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Groves AM, Price AN, Russell-Webster T, Jhaveri S, Yang Y, Battersby EE, Shahid S, Costa Vieira M, Hughes E, Miller F, Briley AL, Singh C, Seed PT, Chowienczyk PJ, Stern KWD, Cohen J, Pasupathy D, Edwards AD, Poston L, Taylor PD. Impact of maternal obesity on neonatal heart rate and cardiac size. Arch Dis Child Fetal Neonatal Ed 2022; 107:481-487. [PMID: 34789488 DOI: 10.1136/archdischild-2021-322860] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/29/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Maternal obesity may increase offspring risk of cardiovascular disease. We assessed the impact of maternal obesity on cardiac structure and function in newborns as a marker of fetal cardiac growth. METHODS Neonates born to mothers of healthy weight (body mass index (BMI) 20-25 kg/m2, n=56) and to mothers who were obese (BMI ≥30 kg/m2, n=31) underwent 25-minute continuous ECG recording and non-sedated, free-breathing cardiac MRI within 72 hours of birth. RESULTS Mean (SD) heart rate during sleep was higher in infants born to mothers who were versus were not obese (123 (12.6) vs 114 (9.8) beats/min, p=0.002). Heart rate variability during sleep was lower in infants born to mothers who were versus were not obese (SD of normal-to-normal R-R interval 34.6 (16.8) vs 43.9 (16.5) ms, p=0.05). Similar heart rate changes were seen during wakefulness. Left ventricular end-diastolic volume (2.35 (0.14) vs 2.54 (0.29) mL/kg, p=0.03) and stroke volume (1.50 (0.09) vs 1.60 (0.14), p=0.04) were decreased in infants born to mothers who were versus were not obese. There were no differences in left ventricular end-systolic volume, ejection fraction, output or myocardial mass between the groups. CONCLUSION Maternal obesity was associated with increased heart rate, decreased heart rate variability and decreased left ventricular volumes in newborns. If persistent, these changes may provide a causal mechanism for the increased cardiovascular risk in adult offspring of mothers with obesity. In turn, modifying antenatal and perinatal maternal health may have the potential to optimise long-term cardiovascular health in offspring.
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Affiliation(s)
- Alan M Groves
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Anthony N Price
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Tamarind Russell-Webster
- Women's and Children's Health, King's College London, London, UK
- Academic Women's Health, University of Bristol, Bristol, UK
| | - Simone Jhaveri
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Yang Yang
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ellie E Battersby
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Shiffa Shahid
- Women's and Children's Health, King's College London, London, UK
| | | | - Emer Hughes
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Faith Miller
- Women's and Children's Health, King's College London, London, UK
| | - Annette L Briley
- Women's and Children's Health, King's College London, London, UK
| | - Claire Singh
- Women's and Children's Health, King's College London, London, UK
| | - Paul T Seed
- Women's and Children's Health, King's College London, London, UK
| | | | - Kenan W D Stern
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Cohen
- Department of Pediatric Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dharmintra Pasupathy
- Women's and Children's Health, King's College London, London, UK
- Department of Maternal and Fetal Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - A David Edwards
- Centre for the Developing Brain, Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Lucilla Poston
- Women's and Children's Health, King's College London, London, UK
| | - Paul D Taylor
- Women's and Children's Health, King's College London, London, UK
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Doumas M, Imprialos KP, Kallistratos MS, Manolis AJ. Recent advances in understanding and managing resistant/refractory hypertension. F1000Res 2020; 9. [PMID: 32201574 PMCID: PMC7065661 DOI: 10.12688/f1000research.21669.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/03/2020] [Indexed: 12/11/2022] Open
Abstract
The management of resistant hypertension presents several challenges in everyday clinical practice. During the past few years, several studies have been performed to identify efficient and safe pharmacological and non-pharmacological options for the management of such patients. The Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2) trial demonstrated significant benefits with the use of spinorolactone as a fourth-line drug for the treatment of resistant hypertension over doxazosin and bisoprolol. In addition, recent data support that spironolactone may demonstrate superiority over central acting drugs in such patients, as well. Based on the European guidelines, spironolactone is recommended as the fourth-line drug option, followed by amiloride, other diuretics, doxazosin, bisoprolol or clonidine. Among several device-based approaches, renal sympathetic denervation had fallen into hibernation after the disappointing results of the Renal Denervation in Patients With Uncontrolled Hypertension (SYMPLICITY HTN) 3 trial. However, the technique re-emerged at the epicenter of the clinical and research interest after the favorable results of three sham-controlled studies, which facilitated novel catheters and techniques to perform the denervation. Significant results of iliac anastomosis on blood pressure levels have also been demonstrated. Nevertheless, the technique-related adverse events resulted in withdrawal of this interventional approach. Last, the sympatholytic properties of the carotid baroreceptor activation therapy were associated with significant blood pressure reductions in patients with resistant hypertension, which need to be verified in larger controlled trials. Currently device-based approaches are recommended only in the setting of clinical trials until more safety and efficacy data become available.
