explore the influence of TNPs on circulating EPCs with surface markers of CD34, CD133, and/or KDR, and colony-forming function plus migration activity of early EPCs derived from cultured peripheral blood mononuclear cells before and after TNP treatments in young healthy nonsmokers. In parallel, pulse wave analysis (PWA) was applied to evaluate the vascular effect of TNP treatments. Twenty-one participants (25.8 ± 3.6 years old, 10 males) used TNP (nicotine: 4.2 mg/day) for 7 consecutive days. During the treatment, the CD34+ EPCs progressively increased in number. In addition, the number of EPCs positive for CD34/KDR, CD133, and CD34/CD133 were also increased on day 7 of the treatment. Furthermore, the early EPC colony-forming function and migration activity were increased with the plasma cotinine level positively correlating with change in colony-forming unit number. PWA analyses on day 7, compared with pretreatment, did not show significant change except diastolic pressure time index, which was prolonged and implied potential vascular benefit. In conclusion, 7-day TNP treatments could be a practical strategy to enhance angiogenesis of circulating EPCs to alleviate tissue ischemia without any hemodynamic concern.
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Affiliation(s)
- Yen-Yu Liu
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ting-Yi Tien
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei City, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Yih-Jer Wu
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Cheng-Huang Su
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
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Wang T, Han Y, Chen X, Chen W, Li H, Wang Y, Qiu X, Gong J, Li W, Zhu T. Particulate Air Pollution and Blood Pressure: Signaling by the Arachidonate Metabolism. Hypertension 2023; 80:2687-2696. [PMID: 37869894 DOI: 10.1161/hypertensionaha.123.21410] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 09/25/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Short-term exposure to ambient particulate matter (PM) can raise blood pressure, but the underlying mechanisms are unclear. We explored whether arachidonate metabolites serve as biological intermediates in PM-associated prohypertensive changes. METHODS This panel study recruited 110 adults aged 50 to 65 years living in Beijing, China. The participants' blood pressure, arterial stiffness, and cardiac and endothelial function were measured up to 7 times. The serum concentrations of arachidonate metabolites were quantified by targeted lipidomics. Ambient concentrations of fine PM (PM2.5), black carbon, and accumulation mode particles were continuously monitored at a station and their associations with the health indicators were evaluated. RESULTS Interquartile range increases in 25 to 96-hour-lag exposure to PM2.5, black carbon, and accumulation mode particles were associated with significant increases in systolic blood pressure (brachial: 0.8-3.2 mm Hg; central: 0.7-2.8 mm Hg) and diastolic blood pressure (brachial, 0.5-1.5 mm Hg; central, 0.5-1.6 mm Hg). At least 1 pollutant was associated with increases in augmentation pressure and heart rate and decreases in reactive hyperemia index and ejection time. The serum concentrations of arachidonate were significantly increased by 3.3% to 14.6% in association with PM exposure, which mediated 9% of the PM-associated increases in blood pressure. The levels of eicosanoids from the cytochrome P450, cyclooxygenase, and lipoxygenase pathways changed with PM exposure, and those from the cytochrome pathway significantly mediated the association between PM exposure and blood pressure. CONCLUSIONS Short-term exposure to particulate air pollution was associated with a prohypertensive change in adults, which was in part mediated by alteration of arachidonate metabolism.
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Affiliation(s)
- Teng Wang
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing (T.W.)
| | - Yiqun Han
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
- Environmental Research Group, MRC Centre for Environment and Health, Imperial College London, United Kingdom (Y.H.)
| | - Xi Chen
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
- GRiC, Shenzhen Institute of Building Research Co., Ltd., China (X.C.)
| | - Wu Chen
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles (W.C.)
| | - Haonan Li
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
| | - Yanwen Wang
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.W.)
| | - Xinghua Qiu
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
| | - Jicheng Gong
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
| | - Weiju Li
- Peking University Hospital (W.L.), Peking University, Beijing, China
| | - Tong Zhu
- BIC-ESAT and SKL-ESPC, College of Environmental Sciences and Engineering (T.W., Y.H., X.C., W.C., H.L., Y.W., X.Q., J.G., T.Z.), Peking University, Beijing, China
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Singh J, Carleton RN, Neary JP. Cardiac function and posttraumatic stress disorder: a review of the literature and case report. Health Promot Chronic Dis Prev Can 2023; 43:472-480. [PMID: 37991890 PMCID: PMC10753899 DOI: 10.24095/hpcdp.43.10/11.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) can induce an elevation in sympathetic tone; however, research pertaining to the cardiac cycle in patients with PTSD is limited. METHODS A literature review was conducted with PubMed, MEDLINE and Web of Science. Articles discussing changes and associations in echocardiography and PTSD or related symptoms were synthesized for the current review. We have also included data from a case report of a male participant aged 33 years experiencing potentially psychologically traumatic events, who wore a noninvasive cardiac sensor to assess the timing intervals and contractility parameters of the cardiac cycle using seismocardiography. The intervals included systolic time, isovolumic contraction time (IVCT) and isovolumic relaxation time (IVRT). Calculations of systolic (IVCT/systole), diastolic (IVRT/systole) and myocardial [(IVCT+IVRT)/systole] performance indices were completed. RESULTS The review identified 55 articles, 14 of which assessed cardiac function using echocardiography in patients with PTSD symptoms. Cardiac dysfunction varied across studies, with diastolic and systolic impairments found in patients with PTSD. Our case study showed that occupational stress elevated cardiac performance indices, suggesting increased ventricular stress and supporting results in the existing literature. CONCLUSIONS The literature review results suggest that a controlled approach to assessing cardiac function in patients with PTSD is required. The case study results further suggest that acute bouts of stress can alter cardiac function, with potential for sustained occupational stress to induce changes in cardiac function. Cardiac monitoring can be used prospectively to identify changes induced by potentially psychologically traumatic event exposures that can lead to the development of PTSD symptoms.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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Akkoca A, Büyükakıllı B, Ballı E, Gültekin B, Özbay E, Oruç Demirbağ H, Türkseven ÇH. Protective effect of MitoTEMPO against cardiac dysfunction caused by ischemia-reperfusion: MCAO stroke model study. Int J Neurosci 2023:1-12. [PMID: 37862003 DOI: 10.1080/00207454.2023.2273768] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/17/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Neurological impairments are the leading cause of post-stroke mortality, while stroke-related cardiovascular diseases rank second in significance. This study investigates the potential protective effects of MitoTEMPO (2,2,6,6-tetramethyl-4-[[2-(triphenylphosphonio) acetyl] amino]-1-piperidinyloxy, monochloride, monohydrate), a mitochondria-specific antioxidant, against cardiac and neurological complications following stroke. The objective is to assess whether MitoTEMPO can be utilized as a protective agent for individuals with a high risk of stroke. MATERIALS AND METHODS Seventeen-week-old male Wistar Albino rats were randomly assigned to three groups: SHAM, ischemia-reperfusion and MitoTEMPO + ischemia-reperfusion (MitoTEMPO injection 0.7 mg/kg/day for 14 days). The SHAM group underwent a sham operation, while the ischemia-reperfusion group underwent 1-h middle cerebral artery occlusion followed by three days of reperfusion. Afterwards, noninvasive thoracic electrical bioimpedance and electrocardiography measurements were taken, and sample collection was performed for histological and biochemical examinations. RESULTS Our thoracic electrical bioimpedance and electrocardiography findings demonstrated that MitoTEMPO exhibited a protective effect on most parameters affected by ischemia-reperfusion compared to the SHAM group. Furthermore, our biochemical and histological data revealed a significant protective effect of MitoTEMPO against oxidative damage. CONCLUSIONS The findings suggest that both ischemia-reperfusion-induced cardiovascular abnormalities and the protective effect of MitoTEMPO may involve G-protein coupled receptor-mediated signaling mechanisms. This study was conducted with limitations including a single gender, a uniform age group, a specific stroke model limited to middle cerebral artery, and pre-scheduled only one ischemia-reperfusion period. In future studies, addressing these limitations may enable the implementation of preventive measures for individuals at high risk of stroke.
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Affiliation(s)
- Ahmet Akkoca
- Department of Occupational Health and Safety, Taşkent Vocational School, Selcuk University, Konya, Türkiye
| | - Belgin Büyükakıllı
- Department of Biophysics, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Ebru Ballı
- Department of Histology and Embryology, Faculty of Medicine, Mersin University, Mersin, Türkiye
| | - Burcu Gültekin
- Department of Histology and Embryology, Faculty of Medicine, Necmettin Erbakan University, Konya, Türkiye
| | - Erkan Özbay
- Department of Medical Services and Techniques, Health Services Vocational School, Karamanoğlu Mehmetbey University, Karaman, Türkiye
| | - Hatice Oruç Demirbağ
- Department of Histology and Embryology, Faculty of Medicine, Mersin University, Mersin, Türkiye
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Narayan SI, Terre GV, Amin R, Shanghavi KV, Chandrashekar G, Ghouse F, Ahmad BA, S GN, Satram C, Majid HA, Bayoro DK. The Pathophysiology and New Advancements in the Pharmacologic and Exercise-Based Management of Heart Failure With Reduced Ejection Fraction: A Narrative Review. Cureus 2023; 15:e45719. [PMID: 37868488 PMCID: PMC10590213 DOI: 10.7759/cureus.45719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is a clinical syndrome whose management has significantly evolved based on the pathophysiology and disease process. It is widely prevalent, has a relatively high mortality rate, and is comparatively more common in men than women. In HFrEF, the series of maladaptive processes that occur lead to an inability of the muscle of the left ventricle to pump blood efficiently and effectively, causing cardiac dysfunction. The neurohormonal and hemodynamic adaptations play a significant role in the advancement of the disease and are critical to guiding the treatment and management of HFrEF. The first-line therapy, which includes loop diuretics, β-blockers, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, hydralazine/isosorbide-dinitrate, and mineralocorticoid receptor antagonists (MRAs), has been proven to provide symptomatic relief and decrease mortality and complications. The newly recommended drugs for guideline-based therapy, angiotensin receptor/neprilysin inhibitor (ARNI), sodium-glucose cotransporter 2 inhibitors, soluble guanylate cyclase, and myosin activators and modulators have also been shown to improve cardiac function, reverse cardiac remodeling, and reduce mortality rates. Recent studies have demonstrated that exercise-based therapy has resulted in an improved quality of life, exercise capacity, cardiac function, and decreased hospital readmission rates, but it has not had a considerable reduction in mortality rates. Combining multiple therapies alongside holistic advances such as exercise therapy may provide synergistic benefits, ultimately leading to improved outcomes for patients with HFrEF. Although first-line treatment, novel pharmacologic management, and exercise-based therapy have been shown to improve prognosis, the existing literature suggests a need for further studies evaluating the long-term effects of MRA and ARNI.
