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Lin PS, Qi WH, Ding CY, An YJ, Yao YT. The Effects of Daytime Variation on Short-term Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2024; 38:931-938. [PMID: 38246822 DOI: 10.1053/j.jvca.2023.12.036] [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: 10/22/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the effects of time of surgery on the short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG). DESIGN A retrospective cohort study. SETTING A single large-volume cardiovascular center. PATIENTS Patients undergoing elective OPCABG between September 2019 and July 2022. INTERVENTIONS Patients were divided into the following 2 groups according to the start time of surgery: morning (AM group, before 11 AM) and afternoon (PM group, after 11 AM). Propensity-score matching (PSM) with a 1:1 matching ratio was used to create comparable cohorts. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the composite incidence of mortality and morbidities during hospitalization. Secondary endpoints included postoperative bleeding and transfusion, mechanical ventilation duration (MVD), and lengths of stay (LOS) in the intensive care unit (ICU) and hospital. From a consecutive series of 1,039 patients, PSM yielded 317 well-matched pairs. There was no difference in the composite incidence of in-hospital mortality and morbidities between the AM and PM groups (16.4% v 17.4%, p = 0.832). However, patients in the PM group were associated with less postoperative blood loss over the first 24 hours (470 v 540 mL, p = 0.002), decreased MVD (14 v 16 hours, p < 0.001), and shorter LOS in ICU (46 v 68 hours, p = 0.002) compared to patients in AM group. CONCLUSIONS The current study suggested a lack of relevance regarding the time of surgery with in-hospital mortality and morbidities in patients undergoing OPCABG.
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Affiliation(s)
- Pei-Shuang Lin
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China; Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Hui Qi
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, Hengshui People's Hospital, Hengshui, China
| | - Chen-Ying Ding
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the First Hospital of Hohhot, Hohhot, China
| | - Yu-Jie An
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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2
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Zeng Q, Oliva VM, Moro MÁ, Scheiermann C. Circadian Effects on Vascular Immunopathologies. Circ Res 2024; 134:791-809. [PMID: 38484032 DOI: 10.1161/circresaha.123.323619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024]
Abstract
Circadian rhythms exert a profound impact on most aspects of mammalian physiology, including the immune and cardiovascular systems. Leukocytes engage in time-of-day-dependent interactions with the vasculature, facilitating the emigration to and the immune surveillance of tissues. This review provides an overview of circadian control of immune-vascular interactions in both the steady state and cardiovascular diseases such as atherosclerosis and infarction. Circadian rhythms impact both the immune and vascular facets of these interactions, primarily through the regulation of chemoattractant and adhesion molecules on immune and endothelial cells. Misaligned light conditions disrupt this rhythm, generally exacerbating atherosclerosis and infarction. In cardiovascular diseases, distinct circadian clock genes, while functioning as part of an integrated circadian system, can have proinflammatory or anti-inflammatory effects on these immune-vascular interactions. Here, we discuss the mechanisms and relevance of circadian rhythms in vascular immunopathologies.
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Affiliation(s)
- Qun Zeng
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland (Q.Z., V.M.O., C.S.)
| | - Valeria Maria Oliva
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland (Q.Z., V.M.O., C.S.)
| | - María Ángeles Moro
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Madrid, Spain (M.Á.M.)
| | - Christoph Scheiermann
- Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland (Q.Z., V.M.O., C.S.)
- Geneva Center for Inflammation Research, Switzerland (C.S.)
- Translational Research Centre in Oncohaematology, Geneva, Switzerland (C.S.)
- Biomedical Center, Institute for Cardiovascular Physiology and Pathophysiology, Walter Brendel Center for Experimental Medicine, Faculty of Medicine, Ludwig-Maximilians-Universität Munich, Germany (C.S.)
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3
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Young ME. The Cardiac Circadian Clock: Implications for Cardiovascular Disease and its Treatment. JACC Basic Transl Sci 2023; 8:1613-1628. [PMID: 38205356 PMCID: PMC10774593 DOI: 10.1016/j.jacbts.2023.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 01/12/2024]
Abstract
Virtually all aspects of physiology fluctuate with respect to the time of day. This is beautifully exemplified by cardiovascular physiology, for which blood pressure and electrophysiology exhibit robust diurnal oscillations. At molecular/biochemical levels (eg, transcription, translation, signaling, metabolism), cardiovascular-relevant tissues (such as the heart) are profoundly different during the day vs the night. Unfortunately, this in turn contributes toward 24-hour rhythms in both risk of adverse event onset (eg, arrhythmias, myocardial infarction) and pathogenesis severity (eg, extent of ischemic damage). Accumulating evidence indicates that cell-autonomous timekeeping mechanisms, termed circadian clocks, temporally govern biological processes known to play critical roles in cardiovascular function/dysfunction. In this paper, a comprehensive review of our current understanding of the cardiomyocyte circadian clock during both health and disease is detailed. Unprecedented basic, translational, and epidemiologic studies support a need to implement chronobiological considerations in strategies designed for both prevention and treatment of cardiovascular disease.
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Affiliation(s)
- Martin E. Young
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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4
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The impact of time-of-day reperfusion on remote ischemic conditioning in ST-elevation myocardial infarction: a RIC-STEMI substudy. Heart Vessels 2023; 38:909-918. [PMID: 36930231 DOI: 10.1007/s00380-023-02247-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/08/2023] [Indexed: 03/18/2023]
Abstract
Daytime variation affects the tolerance of cardiomyocytes to ischemia-reperfusion injury (IRI). This study aims to evaluate the impact of time-of-day reperfusion on clinical outcomes of remote ischemic conditioning (RIC) as an adjuvant to primary percutaneous coronary intervention(PPCI) in ST-elevation myocardial infarction(STEMI) patients. A post-hoc analysis of a prospective, single-center parallel 1:1 randomized trial (RIC-STEMI) was performed. This analysis included 448 STEMI patients previously randomized to either PPCI alone (PPCI group) (n = 217) or RIC as an adjuvant to PPCI (RIC + PPCI group) (n = 231). Moreover, the sample was divided according to the time of PPCI: night-morning (22 h-11h59min) (n = 216) or afternoon (12 h-21h59min) (n = 232) groups. The primary follow-up endpoint was a composite of cardiac death and hospitalization due to heart failure. There were no significant differences in the clinical characteristics and the follow-up outcomes between groups. The afternoon period (HR = 0.474; 95% CI 0.230-0.977; p = 0.043) and RIC (HR = 0.423; 95% CI 0.195-0.917; p = 0.029) were independent predictors of the primary follow-up endpoint. An univariate analysis showed a lower frequency of primary follow-up endpoint, just in the afternoon period (10.3%vs0.9%; p = 0.002), in the RIC + PPCI group. A multivariate analysis revealed that RIC was an independent predictor of the primary follow-up endpoint in the afternoon group (HR = 0.098; 95% CI 0.012-0.785; p = 0.029), but not in the night-morning group. In addition, the afternoon period was not an independent predictor of the primary follow-up endpoint when the multivariate analysis was performed in the PPCI group. In conclusion, this study showed an important cardioprotective effect of RIC, namely in the afternoon period, suggesting that the afternoon period enhances the cardioprotection induced by RIC.
