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Di Santo P, Dehghan K, Mao B, Jung RG, Fadare D, Paydar J, Parlow S, Motazedian P, Prosperi-Porta G, Abdel-Razek O, Joseph J, Goh CY, Chung K, Mulloy A, Ramirez FD, Simard T, Hibbert B, Mathew R, Russo JJ. Milrinone vs Dobutamine for the Management of Cardiogenic Shock: Implications of Renal Function and Injury. JACC. ADVANCES 2023; 2:100393. [PMID: 38938997 PMCID: PMC11198346 DOI: 10.1016/j.jacadv.2023.100393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 06/29/2024]
Abstract
Background Cardiogenic shock is associated with poor clinical outcomes. There is a paucity of prospective data examining the efficacy and safety of inotropic therapy in patients with cardiogenic shock and renal dysfunction. Objectives This study sought to examine the treatment effect of milrinone compared to dobutamine in relation to renal function. Methods In this post hoc analysis of the DOREMI (Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock) trial, we examined clinical outcomes with milrinone compared to dobutamine after stratification based on baseline estimated glomerular filtration rate (eGFR) 60 ml/min/1.73 m2 and acute kidney injury (AKI). The primary outcome was the composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke, or initiation of renal replacement therapy. Results Baseline eGFR <60 ml/min/1.73 m2 and AKI were observed in 78 (45%) and 124 (65%) of patients, respectively. The primary outcome and death from any cause occurred in 99 (52%) and 76 (40%) patients, respectively. eGFR <60 ml/min/1.73 m2 did not appear to modulate the treatment effect of milrinone compared to dobutamine. In contrast, there was a significant interaction between the treatment effect of milrinone compared to dobutamine and AKI with respect to the primary outcome (P interaction = 0.02) and death (P interaction = 0.04). The interaction was characterized by lower risk of primary outcome and death with milrinone compared to dobutamine in patients without, but not with, AKI. Conclusions In patients requiring inotropic support for cardiogenic shock, baseline renal dysfunction and AKI are common. A modulating effect of AKI on the relative efficacy of milrinone compared to dobutamine was observed, characterized by attenuation of a potential clinical benefit with milrinone compared to dobutamine in patients who develop AKI.
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Affiliation(s)
- Pietro Di Santo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Kooroush Dehghan
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brennan Mao
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard G. Jung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Daniel Fadare
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - John Paydar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simon Parlow
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Pouya Motazedian
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Graeme Prosperi-Porta
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Omar Abdel-Razek
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Joanne Joseph
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cheng Yee Goh
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Kevin Chung
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Andrew Mulloy
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - F. Daniel Ramirez
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor Simard
- Department of Cardiovascular Diseases, Mayo Clinic School of Medicine, Rochester, Minnesota, USA
| | - Benjamin Hibbert
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Rebecca Mathew
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Juan J. Russo
- CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Bouchez S, Fedele F, Giannakoulas G, Gustafsson F, Harjola VP, Karason K, Kivikko M, von Lewinski D, Oliva F, Papp Z, Parissis J, Pollesello P, Pölzl G, Tschöpe C. Levosimendan in Acute and Advanced Heart Failure: an Expert Perspective on Posology and Therapeutic Application. Cardiovasc Drugs Ther 2019; 32:617-624. [PMID: 30402660 PMCID: PMC6267661 DOI: 10.1007/s10557-018-6838-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Levosimendan, a calcium sensitizer and potassium channel-opener, is widely appreciated by many specialist heart failure practitioners for its effects on systemic and pulmonary hemodynamics and for the relief of symptoms of acute heart failure. The drug’s impact on mortality in large randomized controlled trials has been inconsistent or inconclusive but, in contrast to conventional inotropes, there have been no indications of worsened survival and some signals of improved heart failure-related quality of life. For this reason, levosimendan has been proposed as a safer inodilator option than traditional agents in settings, such as advanced heart failure. Positive effects of levosimendan on renal function have also been described. At the HEART FAILURE 2018 congress of the Heart Failure Association of the European Society of Cardiology, safe and effective use levosimendan in acute and advanced heart failure was examined in a series of expert tutorials. The proceedings of those tutorials are summarized in this review, with special reference to advanced heart failure and heart failure with concomitant renal dysfunction. Meta-analysis of clinical trials data is supportive of a renal-protective effect of levosimendan, while physiological observations suggest that this effect is exerted at least in part via organ-specific effects that may include selective vasodilation of glomerular afferent arterioles and increased renal blood flow, with no compromise of renal oxygenation. These lines of evidence require further investigation and their clinical significance needs to be evaluated in specifically designed prospective trials.