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Affiliation(s)
| | - Giselle V Terre
- Department of Medicine, Universidad Iberoamericana (UNIBE), Santo Domingo, DOM
| | - Rutvi Amin
- Department of Medicine, Surat Municipal Institute of Medical Education and Research, Surat, IND
| | - Keshvi V Shanghavi
- Department of Medicine, Lokmanya Tilak Municipal Medical College and Sion Hospital, Mumbai, IND
| | | | - Farhana Ghouse
- Department of Medicine, Saint James School of Medicine, St. Vincent, VCT
| | - Binish A Ahmad
- Department of Medicine, King Edward Medical University, Lahore, PAK
| | - Gowri N S
- Department of Medicine, Taras Shevchenko National University of Kyiv, Kyiv, UKR
| | - Christena Satram
- Department of Medicine, Lincoln American University, Georgetown, GUY
| | - Hamna A Majid
- Department of Medicine, Dow University of Health Sciences, Dow International Medical College, Karachi, PAK
| | - Danielle K Bayoro
- Department of Medicine, Medical University of the Americas, Nevis, KNA
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Alhakak AS, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Espersen C, Abildgaard U, Jensen GB, Schnohr P, Marott JL, Søgaard P, Møgelvang R, Biering-Sørensen T. Changes in cardiac time intervals over a decade and the risk of incident heart failure: The Copenhagen City heart study. Int J Cardiol 2023:S0167-5273(23)00709-X. [PMID: 37178800 DOI: 10.1016/j.ijcard.2023.05.018] [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: 01/01/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The cardiac time intervals include the isovolumic contraction time (IVCT), the left ventricular ejection time (LVET), the isovolumic relaxation time (IVRT) and the combination of all the cardiac time intervals in the myocardial performance index (MPI) (defined as [(IVCT+IVRT)/LVET)]. Whether the cardiac time intervals change over time and which clinical factors that accelerate these changes is not well-established. Additionally, whether these changes are associated with subsequent heart failure (HF), remains unknown. METHODS We investigated participants from the general population (n = 1064) who had an echocardiographic examination including color tissue Doppler imaging performed in both the 4th and 5th Copenhagen City Heart Study. The examinations were performed 10.5 years apart. RESULTS The IVCT, LVET, IVRT and MPI increased significantly over time. None of the investigated clinical factors were associated with increase in IVCT. Systolic blood pressure (standardized β= - 0.09) and male sex (standardized β= - 0.08) were associated with an accelerated decrease in LVET. Age (standardized β=0.26), male sex (standardized β=0.06), diastolic blood pressure (standardized β=0.08), and smoking (standardized β=0.08) were associated with an increase in IVRT, while HbA1c (standardized β= - 0.06) was associated with a decrease in IVRT. Increasing IVRT over a decade was associated with an increased risk of subsequent HF in participants aged <65 years (per 10 ms increase: HR 1.33; 95%CI (1.02-1.72), p = 0.034). CONCLUSION The cardiac time increased significantly over time. Several clinical factors accelerated these changes. An increase in IVRT was associated with an increased risk of subsequent HF in participants aged <65 years.
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Affiliation(s)
- Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Niklas Dyrby Johansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Caroline Espersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, University of Aalborg, Aalborg, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Cardiovascular Research Unit, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; The Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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8
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Saffarpour M, Basu D, Radaei F, Vali K, Adams JY, Chuah CN, Ghiasi S. Physiowise: A Physics-aware Approach to Dicrotic Notch Identification. ACM TRANSACTIONS ON COMPUTING FOR HEALTHCARE 2023; 4:10. [PMID: 38348358 PMCID: PMC10861158 DOI: 10.1145/3578556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 11/01/2022] [Indexed: 02/15/2024]
Abstract
Dicrotic Notch (DN), one of the most significant and indicative features of the arterial blood pressure (ABP) waveform, becomes less pronounced and thus harder to identify as a matter of aging and pathological vascular stiffness. Generalizable and automatic DN identification for such edge cases is even more challenging in the presence of unexpected ABP waveform deformations that happen due to internal and external noise sources or pathological conditions that cause hemodynamic instability. We propose a physics-aware approach, named Physiowise (PW), that first employs a cardiovascular model to augment the original ABP waveform and reduce unexpected deformations, then apply a set of predefined rules on the augmented signal to find DN locations. We have tested the proposed method on in-vivo data gathered from 14 pigs under hemorrhage and sepsis study. Our result indicates 52% overall mean error improvement with 16% higher detection accuracy within the lowest permitted error range of 30ms. An additional hybrid methodology is also proposed to allow combining augmentation with any application-specific user-defined rule set.
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Affiliation(s)
| | - Debraj Basu
- Department of Electrical and Computer Engineering, UC Davis
| | - Fatemeh Radaei
- Department of Electrical and Computer Engineering, UC Davis
| | - Kourosh Vali
- Department of Electrical and Computer Engineering, UC Davis
| | - Jason Y Adams
- Department of Pulmonary and Critical Care Medicine, UC Davis School of Medicine
| | - Chen-Nee Chuah
- Department of Electrical and Computer Engineering, UC Davis
| | - Soheil Ghiasi
- Department of Electrical and Computer Engineering, UC Davis
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Liu YY, Wu SH, Tsai CT, Sun FJ, Hou CJY, Yeh HI, Wu YJ. Pulse Wave Analysis Predicts Invasive Hemodynamics in Pre-Capillary Pulmonary Hypertension. ACTA CARDIOLOGICA SINICA 2023; 39:319-330. [PMID: 36911541 PMCID: PMC9999185 DOI: 10.6515/acs.202303_39(2).20220826a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/26/2022] [Indexed: 03/14/2023]
Abstract
Background We tested the hypothesis that non-invasive pulse wave analysis (PWA)-derived systemic circulation variables can predict invasive hemodynamics of pulmonary circulation and the indicator of right heart function, N-terminal pro-brain natriuretic peptide (NT-proBNP), in patients with precapillary pulmonary hypertension (PH). Methods This prospective study enrolled patients with group 1 and 4 PH who had complete PWA, NT-proBNP, and hemodynamics data. Risk assessment-based "hemodynamic score (HS)" and principal component analysis-based PWA variable grouping were determined/performed. Models of hierarchical multiple linear regression (HMLR) and receiver operating characteristic (ROC) curves were used to determine the relationships of PWA variables with HS and NT-proBNP and to predict the latter parameters. Results Fifty-three PWAs were included. PWA variables were classified into 4 eigenvalue principal components (representing 90% configuration). Univariate analysis showed that left ventricular ejection time (LVET) was significantly negatively associated with HS and NT-proBNP levels. HMLR analysis showed that LVET was still significantly, negatively, and independently associated with HS (B = -0.006 [-0.010~-0.001]) and NT-proBNP (B = -13.47 [-21.20~-5.73]). ROC curve analysis showed that LVET > 306.9 msec and > 313.2 msec predicted the low-risk group of HS (AUC: 0.802; p = 0.001; sensitivity: 100%; and specificity: 59%) and low-to-intermediate risk levels of NT-proBNP (AUC: 0.831; p < 0.001; sensitivity: 100%; and specificity: 59%). Conclusions The non-invasive PWA parameter, LVET, is an independent predictor of invasive right heart HS and NT-proBNP levels; it may serve as a novel biomarker of right ventricular function in patients with pre-capillary PH.
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Affiliation(s)
- Yen-Yu Liu
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,Department of Medicine, and Institute of Biomedical Sciences, MacKay Medical College
| | - Shu-Hao Wu
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,Department of Medicine, and Institute of Biomedical Sciences, MacKay Medical College
| | - Cheng-Ting Tsai
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Fang-Ju Sun
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,MacKay Junior College of Medicine, Nursing and Management, New Taipei City, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei
| | - Hung-I Yeh
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,Department of Medicine, and Institute of Biomedical Sciences, MacKay Medical College
| | - Yih-Jer Wu
- Cardiovascular Center, Department of Internal Medicine, and Department of Critical Care Medicine, and Department of Medical Research, MacKay Memorial Hospital, Taipei.,Department of Medicine, and Institute of Biomedical Sciences, MacKay Medical College
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10
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Bai Y, Jia H, Avolio A, Qian Y, Zuo J. Association of Carotid-Femoral Pulse Wave Velocity and Ejection Duration with Target Organ Damage. Rev Cardiovasc Med 2023; 24:41. [PMID: 39077415 PMCID: PMC11273147 DOI: 10.31083/j.rcm2402041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/19/2022] [Accepted: 12/06/2022] [Indexed: 07/31/2024] Open
Abstract
Background Carotid-femoral pulse wave velocity (cfPWV) and ejection duration (ED) have different impacts on target organ damage (TOD). The aim of this study was to determine the relationship of cfPWV and ED with TOD. Methods A total of 1254 patients (64.27% males) from Ruijin Hospital were enrolled in this study from December 2018 to August 2022. Medical records, blood samples and urine samples were collected. The cfPWV was measured and ED was generated using SphygmoCor software (version 8.0, AtCor Medical, Sydney, Australia). TOD including left ventricular hypertrophy (LVH), microalbuminuria, chronic kidney disease (CKD), and abnormality of carotid intima-media thickness (CIMT) were evaluated. Results Multiple stepwise linear regression models of cfPWV and ED (individually or together) showed that cfPWV was positively correlated with left ventricular mass index (LVMI) ( β = 0.131, p = 0.002) and Log (albumin-creatinine ratio, ACR) ( β = 0.123, p = 0.004), while ED was negatively correlated with LVMI ( β = -0.244, p < 0.001) and positively correlated with the estimated glomerular filtration rate (eGFR) ( β = 0.115, p = 0.003). When cfPWV and ED were added separately or together in multiple stepwise logistic regression models, cfPWV was associated with CKD [odds ratio (OR) = 1.240, 95% confidence interval (CI) 1.055-1.458, p = 0.009], while ED was associated with LVH (OR = 0.983, 95% CI 0.975-0.992, p < 0.001). In the control group with normal cfPWV and normal ED, LVH was significantly lower in patients with high ED (OR = 0.574, 95% CI 0.374-0.882, p = 0.011), but significantly elevated in those with high cfPWV and low ED (OR = 6.799, 95% CI 1.305-35.427, p = 0.023). Conclusions cfPWV was more strongly associated with renal damage, while ED was more strongly associated with cardiac dysfunction. cfPWV and ED affect each other, and together have an effect on LVH.