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Ozbek M, Ildirimli K, Arik B, Aktan A, Coskun MS, Evsen A, Guzel T, Acet H, Demira M. Dependence of clinical outcomes on time of hospital admission in patients with ST-segment elevation myocardial infarction. Ann Saudi Med 2023; 43:25-34. [PMID: 36739499 PMCID: PMC9899343 DOI: 10.5144/0256-4947.2023.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are conflicting results in studies investigating the effects of percutaneous coronary intervention (PCI) on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI) during or outside of usual hospital working hours. While some researchers have reported higher mortality rates in STEMI patients admitted outside of working hours, others did not find a statistically significant difference. OBJECTIVES Investigate the short-term endpoints and long-term outcomes of STEMI patients by time of admission. DESIGN Retrospective SETTING: Tertiary percutaneous coronary intervention center. PATIENTS AND METHODS Patients were grouped by admission, which consisted of four intervals: 06:00 to <12:00, 12:00 to <18:00, 18:00 to <24:00, and 24:00 to <06:00. We analyzed demographic, clinical and mortality by admission time interval and mortality by multivariate analyses, including the time intervals. MAIN OUTCOME MEASURES Clinical data and mortality SAMPLE SIZE: 735 patients; median (IQR) age 62 (22) years; 215 (29.3%) women. RESULTS Patients admitted at night were 1.37 times more likely to experience pulmonary edema than patients whose symptoms started in the daytime (P=.012); 32.9% of the patients whose symptoms started at night presented with Killip class II-IV, while during the daytime, 21.4% presented with Killip class II-IV (P=.001). Among the patients, the most common was inferior STEMI (38.6%). However, no-reflow was significantly higher during the daytime compared to the nighttime (P=.12). The risk of the cardiac arrest on admission was 1.2 times higher in patients admitted at night (P=.034). Neither time interval of admission nor several other variables had an effect on clinical outcome or mortality. CONCLUSIONS While patients admitted at night presented with pulmonary edema and cardiogenic shock more frequently, no reflow was observed during the day after the procedure. Although patients admitted at night with STEMI presented with worse clinical conditions, similar results were observed between the groups in clinical outcomes. LIMITATIONS More "real world" results might have been obtained if the study had replicated more typical referral conditions for PCI. CONFLICT OF INTEREST None.
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Affiliation(s)
- Mehmet Ozbek
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Kamran Ildirimli
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Baran Arik
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Adem Aktan
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Mehmet Sait Coskun
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Ali Evsen
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Tuncay Guzel
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Halit Acet
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
| | - Muhammed Demira
- From the Department of Cardiology, Dicle University, Diyarbakir, Turkiye
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6
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Wang X, Wang X, Ma J, Jia M, Wu L, Li W, Li C, Wu C, Ren C, Chen X, Zhao W, Ji X. Association between the time of day at stroke onset and functional outcome of acute ischemic stroke patients treated with endovascular therapy. J Cereb Blood Flow Metab 2022; 42:2191-2200. [PMID: 35791272 PMCID: PMC9670006 DOI: 10.1177/0271678x221111852] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
To investigate the association between time-of-day of stroke onset and functional outcome in patients with acute ischemic stroke(AIS) treated with endovascular thrombectomy(EVT). AIS patients treated with EVT between January 2013 and December 2018 were recruited and divided them into four 6-h interval groups according to the time-of-day of stroke onset. A total of 438 patients were enrolled, 3-month favorable outcome were achieved in 58.6%, 43.7%, 36.6%, and 30.5% of patients in the 00:00-06:00, 06:00-12:00, 12:00-18:00, and 18:00-24:00 groups, respectively (adjusted OR 0.61, 95% CI 0.40-0.93; p = 0.020). Compared with the 18:00-24:00 interval, patients in the 00:00-06:00 interval (adjusted OR 4.01, 95%CI 1.02-15.80, p = 0.047) and the 06:00-12:00 interval (adjusted OR 3.24, 95% CI 1.09-9.64, p = 0.034) were more likely to achieve favorable outcome. The time-of-day of stroke onset was not associated with 3-month mortality (adjusted p = 0.829), symptomatic intracerebral hemorrhage (sICH, adjusted p = 0.296), or early successful recanalization (adjusted p = 0.074). In conclusion, in AIS patients treated with EVT, those onsets either between 00:00 and 06:00 or between 06:00 and 12:00 appeared to be associated with a higher proportion of favorable outcomes at 3 months, but the time-of-day at stroke onset was not associated with the incidence of sICH, rate of early successful recanalization, or 3-month mortality.
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Affiliation(s)
- Xian Wang
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Xiaoyin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Milan Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longfei Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Weili Li
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Chuanhui Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chuanjie Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Changhong Ren
- Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Chen
- Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wenbo Zhao
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xunming Ji
- Beijing Institute of Brain Disorders, Laboratory of Brain Disorders, Ministry of Science and Technology, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Hypoxic Conditioning Translational Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.,Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
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7
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Lower morning levels of cortisol and neuropeptides in blood samples from patients with bipolar disorder. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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8
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Lecour S, Du Pré BC, Bøtker HE, Brundel BJJM, Daiber A, Davidson SM, Ferdinandy P, Girao H, Gollmann-Tepeköylü C, Gyöngyösi M, Hausenloy DJ, Madonna R, Marber M, Perrino C, Pesce M, Schulz R, Sluijter JPG, Steffens S, Van Linthout S, Young ME, Van Laake LW. Circadian rhythms in ischaemic heart disease: key aspects for preclinical and translational research: position paper of the ESC working group on cellular biology of the heart. Cardiovasc Res 2022; 118:2566-2581. [PMID: 34505881 DOI: 10.1093/cvr/cvab293] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/04/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Circadian rhythms are internal regulatory processes controlled by molecular clocks present in essentially every mammalian organ that temporally regulate major physiological functions. In the cardiovascular system, the circadian clock governs heart rate, blood pressure, cardiac metabolism, contractility, and coagulation. Recent experimental and clinical studies highlight the possible importance of circadian rhythms in the pathophysiology, outcome, or treatment success of cardiovascular disease, including ischaemic heart disease. Disturbances in circadian rhythms are associated with increased cardiovascular risk and worsen outcome. Therefore, it is important to consider circadian rhythms as a key research parameter to better understand cardiac physiology/pathology, and to improve the chances of translation and efficacy of cardiac therapies, including those for ischaemic heart disease. The aim of this Position Paper by the European Society of Cardiology Working Group Cellular Biology of the Heart is to highlight key aspects of circadian rhythms to consider for improvement of preclinical and translational studies related to ischaemic heart disease and cardioprotection. Applying these considerations to future studies may increase the potential for better translation of new treatments into successful clinical outcomes.