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Affiliation(s)
- S Bouchez
- Department of Anesthesiology, University Hospital, Ghent, Belgium
| | - F Fedele
- Policlinico "Umberto I," University "La Sapienza", Rome, Italy
| | - G Giannakoulas
- Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - V-P Harjola
- Cardiology Clinic, HUS Meilahti Hospital, Helsinki, Finland
| | - K Karason
- Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Kivikko
- Critical Care Proprietary Products Division, Orion Pharma, P.O. Box 65, FIN-02101, Espoo, Finland
- Department of Cardiology S7, Jorvi Hospital, Espoo, Finland
| | - D von Lewinski
- Myokardiale Energetik und Metabolismus Research Unit, Medical University, Graz, Austria
| | - F Oliva
- Niguarda Ca'Granda Hospital, Milan, Italy
| | - Z Papp
- Division of Clinical Physiology, Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - J Parissis
- Second University Cardiology Clinic, Attiko Teaching Hospital, Athens, Greece
| | - Piero Pollesello
- Critical Care Proprietary Products Division, Orion Pharma, P.O. Box 65, FIN-02101, Espoo, Finland.
| | - G Pölzl
- Universitätsklinik für Innere Medizin III Innsbruck, Medizinsche Universität, Innsbruck, Austria
| | - C Tschöpe
- Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany
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Abstract
Myofibroblast activation is a critical process in the pathogenesis of tissue fibrosis accounting for 45% of all deaths. No effective therapies are available for the treatment of fibrotic diseases. We focus our mini-review on recent data showing that cardiotonic steroids (CTS) that are known as potent inhibitors of Na+,K+-ATPase affect myofibroblast differentiation in a cell type-specific manner. In cultured human lung fibroblasts (HLF), epithelial cells, and cancer-associated fibroblasts, CTS blocked myofibroblast differentiation triggered by profibrotic cytokine TGF-β. In contrast, in the absence of TGF-β, CTS augmented myofibroblast differentiation of cultured cardiac fibroblasts. The cell type-specific action of CTS in myofibroblast differentiation is consistent with data obtained in in vivo studies. Thus, infusion of ouabain via osmotic mini-pumps attenuated the development of lung fibrosis in bleomycintreated mice, whereas marinobufagenin stimulated renal and cardiac fibrosis in rats with experimental renal injury. In TGF-β-treated HLF, suppression of myofibroblast differentiation by ouabain is mediated by elevation of the [Na+]i/[K+]i ratio and is accompanied by upregulation of cyclooxygenase COX-2 and downregulation of TGF-β receptor TGFBR2. Augmented expression of COX-2 is abolished by inhibition of Na+/Ca2+ exchanger, suggesting a key role of [Ca2+]i-mediated signaling. What is the relative impact in tissue fibrosis of [Na+]i,[K+]iindependent signaling documented in several types of CTS-treated cells? Do the different conformational transitions of Na+,K+-ATPase α1 subunit in the presence of ouabain and marinobufagenin contribute to their distinct involvement in myofibroblast differentiation? Additional experiments should be done to answer these questions and to develop novel pharmacological approaches for the treatment of fibrosis-related disorders.