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Affiliation(s)
- Yaya Bai
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Huiying Jia
- Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Alberto Avolio
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, 2109 Sydney, Australia
| | - Yi Qian
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
| | - Junli Zuo
- Department of Geriatrics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 200025 Shanghai, China
- Department of Biomedical Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, 2109 Sydney, Australia
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11
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Radchenko GD, Botsiuk YA, Sirenko YM. Ventricular Function and Cardio-Ankle Vascular Index in Patients With Pulmonary Artery Hypertension. Vasc Health Risk Manag 2022; 18:889-904. [PMID: 36597509 PMCID: PMC9805732 DOI: 10.2147/vhrm.s385536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/18/2022] [Indexed: 12/29/2022] Open
Abstract
Aim This study aims to evaluate the left ventricle (LV) systolic and diastolic function in patients with idiopathic pulmonary arterial hypertension (IPAH) and its correlation with systemic arterial stiffness assessed by cardio-ankle vascular index (CAVI). Patient and methods We included 37 patients with IPAH and 20 healthy people matched by age. All patients were assessed: vital signs, 6-minute walk test, NT-proBNP level, the CAVI, the right ventricular (RV) and LV function parameters, including ejection time (ET), tissue speckle-tracking values - global longitudinal strain (GLS) and strain rate (SR). Results The groups were matched by age, gender, BMI, office SBP and DBP. Patients with IPAH had higher heart rate, NT-proBNP level and lower ferritin level, GFR (CKD-EPI), SaO2 than healthy people. The mean CAVIleft was higher in IPAH patients than in the control group- 8.7±1.1 vs 7.5±0.9, P=0.007. Healthy people had significantly less E/e' and lower IVRT. LVET and RVET were shorter in IPAH patients. Patients with IPAH had mean LVGLS -(-17.6±4.8%) and 35.1% of them were with LVGLS ≤16% compared to healthy people -(-21.8±1.4%) and 0%, respectively. LVSR was significant less in IPAH patients, but in the normal range. We found significant correlations of CAVI with age, history of syncope, bilirubin, uric acid, total cholesterol, cardiac output, cardiac index, RVET, LVET and E/A. Multiple linear regression confirmed the independent significance for age (β=0.083±0.023, CI 0.033-0.133) and RVET (β=-0.018±0.005, CI -0.029 to -0.008) only. The risk to have CAVI ≥8 increased in 5.8 times in IPAH patients with RVET <248 ms (P=0.046). CAVI did not correlate with LVGLS and LVSR. Conclusion Significant worse systolic and diastolic LV functions were stated in pulmonary hypertensive patients compared to the control group. No LV GLS, no LV SR had significant associations with arterial stiffness evaluated by CAVI.
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Affiliation(s)
- Ganna Dmytrivna Radchenko
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine,Correspondence: Ganna Dmytrivna Radchenko, State Institution National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, 5, Svyatoslava Khorobroho str., Kyiv, 03151, Ukraine, Tel +38-0667128405, Email
| | - Yurii Anatoliiovych Botsiuk
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
| | - Yuriy Mykolaiyovich Sirenko
- State Institution “National Scientific Center “The M.D. Strazhesko Institute of Cardiology, Clinical and Regenerative Medicine of the National Academy of Medical Science of Ukraine”, Kyiv, Ukraine
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12
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Luo H, Westphal P, Shahmohammadi M, Heckman LIB, Kuiper M, Cornelussen RN, Delhaas T, Prinzen FW. Heart sound-derived systolic time intervals for atrioventricular delay optimization in cardiac resynchronization therapy. Heart Rhythm 2022; 20:572-579. [PMID: 36574867 DOI: 10.1016/j.hrthm.2022.12.031] [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: 06/21/2022] [Revised: 12/20/2022] [Accepted: 12/20/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Phonocardiography (PCG) can be used to determine systolic time intervals (STIs) from ventricular pacing spike to the first heart sound (VS1) and from the first to the second heart sound (S1S2). OBJECTIVE The purpose of this study was to investigate the relations between STIs and hemodynamics during atrioventricular (AV) delay optimization of biventricular pacing (BiVP) in animals and patients. METHODS Five pigs with AV block underwent BiVP, while PCG was collected from an epicardial accelerometer. In 21 patients undergoing cardiac resynchronization therapy device implantation, PCG was recorded with a pulse generator-embedded microphone. Optimal AV delays derived from shortest VS1 and longest S1S2 were compared with AV delays derived from highest left ventricular pressure (LVP), maximal rate of rise in LVP, and stroke work. RESULTS In pigs, VS1 and S1S2 predicted the AV delays with optimal hemodynamics (highest LVP, maximal rate of rise in LVP, and stroke work) by a median error of 2-28 ms, resulting in a median loss of <2% of pump function. In patients, VS1 and S1S2 predicted the optimal AV delay by errors of 32.5 and 37.5 ms, respectively, resulting in 0.2%-0.9% lower LVP and stroke work, which were reduced to 21 and 24 ms in 8 patients with a full-capture AV delay of >180 ms. CONCLUSION During BiVP with varying AV delays, close relations exist between PCG-derived STIs and hemodynamic parameters. AV delays advised by PCG-derived STIs cause only a minimal loss of pump function compared with those based on invasive hemodynamic measurements. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01832493.
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Affiliation(s)
- Hongxing Luo
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
| | - Philip Westphal
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Medtronic Bakken Research Center BV, Maastricht, The Netherlands
| | - Mehrdad Shahmohammadi
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Luuk I B Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Marion Kuiper
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Richard N Cornelussen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Medtronic Bakken Research Center BV, Maastricht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
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Goeddel LA, Grant MC. Preoperative Evaluation and Cardiac Risk Assessment in Vascular Surgery. Anesthesiol Clin 2022; 40:575-585. [PMID: 36328616 DOI: 10.1016/j.anclin.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
We summarize epidemiologic trends, outcomes, and preoperative guidelines for vascular surgery patients from 2010 to 2022. Vascular surgery continues to evolve in technology and engineering to treat a surgical population that suffers from a high prevalence of comorbidities. Preoperative optimization seeks to characterize the burden of disease and to achieve medical control in the timeline available before surgery. Risk assessment, evaluation, optimization, and prediction of major adverse cardiac events is an evolving science where the Vascular Surgery Quality Initiative has made an impact. Ongoing investigation may demonstrate value for preoperative echocardiography, functional capacity, frailty, and mobility assessments.
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Affiliation(s)
- Lee A Goeddel
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA.
| | - Michael C Grant
- Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Zayed 6208J, 1800 Orleans, Baltimore, MD 21287, USA
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14
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Li-ping Q, Hong-wei L, Chang-ming H, Yong-yi B, Ang L. Safety and efficacy of pulse-induced contour cardiac output monitoring in elderly patients with coronary artery disease and severe heart failure at coronary care units. Front Cardiovasc Med 2022; 9:910898. [DOI: 10.3389/fcvm.2022.910898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe optimal treatment for elderly patients with severe heart failure depends on the accurate assessment of their hemodynamic status. Due to its less invasive nature, the safety and efficacy of invasive pulse-induced contour cardiac output (PiCCO)-based hemodynamic monitoring remains uncertain.MethodsThis was a prospective observational study. Between January 2016 and July 2020, 190 elderly patients with severe heart failure were consecutively enrolled. The PiCCO group (89 patients) and non-invasive hemodynamic monitoring group (101 patients) were observed. Hospital stays results were evaluated.ResultsNo significant difference in clinical data (P > 0.05) or the incidence of 1-month mortality (16.0 vs. 35.0%, P = 0.141) were observed between groups. The coronary care unit (CCU) stay was shorter in the PiCCO group than in the non-invasive group (40.0 vs. 43.0%, P = 0.049). Indicators such as low Extravascular Lung Water Index (EVLWI), high Body Mass Index (BMI), low Pulmonary Artery Pressure (PAP), and high Left Ventricular Ejection Time (LVET), were associated with favorable clinical results.ConclusionEarly invasive PiCCO monitoring is safe in critically ill elderly patients with severe heart failure. The hospital stay was reduced using PiCCO monitoring. These encouraging PiCCO results favor its use in elderly patients with severe heart failure at CCUs.
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15
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Tonhajzerova I, Visnovcova Z, Ondrejka I, Funakova D, Hrtanek I, Ferencova N. Major depressive disorder at adolescent age is associated with impaired cardiovascular autonomic regulation and vasculature functioning. Int J Psychophysiol 2022; 181:14-22. [PMID: 36029918 DOI: 10.1016/j.ijpsycho.2022.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022]
Abstract
Cardiovascular adverse complications represent a risk factor for increased cardiovascular morbidity and mortality in patients with major depressive disorder (MDD). However, there is little knowledge of adolescent MDD. We aimed to study complex cardiovascular autonomic regulation and early atherosclerotic damage with a focus on an analysis of heart rate variability (HRV), blood pressure variability (BPV), systolic time intervals, and measures of early atherosclerotic changes in adolescent MDD. Ninety depressive adolescents (34 boys, age 15.8 ± 1.3 yrs.) and 90 age-/gender-matched controls were examined. Evaluated parameters: HRV - time and spectral parameters, BPV - mean, systolic, and diastolic blood pressure, spectral systolic parameters; haemodynamic indices - stroke volume, cardiac output, total peripheral resistance, systolic time intervals - left ventricular ejection time, pre-ejection period; atherosclerotic indices - ankle-brachial index (ABI), pulse wave velocity, brachial-ankle pulse wave velocity, cardio-ankle vascular index; growth factors - epidermal growth factor (EGF), vascular endothelial growth factor associated with monocyte chemoattractant protein-1. Our results showed that the MDD group had significantly reduced HRV and higher BPV measures, shortened systolic time intervals, lower ABI, and higher EGF compared to controls. Concluding, our study revealed that adolescent MDD is associated with cardiovascular dysregulation and early vasculature dysfunction as preclinical markers of higher risk for cardiovascular morbidity, thus adolescence seems to represent an important age period for early diagnosis and prevention of later MDD-linked cardiovascular diseases manifesting in adulthood.
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Affiliation(s)
- Ingrid Tonhajzerova
- Department of Physiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4C, 036 01 Martin, Slovak Republic.
| | - Zuzana Visnovcova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4D, 036 01 Martin, Slovak Republic.
| | - Igor Ondrejka
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovak Republic.
| | - Dana Funakova
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovak Republic.
| | - Igor Hrtanek
- Psychiatric Clinic, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, University Hospital Martin, Kollarova 2, 036 59 Martin, Slovak Republic.
| | - Nikola Ferencova
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Mala Hora 4D, 036 01 Martin, Slovak Republic.