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Affiliation(s)
- Sandrine Lecour
- Department of Medicine, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Bastiaan C Du Pré
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianca J J M Brundel
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Andreas Daiber
- Department of Cardiology, Molecular Cardiology, Medical Center of the Johannes Gutenberg University, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Sean M Davidson
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Peter Ferdinandy
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
- Pharmahungary Group, Szeged, Hungary
| | - Henrique Girao
- Faculty of Medicine, Univ Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Center for Innovative Biomedicine and Biotechnology (CIBB), Clinical Academic Centre of Coimbra (CACC), Coimbra, Portugal
| | | | - Mariann Gyöngyösi
- Department of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Derek J Hausenloy
- Cardiovascular & Metabolic Disorders Program, Duke-National University of Singapore Medical School, Singapore, Singapore
- National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
- The Hatter Cardiovascular Institute, University College London, London, UK
- Cardiovascular Research Center, College of Medical and Health Sciences, Asia University, Taichung City, Taiwan
| | - Rosalinda Madonna
- Institute of Cardiology, University of Pisa, Pisa, Italy
- Department of Internal Medicine, University of Texas Medical School in Houston, Houston, TX, USA
| | - Michael Marber
- King's College London BHF Centre, The Rayne Institute, St Thomas' Hospital, London, UK
| | - Cinzia Perrino
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maurizio Pesce
- Unità di Ingegneria Tissutale Cardiovascolare, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Rainer Schulz
- Institute of Physiology, Justus-Liebig University Giessen, Giessen, Germany
| | - Joost P G Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, Regenerative Medicine Center, Circulatory Health Laboratory, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention, Ludwig-Maximilians-University, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Sophie Van Linthout
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité, University Medicine Berlin, Berlin 10178, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Martin E Young
- Division of Cardiovascular Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Linda W Van Laake
- Cardiology and UMC Utrecht Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
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9
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Liu Z, Penny-Dimri JC, Nagel M, Plummer M, Segal R, Morley P, Smith J, Perry LA. Early versus late surgical start times for on-pump cardiac surgery. Hippokratia 2022. [DOI: 10.1002/14651858.cd014901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Zhengyang Liu
- Department of Surgery; Melbourne Medical School, The University of Melbourne; Melbourne Australia
- Department of Anaesthesia; Royal Melbourne Hospital; Melbourne Australia
| | | | - Matthew Nagel
- Department of Surgery; Melbourne Medical School, The University of Melbourne; Melbourne Australia
| | - Mark Plummer
- Intensive Care Unit; Royal Melbourne Hospital; Melbourne Australia
| | - Reny Segal
- Department of Anaesthesia; Royal Melbourne Hospital; Melbourne Australia
- Department of Medicine; University of Melbourne; Melbourne Australia
| | - Peter Morley
- Intensive Care Unit; Royal Melbourne Hospital; Melbourne Australia
| | - Julian Smith
- Department of Surgery; Monash University; Melbourne Australia
| | - Luke A Perry
- Department of Anaesthesia; Royal Melbourne Hospital; Melbourne Australia
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10
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Kilgallen AB, van den Akker F, Feyen DAM, Crnko S, Snijders Blok CJB, Gremmels H, du Pré BC, Reijers R, Doevendans PA, de Jager SCA, Sluijter JPG, Sampaio-Pinto V, van Laake LW. Circadian Dependence of the Acute Immune Response to Myocardial Infarction. Front Pharmacol 2022; 13:869512. [PMID: 35694249 PMCID: PMC9174900 DOI: 10.3389/fphar.2022.869512] [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: 02/04/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Circadian rhythms influence the recruitment of immune cells and the onset of inflammation, which is pivotal in the response to ischemic cardiac injury after a myocardial infarction (MI). The hyperacute immune response that occurs within the first few hours after a MI has not yet been elucidated. Therefore, we characterized the immune response and myocardial damage 3 hours after a MI occurs over a full twenty-four-hour period to investigate the role of the circadian rhythms in this response. MI was induced at Zeitgeber Time (ZT) 2, 8, 14, and 20 by permanent ligation of the left anterior descending coronary artery. Three hours after surgery, animals were terminated and blood and hearts collected to assess the immunological status and cardiac damage. Blood leukocyte numbers varied throughout the day, peaking during the rest-phase (ZT2 and 8). Extravasation of leukocytes was more pronounced during the active-phase (ZT14 and 20) and was associated with greater chemokine release to the blood and expression of adhesion molecules in the heart. Damage to the heart, measured by Troponin-I plasma levels, was elevated during this time frame. Clock gene oscillations remained intact in both MI-induced and sham-operated mice hearts, which could explain the circadian influence of the hyperacute inflammatory response after a MI. These findings are in line with the clinical observation that patients who experience a MI early in the morning (i.e., early active phase) have worse clinical outcomes. This study provides further insight on the immune response occurring shortly after an MI, which may contribute to the development of novel and optimization of current therapeutic approaches.
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Affiliation(s)
- Aoife B. Kilgallen
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Circulatory Health Laboratory, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Dries A. M. Feyen
- Department of Medicine and Cardiovascular Institute, Stanford University, Stanford, CA, United States
| | - Sandra Crnko
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Circulatory Health Laboratory, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christian J. B. Snijders Blok
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
| | - Hendrik Gremmels
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bastiaan C. du Pré
- Division of Internal Medicine, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Robin Reijers
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pieter A. Doevendans
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Netherlands Heart Institute, Utrecht, Netherlands
- Central Military Hospital, Utrecht, Netherlands
| | - Saskia C. A. de Jager
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost P. G. Sluijter
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Circulatory Health Laboratory, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
- Utrecht University, Utrecht, Netherlands
| | - Vasco Sampaio-Pinto
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Circulatory Health Laboratory, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
| | - Linda W. van Laake
- Department of Cardiology, Experimental Cardiology Laboratory, University Medical Center Utrecht, Utrecht, Netherlands
- Circulatory Health Laboratory, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht, Netherlands
- Utrecht University, Utrecht, Netherlands
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11
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Xu C, Dong M, Sun L, Deng Y, Zhou J, Yuan Z. Sex differences in the impact of day/Night distribution of ST-segment elevation myocardial infarction onset on in-hospital outcomes: Findings from the improving care for cardiovascular disease in China-Acute Coronary Syndrome Project. Sleep Med 2022; 95:112-119. [DOI: 10.1016/j.sleep.2022.04.011] [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: 01/06/2022] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
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Zhong Y, Yu X, Li X, Zhou H, Wang Y. Augmented early aged neutrophil infiltration contributes to late remodeling post myocardial infarction. Microvasc Res 2022; 139:104268. [PMID: 34728225 DOI: 10.1016/j.mvr.2021.104268] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022]
Abstract
Neutrophils oscillate in number and phenotype after being released from bone marrow. Myocardial infarction (MI) outcome is associated with the time-of-day of ischemia onset. However, the underlying contributive factors of neutrophils to cardiac remodeling post MI remain unknown. We examined neutrophil infiltration into the heart and cardiac function and remodeling in C57BL/6J MI model created by permanent coronary ligation at different zeitgeber times (ZT). We found that cell surface markers (CD62L, CXCR2, CXCR4) of neutrophils in peripheral blood lost diurnal oscillation 24 h post MI. Meanwhile, circadian gene Bmal1, Nr1d1, and Clock mRNA expression displayed disrupted diurnal patterns. Flow cytometry showed augmented aged neutrophil (CD11b+Ly6G+CD62Llow) infiltration into the heart along with increased circulating aged neutrophils in MI groups with more infiltration at ZT5 (p < 0.05), but no difference for aged neutrophil infiltration at different ZT points in late stage. Infiltrated neutrophils had significantly higher CXCL2 and CXCR2 but lower CXCR4 gene expression (p < 0.05). Mice that underwent ligation at ZT5 had high mortality rate and large infarct size. Echocardiography showed that those mice had significantly larger end diastolic and systolic volume and lower ejection fraction (p < 0.05). Immunohistology revealed that those mice displayed more fibrosis, cardiomyocyte hypertrophy, and less angiogenesis compared to ZT13 or ZT21 group (p < 0.05). However, treatment with anti-CXCL2 antibody significantly reduced LV dilatation, fibrosis, hypertrophy and improved cardiac function. These results indicate greater aged neutrophil infiltration into the heart contributes to cardiac hypertrophy, fibrosis, and dysfunction which suggests that blocking neutrophil aging may be a therapeutic alternative following acute myocardial infarction.