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Affiliation(s)
- Sergei N. Orlov
- Faculty of Biology, Lomonosov Moscow State University, Russian Federation
| | - Jennifer La
- Department of Medicine, The University of Chicago, IL, United States
| | | | - Nickolai O. Dulin
- Department of Medicine, The University of Chicago, IL, United States
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Palazzuoli A, Ruocco G. Heart-Kidney Interactions in Cardiorenal Syndrome Type 1. Adv Chronic Kidney Dis 2018; 25:408-417. [PMID: 30309458 DOI: 10.1053/j.ackd.2018.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/16/2018] [Accepted: 08/16/2018] [Indexed: 01/15/2023]
Abstract
The exact significance of kidney function deterioration during acute decompensated heart failure (ADHF) episodes is still under debate. Several studies reported a wide percentage of worsening renal function (WRF) in ADHF patients ranging from 20% to 40%. This is probably because of different populations enrolled with different baseline kidney and cardiac function, varying definition of acute kidney injury (AKI), etiology of kidney dysfunction (KD), and occurrence of transient or permanent KD over the observational period. Current cardiorenal syndrome classification does not distinguish among the mechanisms leading to cardiac and renal deterioration. Cardiorenal syndrome type 1 (CRS-1) is the result of a combination of neurohormonal activation, fluid imbalance, arterial underfilling, increased renal and abdominal pressure, and aggressive decongestive treatment. A more complete mechanistic approach to CRS-1 should include evaluation of baseline kidney function, timing, course and magnitude of KD, and introduction of specific biomarkers able to identify early kidney damage. Therefore, clinical and laboratory parameters may yield a different combination among predisposing, precipitating, and amplifying factors that may influence cardiorenal syndrome development. Thus, CRS-1 is a heterogeneous syndrome that needs to be better defined and categorized taking into account clinical status, renal condition, and treatment. The application of universal definitions for WRF/AKI definition would be the first step to achieve a clear classification.
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Wang X, Liu J, Drummond CA, Shapiro JI. Sodium potassium adenosine triphosphatase (Na/K-ATPase) as a therapeutic target for uremic cardiomyopathy. Expert Opin Ther Targets 2017; 21:531-541. [PMID: 28338377 PMCID: PMC5590225 DOI: 10.1080/14728222.2017.1311864] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/23/2017] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Clinically, patients with significant reductions in renal function present with cardiovascular dysfunction typically termed, uremic cardiomyopathy. It is a progressive series of cardiac pathophysiological changes, including left ventricular diastolic dysfunction and hypertrophy (LVH) which sometimes progress to left ventricular dilation (LVD) and systolic dysfunction in the setting of chronic kidney disease (CKD). Uremic cardiomyopathy is almost ubiquitous in patients afflicted with end stage renal disease (ESRD). Areas covered: This article reviews recent epidemiology, pathophysiology of uremic cardiomyopathy and provide a board overview of Na/K-ATPase research with detailed discussion on the mechanisms of Na/K-ATPase/Src/ROS amplification loop. We also present clinical and preclinical evidences as well as molecular mechanism of this amplification loop in the development of uremic cardiomyopathy. A potential therapeutic peptide that targets on this loop is discussed. Expert opinion: Current clinical treatment for uremic cardiomyopathy remains disappointing. Targeting the ROS amplification loop mediated by the Na/K-ATPase signaling function may provide a novel therapeutic target for uremic cardiomyopathy and related diseases. Additional studies of Na/K-ATPase and other strategies that regulate this loop will lead to new therapeutics.