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Affiliation(s)
- Michael Doumas
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece.,VAMC and George Washington University, Washington, USA
| | - Konstantinos P Imprialos
- 2nd Propedeutic Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Makedonia, 54250, Greece
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Grassi G, Quarti-Trevano F, Esler MD. Sympathetic activation in congestive heart failure: an updated overview. Heart Fail Rev 2019; 26:173-182. [PMID: 31832833 DOI: 10.1007/s10741-019-09901-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Conclusive evidence demonstrates that the sympathetic nervous system activation is a hallmark of congestive heart failure. This has been shown via a variety of biochemical, neurophysiological, and neuroimaging approaches for studying human sympathetic neural function. The sympathetic activation appears to be an early phenomenon in the clinical course of the disease, closely related to its severity and potentiated by the concomitant presence of other comorbidities, such as obesity, diabetes mellitus, metabolic syndrome, hypertension, and renal failure. The adrenergic overdrive in heart failure is associated with other sympathetic abnormalities, such as the downregulation of beta-adrenergic adrenoreceptors at cardiac level, and exerts unfavorable consequences on the cardiovascular system. These include the endothelial dysfunction, the development of left ventricular hypertrophy, the atherosclerosis development, as well as the generation of atrial and ventricular arrhythmias, and, at very extreme levels of sympathetic activation, the occurrence of microscopic myocardial necrosis. Given the close direct independent relationships detected in heart failure between sympathetic activation and mortality, the adrenergic overdrive has become a target of neuromodulatory therapeutic interventions, which include non-pharmacological, pharmacological, and device-based interventions. For some of these approaches (specifically bilateral renal nerves ablation and carotid baroreceptor stimulation), additional studies are needed to better define their impact on the clinical course of the disease.
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Affiliation(s)
- Guido Grassi
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy.
| | - Fosca Quarti-Trevano
- Clinica Medica, Department of Medicine and Surgery, University of Milano-Bicocca, Via Pergolesi 33, 20052, Monza, Italy
| | - Murray D Esler
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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Xu G, Dodaballapur S, Mihaylova T, Borjigin J. Electrocardiomatrix facilitates qualitative identification of diminished heart rate variability in critically ill patients shortly before cardiac arrest. J Electrocardiol 2018; 51:955-961. [PMID: 30497755 DOI: 10.1016/j.jelectrocard.2018.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/31/2018] [Accepted: 08/07/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Although heart rate variability (HRV) has diagnostic and prognostic value for the assessment of cardiac risk, HRV analysis is not routinely performed in a hospital setting. Current HRV analysis methods are primarily quantitative; such methods are sensitive to signal contamination and require extensive post hoc processing. METHODS AND RESULTS Raw electrocardiogram (ECG) data from the Sleep Heart Health Study was transformed into electrocardiomatrix (ECM), in which sequential cardiac cycles are aligned, in parallel, along a shared axis. Such juxtaposition facilitates the visual evaluation of beat-to-beat changes in the R-R interval without sacrificing the morphology of the native ECG signal. Diminished HRV, verified by traditional methods, was readily identifiable. We also examined data from a cohort of hospitalized patients who suffered cardiac arrest within 24 h of data acquisition, all of whom exhibited severely diminished HRV that were visually apparent on ECM display. CONCLUSIONS ECM streamlines the identification of depressed HRV, which may signal deteriorating patient condition.
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Affiliation(s)
- Gang Xu
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | - Sneha Dodaballapur
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States
| | | | - Jimo Borjigin
- Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, United States; Department of Neurology, Michigan Medicine, Ann Arbor, MI, United States; Michigan Center for Integrative Research in Critical Care, University of Michigan, Ann Arbor, MI, United States.
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