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Affiliation(s)
- Yihan Zhong
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China; Department of Neuroscience and Behavioral Biology, Emory University, Atlanta, GA, United States of America
| | - Xiaoyan Yu
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - Xiangjun Li
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Sciences, Jilin University, Changchun, China
| | - Helen Zhou
- Department of Biochemistry and Molecular Genetic, University of Alabama at Birmingham, Birmingham, AL, United States of America.
| | - Yushi Wang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China.
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13
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Vincent F, Thourani VH, Ternacle J, Redfors B, Cohen DJ, Hahn RT, Li D, Crowley A, Webb JG, Mack MJ, Kapadia S, Russo M, Smith CR, Alu MC, Leon MB, Pibarot P. Time-of-Day and Clinical Outcomes After Surgical or Transcatheter Aortic Valve Replacement: Insights From the PARTNER Trials. Circ Cardiovasc Qual Outcomes 2022; 15:e007948. [PMID: 35041482 DOI: 10.1161/circoutcomes.121.007948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Circadian rhythms may influence myocardial tolerance to ischemia-reperfusion phenomena occurring during cardiac procedures. While conflicting results exist on the effect of time-of-day on surgical aortic valve replacement (SAVR), afternoon procedures could be associated with a reduced risk of death, rehospitalization or periprocedural myocardial infarction, compared with morning procedures. We examined the impact of procedure time-of-day on outcomes after transcatheter aortic valve replacement (TAVR) or SAVR. METHODS We analyzed patients at intermediate- or high-surgical risk who underwent elective TAVR (n=4457) or SAVR (n=1129) in the PARTNER (Placement of Aortic Transcatheter Valve) 1 and 2 trials and registries according to time-of-day (morning versus afternoon) using the Kaplan-Meier event rates and multivariable Cox proportional hazards regression models. Sensitivity analysis was conducted using 1:1 propensity-score matching. The primary end point was all-cause death or rehospitalization at 2 years. RESULTS At 2 years, no difference was observed between patients operated in the morning versus the afternoon within the SAVR (32.3% versus 30.6%, adjusted hazard ratio, 1.08 [95% CI, 0.82-1.41], P=0.58) and TAVR cohorts (35.7% versus 35.4%, adjusted hazard ratio, 1.01 [95% CI, 0.89-1.14], P=0.86) with regards to the primary end point. Rates of periprocedural myocardial infarction were low and similar between morning and afternoon in SAVR (1.6% versus 1.0%, P=0.51) and TAVR (0.4% versus 0.4%, P=0.86), as were all other clinical end points. Similar results were observed in propensity-score matched analysis. CONCLUSIONS Procedure time-of-day was not associated with clinical outcomes after TAVR or SAVR. Registration: URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00530894, NCT01314313, NCT03222141, and NCT03222128.
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Affiliation(s)
- Flavien Vincent
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.).,Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA (V.H.T.)
| | - Julien Ternacle
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.)
| | - Bjorn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - David J Cohen
- University of Missouri-Kansas City School of Medicine (D.J.C.)
| | - Rebecca T Hahn
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Ditian Li
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - Aaron Crowley
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.)
| | - John G Webb
- Saint Paul's Hospital, Vancouver, Canada (J.G.W.)
| | - Michael J Mack
- Department of Cardiovascular Surgery, Baylor Scott & White Health, Plano, TX (M.J.M.)
| | - Samir Kapadia
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (S.K.)
| | - Mark Russo
- Robert Wood Johnson Medical School, Rutgers University, New Brunswick (M.R.)
| | - Craig R Smith
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Maria C Alu
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.).,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Martin B Leon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (F.V., B.R., D.L., A.C., M.C.A., M.B.L.).,Center for Interventional Vascular Therapy, Columbia University Irving Medical Center, NewYork-Presbyterian Hospital (R.T.H., C.R.S., M.C.A., M.B.L.)
| | - Philippe Pibarot
- Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval/Québec Heart and Lung Institute, Laval University, Canada (F.V., J.T., P.P.)
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14
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Peng H, Sun Z, Di B, Ding X, Chen H, Li H. Contemporary impact of circadian symptom-onset patterns of acute ST-Segment elevation myocardial infarction on long-term outcomes after primary percutaneous coronary intervention. Ann Med 2021; 53:247-256. [PMID: 33349057 PMCID: PMC7877989 DOI: 10.1080/07853890.2020.1863457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Daytime variation with regard to onset time of ST-elevation myocardial infarction (STEMI) symptoms has been observed. Nevertheless, with the advanced medical therapy, it is not uncertainty if a similar circadian pattern of STEMI symptom onset occurs, as well as its possible impact on clinical outcomes. Few long-term data are available. We assess the impact of circadian symptom-onset patterns of STEMI on major adverse cardiovascular events (MACE) in more contemporary patients treated with primary percutaneous coronary intervention (PPCI). METHODS AND RESULTS A total of 1099 consecutive STEMI patients undergoing PPCI ≤12h from symptom onset during 2013 to 2019 were classified into 4 groups by 6-h intervals according to time-of-day at symptom onset: night (0:00-5:59), morning (6:00-11:59), afternoon (12:00-17:59), and evening (18:00-23:59). Incidence of MACE including cardiovascular death and nonfatal MI during a median follow-up of 48 months was compared among the 4 groups. A morning peak of symptom onset of STEMI was detected during the period 06:00-11:59 (p < .001). Compared with other three 6-h intervals, the incidence of long-term MACE during night onset-time (18.8%, 10.1%, 10.7% and 12.4%, p = .020) was significant higher that was driven by more mortality (13.1%, 6.5%, 7.1%and 7.7%, p = .044). Night symptom-onset STEMI was independently associated with subsequent MACE (hazard ratio = 1.57, 95%CI: 1.09-2.27, p = .017) even after multivariable adjustment. CONCLUSIONS Circadian variation of STEMI symptom-onset with morning predominance still exists in contemporary practice. Night symptom-onset STEMI was independently associated with increased risk of MACE in Chinese patients treated with PPCI.