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Affiliation(s)
- Xiaoliang Wang
- a Joan C Edwards School of Medicine at Marshall University , Huntington , WV , United States
- b University of Toledo College of Medicine and Life Sciences , Toledo , OH , United States
| | - Jiang Liu
- a Joan C Edwards School of Medicine at Marshall University , Huntington , WV , United States
| | - Christopher A Drummond
- b University of Toledo College of Medicine and Life Sciences , Toledo , OH , United States
| | - Joseph I Shapiro
- a Joan C Edwards School of Medicine at Marshall University , Huntington , WV , United States
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Drummond CA, Crotty Alexander LE, Haller ST, Fan X, Xie JX, Kennedy DJ, Liu J, Yan Y, Hernandez DA, Mathew DP, Cooper CJ, Shapiro JI, Tian J. Cigarette smoking causes epigenetic changes associated with cardiorenal fibrosis. Physiol Genomics 2016; 48:950-960. [PMID: 27789733 DOI: 10.1152/physiolgenomics.00070.2016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 10/22/2016] [Indexed: 12/14/2022] Open
Abstract
Clinical studies indicate that smoking combustible cigarettes promotes progression of renal and cardiac injury, leading to functional decline in the setting of chronic kidney disease (CKD). However, basic studies using in vivo small animal models that mimic clinical pathology of CKD are lacking. To address this issue, we evaluated renal and cardiac injury progression and functional changes induced by 4 wk of daily combustible cigarette smoke exposure in the 5/6th partial nephrectomy (PNx) CKD model. Molecular evaluations revealed that cigarette smoke significantly (P < 0.05) decreased renal and cardiac expression of the antifibrotic microRNA miR-29b-3 and increased expression of molecular fibrosis markers. In terms of cardiac and renal organ structure and function, exposure to cigarette smoke led to significantly increased systolic blood pressure, cardiac hypertrophy, cardiac and renal fibrosis, and decreased renal function. These data indicate that decreased expression of miR-29b-3p is a novel mechanism wherein cigarette smoke promotes accelerated cardiac and renal tissue injury in CKD. (155 words).
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Affiliation(s)
- Christopher A Drummond
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio;
| | - Laura E Crotty Alexander
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego Health Sciences, San Diego, California; and
| | - Steven T Haller
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
| | - Xiaoming Fan
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
| | - Jeffrey X Xie
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
| | - David J Kennedy
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
| | - Jiang Liu
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Yanling Yan
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Dawn-Alita Hernandez
- Division of Pulmonary Medicine (Critical Care and Sleep Medicine), University of Toledo, Toledo, Ohio
| | - Denzil P Mathew
- Pulmonary Critical Care Section, Veterans Affairs San Diego Healthcare System and Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego Health Sciences, San Diego, California; and
| | - Christopher J Cooper
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Jiang Tian
- College of Medicine and Life Sciences, Department of Medicine, Division of Cardiovascular Medicine and Center for Hypertension and Personalized Medicine, University of Toledo, Toledo, Ohio
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Palazzuoli A, Lombardi C, Ruocco G, Padeletti M, Nuti R, Metra M, Ronco C. Chronic kidney disease and worsening renal function in acute heart failure: different phenotypes with similar prognostic impact? EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:534-548. [DOI: 10.1177/2048872615589511] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 05/10/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Alberto Palazzuoli
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | - Carlo Lombardi
- Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy
| | - Gaetano Ruocco
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | | | - Ranuccio Nuti
- Department of Internal and Surgical Medicine, Cardiology Unit, University of Siena, Italy
| | - Marco Metra
- Department of Experimental and Applied Medicine, University and Civil Hospital of Brescia, Italy
| | - Claudio Ronco
- Nephrology Dialysis and Transplantation International Renal Research Institute (IRRIV), St Bortolo Hospital, Italy
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Drummond CA, Hill MC, Shi H, Fan X, Xie JX, Haller ST, Kennedy DJ, Liu J, Garrett MR, Xie Z, Cooper CJ, Shapiro JI, Tian J. Na/K-ATPase signaling regulates collagen synthesis through microRNA-29b-3p in cardiac fibroblasts. Physiol Genomics 2015; 48:220-9. [PMID: 26702050 DOI: 10.1152/physiolgenomics.00116.2015] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 12/22/2015] [Indexed: 01/19/2023] Open