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Significance of Left Ventricular Ejection Time in Primary Mitral Regurgitation. Am J Cardiol 2022; 178:97-105. [PMID: 35778308 DOI: 10.1016/j.amjcard.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
The optimal timing for mitral valve (MV) surgery in asymptomatic patients with primary mitral regurgitation (MR) remains controversial. We aimed at evaluating the relation between left ventricular ejection time (LVET) and outcome in patients with moderate or severe chronic primary MR because of prolapse. Clinical, Doppler echocardiographic, and outcome data prospectively collected from 302 patients (median age 61 [54 to 74] years, 34% women) with moderate or severe primary MR were analyzed. Patients were retrospectively stratified by quartiles of LVET. The primary end point of the study was the composite of need for MV surgery or all-cause mortality. During a median follow-up time of 66 (25th to 75th percentile, 33 to 95) months, 178 patients reached the primary end point. Patients in the lowest quartile of LVET (<260 ms) were at high risk for adverse events compared with those in the other quartiles of LVET (global p = 0.005), whereas the rate of events was similar for the other quartiles (p = NS for all). After adjustment for clinical predictors of outcome, including age, gender, history of atrial fibrillation, MR severity, and current recommended triggers for MV surgery in asymptomatic primary MR, LVET <260 ms was associated with an increased risk of events (adjusted hazard ratio 1.49, 95% confidence interval 1.03 to 2.16, p = 0.033). In conclusion, we observed that shorter LVET is associated with increased risk of adverse events in patients with moderate or severe primary MR because of prolapse. Further studies are required to investigate whether shorter LVET has a direct effect on outcomes or is solely a risk marker in primary MR.
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Pestelli G, Pergola V, Totaro G, Previtero M, Aruta P, Cecchetto A, Fiorencis A, Palermo C, Iliceto S, Mele D. Value of Left Ventricular Indexed Ejection Time to Characterize the Severity of Aortic Stenosis. J Clin Med 2022; 11:jcm11071877. [PMID: 35407484 PMCID: PMC9000205 DOI: 10.3390/jcm11071877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 01/27/2023] Open
Abstract
Aims: The assessment of aortic stenosis (AS) severity is still challenging, especially in abnormal hemodynamic conditions. Left ventricular ejection time (LVET) has been historically related to AS severity, but it also depends on heart rate (HR) and systolic function. Our aim was to verify if correcting LVET (LVET index, LVETI) by its determinants is helpful for the assessment of AS severity, irrespective of hemodynamic conditions. Methods and results: We retrospectively studied 152 patients with AS and 378 patients with heart failure and no-AS. At multivariate analysis, LVET (assessed with pulsed-wave Doppler) showed a strong correlation with stroke volume index (SVI) (Beta 0.354; p < 0.001), HR (−0.385; p < 0.001), AS grade (Beta 0.301; p < 0.001) and, less significantly, ejection fraction (LVEF) (Beta 0.108; p = 0.001). AS grade was confirmed to be a major determinant of LVET, irrespective of forward flow (assessed by SVI and transvalvular flow rate) and LVEF (above and below 50%). A regression equation was derived to index LVET (LVETI) to HR and SVI. By using this formula, LVETI detected severe AS more accurately (AUC 0.812, p < 0.001) than LVET alone (AUC 0.755, p for difference = 0.005). Similar results were observed in patients with abnormal flow status. As an exploratory finding, we observed that the highest tertile of LVETI was associated with a higher rate of aortic valve interventions during follow-up. Conclusions: LVETI correlates with AS severity better than uncorrected LVET, independently from hemodynamic conditions, and may help to discriminate severe AS. This finding needs confirmation in larger prospective multicenter studies.
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Affiliation(s)
- Gabriele Pestelli
- Cardiology Unit, Morgagni-Pierantoni Hospital, 47121 Forli, Italy;
- Cardiovascular Research Unit, Fondazione Sacco, 47121 Forli, Italy
| | - Valeria Pergola
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Giuseppe Totaro
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Marco Previtero
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Patrizia Aruta
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Andrea Fiorencis
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Chiara Palermo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Sabino Iliceto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova Medical School, 35128 Padova, Italy; (V.P.); (G.T.); (M.P.); (P.A.); (A.C.); (A.F.); (C.P.); (S.I.)
- Correspondence: ; Tel.: +39-049-821-8642
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Charlton PH, Kyriacou PA, Mant J, Marozas V, Chowienczyk P, Alastruey J. Wearable Photoplethysmography for Cardiovascular Monitoring. PROCEEDINGS OF THE IEEE. INSTITUTE OF ELECTRICAL AND ELECTRONICS ENGINEERS 2022; 110:355-381. [PMID: 35356509 PMCID: PMC7612541 DOI: 10.1109/jproc.2022.3149785] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/06/2022] [Accepted: 01/27/2022] [Indexed: 05/29/2023]
Abstract
Smart wearables provide an opportunity to monitor health in daily life and are emerging as potential tools for detecting cardiovascular disease (CVD). Wearables such as fitness bands and smartwatches routinely monitor the photoplethysmogram signal, an optical measure of the arterial pulse wave that is strongly influenced by the heart and blood vessels. In this survey, we summarize the fundamentals of wearable photoplethysmography and its analysis, identify its potential clinical applications, and outline pressing directions for future research in order to realize its full potential for tackling CVD.
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Affiliation(s)
- Peter H. Charlton
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College London, King’s Health PartnersLondonSE1 7EUU.K.
- Research Centre for Biomedical Engineering, CityUniversity of LondonLondonEC1V 0HBU.K.
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeCB1 8RNU.K.
| | - Panicos A. Kyriacou
- Research Centre for Biomedical Engineering, CityUniversity of LondonLondonEC1V 0HBU.K.
| | - Jonathan Mant
- Department of Public Health and Primary CareUniversity of CambridgeCambridgeCB1 8RNU.K.
| | - Vaidotas Marozas
- Department of Electronics Engineering and the Biomedical Engineering Institute, Kaunas University of Technology44249KaunasLithuania
| | - Phil Chowienczyk
- Department of Clinical PharmacologyKing’s College LondonLondonSE1 7EHU.K.
| | - Jordi Alastruey
- Department of Biomedical EngineeringSchool of Biomedical Engineering and Imaging SciencesKing’s College London, King’s Health PartnersLondonSE1 7EUU.K.
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Seetharam S, Vinutha Shankar MS, Reddy N. Evaluation of systolic time intervals in patients of ischemic heart disease with clinical heart failure. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_17_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Seetharam S, Shankar MSV, Reddy N. A narrative review of clinical applications of systolic time intervals. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_63_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Bona Olexova L, Visnovcova Z, Ferencova N, Jurko A, Tonhajzerova I. Complex sympathetic regulation in adolescent mitral valve prolapse. Physiol Res 2021; 70:S317-S325. [PMID: 35099250 DOI: 10.33549/physiolres.934830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Mitral valve prolapse (MVP) belongs to cardiac disorders characterized by impaired closure of mitral leaflets. We studied adolescent group of patients with MVP suffering from symptomatology that cannot be explained by mitral regurgitation alone. Several studies suggested that symptoms can be explained by autonomic, in particular sympathetic-linked dysfunction. Thus, we assessed non-invasive sympathetic indices of blood pressure and heart rate variability and electrodermal activity (EDA). Fifty-three adolescents with MVP (age: 15.1+/-0.4 years) and 43 healthy age- and gender-matched adolescents (age: 14.9+/-0.4 years) were examined. Blood pressure, heart rate and EDA were continuously recorded during 6-min rest. Evaluated parameters were: low frequency band of systolic blood pressure variability, systolic, diastolic and mean blood pressure, mean RR interval, cardiac sympathetic indices: symbolic dynamics (0V%), left ventricular ejection time (LVET), pre-ejection period (PEP), and EDA. Our findings revealed significantly higher systolic, diastolic, and mean blood pressure values, shortened mean RR interval, increased 0V%, and shortened LVET in MVP patients vs. controls (p=0.028, p<0.001, p=0.002, p<0.001, p=0.050, p<0.001; respectively). Our study revealed enhanced cardiovascular sympathetic regulation in adolescent MVP patients. We suggest that evaluation of non-invasive sympathetic parameters could represent potential biomarkers for early diagnosis of cardiovascular complications associated with MVP already at adolescent age.
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Affiliation(s)
- L Bona Olexova
- Department of Physiology and Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovak Republic.
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22
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Altes A, Thellier N, Bohbot Y, Ringle Griguer A, Verdun S, Levy F, Castel AL, Delelis F, Mailliet A, Tribouilloy C, Maréchaux S. Relationship Between the Ratio of Acceleration Time/Ejection Time and Mortality in Patients With High-Gradient Severe Aortic Stenosis. J Am Heart Assoc 2021; 10:e021873. [PMID: 34845911 PMCID: PMC9075380 DOI: 10.1161/jaha.121.021873] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background The ratio of acceleration time/ejection time (AT/ET) is a simple and reproducible echocardiographic parameter that integrates aortic stenosis severity and its consequences on the left ventricle. No study has specifically assessed the prognostic impact of AT/ET on outcome in patients with high‐gradient severe aortic stenosis (SAS) and no or mild symptoms. We sought to evaluate the relationship between AT/ET and mortality and determine the best predictive AT/ET cutoff value in these patients. Methods and Results A total of 353 patients (median age, 79 years; 46% women) with high‐gradient (mean pressure gradient ≥40 mm Hg and/or aortic peak jet velocity ≥4 m/s) SAS, left ventricular ejection fraction ≥50%, and no or mild symptoms were studied. The impact of AT/ET ≤0.35 or >0.35 on all‐cause mortality was retrospectively studied. During a median follow‐up of 39 (25th–75th percentile, 23–62) months, 70 patients died. AT/ET >0.35 was associated with a considerable increased mortality risk after adjustment for established prognostic factors in SAS under medical and/or surgical management (adjusted hazard ratio [HR], 2.54; 95% CI, 1.47–4.37; P<0.001) or conservative management (adjusted HR, 3.29; 95% CI, 1.70–6.39; P<0.001). Moreover, AT/ET >0.35 improved the predictive performance of models including established risk factors in SAS with better global model fit, reclassification, and discrimination. After propensity matching, increased mortality risk persisted when AT/ET >0.35 (adjusted HR, 2.10; 95% CI, 1.12–3.90; P<0.001). Conclusions AT/ET >0.35 is a strong predictor of outcome in patients with SAS and no or only mild symptoms and identifies a subgroup of patients at higher risk of death who may derive benefit from earlier aortic valve replacement.
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Affiliation(s)
- Alexandre Altes
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - Nicolas Thellier
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - Yohann Bohbot
- Centre Hospitalier Universitaire d'Amiens Amiens France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Anne Ringle Griguer
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - Stéphane Verdun
- Biostatistics Department Lille Catholic Hospitals Delegations for Clinical Research and Innovation Lille Catholic University Lomme France
| | - Franck Levy
- Department of Cardiology Centre Cardio-Thoracique de Monaco Monaco Monaco
| | - Anne Laure Castel
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - François Delelis
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - Amandine Mailliet
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France
| | - Christophe Tribouilloy
- Centre Hospitalier Universitaire d'Amiens Amiens France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
| | - Sylvestre Maréchaux
- Cardiology Department Lille Catholic Hospitals Heart Valve Center Lille Catholic University Lille France.,EA 7517 MP3CV Jules Verne University of Picardie Amiens France
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23
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Saffarpour M, Basu D, Radaei F, Vali K, Adams JY, Chuah CN, Ghiasi S. Dicrotic Notch Identification: a Generalizable Hybrid Approach under Arterial Blood Pressure (ABP) Curve Deformations. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4424-4427. [PMID: 34892201 DOI: 10.1109/embc46164.2021.9629981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Dicrotic Notch (DN) is a distinctive and clinically significant feature of the arterial blood pressure curve. Its automatic identification has been the focus of many kinds of research using either model-based or rule-based methodologies. However, since DN morphology is quite variant following the patient-specific underlying physiological and pathological conditions, its automatic identification with these methods is challenging. This work proposes a hybrid approach that employs both model-based and rule-based approaches to enhance DN detection's generalizability. We have tested our approach on ABP data gathered from 14 pigs. Our result strongly indicates 36% overall mean error improvement with maximum 52% and -11% accuracy enhancement and degradation in extreme cases.