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Affiliation(s)
- Hui Peng
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Zhijun Sun
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Beibing Di
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Xiaosong Ding
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Hui Chen
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China
| | - Hongwei Li
- Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P. R. China.,Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, P.R. China.,Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, P. R. China
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15
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Daytime variation does not impact outcome of cardiac surgery: Results from a diverse, multi-institutional cardiac surgery network. J Thorac Cardiovasc Surg 2021; 162:56-67.e44. [DOI: 10.1016/j.jtcvs.2019.11.131] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/25/2019] [Accepted: 11/26/2019] [Indexed: 12/13/2022]
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16
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Daytime-Dependent Cardioprotection in Cardiac Surgery: A Large Propensity-matched Cohort Study. Ann Thorac Surg 2020; 110:1629-1636. [DOI: 10.1016/j.athoracsur.2020.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 11/30/2022]
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17
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Abstract
The Earth turns on its axis every 24 h; almost all life on the planet has a mechanism - circadian rhythmicity - to anticipate the daily changes caused by this rotation. The molecular clocks that control circadian rhythms are being revealed as important regulators of physiology and disease. In humans, circadian rhythms have been studied extensively in the cardiovascular system. Many cardiovascular functions, such as endothelial function, thrombus formation, blood pressure and heart rate, are now known to be regulated by the circadian clock. Additionally, the onset of acute myocardial infarction, stroke, arrhythmias and other adverse cardiovascular events show circadian rhythmicity. In this Review, we summarize the role of the circadian clock in all major cardiovascular cell types and organs. Second, we discuss the role of circadian rhythms in cardiovascular physiology and disease. Finally, we postulate how circadian rhythms can serve as a therapeutic target by exploiting or altering molecular time to improve existing therapies and develop novel ones.
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18
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Baik J, Nam J, Oh J, Kim GW, Lee E, Lee Y, Chung CH, Choi I. Effect of operative time on the outcome of patients undergoing off‐pump coronary artery bypass surgery. J Card Surg 2019; 34:1220-1227. [DOI: 10.1111/jocs.14231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jaewon Baik
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jae‐Sik Nam
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Jimi Oh
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Go Wun Kim
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Eun‐Ho Lee
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - Yoon‐Kyung Lee
- Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart HospitalHallym University College of MedicineSeoul Korea
| | - Cheol Hyun Chung
- Department of Thoracic and Cardiovascular Surgery, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
| | - In‐Cheol Choi
- Laboratory for Perioperative Outcomes Analysis and Research, Department of Anesthesiology and Pain Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoul Korea
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19
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Sager HB, Husser O, Steffens S, Laugwitz KL, Schunkert H, Kastrati A, Ndrepepa G, Kessler T. Time-of-day at symptom onset was not associated with infarct size and long-term prognosis in patients with ST-segment elevation myocardial infarction. J Transl Med 2019; 17:180. [PMID: 31142323 PMCID: PMC6542088 DOI: 10.1186/s12967-019-1934-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 05/22/2019] [Indexed: 11/13/2022] Open
Abstract
Background ST-segment elevation myocardial infarction (STEMI) displays circadian variability with the highest incidence in the morning hours. Data on whether the time-of-day at symptom onset affects infarct size or patients’ long-term prognosis are conflicting. We sought to investigate the association of time-of-day at symptom onset with infarct size or long-term mortality in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods This study included 1206 STEMI patients undergoing PPCI. All patients underwent single photon emission computed tomography (SPECT) imaging with 99mTc-sestamibi before and 7–14 days after PPCI. The co-primary endpoints were final infarct size on day 10 after STEMI and all-cause mortality at 5-year follow-up. Time-of-day at symptom onset of STEMI was categorized in 6-h intervals. Results In patients presenting from 0 to 6 h, 6 to 12 h, 12 to 18 h, and 18 to 24 h, the infarct sizes (median [25th–75th percentiles]) were 10.0 [3.0–24.7], 10.0 [3.0–24.0], 10.0 [3.0–22.0], and 9.0 [3.0–21.0] of the left ventricle, respectively (p = 0.87); the Kaplan–Meier estimates of 5-year all-cause mortality were 13.6%, 8.7%, 13.7% and 9.3%, respectively (log-rank test p = 0.30). After adjustment, time-of-day was not associated with infarct size (p ≥ 0.76 for comparisons with infarct size from reference [6–12 h] time interval) or 5-year all-cause mortality (p ≥ 0.25 for comparisons with mortality from reference [6–12 h] time interval). Time-of-day at symptom onset of STEMI was not associated with differences in the recovery of left ventricular ejection fraction 6 months after STEMI. Conclusions In patients with STEMI undergoing PPCI, time-of-day at symptom onset was neither associated with scintigraphic infarct size, left ventricular ejection fraction recovery at 6 months nor with 5-year mortality. Electronic supplementary material The online version of this article (10.1186/s12967-019-1934-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hendrik B Sager
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany.
| | - Oliver Husser
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,Klinik für Innere Medizin I, Kardiologie, St. Johannes-Hospital Dortmund, Dortmund, Germany
| | - Sabine Steffens
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany.,Institut für Prophylaxe und Epidemiologie der Kreislaufkrankheiten, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Karl-Ludwig Laugwitz
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany.,I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Heribert Schunkert
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany.,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany
| | - Gjin Ndrepepa
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Thorsten Kessler
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany. .,Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK) e.V, Partner Site Munich Heart Alliance, Munich, Germany.
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20
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Puhl SL, Steffens S. Neutrophils in Post-myocardial Infarction Inflammation: Damage vs. Resolution? Front Cardiovasc Med 2019; 6:25. [PMID: 30937305 PMCID: PMC6431642 DOI: 10.3389/fcvm.2019.00025] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/26/2019] [Indexed: 01/08/2023] Open
Abstract
Inflammation not only plays a crucial role in acute ischemic cardiac injury, but also contributes to post-infarction repair and remodeling. Traditionally, neutrophils have been merely considered as detrimental in the setting of an acute myocardial infarction. However, recently published studies demonstrated that neutrophils might also play an important role in cardiac repair by regulating reparative processes. An emerging concept is that different neutrophil subsets exist, which might exhibit separate functional properties. In support of the existence of distinct neutrophil subsets in the ischemic heart, transcriptional changes in cardiac neutrophils have been reported within the first few days after myocardial infarction. In addition, there is an increasing awareness of sex-specific differences in many physiological and pathophysiological responses, including cardiovascular parameters and inflammation. Of particular interest in this context are recent experimental data dissecting sex-specific differences in neutrophil signaling after myocardial infarction. Unraveling the distinct and possibly stage-dependent properties of neutrophils in cardiac repair may provide new therapeutic strategies in order to improve the clinical outcome for myocardial infarction patients. This review will briefly discuss recent advances in our understanding of the neutrophil functional repertoire and emerging insights of sex-specific differences in post-myocardial infarction inflammatory responses.