Abstract
Chronic kidney disease (CKD) is accompanied by cardiac fibrosis, hypertrophy, and dysfunction, which are commonly referred to as uremic cardiomyopathy. Our previous studies found that Na/K-ATPase ligands or 5/6th partial nephrectomy (PNx) induces cardiac fibrosis in rats and mice. The current study used in vitro and in vivo models to explore novel roles for microRNA in this mechanism of cardiac fibrosis formation. To accomplish this, we performed microRNA profiling with RT-qPCR based arrays on cardiac tissue from rats subjected to marinobufagenin (MBG) infusion or PNx. The analysis showed that a series of fibrosis-related microRNAs were dysregulated. Among the dysregulated microRNAs, microRNA (miR)-29b-3p, which directly targets mRNA of collagen, was consistently reduced in both PNx and MBG-infused animals. In vitro experiments demonstrated that treatment of primary cultures of adult rat cardiac fibroblasts with Na/K-ATPase ligands induced significant increases in the fibrosis marker, collagen protein, and mRNA expression compared with controls, whereas miR-29b-3p expression decreased >50%. Transfection of miR-29b-3p mimics into cardiac fibroblasts inhibited cardiotonic steroids-induced collagen synthesis. Moreover, a specific Na/K-ATPase signaling antagonist, pNaKtide, prevented ouabain-induced increases in collagen synthesis and decreases in miR-29b-3p expression in these cells. In conclusion, these data are the first to indicate that signaling through Na/K-ATPase regulates miRNAs and specifically, miR-29b-3p expression both in vivo and in vitro. Additionally, these data indicate that miR-29b-3p expression plays an important role in the formation of cardiac fibrosis in CKD.
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Affiliation(s)
- Christopher A Drummond
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Michael C Hill
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Huilin Shi
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Xiaoming Fan
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Jeffrey X Xie
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Steven T Haller
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - David J Kennedy
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Jiang Liu
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Michael R Garrett
- Departments of Pharmacology and Toxicology, Medicine, and Molecular and Genomics Core, University of Mississippi Medical Center, Jackson, Mississippi; and
| | - Zijian Xie
- Marshall Institute for Interdisciplinary Research, Marshall University, Huntington, West Virginia
| | - Christopher J Cooper
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Jiang Tian
- Department of Medicine, Division of Cardiovascular Medicine; Center for Hypertension and Personalized Medicine, College of Medicine, University of Toledo, Toledo, Ohio;
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Drummond CA, Sayed M, Evans KL, Shi H, Wang X, Haller ST, Liu J, Cooper CJ, Xie Z, Shapiro JI, Tian J. Reduction of Na/K-ATPase affects cardiac remodeling and increases c-kit cell abundance in partial nephrectomized mice. Am J Physiol Heart Circ Physiol 2014; 306:H1631-43. [PMID: 24748592 DOI: 10.1152/ajpheart.00102.2014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The current study examined the role of Na/K-ATPase α1-subunit in animals subjected to 5/6th partial nephrectomy (PNx) using Na/K-ATPase α1-heterozygous (α1(+/-)) mice and their wild-type (WT) littermates. After PNx, both WT and α1(+/-) animals displayed diastolic dimension increases, increased blood pressure, and increased cardiac hypertrophy. However, in the α1(+/-) animals we detected significant increases in cardiac cell death in PNx animals. Given that reduction of α1 elicited increased cardiac cell death with PNx, while at the same time these animals developed cardiac hypertrophy, an examination of cardiac cell number, and proliferative capabilities of those cells was carried out. Cardiac tissues were probed for the progenitor cell marker c-kit and the proliferation marker ki-67. The results revealed that α1(+/-) mice had significantly higher numbers of c-kit-positive and ki-67-positive cells, especially in the PNx group. We also found that α1(+/-) mice express higher levels of stem cell factor, a c-kit ligand, in their heart tissue and had higher circulating levels of stem cell factor than WT animals. In addition, PNx induced significant enlargement of cardiac myocytes in WT mice but has much less effect in α1(+/-) mice. However, the total cell number determined by nuclear counting is higher in α1(+/-) mice with PNx compared with WT mice. We conclude that PNx induces hypertrophic growth and high blood pressure regardless of Na/K-ATPase content change. However, total cardiac cell number as well as c-kit-positive cell number is increased in α1(+/-) mice with PNx.
