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Melman YF, Shah R, Danielson K, Xiao J, Simonson B, Barth A, Chakir K, Lewis GD, Lavender Z, Truong QA, Kleber A, Das R, Rosenzweig A, Wang Y, Kass D, Singh JP, Das S. Circulating MicroRNA-30d Is Associated With Response to Cardiac Resynchronization Therapy in Heart Failure and Regulates Cardiomyocyte Apoptosis: A Translational Pilot Study. Circulation 2015; 131:2202-2216. [PMID: 25995320 DOI: 10.1161/circulationaha.114.013220] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 04/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Biomarkers that predict response to cardiac resynchronization therapy (CRT) in heart failure patients with dyssynchrony (HFDYS) would be clinically important. Circulating extracellular microRNAs (miRNAs) have emerged as novel biomarkers that may also play important functional roles, but their relevance as markers for CRT response has not been examined. METHODS AND RESULTS Comprehensive miRNA polymerase chain reaction arrays were used to assess baseline levels of 766 plasma miRNAs in patients undergoing clinically indicated CRT in an initial discovery set (n=12) with and without subsequent echocardiographic improvement at 6 months after CRT. Validation of candidate miRNAs in 61 additional patients confirmed that baseline plasma miR-30d was associated with CRT response (defined as an increase in left ventricular ejection fraction ≥10%). MiR-30d was enriched in coronary sinus blood and increased in late-contracting myocardium in a canine model of HFDYS, indicating cardiac origin with maximal expression in areas of high mechanical stress. We examined the functional effects of miR-30d in cultured cardiomyocytes and determined that miR-30d is expressed in cardiomyocytes and released in vesicles in response to mechanical stress. Overexpression of miR-30d in cultured cardiomyocytes led to cardiomyocyte growth and protected against apoptosis by targeting the mitogen-associated kinase 4, a downstream effector of tumor necrosis factor. In HFDYS patients, miR-30d plasma levels inversely correlated with high-sensitivity troponin T, a marker of myocardial necrosis. CONCLUSIONS Baseline plasma miR-30d level is associated with response to CRT in HFDYS in this translational pilot study. MiR-30d increase in cardiomyocytes correlates with areas of increased wall stress in HFDYS and is protective against deleterious tumor necrosis factor signaling.
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Affiliation(s)
- Yonathan F Melman
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
| | - Ravi Shah
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA.,Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Kirsty Danielson
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
| | - Junjie Xiao
- Experimental Center of Life Sciences and Regeneration Lab, School of Life Science, Shanghai University, Shanghai, China
| | - Bridget Simonson
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
| | - Andreas Barth
- The Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Khalid Chakir
- The Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Boston, MA
| | | | - Quynh A Truong
- Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Andre Kleber
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Anthony Rosenzweig
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
| | - Yaoyu Wang
- Dana Farber Cancer Institute, Center for Computational Biology, Boston MA
| | - David Kass
- The Johns Hopkins University Medical Institutions, Baltimore, MD
| | - Jagmeet P Singh
- Cardiology Division, Massachusetts General Hospital, Boston, MA
| | - Saumya Das
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA
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Gasparini M, Muto C, Iacopino S, Zanon F, Dicandia C, Distefano G, Favale S, Peraldo Neja C, Bragato R, Davinelli M, Mangoni L, Denaro A. Low-dose dobutamine test associated with interventricular dyssynchrony: a useful tool to identify cardiac resynchronization therapy responders: data from the LOw dose DObutamine stress-echo test in Cardiac Resynchronization Therapy (LODO-CRT) phase 2 study. Am Heart J 2012; 163:422-9. [PMID: 22424013 DOI: 10.1016/j.ahj.2011.11.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 11/17/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is effective in patients with heart failure, but 30% to 50% of subjects are classified as nonresponders. Identifying responders remains a challenging task. AIMS The LODO-CRT trial investigated the association between left ventricular contractile reserve (LVCR) and clinical and echocardiographic long-term CRT response. METHODS This is a multicenter, prospective, observational study. Left ventricular contractile reserve was detected using a dobutamine stress echocardiography test, defined as an ejection fraction increase of >5 points. Clinical CRT response was defined as the absence of major cardiovascular events (ie, cardiovascular death or heart failure hospitalization). Echocardiographic response was defined as a left ventricle end-systolic volume reduction of >10%. RESULTS A total of 221 CRT-indicated patients were studied (80% presented LVCR). During a mean follow-up of 15 ± 5 months, 17 patients died and 16 were hospitalized due to heart failure. The proportion of clinical responders was 155 (88%) of 177 and 33 (75%) of 44 (P = .036) in the groups with and without LVCR, respectively. Kaplan-Meier analysis showed a significant difference in cardiac survival/hospitalization between patients with and without LVCR. The proportion of echocardiographic responders was 144 (87%) of 166 and 16 (42%) of 38 in the groups with and without LVCR (P < .001), respectively; LVCR showed 90% sensitivity and 87% positive predictive value to prefigure echocardiographic CRT responders. Multivariable analysis identified LVCR and interventricular dyssynchrony as independent predictors of CRT response. The concomitant presence of both factors showed 99% specificity and 83% sensitivity in detecting responders. CONCLUSION The presence of LVCR helps in predicting a clinical and echocardiographic CRT response. Concomitant assessment of LVCR and interventricular dyssynchrony accurately stratifies responder and nonresponder patients.