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Affiliation(s)
- Sarah-Lena Puhl
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Sabine Steffens
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU), Munich, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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21
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Albackr HB, AlHabib KF, AlShamiri MQ, Ullah A, Al Subaie FA, Alghamdi AG, Alfaleh H, Kashour T, Al Suwaidi J, Alsheikh-Ali AA, Almahmeed W, Salam AM. Circadian Rhythm and ST-Segment Elevation Myocardial Infarction: Insights From the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). Angiology 2018; 70:352-360. [DOI: 10.1177/0003319718797470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circadian rhythms have been identified in multiple physiological processes that may affect cardiovascular diseases, yet little is known about the impact of circadian rhythm on acute ST-segment elevation myocardial infarction (STEMI) onset and outcomes in the Middle East. The relationship between time of symptom onset during the 24-hour circadian cycle and prehospital delays and in-hospital death was assessed in 2909 patients with STEMI presenting in 6 Arabian Gulf countries. A sinusoidal smoothing function was used to show the average circadian trends. There was a significant association between time of symptom onset and the circadian cycle. The STEMIs were more frequent during the late morning and early afternoon hours ( P < .001). Patients with pain onset from 0.00 to 5:59 had median prehospital delays of 150 minutes versus 90 minutes from 6:00 to 11:59 and 12:00 to 17:59, respectively ( P < .001). Although there was no significant difference in mortality between the 4 groups ( P = .230), there was a significant association between time of symptom onset as sinusoidal function and in-hospital mortality ( P = .032). Patients with STEMI in the Middle East have significant circadian patterns in symptoms onset, prehospital delay, and timeliness of reperfusion. A circadian rhythm of in-hospital mortality was found over the 24-hour clock of symptom onset time.
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Affiliation(s)
- Hanan B. Albackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mostafa Q. AlShamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Al Subaie
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abduljabar G. Alghamdi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Amar M. Salam
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
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22
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Kim HO, Kim JM, Woo JS, Park CB, Cho JM, Lee SU, Kim CJ, Jeong MH, Kim W. Circadian Distribution of Acute Myocardial Infarction in Different Age Groups. Am J Cardiol 2018; 121:1279-1284. [PMID: 29602440 DOI: 10.1016/j.amjcard.2018.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/01/2018] [Accepted: 02/08/2018] [Indexed: 10/17/2022]
Abstract
Many epidemiologic studies reported a morning peak in the incidence of acute myocardial infarction (AMI). However, clinical outcomes and the relation between age distribution and circadian pattern have not been fully investigated in a large number of patients. Our study aimed to clarify the impacts of onset time in circadian variation on incidence and clinical outcomes of AMI according to age. From the Korea Acute Myocardial Infarction Registry, we gathered data of 20,685 patients from 53 centers in Republic of Korea. Data from a total of 19,915 patients (11,339 ST elevation myocardial infarction, 8,576 non-ST elevation myocardial infarction) were analyzed from the registry, after exclusion of diagnoses other than AMI. A morning-dominant incidence was shown by sinusoidal function, in all patients and in all separate age groups (age < 55, 55 ≤ age < 75, 75 ≤ age). In-hospital mortality and major adverse cardiovascular events (MACEs), including cardiac deaths, noncardiac deaths, recurrent myocardial infarction, repeated percutaneous coronary intervention, and coronary artery bypass graft at 1, 12, and 24 months' follow-up, were compared in 4 periods (00:00~05:59, 06:00~11:59, 12:00~17:59, and 18:00~23:59), and no significant difference was noted. Kaplan-Meier curve was drawn for death and MACE-free survival, and no significant different event-free survival was depicted (p value = 0.31). In conclusion, the incidences of myocardial infarction by onset time were uneven in 24 hours, in all patients and age groups, by sinusoidal function. However, there were no significant differences in in-hospital mortality or MACEs in the 4 time periods during 24 months of follow-up.
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Fournier S, Guenat F, Fournier A, Alberio L, Bonny O, Bertaggia Calderara D, Bardy D, Lauriers N, Harbaoui B, Monney P, Pascale P, Eeckhout E, Muller O. Circadian variation of ticagrelor-induced platelet inhibition in healthy adulty. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2018; 4:166-171. [DOI: 10.1093/ehjcvp/pvy003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/19/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Stephane Fournier
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Florine Guenat
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Anne Fournier
- Department of Pharmacy, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Lorenzo Alberio
- Department of Hematology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Olivier Bonny
- Department of Nephrology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | | | - Daniel Bardy
- Laboratory Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Nathalie Lauriers
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Brahim Harbaoui
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Patrizio Pascale
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Eric Eeckhout
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland
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Hsieh PN, Zhang L, Jain MK. Coordination of cardiac rhythmic output and circadian metabolic regulation in the heart. Cell Mol Life Sci 2018; 75:403-416. [PMID: 28825119 PMCID: PMC5765194 DOI: 10.1007/s00018-017-2606-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/13/2017] [Accepted: 08/02/2017] [Indexed: 02/07/2023]
Abstract
Over the course of a 24-h day, demand on the heart rises and falls with the sleep/wake cycles of the organism. Cardiac metabolism oscillates appropriately, with the relative contributions of major energy sources changing in a circadian fashion. The cardiac peripheral clock is hypothesized to drive many of these changes, yet the precise mechanisms linking the cardiac clock to metabolism remain a source of intense investigation. Here we summarize the current understanding of circadian alterations in cardiac metabolism and physiology, with an emphasis on novel findings from unbiased transcriptomic studies. Additionally, we describe progress in elucidating the links between the cardiac peripheral clock outputs and cardiac metabolism, as well as their implications for cardiac physiology.
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Affiliation(s)
- Paishiun Nelson Hsieh
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Room 4-503, Cleveland, OH, USA
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA
- Department of Pathology, Case Western Reserve University, Cleveland, OH, USA
| | - Lilei Zhang
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Mukesh Kumar Jain
- Department of Medicine, Case Cardiovascular Research Institute, Case Western Reserve University, 2103 Cornell Road, Room 4-503, Cleveland, OH, USA.
- Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Cleveland, OH, USA.