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Affiliation(s)
| | - Moustafa Sayed
- Department of Medicine, University of Toledo, Toledo, Ohio
| | | | - Huilin Shi
- Department of Medicine, University of Toledo, Toledo, Ohio
| | - Xiaoliang Wang
- Department of Physiology Pharmacology, University of Toledo, Toledo, Ohio; and
| | | | - Jiang Liu
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | | | - Zijian Xie
- Department of Physiology Pharmacology, University of Toledo, Toledo, Ohio; and
| | - Joseph I Shapiro
- Joan C. Edwards School of Medicine, Marshall University, Huntington, West Virginia
| | - Jiang Tian
- Department of Medicine, University of Toledo, Toledo, Ohio;
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Cioffi G, Mortara A, Di Lenarda A, Oliva F, Lucci D, Senni M, Cacciatore G, Chinaglia A, Tarantini L, Metra M, Maggioni AP, Tavazzi L. Clinical features, and in-hospital and 1-year mortalities of patients with acute heart failure and severe renal dysfunction. Data from the Italian Registry IN-HF Outcome. Int J Cardiol 2013; 168:3691-7. [DOI: 10.1016/j.ijcard.2013.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/23/2013] [Accepted: 06/15/2013] [Indexed: 12/31/2022]
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Iyngkaran P, Thomas M, Majoni W, Anavekar NS, Ronco C. Comorbid Heart Failure and Renal Impairment: Epidemiology and Management. Cardiorenal Med 2012; 2:281-297. [PMID: 23381594 DOI: 10.1159/000342487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Heart failure mortality is significantly increased in patients with baseline renal impairment and those with underlying heart failure who subsequently develop renal dysfunction. This accelerated progression occurs independent of the cause or grade of renal dysfunction and baseline risk factors. Recent large prospective databases have highlighted the depth of the current problem, while longitudinal population studies support an increasing disease burden. We have extensively reviewed the epidemiological and therapeutic data among these patients. The evidence points to a progression of heart failure early in renal impairment, even in the albuminuric stage. The data also support poor prescription of prognostic therapies. As renal function is the most important prognostic factor in heart failure, it is important to establish the current understanding of the disease burden and the therapeutic implications.
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Affiliation(s)
- Pupalan Iyngkaran
- Department of Cardiology, Royal Darwin Hospital and Senior Lecturer, Flinders University, Darwin, N.T., Australia
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Palazzuoli A, Ronco C. Cardio-renal syndrome: an entity cardiologists and nephrologists should be dealing with collegially. Heart Fail Rev 2012; 16:503-8. [PMID: 21822604 DOI: 10.1007/s10741-011-9267-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Heart failure may lead to acute kidney injury and vice versa. Chronic kidney disease may affect the clinical outcome in terms of cardiovascular morbidity and mortality while chronic heart failure may cause CKD. All these disorders contribute to the composite definition of cardio-renal syndromes. Renal impairment in HF patients has been increasingly recognized as an independent risk factor for morbidity and mortality; however, the most important clinical trials in HF tend to exclude patients with significant renal dysfunction. The mechanisms whereby renal insufficiency worsens the outcome in HF are not known, and several pathways could contribute to the "vicious heart/kidney circle." Traditionally, renal impairment has been attributed to the renal hypoperfusion due to reduced cardiac output and decreased systemic pressure. The hypovolemia leads to sympathetic activity, increased renin-angiotensin-aldosterone pathways and arginine-vasopressin release. All these mechanisms cause fluid and sodium retention, peripheral vasoconstriction and an increased congestion as well as cardiac workload. Therapy addressed to improve renal dysfunction, reduce neurohormonal activation and ameliorate renal blood flow could lead to a reduction in mortality and hospitalization in patients with cardio-renal syndrome.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Cardiology Section, University of Siena, Siena, Italy.