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24
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Chen YJ, Chien CS, Chiang CE, Chen CH, Cheng HM. From Genetic Mutations to Molecular Basis of Heart Failure Treatment: An Overview of the Mechanism and Implication of the Novel Modulators for Cardiac Myosin. Int J Mol Sci 2021; 22:6617. [PMID: 34205587 PMCID: PMC8234187 DOI: 10.3390/ijms22126617] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/11/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
Heart failure (HF) is a syndrome encompassing several important etiologies that lead to the imbalance between oxygen demand and supply. Despite the usage of guideline-directed medical therapy for HF has shown better outcomes, novel therapeutic strategies are desirable, especially for patients with preserved or mildly reduced left ventricular ejection fraction. In this regard, understanding the molecular basis for cardiomyopathies is expected to fill in the knowledge gap and generate new therapies to improve prognosis for HF. This review discusses an evolutionary mechanism designed to regulate cardiac contraction and relaxation through the most often genetically determined cardiomyopathies associated with HF. In addition, both the myosin inhibitor and myosin activator are promising new treatments for cardiomyopathies. A comprehensive review from genetic mutations to the molecular basis of direct sarcomere modulators will help shed light on future studies for a better characterization of HF etiologies and potential therapeutic targets.
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Affiliation(s)
- Yu-Jen Chen
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116081, Taiwan;
- Department of Internal Medicine, Division of Cardiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chian-Shiu Chien
- Innovative Cellular Therapy Center, Department of Medical Research, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
| | - Chern-En Chiang
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei 112304, Taiwan
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112201, Taiwan;
- College of Medicine, National Yang Ming Chiao Tung University, Taipei 112201, Taiwan
| | - Hao-Min Cheng
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei 112304, Taiwan
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei 112201, Taiwan
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25
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Tocci ND, Collier SR, Meucci M. Measures of ejection duration and subendocardial viability ratio in normal weight and overweight adolescent children. Physiol Rep 2021; 9:e14852. [PMID: 33991440 PMCID: PMC8123553 DOI: 10.14814/phy2.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/29/2021] [Accepted: 04/08/2021] [Indexed: 12/03/2022] Open
Abstract
The aim of our study was to determine how being overweight (OW) affects measures of ejection duration (ED), subendocardial viability ratio (SEVR), and central arterial health in a sample of adolescent children. Thirty‐four sex and age‐matched adolescent children (n = 34, 17 OW, age = 14 ± 2 years) participated in one laboratory visit. Anthropometric measures, body composition, and cardiovascular measures including resting heart rate, aortic systolic blood pressure (ASBP), carotid‐femoral pulse wave velocity (cf‐PWV), ED (EDms absolute vs. relative ED%), and the SEVR were ascertained. Transfer functions were applied to obtain ASBP. ED was measured as the time from the beginning of the upstroke of the pulse wave and the dicrotic notch, SEVR as the quotient of the diastolic pressure‐time area to the systolic pressure‐time area, and cf‐PWV as the quotient of distance between carotid‐femoral measurement sites and the transit time of the pulse wave. cf‐PWV was significantly higher in OW compared to normal weight participants (5.13 ± 0.85 vs. 4.53 ± 0.46 m/s respectively; p = 0.015, d = 0.51). OW adolescents also reported significantly higher values for ASBP (103.1 ± 11.8 vs. 95.7 ± 8.2 mmHg respectively; p = 0.043, d = 0.72) and significantly lower values of SEVR (114.4 ± 25.9% vs. 132.2 ± 22.0% respectively; p = 0.038; d = 0.33). Overweight adolescents demonstrated higher cf‐PWV, ASBP, and SEVR then normal weight peers.
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Affiliation(s)
- Nicholas D Tocci
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Scott R Collier
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
| | - Marco Meucci
- Department of Health and Exercise Science, Appalachian State University, Boone, NC, USA
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26
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Bikia V, Adamopoulos D, Pagoulatou S, Rovas G, Stergiopulos N. AI-Based Estimation of End-Systolic Elastance From Arm-Pressure and Systolic Time Intervals. Front Artif Intell 2021; 4:579541. [PMID: 33937742 PMCID: PMC8079739 DOI: 10.3389/frai.2021.579541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/03/2021] [Indexed: 12/15/2022] Open
Abstract
Left ventricular end-systolic elastance (Ees) is a major determinant of cardiac systolic function and ventricular-arterial interaction. Previous methods for the Ees estimation require the use of the echocardiographic ejection fraction (EF). However, given that EF expresses the stroke volume as a fraction of end-diastolic volume (EDV), accurate interpretation of EF is attainable only with the additional measurement of EDV. Hence, there is still need for a simple, reliable, noninvasive method to estimate Ees. This study proposes a novel artificial intelligence—based approach to estimate Ees using the information embedded in clinically relevant systolic time intervals, namely the pre-ejection period (PEP) and ejection time (ET). We developed a training/testing scheme using virtual subjects (n = 4,645) from a previously validated in-silico model. Extreme Gradient Boosting regressor was employed to model Ees using as inputs arm cuff pressure, PEP, and ET. Results showed that Ees can be predicted with high accuracy achieving a normalized RMSE equal to 9.15% (r = 0.92) for a wide range of Ees values from 1.2 to 4.5 mmHg/ml. The proposed model was found to be less sensitive to measurement errors (±10–30% of the actual value) in blood pressure, presenting low test errors for the different levels of noise (RMSE did not exceed 0.32 mmHg/ml). In contrast, a high sensitivity was reported for measurements errors in the systolic timing features. It was demonstrated that Ees can be reliably estimated from the traditional arm-pressure and echocardiographic PEP and ET. This approach constitutes a step towards the development of an easy and clinically applicable method for assessing left ventricular systolic function.
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Affiliation(s)
- Vasiliki Bikia
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | | | - Stamatia Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Georgios Rovas
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Swiss Federal Institute of Technology, Lausanne, Switzerland
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27
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Trivedi A, Oberoi RK, Jafarinasabian P, Zhang H, Flach S, Abbasi S, Dutta S, Lee E. Effect of Varying Degrees of Renal Impairment on the Pharmacokinetics of Omecamtiv Mecarbil. Clin Pharmacokinet 2021; 60:1041-1048. [PMID: 33768487 PMCID: PMC8332597 DOI: 10.1007/s40262-021-01014-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2021] [Indexed: 01/28/2023]
Abstract
Background and Objective Omecamtiv mecarbil is a novel selective cardiac myosin activator (myotrope) under investigation for the treatment of heart failure with reduced ejection fraction. The objective of this clinical study was to estimate the effect of varying degrees of renal impairment on the pharmacokinetics of omecamtiv mecarbil single dose (50 mg) under fasted conditions. Methods This phase I, open-label, non-randomized, parallel-group study evaluated the pharmacokinetics, safety, and tolerability of a single oral dose of omecamtiv mecarbil 50 mg in individuals with normal renal function or mild, moderate, and severe renal impairment, including end-stage renal disease requiring dialysis. Geometric least-squares mean ratios of maximum observed concentration (Cmax) and area under the plasma concentration–time curve (AUC) and 90% confidence intervals were derived for comparisons of renal impairment vs normal renal function. Participants were monitored for adverse events. Results Thirty-one participants received treatment and completed the study. Geometric mean exposures were similar for participants with renal impairment (AUC∞ range, 2550–3220 h*ng/mL; Cmax range, 78.9–107 ng/mL) and participants with normal renal function (AUC∞, 2790 h*ng/mL; Cmax, 92.6 ng/mL), with geometric least-squares mean ratios of 85.2–125.9. Exposure was similar on dialysis vs non-dialysis days in participants with end-stage renal disease (AUC0–24, 1650 vs 1700 h*ng/mL; Cmax, 100.0 vs 107.0 ng/mL). Four participants (12.9%) reported four treatment-emergent adverse events. No deaths, treatment-emergent adverse events leading to discontinuation, or serious adverse events occurred. Conclusions Omecamtiv mecarbil pharmacokinetics were not meaningfully affected by renal function or hemodialysis, suggesting the same dosing strategy can be used in individuals with normal renal function or renal impairment. Oral administration of omecamtiv mecarbil was not associated with major tolerability findings. This study supports omecamtiv mecarbil for the treatment of heart failure in individuals with or without renal impairment. Supplementary Information The online version contains supplementary material available at 10.1007/s40262-021-01014-0.
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Affiliation(s)
- Ashit Trivedi
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA.
| | - Rajneet K Oberoi
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | | | - Hanze Zhang
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | | | - Siddique Abbasi
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Sandeep Dutta
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Edward Lee
- Amgen, Inc., 1 Amgen Center Drive, Thousand Oaks, CA, 91320, USA
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28
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Alhakak AS, Teerlink JR, Lindenfeld J, Böhm M, Rosano GMC, Biering-Sørensen T. The significance of left ventricular ejection time in heart failure with reduced ejection fraction. Eur J Heart Fail 2021; 23:541-551. [PMID: 33590579 DOI: 10.1002/ejhf.2125] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/25/2021] [Accepted: 02/10/2021] [Indexed: 01/10/2023] Open
Abstract
Left ventricular ejection time (LVET) is defined as the time interval from aortic valve opening to aortic valve closure, and is the phase of systole during which the left ventricle ejects blood into the aorta. LVET has been used for several decades to assess left ventricular function and contractility. However, there is a recent interest in LVET as a measure of therapeutic action for novel drugs in patients with heart failure with reduced ejection fraction (HFrEF), since LVET is shortened in these patients. This review provides an overview of the available information on LVET including methods of measuring LVET, mechanistic understanding of LVET, association of LVET with outcomes, mechanisms behind shortened LVET in HFrEF and the potential implications of drugs that affect and normalize LVET.