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25
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Montaigne D, Marechal X, Modine T, Coisne A, Mouton S, Fayad G, Ninni S, Klein C, Ortmans S, Seunes C, Potelle C, Berthier A, Gheeraert C, Piveteau C, Deprez R, Eeckhoute J, Duez H, Lacroix D, Deprez B, Jegou B, Koussa M, Edme JL, Lefebvre P, Staels B. Daytime variation of perioperative myocardial injury in cardiac surgery and its prevention by Rev-Erbα antagonism: a single-centre propensity-matched cohort study and a randomised study. Lancet 2018; 391:59-69. [PMID: 29107324 DOI: 10.1016/s0140-6736(17)32132-3] [Citation(s) in RCA: 211] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/05/2017] [Accepted: 07/13/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND On-pump cardiac surgery provokes a predictable perioperative myocardial ischaemia-reperfusion injury which is associated with poor clinical outcomes. We determined the occurrence of time-of-the-day variation in perioperative myocardial injury in patients undergoing aortic valve replacement and its molecular mechanisms. METHODS We studied the incidence of major adverse cardiac events in a prospective observational single-centre cohort study of patients with severe aortic stenosis and preserved left ventricular ejection fraction (>50%) who were referred to our cardiovascular surgery department at Lille University Hospital (Lille, France) for aortic valve replacement and underwent surgery in the morning or afternoon. Patients were matched into pairs by propensity score. We also did a randomised study, in which we evaluated perioperative myocardial injury and myocardial samples of patients randomly assigned (1:1) via permuted block randomisation (block size of eight) to undergo isolated aortic valve replacement surgery either in the morning or afternoon. We also evaluated human and rodent myocardium in ex-vivo hypoxia-reoxygenation models and did a transcriptomic analysis in myocardial samples from the randomised patients to identify the signalling pathway(s) involved. The primary objective of the study was to assess whether myocardial tolerance of ischaemia-reperfusion differed depending on the timing of aortic valve replacement surgery (morning vs afternoon), as measured by the occurrence of major adverse cardiovascular events (cardiovascular death, myocardial infarction, and admission to hospital for acute heart failure). The randomised study is registered with ClinicalTrials.gov, number NCT02812901. FINDINGS In the cohort study (n=596 patients in matched pairs who underwent either morning surgery [n=298] or afternoon surgery [n=298]), during the 500 days following aortic valve replacement, the incidence of major adverse cardiac events was lower in the afternoon surgery group than in the morning group: hazard ratio 0·50 (95% CI 0·32-0·77; p=0·0021). In the randomised study, 88 patients were randomly assigned to undergo surgery in the morning (n=44) or afternoon (n=44); perioperative myocardial injury assessed with the geometric mean of perioperative cardiac troponin T release was significantly lower in the afternoon group than in the morning group (estimated ratio of geometric means for afternoon to morning of 0·79 [95% CI 0·68-0·93; p=0·0045]). Ex-vivo analysis of human myocardium revealed an intrinsic morning-afternoon variation in hypoxia-reoxygenation tolerance, concomitant with transcriptional alterations in circadian gene expression with the nuclear receptor Rev-Erbα being highest in the morning. In a mouse Langendorff model of hypoxia-reoxygenation myocardial injury, Rev-Erbα gene deletion or antagonist treatment reduced injury at the time of sleep-to-wake transition, through an increase in the expression of the ischaemia-reperfusion injury modulator CDKN1a/p21. INTERPRETATION Perioperative myocardial injury is transcriptionally orchestrated by the circadian clock in patients undergoing aortic valve replacement, and Rev-Erbα antagonism seems to be a pharmacological strategy for cardioprotection. Afternoon surgery might provide perioperative myocardial protection and lead to improved patient outcomes compared with morning surgery. FUNDING Fondation de France, Fédération Française de Cardiologie, EU-FP7-Eurhythdia, Agence Nationale pour la Recherche ANR-10-LABX-46, and CPER-Centre Transdisciplinaire de Recherche sur la Longévité.
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Affiliation(s)
- David Montaigne
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France.
| | - Xavier Marechal
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | | | - Augustin Coisne
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Stéphanie Mouton
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | | | - Sandro Ninni
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Cédric Klein
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Staniel Ortmans
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Claire Seunes
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Charlotte Potelle
- University of Lille, EGID, Lille, France; University Hospital CHU Lille, Lille, France
| | - Alexandre Berthier
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Celine Gheeraert
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Catherine Piveteau
- University of Lille, EGID, Lille, France; Institut Pasteur de Lille, Lille, France; Inserm, U1177, Lille, France
| | - Rebecca Deprez
- University of Lille, EGID, Lille, France; Institut Pasteur de Lille, Lille, France; Inserm, U1177, Lille, France
| | - Jérome Eeckhoute
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Hélène Duez
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Dominique Lacroix
- University of Lille, EGID, Lille, France; University Hospital CHU Lille, Lille, France
| | - Benoit Deprez
- University of Lille, EGID, Lille, France; Institut Pasteur de Lille, Lille, France; Inserm, U1177, Lille, France
| | - Bruno Jegou
- University Hospital CHU Lille, Lille, France
| | | | - Jean-Louis Edme
- University of Lille, EGID, Lille, France; University Hospital CHU Lille, Lille, France
| | - Philippe Lefebvre
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; Institut Pasteur de Lille, Lille, France
| | - Bart Staels
- University of Lille, EGID, Lille, France; Inserm, U1011, Lille, France; University Hospital CHU Lille, Lille, France; Institut Pasteur de Lille, Lille, France
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Circadian dependence of manual thrombus aspiration benefit in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Clin Res Cardiol 2017; 107:338-346. [DOI: 10.1007/s00392-017-1189-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/27/2017] [Indexed: 11/28/2022]
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Fournier S, Iten L, Marques-Vidal P, Boulat O, Bardy D, Beggah A, Calderara R, Morawiec B, Lauriers N, Monney P, Iglesias JF, Pascale P, Harbaoui B, Eeckhout E, Muller O. Circadian rhythm of blood cardiac troponin T concentration. Clin Res Cardiol 2017; 106:1026-1032. [DOI: 10.1007/s00392-017-1152-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 08/07/2017] [Indexed: 11/29/2022]
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Variation within Variation: Comparison of 24-h Rhythm in Rodent Infarct Size between Ischemia Reperfusion and Permanent Ligation. Int J Mol Sci 2017; 18:ijms18081670. [PMID: 28763007 PMCID: PMC5578060 DOI: 10.3390/ijms18081670] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 01/06/2023] Open
Abstract
The detrimental effects of myocardial infarction in humans and rodents have a 24-h rhythm. In some human cohorts however, rhythmicity was absent, while the time of maximum damage differs between cohorts. We hypothesized that the type of damage influences the 24-h rhythm in infarct size. Myocardial infarction was induced in 12-week-old C57BL/six mice at four different time-points during the day using either permanent ligation (PL) or 30-min of ischemia followed by reperfusion (IR), with a control group wherein no ligation was applied. Infarct size was measured by echocardiography and histology at a 1-month follow-up. Rhythmicity in infarct size was present in the PL group at the functional and histological level, with maximal damage occurring when the infarct was induced at noon. In the IR group, no circadian rhythm was found. The time of the coronary artery ligation determines the outcome of myocardial infarction. Our data showed that in rodents, the presence of circadian rhythmicity and time of peak infarct size varies between experimental setups.