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Jenkins K, Kirk M. Heart failure and chronic kidney disease: an integrated care approach. J Ren Care 2010; 36 Suppl 1:127-35. [PMID: 20586908 DOI: 10.1111/j.1755-6686.2010.00158.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Renal impairment may be evident at any stage of heart failure (CHF). Up to 30% of patients with heart failure have abnormal renal function. Chronic kidney disease (CKD) can be a complication of heart failure and chronic heart disease can be a consequence of CKD. Members of the multidisciplinary team, such as nurses, dieticians and physiotherapists should be encouraged to maximise their knowledge and skills across disease areas to influence and improve outcomes of those with CKD and CHF. In particular management of fluid balance, blood pressure control/monitoring, discussion of blood results and reduction of cardiovascular risk factors. Close monitoring and effective management of modifiable cardiac risk factors, such as diabetes and hypertension can reduce onset and slow progression of CKD. This can be done by applying the key principles of good practice, such as communication between healthcare professionals, patient education and empowerment alongside early identification and management of symptoms of CKD and CHF.
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Affiliation(s)
- Karen Jenkins
- East Kent Hospitals University NHS Foundation Trust, Kent Kidney Care Centre, Kent & Canterbury Hospital,University of Kent, Canterbury, UK.
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House AA, Haapio M, Lassus J, Bellomo R, Ronco C. Therapeutic strategies for heart failure in cardiorenal syndromes. Am J Kidney Dis 2010; 56:759-73. [PMID: 20557988 DOI: 10.1053/j.ajkd.2010.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/14/2010] [Indexed: 12/22/2022]
Abstract
Cardiorenal syndromes are disorders of the heart and kidneys whereby acute or long-term dysfunction in one organ may induce acute or long-term dysfunction of the other. The management of cardiovascular diseases and risk factors may influence, in a beneficial or harmful way, kidney function and progression of kidney injury. In this review, we assess therapeutic strategies and discuss treatment options for the management of patients with heart failure with decreased kidney function and highlight the need for future high-quality studies in patients with coexisting heart and kidney disease.
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Affiliation(s)
- Andrew A House
- London Health Sciences Centre, Division of Nephrology, London, Canada.
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16
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Siragy HM. Comparing angiotensin II receptor blockers on benefits beyond blood pressure. Adv Ther 2010; 27:257-84. [PMID: 20524096 DOI: 10.1007/s12325-010-0028-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Accepted: 06/01/2010] [Indexed: 01/13/2023]
Abstract
The renin-angiotensin-aldosterone system (RAAS) is one of the main regulators of blood pressure, renal hemodynamics, and volume homeostasis in normal physiology, and contributes to the development of renal and cardiovascular (CV) diseases. Therefore, pharmacologic blockade of RAAS constitutes an attractive strategy in preventing the progression of renal and CV diseases. This concept has been supported by clinical trials involving patients with hypertension, diabetic nephropathy, and heart failure, and those after myocardial infarction. The use of angiotensin II receptor blockers (ARBs) in clinical practice has increased over the last decade. Since their introduction in 1995, seven ARBs have been made available, with approved indications for hypertension and some with additional indications beyond blood pressure reduction. Considering that ARBs share a similar mechanism of action and exhibit similar tolerability profiles, it is assumed that a class effect exists and that they can be used interchangeably. However, pharmacologic and dosing differences exist among the various ARBs, and these differences can potentially influence their individual effectiveness. Understanding these differences has important implications when choosing an ARB for any particular condition in an individual patient, such as heart failure, stroke, and CV risk reduction (prevention of myocardial infarction). A review of the literature for existing randomized controlled trials across various ARBs clearly indicates differences within this class of agents. Ongoing clinical trials are evaluating the role of ARBs in the prevention and reduction of CV rates of morbidity and mortality in high-risk patients.
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Affiliation(s)
- Helmy M Siragy
- Department of Medicine, Hypertension Center, University of Virginia, Charlottesville, VA 22908, USA.