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Affiliation(s)
- Alia S Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Michael Böhm
- Department of Internal Medicine, Klinik für Innere Medizin III, Universitätsklinikum Des Saarlandes, Saarland University, Homburg/Saar, Germany
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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29
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Einarsen E, Cramariuc D, Bahlmann E, Midtbo H, Chambers JB, Gerdts E. Higher Acceleration/Ejection Time Ratio Predicts Impaired Outcome in Aortic Valve Stenosis. Circ Cardiovasc Imaging 2021; 14:e011467. [PMID: 33461302 DOI: 10.1161/circimaging.120.011467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acceleration time (AT)/ejection time (ET) ratio is a marker of aortic valve stenosis (AS) severity and predicts outcome in moderate-severe AS. METHODS We explored the association of increased AT/ET ratio on prognosis in 1530 asymptomatic patients with presumably mild-moderate AS, normal ejection fraction, and without known diabetes or cardiovascular disease. Patients were part of the SEAS study (Simvastatin Ezetimibe Aortic Stenosis). Patients were grouped according to the optimal AT/ET ratio threshold to predict cardiovascular death and heart failure hospitalization. Low-gradient severe AS was identified as combined valve area ≤1.0 cm2 and mean gradient <40 mm Hg. Outcome was assessed in Cox regression analyses, and results are reported as hazard ratio and 95% CI. RESULTS Higher AT/ET ratio was significantly associated with lower systolic blood pressure, lower left ventricular ejection fraction, lower stress-corrected midwall shortening, low flow, and with higher left ventricular mass and higher peak aortic jet velocity. AT/ET ratio ≥0.32 provided the optimal cutoff for predicting incident cardiovascular death and heart failure hospitalization in the total study sample. In patients with low-gradient severe AS, this threshold was >0.32. AT/ET ratio ≥0.32 had a 79% higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 1.79 [95% CI, 1.20-2.68]). In patients with low-gradient severe AS, AT/ET ratio >0.32 was associated with a 2-fold higher risk of cardiovascular death and heart failure hospitalization (hazard ratio, 2.15 [95% CI, 1.22-3.77]). CONCLUSIONS In asymptomatic nonsevere AS and low-gradient severe AS, higher AT/ET ratio was associated with increased cardiovascular morbidity and mortality. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00092677.
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Affiliation(s)
- Eigir Einarsen
- Department of Clinical Science, University of Bergen, Norway (E.E., E.G.)
| | - Dana Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C., H.M., E.G.)
| | - Edda Bahlmann
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany (E.B.)
| | - Helga Midtbo
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C., H.M., E.G.)
| | - John B Chambers
- Cardiothoracic Centre, Guys and St. Thomas Hospitals, London, United Kingdom (J.B.C.)
| | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Norway (E.E., E.G.).,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway (D.C., H.M., E.G.)
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30
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Tomasoni D, Adamo M, Anker MS, von Haehling S, Coats AJS, Metra M. Heart failure in the last year: progress and perspective. ESC Heart Fail 2020; 7:3505-3530. [PMID: 33277825 PMCID: PMC7754751 DOI: 10.1002/ehf2.13124] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 12/11/2022] Open
Abstract
Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM-HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA-HF and EMPEROR-Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65-0.85; P < 0.001 and HR 0.75; 95% CI 0.65-0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82-0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.
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Affiliation(s)
- Daniela Tomasoni
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Marianna Adamo
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
| | - Markus S. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK)Charité–University Medicine BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK), partner site BerlinBerlinGermany
- Department of Cardiology (CBF)Charité–University Medicine BerlinBerlinGermany
| | - Stephan von Haehling
- Department of Cardiology and PneumologyUniversity of Göttingen Medical CenterGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Andrew J. S. Coats
- Centre for Clinical and Basic Research, Department of Medical SciencesIRCCS San Raffaele PisanaRomeItaly
| | - Marco Metra
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public HealthUniversity of BresciaBresciaItaly
- Cardiology and Cardiac Catheterization Laboratory, Cardio‐thoracic DepartmentCivil HospitalsBresciaItaly
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31
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Georgiopoulos G, Aimo A, Barison A, Magkas N, Emdin M, Masci PG. Imaging predictors of incident heart failure: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 22:378-387. [PMID: 33136816 DOI: 10.2459/jcm.0000000000001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. METHODS This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. RESULTS Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). CONCLUSION LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto Aimo
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Division, University Hospital of Pisa
| | - Andrea Barison
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nikolaos Magkas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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32
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Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Adams KF, Anand I, Arias-Mendoza A, Biering-Sørensen T, Böhm M, Bonderman D, Cleland JGF, Corbalan R, Crespo-Leiro MG, Dahlström U, Echeverria Correa LE, Fang JC, Filippatos G, Fonseca C, Goncalvesova E, Goudev AR, Howlett JG, Lanfear DE, Lund M, Macdonald P, Mareev V, Momomura SI, O'Meara E, Parkhomenko A, Ponikowski P, Ramires FJA, Serpytis P, Sliwa K, Spinar J, Suter TM, Tomcsanyi J, Vandekerckhove H, Vinereanu D, Voors AA, Yilmaz MB, Zannad F, Sharpsten L, Legg JC, Abbasi SA, Varin C, Malik FI, Kurtz CE. Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction: GALACTIC-HF baseline characteristics and comparison with contemporary clinical trials. Eur J Heart Fail 2020; 22:2160-2171. [PMID: 32985088 PMCID: PMC7756903 DOI: 10.1002/ejhf.2015] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 09/17/2020] [Accepted: 09/20/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is being tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) trial. Here we describe the baseline characteristics of participants in GALACTIC-HF and how these compare with other contemporary trials. METHODS AND RESULTS Adults with established HFrEF, New York Heart Association (NYHA) functional class ≥II, ejection fraction ≤35%, elevated natriuretic peptides and either current hospitalization for heart failure or history of hospitalization/emergency department visit for heart failure within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic-guided dosing: 25, 37.5, or 50 mg bid). A total of 8256 patients [male (79%), non-white (22%), mean age 65 years] were enrolled with a mean ejection fraction 27%, ischaemic aetiology in 54%, NYHA class II 53% and III/IV 47%, and median N-terminal pro-B-type natriuretic peptide 1971 pg/mL. Heart failure therapies at baseline were among the most effectively employed in contemporary heart failure trials. GALACTIC-HF randomized patients representative of recent heart failure registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure <100 mmHg (n = 1127), estimated glomerular filtration rate <30 mL/min/1.73 m2 (n = 528), and treated with sacubitril/valsartan at baseline (n = 1594). CONCLUSIONS GALACTIC-HF enrolled a well-treated, high-risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation.
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Rafael Diaz
- Estudios Clinicos Latino America (ECLA), Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine and Duke Clinical Research Institute, Durham, NC, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Marco Metra
- Cardiology, ASST Spedali Civili; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Inder Anand
- University of Minnesota, Minneapolis, MN, USA
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital & Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Böhm
- Saarland University, Universitätsklinikum des Saarlandes, Homburg, Germany
| | | | - John G F Cleland
- National Heart and Lung Institute, Imperial College, London, UK.,Robertson Centre for Biostatistics and Clinical Trials, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ramon Corbalan
- Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Maria G Crespo-Leiro
- Complexo Hospitalario Universitario A Coruña (CHUAC). CIBERCV. INIBIC. Universidade da Coruña, A Coruña, Spain
| | - Ulf Dahlström
- Department of Cardiology and Department of Health, Medicine and Caring Sciences, Linkoping University, Linkoping, Sweden
| | | | | | | | - Cândida Fonseca
- Hospital S. Francisco Xavier, CHLO; NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Assen R Goudev
- Department of Cardiology, Queen Giovanna University Hospital and Medical University, Sofia, Bulgaria
| | - Jonathan G Howlett
- Libin Cardiovascular Institute and Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | | | | | - Vyacheslav Mareev
- University Clinic of Lomonosov Moscow State University, Moscow, Russia
| | | | - Eileen O'Meara
- Montreal Heart Institute and Université de Montréal, Montreal, Canada
| | | | | | - Felix J A Ramires
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Karen Sliwa
- University of Cape Town, Johannesburg, South Africa
| | | | - Thomas M Suter
- Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | | | | | - Faiez Zannad
- Université de Lorraine, Inserm INI CRCT, CHRU Nancy, Nancy, France
| | | | | | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
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33
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Alhakak AS, Sengeløv M, Jørgensen PG, Bruun NE, Johnsen C, Abildgaard U, Iversen AZ, Hansen TF, Teerlink JR, Malik FI, Solomon SD, Gislason G, Biering-Sørensen T. Left ventricular systolic ejection time is an independent predictor of all-cause mortality in heart failure with reduced ejection fraction. Eur J Heart Fail 2020; 23:240-249. [PMID: 33034122 DOI: 10.1002/ejhf.2022] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/16/2020] [Accepted: 10/07/2020] [Indexed: 01/10/2023] Open
Abstract
AIMS Colour tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain cardiac time intervals including isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT) and systolic ejection time (SET). The myocardial performance index (MPI) is defined as [(IVCT + IVRT)/SET]. Whether cardiac time intervals obtained by the TDI M-mode method can be used to predict outcome in patients with heart failure with reduced ejection fraction (HFrEF) remains unknown. METHODS AND RESULTS A total of 997 patients with HFrEF (mean age 67 ± 11 years, 74% male) underwent an echocardiographic examination including TDI. During a median follow-up of 3.4 years (interquartile range 1.9-4.8 years), 165 (17%) patients died. The risk of mortality increased by 9% per 10 ms decrease in SET [per 10 ms decrease: hazard ratio (HR) 1.09, 95% confidence interval (CI) 1.06-1.13; P < 0.001]. The association remained significant even after multivariable adjustment for clinical and echocardiographic parameters (per 10 ms decrease: HR 1.06, 95% CI 1.01-1.11; P = 0.030). The MPI was a significant predictor in an unadjusted model (per 0.1 increase: HR 3.06, 95% CI 1.16-8.06; P = 0.023). However, the association did not remain significant after multivariable adjustment. No significant associations between IVCT or IVRT and mortality were found in unadjusted nor adjusted models. Additionally, SET provided incremental prognostic information with regard to predicting mortality when added to established clinical predictors of mortality in patients with HFrEF. CONCLUSION In patients with HFrEF, SET provides independent and incremental prognostic information regarding all-cause mortality.