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Geng J, Wu B, Zheng L, Zhu J. Heart failure patients selection for cardiac resynchronization therapy. Eur J Intern Med 2011; 22:32-8. [PMID: 21238890 DOI: 10.1016/j.ejim.2010.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2010] [Revised: 10/27/2010] [Accepted: 11/02/2010] [Indexed: 11/19/2022]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for refractory chronic heart failure (CHF) patients with ventricular dyssynchrony. The patient selection for this therapy remains the basis for response improvement. Various parameters, methods and technology for identification of appropriate patient are under research. The influences of age and gender, disease progress stage such as mild and late stage CHF including right ventricular dysfunction, dyssynchrony and scar identified by imaging techniques like echocardiography, magnetic resonance and nuclear imaging, and atrial fibrillation on CRT benefits were respectively discussed. This review summarizes the current advancement in these areas.
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Affiliation(s)
- Junchao Geng
- Department of Cardiology, No 1 Hospital affiliated to Medical School of Zhejiang University, Hangzhou, China
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Muto C, Gasparini M, Neja CP, Iacopino S, Davinelli M, Zanon F, Dicandia C, Distefano G, Donati R, Calvi V, Denaro A, Tuccillo B. Presence of left ventricular contractile reserve predicts midterm response to cardiac resynchronization therapy—results from the LOw dose DObutamine Stress-Echo Test in Cardiac Resynchronization Therapy (LODO-CRT) Trial. Heart Rhythm 2010; 7:1600-5. [DOI: 10.1016/j.hrthm.2010.07.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 07/31/2010] [Indexed: 10/19/2022]
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Iacopino S, Gasparini M, Zanon F, Dicandia C, Distefano G, Curnis A, Donati R, Neja CP, Calvi V, Davinelli M, Novelli V, Muto C. Low-Dose Dobutamine Stress Echocardiography to Assess Left Ventricular Contractile Reserve for Cardiac Resynchronization Therapy: Data From the Low-Dose Dobutamine Stress Echocardiography to Predict Cardiac Resynchronization Therapy Response (LODO-CRT) Tr. ACTA ACUST UNITED AC 2010; 16:104-10. [DOI: 10.1111/j.1751-7133.2010.00141.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Edner M, Kim Y, Hansen KN, Nissen H, Espersen G, La Rosee K, Maru F, Freemantle N, Cleland J, Sogaard P. Prevalence and inter-relationship of different Doppler measures of dyssynchrony in patients with heart failure and prolonged QRS: a report from CARE-HF. Cardiovasc Ultrasound 2009; 7:1. [PMID: 19128462 PMCID: PMC2630933 DOI: 10.1186/1476-7120-7-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 01/07/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac resynchronisation therapy (CRT) improves mortality and morbidity in heart failure patients with wide QRS. Observational studies suggest that patients having more left ventricular dyssynchrony pre-implantation obtain greater benefit on ventricular function and symptoms with CRT. AIM To provide an analysis of the prevalence and type of dyssynchrony in patients included in the CARE-HF trial. METHODS 100 patients 67 (58 to 71) years were examined with echocardiography including tissue doppler imaging before receiving a CRT-pacemaker. Atrio-ventricular dyssynchrony (LVFT/RR) was defined as left ventricular filling time <40% of the RR-interval. Inter-ventricular mechanical delay (IVMD) was measured as the difference in onset of Doppler-flow in the pulmonary and aortic outflow tracts >40 ms. Intra-ventricular (regional) dyssynchrony in a 16-segment model was expressed either as a delayed longitudinal contraction (DLC) during the postsystolic phase or by tissue synchronisation imaging (TSI) with a predefined time-difference in systolic maximal velocities >85 ms. RESULTS LVFT/RR was present in 34% and IVMD in 60% of patients while intra-ventricular dyssynchrony was present in 85% (DLC) and 86% (TSI) with a high agreement between the measures (Kappascore 0.86-1.00), indicating the methods being interchangeable. Patients with cardiomyopathy (53%) were more likely to have LVFT/RR <40% (45% vs. 21% (p= 0.02)) and more segments affected by intra-ventricular dyssynchrony 4(3, 5) vs. 3(1, 4), p = 0.002, compared to patients with ischemic heart disease. CONCLUSION The prevalence of intra-ventricular dyssynchrony is high in patients with heart failure, wide QRS and depressed systolic function. Most important, TSI appears to be a fast and reliable method to identify patients with intra-ventricular dyssynchrony likely to benefit from CRT.
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Affiliation(s)
- Magnus Edner
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
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