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Heywood JT, Fonarow GC, Yancy CW, Albert NM, Curtis AB, Stough WG, Gheorghiade M, McBride ML, Mehra MR, O'Connor CM, Reynolds D, Walsh MN. Influence of renal function on the use of guideline-recommended therapies for patients with heart failure. Am J Cardiol 2010; 105:1140-6. [PMID: 20381667 DOI: 10.1016/j.amjcard.2009.12.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/03/2009] [Accepted: 12/03/2009] [Indexed: 12/20/2022]
Abstract
Guidelines have been established for the treatment of patients with heart failure (HF) and left ventricular dysfunction, but renal dysfunction might limit adherence to these guidelines. Few data have characterized the use of guideline-recommended therapy for patients with HF, left ventricular dysfunction, and renal dysfunction who are treated in outpatient settings. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) was a prospective study of patients receiving treatment as outpatients in cardiology practices in the United States. The rates of adherence to 7 guideline-recommended therapies were evaluated for patients with a left ventricular ejection fraction of < or = 35%. The estimated glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula for 13,164 patients who were categorized as having stage 1 through stage 4/5 chronic kidney disease (CKD). More than 1/2 (52.2%) of the patients had stage 3 or 4/5 CKD. Older patients and women were at increased risk of higher stage CKD, and the rates of co-morbid health conditions were significantly greater among patients with more severe CKD. The patients with more severe CKD were significantly less likely to receive all interventions except cardiac resynchronization therapy. However, multivariate analysis controlling for patient characteristics revealed that the severity of CKD was an independent predictor of adherence to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy but not to any of the 6 other guideline-recommended measures. In conclusion, these results confirm that CKD is common in patients with HF and left ventricular dysfunction but is not independently associated with adherence to guideline-recommended therapy in outpatient cardiology practices, with the exception of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy.
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Tarantini L, Cioffi G, Gonzini L, Oliva F, Lucci D, Di Tano G, Maggioni AP, Tavazzi L. Evolution of renal function during and after an episode of cardiac decompensation: results from the Italian survey on acute heart failure. J Cardiovasc Med (Hagerstown) 2010; 11:234-43. [DOI: 10.2459/jcm.0b013e3283334e12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Cohen-Solal A, Kotecha D, van Veldhuisen DJ, Babalis D, Böhm M, Coats AJ, Roughton M, Poole-Wilson P, Tavazzi L, Flather M. Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial. Eur J Heart Fail 2009; 11:872-80. [PMID: 19648605 PMCID: PMC2729679 DOI: 10.1093/eurjhf/hfp104] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIM To determine the safety and efficacy of nebivolol in elderly heart failure (HF) patients with renal dysfunction. METHODS AND RESULTS SENIORS recruited patients aged 70 years or older with symptomatic HF, irrespective of ejection fraction, and randomized them to nebivolol or placebo. Patients (n = 2112) were divided by tertile of estimated glomerular filtration rate (eGFR). Mean age of patients was 76.1 years, 35% of patients had an ejection fraction of >35%, and 37% were women resulting in a unique cohort, far more representative of clinical practice than previous trials. eGFR was strongly associated with outcomes and nebivolol was similarly efficacious across eGFR tertiles. The primary outcome rate (all-cause mortality or cardiovascular hospital admission) and adjusted hazard ratio for nebivolol use in those with low eGFR was 40% and 0.84 (95% CI 0.67-1.07), 31% and 0.79 (0.60-1.04) in the middle tertile, and 29% and 0.86 (0.65-1.14) in the highest eGFR tertile. There was no interaction noted between renal function and the treatment effect (P = 0.442). Nebivolol use in patients with moderate renal impairment (eGFR <60) was not associated with major safety concerns, apart from higher rates of drug-discontinuation due to bradycardia. CONCLUSION Nebivolol is safe and has a similar effect in elderly HF patients with mild or moderate renal impairment.
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Affiliation(s)
- Alain Cohen-Solal
- Hôpital Lariboisiere, Assistance Publique-Hopitaux de Paris, Université Paris Diderot, INSERM U942, 2 Rue Ambroise Paré, 75475 Paris Cedex 10, France
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