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Affiliation(s)
- Alia S Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter G Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Niels E Bruun
- Department of Cardiology, Zealand University Hospital, University of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie Johnsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ulrik Abildgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Allan Z Iversen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas F Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center and School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, CA, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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34
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The cardiac isovolumetric contraction time is an independent predictor of incident heart failure in the general population. Int J Cardiol 2020; 312:81-86. [DOI: 10.1016/j.ijcard.2020.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/29/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
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35
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Left ventricular output indices in hospitalized heart failure: when "simpler" may not mean "better". Int J Cardiovasc Imaging 2020; 37:59-68. [PMID: 32734497 DOI: 10.1007/s10554-020-01946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/20/2020] [Indexed: 10/23/2022]
Abstract
Assessment of left ventricular (LV) output in hospitalized patients with heart failure (HF) is important to determine prognosis. Although echocardiographic LV ejection fraction (EF) is generally used to this purpose, its prognostic value is limited. In this investigation LV-EF was compared with other echocardiographic per-beat measures of LV output, including non-indexed stroke volume (SV), SV index (SVI), stroke distance (SD), ejection time (ET), and flow rate (FR), to determine the best predictor of all-cause mortality in patients hospitalized with HF. A final cohort of 350 consecutive patients hospitalized with HF who underwent echocardiography during hospitalization was studied. At a median follow-up of 2.7 years, 163 patients died. Non-survivors at follow-up had lower SD, SVI and SV, but not ET, FR and LV-EF than survivors. At multivariate analysis, only age, systolic blood pressure, chronic kidney disease, chronic obstructive pulmonary disease, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and SVI remained significantly associated with outcome [HR for SVI 1.13 (1.04-1.22), P = 0.003]. In particular, for each 5 ml/m2 decrease in SVI, a 13% increase in risk of mortality for any cause was observed. SVI is a powerful prognosticator in HF patients, better than other per-beat measures, which may be simpler but partial or incomplete descriptors of LV output. SVI, therefore, should be considered for the routine echocardiographic evaluation of patients hospitalized with HF to predict prognosis.
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36
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Tomasoni D, Adamo M, Metra M. July 2020 at a glance: focus on imaging and cardiomyopathies. Eur J Heart Fail 2020; 22:1057-1059. [DOI: 10.1002/ejhf.1517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Daniela Tomasoni
- Cardiology and Cardiac Catheterization Laboratory Civil Hospitals; Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Marianna Adamo
- Cardiology and Cardiac Catheterization Laboratory Civil Hospitals; Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia Brescia Italy
| | - Marco Metra
- Cardiology and Cardiac Catheterization Laboratory Civil Hospitals; Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, University of Brescia Brescia Italy
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37
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Patel PA, Ambrosy AP, Phelan M, Alenezi F, Chiswell K, Van Dyke MK, Tomfohr J, Honarpour N, Velazquez EJ. Association between systolic ejection time and outcomes in heart failure by ejection fraction. Eur J Heart Fail 2020; 22:1174-1182. [PMID: 31863532 PMCID: PMC7493053 DOI: 10.1002/ejhf.1659] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/16/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
AIMS Worsening heart failure (HF) is associated with shorter left ventricular systolic ejection time (SET), but there are limited data describing the relationship between SET and clinical outcomes. Thus, the objective was to describe the association between SET and clinical outcomes in an ambulatory HF population irrespective of ejection fraction (EF). METHODS AND RESULTS We identified ambulatory patients with HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF) who had an outpatient transthoracic echocardiogram performed between August 2008 and July 2010 at a tertiary referral centre. Multivariable logistic regression was used to evaluate the association between SET and 1-year outcomes. A total of 545 HF patients (171 HFrEF, 374 HFpEF) met eligibility criteria. Compared with HFpEF, HFrEF patients were younger [median age 60 years (25th-75th percentiles 50-69) vs. 64 years (25th-75th percentiles 53-74], with fewer females (30% vs. 56%) and a similar percentage of African Americans (36% vs. 35%). Median (25th-75th percentiles) EF with HFrEF was 30% (25-35%) and with HFpEF was 54% (48-58%). Median SET was shorter (280 ms vs. 315 ms, P < 0.001), median pre-ejection period was longer (114 ms vs. 89 ms, P < 0.001), and median relaxation time was shorter (78.7 ms vs. 93.3 ms, P < 0.001) among patients with HFrEF vs. HFpEF. Death or HF hospitalization occurred in 26.9% (n = 46) HFrEF and 11.8% (n = 44) HFpEF patients. After adjustment, longer SET was associated with lower odds of the composite of death or HF hospitalization at 1 year among HFrEF but not HFpEF patients. CONCLUSION Longer SET is independently associated with improved outcomes among HFrEF patients but not HFpEF patients, supporting a potential role for normalizing SET as a therapeutic strategy with systolic dysfunction.
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Affiliation(s)
- Priyesh A. Patel
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC, USA
| | - Andrew P. Ambrosy
- Department of Cardiology, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | | | - Fawaz Alenezi
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Jennifer Tomfohr
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
| | | | - Eric J. Velazquez
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven CT, USA
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38
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Luo J, Xu S, Li H, Li Z, Liu B, Qin X, Gong M, Shi B, Wei Y. Long-term impact of new-onset atrial fibrillation complicating acute myocardial infarction on heart failure. ESC Heart Fail 2020; 7:2762-2772. [PMID: 32578394 PMCID: PMC7524129 DOI: 10.1002/ehf2.12872] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/01/2020] [Accepted: 06/12/2020] [Indexed: 11/21/2022] Open
Abstract
Aims New‐onset atrial fibrillation (NOAF) complicating acute myocardial infarction (AMI) has been associated with poor survival, but the clinical implication of NOAF on heart failure (HF) is still not well characterized. We aimed to investigate the relationship between NOAF complicating AMI and HF hospitalization. Methods and results Adult AMI patients identified in the New‐Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in Shanghai registry who, discharged alive, had complete echocardiography and follow‐up data from February 2014 to March 2018 were included. Patients were divided according to the presence of NOAF. The outcome measures were HF hospitalization and death during the observational period (until 10 April 2019). Cox proportional hazard models were performed in the whole population and propensity score‐matched (PSM) cohort to assess the adjusted hazard ratio (HR) and 95% confidence interval (CI). Overall, 2075 patients (mean age: 65.2 ± 12.3 years, 77.3% were men) with AMI were analysed, of whom 228 (11.0%) developed NOAF. Advanced age, admission HF (Killip II–IV), impaired renal function, decreased left ventricular ejection fraction, increased heart rate, and left atrial enlargement were independent predictors of NOAF. Over a median observational period of 2.7 years, the annual incidence rates of HF hospitalization were 18.4% and 2.8% for patients with NOAF and sinus rhythm, respectively. After adjustment for confounders, NOAF was significantly associated with HF hospitalization (HR: 3.14, 95% CI: 2.30–4.28, P < 0.001). Similar results were obtained when accounting for the competing risk of all‐cause death (subdistribution HR: 3.06, 95% CI: 2.18–4.30, P < 0.001) or from the PSM cohort (HR: 2.82, 95% CI: 1.99–4.00, P < 0.001). Patients with persistent NOAF (HR: 5.81, 95% CI: 3.59–9.41) were at significantly higher risk of HF hospitalization when compared with those with transient one (HR: 2.61, 95% CI: 1.84–3.70, P interaction = 0.008). Although post‐MI NOAF was significantly related to cardiovascular death (annual incidence rates for NOAF and sinus rhythm were 9.4% and 2.3%, respectively; HR: 1.97, 95% CI: 1.36–2.85, P < 0.001), such an association was attenuated when HF hospitalization (modelled as a time‐varying covariate) and antithrombotic treatment were adjusted (HR: 1.37, 95% CI: 0.92–2.02, P = 0.121). Conclusions In patients with AMI, NOAF is strongly associated with an increased long‐term risk of HF hospitalization. Our findings suggest that strengthened secondary prevention of HF should be considered in this high‐risk population.
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Affiliation(s)
- Jiachen Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Hongqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Zhiqiang Li
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Baoxin Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Xiaoming Qin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Mengmeng Gong
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Beibei Shi
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
| | - Yidong Wei
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, 301 Middle Yanchang Road, Jingan District, Shanghai, China
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39
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Özdemir ZC, Köşger P, Uçar B, Bör Ö. Myocardial functions, blood pressure changes, and arterial stiffness in children with severe hemophilia A. Thromb Res 2020; 189:102-107. [PMID: 32197138 DOI: 10.1016/j.thromres.2020.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/17/2020] [Accepted: 03/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prolonging the life span of patients with hemophilia has led to the emergence of comorbidities. Cardiovascular diseases are one of the important causes of mortality in patients with hemophilia. This study investigated the myocardial functions, blood pressure changes, arterial stiffness, and risk factors associated with cardiovascular diseases in children with hemophilia. MATERIAL AND METHODS In total, 17 children with severe hemophilia A and 23 healthy children were included in the study. Myocardial functions were evaluated using standard and tissue Doppler echocardiography. Peripheral and central blood pressure measurements were performed, and arterial stiffness was evaluated. Carotid intima-media thicknesses (CIMT) serum glucose, insulin, insulin resistance index, and lipoprotein levels were measured. RESULTS There were no differences between the two groups in terms of age, and biochemical parameters (P > 0.05). The HDL-C levels in the hemophilia group were lower than those in the control group (P < 0.05). Five of the patients had insulin resistance (29.4%), whereas four had low HDL-C levels (23.5%). There were no differences between the groups in terms of the CIMT, peripheral blood pressure, and central systolic blood pressure (P > 0.05). In the hemophilia group, central diastolic blood pressure (cDBP), arterial stiffness, and myocardial performance index were higher (P < 0.05, P = 0.01, P < 0.01), whereas the ejection time was shorter than in the control group (P < 0.05). CONCLUSIONS Compared with the control group, there is an onset of arterial stiffness, cDBP values tend to increase, and serum HDL-C levels are lower in the hemophilia group. Moreover, myocardial systolic functions demonstrate a deterioration that becomes more prominent with the increase in arterial stiffness.
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Affiliation(s)
- Zeynep Canan Özdemir
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
| | - Pelin Köşger
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Birsen Uçar
- Division of Pediatric Cardiology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Eskişehir Osmangazi University, Faculty of Medicine, 26480 Eskişehir, Turkey.
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40
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Njoroge JN, Teerlink JR. Systolic time intervals in patients with heart failure: time to teach new dogs old tricks. Eur J Heart Fail 2020; 22:1183-1185. [PMID: 32056362 PMCID: PMC7540403 DOI: 10.1002/ejhf.1725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 01/10/2023] Open
Affiliation(s)
- Joyce N Njoroge
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - John R Teerlink
- School of Medicine, University of California San Francisco, San Francisco, CA, USA.,Section of Cardiology, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
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41
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Teerlink JR, Diaz R, Felker GM, McMurray JJV, Metra M, Solomon SD, Legg JC, Büchele G, Varin C, Kurtz CE, Malik FI, Honarpour N. Omecamtiv Mecarbil in Chronic Heart Failure With Reduced Ejection Fraction: Rationale and Design of GALACTIC-HF. JACC-HEART FAILURE 2020; 8:329-340. [PMID: 32035892 DOI: 10.1016/j.jchf.2019.12.001] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 12/09/2019] [Indexed: 01/10/2023]
Abstract
A central factor in the pathogenesis of heart failure (HF) with reduced ejection fraction is the initial decrease in systolic function. Prior attempts at increasing cardiac contractility with oral drugs have uniformly resulted in signals of increased mortality at pharmacologically effective doses. Omecamtiv mecarbil is a novel, selective cardiac myosin activator that has been shown to improve cardiac function and to decrease ventricular volumes, heart rate, and N-terminal pro-B-type natriuretic peptide in patients with chronic HF. The GALACTIC-HF (Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure) trial tests the hypotheses that omecamtiv mecarbil can safely improve symptoms, prevent clinical HF events, and delay CV death in patients with chronic HF. The GALACTIC-HF trial is an international, multicenter, randomized, double-blind, placebo-controlled, event-driven cardiovascular outcomes trial. More than 8,000 patients with chronic symptomatic (New York Heart Association functional class II to IV) HF, left ventricular ejection fraction ≤35%, elevated natriuretic peptides, and either current hospitalization for HF or history of hospitalization or emergency department visit for HF within a year of screening will be randomized to either oral placebo or omecamtiv mecarbil employing a pharmacokinetic-guided dose titration strategy using doses of 25, 37.5, or 50 mg twice daily. The primary efficacy outcome is the time to cardiovascular death or first HF event. The study has 90% power to assess a final hazard ratio of approximately 0.80 in cardiovascular death, the first secondary outcome. The GALACTIC-HF trial is the first trial examining whether selectively increasing cardiac contractility in patients with HF with reduced ejection fraction will result in improved clinical outcomes. (Registrational Study With Omecamtiv Mecarbil/AMG 423 to Treat Chronic Heart Failure With Reduced Ejection Fraction [GALACTIC-HF]; NCT02929329).
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Affiliation(s)
- John R Teerlink
- Section of Cardiology, San Francisco Veterans Affairs Medical Center, School of Medicine, University of California-San Francisco, San Francisco, California.
| | - Rafael Diaz
- Estudios Clinicos Latinoamérica, Rosario, Argentina
| | - G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Duke Clinical Research Institute, Durham, North Carolina
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Fady I Malik
- Cytokinetics, Inc., South San Francisco, California
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Carll AP, Salatini R, Pirela SV, Wang Y, Xie Z, Lorkiewicz P, Naeem N, Qian Y, Castranova V, Godleski JJ, Demokritou P. Inhalation of printer-emitted particles impairs cardiac conduction, hemodynamics, and autonomic regulation and induces arrhythmia and electrical remodeling in rats. Part Fibre Toxicol 2020; 17:7. [PMID: 31996220 PMCID: PMC6990551 DOI: 10.1186/s12989-019-0335-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Using engineered nanomaterial-based toners, laser printers generate aerosols with alarming levels of nanoparticles that bear high bioactivity and potential health risks. Yet, the cardiac impacts of printer-emitted particles (PEPs) are unknown. Inhalation of particulate matter (PM) promotes cardiovascular morbidity and mortality, and ultra-fine particulates (< 0.1 μm aerodynamic diameter) may bear toxicity unique from larger particles. Toxicological studies suggest that PM impairs left ventricular (LV) performance; however, such investigations have heretofore required animal restraint, anesthesia, or ex vivo preparations that can confound physiologic endpoints and/or prohibit LV mechanical assessments during exposure. To assess the acute and chronic effects of PEPs on cardiac physiology, male Sprague Dawley rats were exposed to PEPs (21 days, 5 h/day) while monitoring LV pressure (LVP) and electrocardiogram (ECG) via conscious telemetry, analyzing LVP and heart rate variability (HRV) in four-day increments from exposure days 1 to 21, as well as ECG and baroreflex sensitivity. At 2, 35, and 70 days after PEPs exposure ceased, rats received stress tests. RESULTS On day 21 of exposure, PEPs significantly (P < 0.05 vs. Air) increased LV end systolic pressure (LVESP, + 18 mmHg) and rate-pressure-product (+ 19%), and decreased HRV indicating sympathetic dominance (root means squared of successive differences [RMSSD], - 21%). Overall, PEPs decreased LV ejection time (- 9%), relaxation time (- 3%), tau (- 5%), RMSSD (- 21%), and P-wave duration (- 9%). PEPs increased QTc interval (+ 5%) and low:high frequency HRV (+ 24%; all P < 0.05 vs. Air), while tending to decrease baroreflex sensitivity and contractility index (- 15% and - 3%, P < 0.10 vs. Air). Relative to Air, at both 2 and 35 days after PEPs, ventricular arrhythmias increased, and at 70 days post-exposure LVESP increased. PEPs impaired ventricular repolarization at 2 and 35 days post-exposure, but only during stress tests. At 72 days post-exposure, PEPs increased urinary dopamine 5-fold and protein expression of ventricular repolarizing channels, Kv1.5, Kv4.2, and Kv7.1, by 50%. CONCLUSIONS Our findings suggest exposure to PEPs increases cardiovascular risk by augmenting sympathetic influence, impairing ventricular performance and repolarization, and inducing hypertension and arrhythmia. PEPs may present significant health risks through adverse cardiovascular effects, especially in occupational settings, among susceptible individuals, and with long-term exposure.
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Affiliation(s)
- Alex P. Carll
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Renata Salatini
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sandra V. Pirela
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Yun Wang
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
- Department of Occupational and Environmental Health Sciences,School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Zhengzhi Xie
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Pawel Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Nazratan Naeem
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Yong Qian
- Pathology and Physiology Research Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV USA
| | - Vincent Castranova
- Department of Pharmaceutical Sciences/Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV USA
| | - John J. Godleski
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
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Myers J, Christle JW, Tun A, Yilmaz B, Moneghetti KJ, Yuen E, Soofi M, Ashley E. Cardiopulmonary Exercise Testing, Impedance Cardiography, and Reclassification of Risk in Patients Referred for Heart Failure Evaluation. J Card Fail 2019; 25:961-968. [DOI: 10.1016/j.cardfail.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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Lainscak M, Omersa D, Sedlar N, Anker SD, Farkas J. Heart failure prevalence in the general population: SOBOTA-HF study rationale and design. ESC Heart Fail 2019; 6:1077-1084. [PMID: 31347289 PMCID: PMC6816073 DOI: 10.1002/ehf2.12496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/02/2019] [Accepted: 06/25/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Epidemiological heart failure (HF) data in the era of natriuretic peptides and echocardiography are scarce. The primary aim of this study is to evaluate the HF prevalence in the general population. We will also investigate natriuretic peptide cut‐off for diagnosis of HF. Finally, we will be able to identify left ventricular function phenotypes and study relations between cardiac function, clinical presentation, and health‐related quality of life. Methods and results Screening Of adult urBan pOpulation To diAgnose Heart Failure (SOBOTA‐HF) is a cross‐sectional prevalence study in a representative sample of Murska Sobota residents aged 55 years or more. Individuals will be invited to attend screening visit with point‐of‐care N‐terminal pro‐b‐type natriuretic peptide (NT‐proBNP) testing. All subjects with NT‐proBNP ≥ 125 pg/mL will be invited for a diagnostic visit that will include history and physical examination, electrocardiogram, echocardiography, blood and urine sampling, ankle brachial index, pulmonary function tests, body composition measurement, physical performance tests, and questionnaires. To validate the screening procedure, a control group (NT‐proBNP < 125 pg/mL) will undergo the same diagnostic evaluation. An external centre will validate echocardiography results, and the HF diagnosis will be adjudicated within an international HF expert panel. Overall and age‐specific HF prevalence will be calculated in individuals ≥ 55 years and extrapolated to the whole population. Conclusions The SOBOTA‐HF study will test the latest HF guideline diagnostic criteria in the general population sample. Next to HF prevalence, it will provide insight into left ventricular function and general patient phenotype; we will also extend current understanding of natriuretic peptides for HF screening.
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Affiliation(s)
- Mitja Lainscak
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Daniel Omersa
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,General Hospital Jesenice, Jesenice, Slovenia
| | - Natasa Sedlar
- National Institute of Public Health, Ljubljana, Slovenia
| | - Stefan D Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jerneja Farkas
- General Hospital Murska Sobota, Ulica dr. Vrbnjaka 6, Rakican, SI-9000, Murska Sobota, Slovenia.,National Institute of Public Health, Ljubljana, Slovenia
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Metra M. July 2018 at a glance: practical guidance in acute heart failure, pathophysiology and clinical trials of medical therapy. Eur J Heart Fail 2019; 20:1079-1080. [PMID: 29962007 DOI: 10.1002/ejhf.1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Italy
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de Souza Kock K, Marques JLB. Use of photoplethysmography to predict mortality in intensive care units. Vasc Health Risk Manag 2018; 14:311-320. [PMID: 30464494 PMCID: PMC6217313 DOI: 10.2147/vhrm.s172643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study was to evaluate and compare the capacity to predict hemodynamic variables obtained with photoplethysmography (PPG) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients hospitalized in the intensive care unit (ICU). MATERIALS AND METHODS A prospective cohort study was conducted in the adult ICU of Hospital Nossa Senhora da Conceição, located in Tubarão, Santa Catarina, Brazil. The data collected included the diagnosis for hospitalization, age, gender, clinical or surgical profile, PPG pulse curve signal, and APACHE II score in the first 24 hours. A bivariate and a multivariate logistic regressions were performed, with death as an outcome. A mortality model using artificial neural networks (ANNs) was proposed. RESULTS A total of 190 individuals were evaluated. Most of them were males (6:5), with a median age of 67 (54-75) years, and the main reasons for hospitalization were cardiovascular and neurological causes; half of them were surgical cases. APACHE II median score was 14 (8-19), with a median length of stay of 6 (3-15) days, and 28.4% of the patients died. The following factors were associated with mortality: age (OR=1.023; 95% CI 1.001-1.044; P=0.039), clinical profile (OR=5.481; 95% CI 2.646-11.354; P<0.001), APACHE II (OR=1.168; 95% CI 1.106-1.234; P<0.001), heart rate in the first 24 hours (OR=1.020; 95% CI 1.001-1.039; P=0.036), and time between the systolic and diastolic peak (∆T) intervals obtained with PPG (OR=0.989; 95% CI 0.979-0.998; P=0.015). Compared with the accuracy (area under the receiver-operating characteristic curve) 0.780 of APACHE II (95% CI 0.711-0.849; P<0.001), the multivariate logistic model showed a larger area of 0.858 (95% CI 0.803-0.914; P<0.001). In the model using ANNs, the accuracy was 0.895 (95% CI 0.851-0.940; P<0.001). CONCLUSION The mortality models using variables obtained with PPG, with the inclusion of epidemiological parameters, are very accurate and, if associated to APACHE II, improve prognostic accuracy. The use of ANN was even more accurate, indicating that this tool is important to help in the clinical judgment of the intensivist.
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Affiliation(s)
- Kelser de Souza Kock
- Graduate Program in Medical Sciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil,
| | - Jefferson Luiz Brum Marques
- Institute of Biomedical Engineering, Department of Electrical and Electronic Engineering, Federal University of Santa Catarina, Florianópolis, SC, Brazil
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