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Fabbian F, Bhatia S, De Giorgi A, Maietti E, Bhatia S, Shanbhag A, Deshmukh A. Circadian Periodicity of Ischemic Heart Disease: A Systematic Review of the Literature. Heart Fail Clin 2017; 13:673-680. [PMID: 28865776 DOI: 10.1016/j.hfc.2017.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The authors performed a MEDLINE search to identify reports, published during the last 20 years, focused on circadian variation of acute myocardial infarction (AMI), and prevalence and the ratios between the number of events per hour during the morning and the other hours of the day were calculated. Despite the optimization of interventional and medical therapy of AMI since the first reports of circadian patterns in AMI occurrence, it was found that such a pattern still exists and that AMI happens most frequently in the morning hours.
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Affiliation(s)
- Fabio Fabbian
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy.
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Afredo De Giorgi
- Department of Medical Sciences, University of Ferrara, University Hospital St. Anna, Via Aldo Moro 8, I-44124, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Medical Sciences, University of Ferrara, Center for Clinical Epidemiology, 44121 Ferrara, Italy
| | - Sravya Bhatia
- School of Medicine, Duke University, 8 Duke University Medical Center Greenspace, Durham, NC 27703, USA
| | - Anusha Shanbhag
- Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham Street, Little Rock, AR 72205, USA
| | - Abhishek Deshmukh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, 200 First Street Southwest, Rochester, Minnesota 55905, USA
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Steffens S, Winter C, Schloss MJ, Hidalgo A, Weber C, Soehnlein O. Circadian Control of Inflammatory Processes in Atherosclerosis and Its Complications. Arterioscler Thromb Vasc Biol 2017; 37:1022-1028. [DOI: 10.1161/atvbaha.117.309374] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/18/2017] [Indexed: 01/24/2023]
Abstract
Physiological cardiovascular functions show daily diurnal variations, which are synchronized by intrinsic molecular clocks and environment-driven cues. The clinical manifestation of cardiovascular disease also exhibits diurnal variation, with an increased incidence in the early morning. This coincides with circadian oscillations of circulating parameters, such as hormones and leukocyte counts. We are just at the beginning of understanding how circadian rhythms of immune functions are related to cardiovascular disease progression and outcome after an acute ischemic event. Here, we briefly summarize clinical data on oscillations of circulating inflammatory parameters, as well as experimental evidences for the role of circadian clocks in atherosclerosis, postmyocardial infarction inflammatory responses, and cardiac healing.
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Affiliation(s)
- Sabine Steffens
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
| | - Carla Winter
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
| | - Maximilian J. Schloss
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
| | - Andres Hidalgo
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
| | - Christian Weber
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
| | - Oliver Soehnlein
- From the Institute for Cardiovascular Prevention, Department of Medicine, Ludwig-Maximilians-University (LMU) Munich, Germany (S.S., C. Winter, M.J.S., A.H., C. Weber, O.S.); German Center for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Germany (S.S., C. Weber, O.S.); Fundación Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain (A.H.); Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands (C. Weber); and Department
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32
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Bulluck H, Nicholas J, Crimi G, White SK, Ludman AJ, Pica S, Raineri C, Cabrera-Fuentes HA, Yellon D, Rodriguez-Palomares J, Garcia-Dorado D, Hausenloy DJ. Circadian variation in acute myocardial infarct size assessed by cardiovascular magnetic resonance in reperfused STEMI patients. Int J Cardiol 2016; 230:149-154. [PMID: 28038815 PMCID: PMC5267633 DOI: 10.1016/j.ijcard.2016.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/15/2016] [Accepted: 12/16/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Clinical studies using serum cardiac biomarkers to investigate a circadian variation in acute myocardial infarct (MI) size in ST-segment elevation myocardial infarction (STEMI) patients reperfused by primary percutaneous coronary intervention (PPCI) have produced mixed results. We aimed to investigate this phenomenon using acute MI size measured by cardiovascular magnetic resonance (CMR). METHODS Patient-level data was obtained from 4 randomized controlled trials investigating the MI-limiting effects of cardioprotective therapies in this pooled analysis. The primary analysis was performed in those patients with no pre-infarct angina; duration of ischemia >60min and <360min; Thrombolysis In Myocardial Infarction (TIMI) flow pre-PPCI ≤1; TIMI flow post-PPCI 3; and no collateral flow. RESULTS 169 out of 376 patients with CMR data met the inclusion criteria for the primary analysis. A 24-hour circadian variation in acute MI size as a % of the area-at-risk (%AAR), after adjusting for confounders, was observed with a peak and nadir MI size in patients with symptom onset between 00:00 and 01:00 and between 12:00 and 13:00 respectively (difference from the average MI size 5.2%, 95%CI 1.1-9.4%; p=0.013). This was associated with a non-significant circadian variation in left ventricular ejection fraction (LVEF) (difference from the average LVEF 5.9%, 95%CI -0.6-2.2%, p=0.073). There was no circadian variation in MI size or LVEF in the whole cohort. CONCLUSIONS We report a circadian variation in acute MI size assessed by CMR in a subset of STEMI patients treated by PPCI, with the largest and smallest MI size occurring in patients with symptom onset between 00:00 and 01:00 and between 12:00 and 13:00 respectively.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | | | - Gabriele Crimi
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Steven K White
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK
| | - Andrew J Ludman
- Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK
| | - Silvia Pica
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy; Struttura Complessa Cardiologia, Azienda Ospedaliera SS: Antonio e Biagio, Alessandria, Italy
| | - Claudia Raineri
- Struttura Complessa Cardiologia, Fondazione Istituto Di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Hector A Cabrera-Fuentes
- Institute of Biochemistry, Medical School, Justus-Liebig-University, Giessen, Germany; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore
| | - Derek Yellon
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK
| | - Jose Rodriguez-Palomares
- Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - David Garcia-Dorado
- Cardiology Department, Vall d'Hebron Hospital, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, UK; The National Institute of Health Research University College London Hospitals Biomedical Research Centre, UK; National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore; Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore.
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Schloss MJ, Horckmans M, Nitz K, Duchene J, Drechsler M, Bidzhekov K, Scheiermann C, Weber C, Soehnlein O, Steffens S. The time-of-day of myocardial infarction onset affects healing through oscillations in cardiac neutrophil recruitment. EMBO Mol Med 2016; 8:937-48. [PMID: 27226028 PMCID: PMC4967945 DOI: 10.15252/emmm.201506083] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Myocardial infarction (MI) is the leading cause of death in Western countries. Epidemiological studies show acute MI to be more prevalent in the morning and to be associated with a poorer outcome in terms of mortality and recovery. The mechanisms behind this association are not fully understood. Here, we report that circadian oscillations of neutrophil recruitment to the heart determine infarct size, healing, and cardiac function after MI. Preferential cardiac neutrophil recruitment during the active phase (Zeitgeber time, ZT13) was paralleled by enhanced myeloid progenitor production, increased circulating numbers of CXCR2hi neutrophils as well as upregulated cardiac adhesion molecule and chemokine expression. MI at ZT13 resulted in significantly higher cardiac neutrophil infiltration compared to ZT5, which was inhibited by CXCR2 antagonism or neutrophil‐specific CXCR2 knockout. Limiting exaggerated neutrophilic inflammation at this time point significantly reduced the infarct size and improved cardiac function.
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Affiliation(s)
- Maximilian J Schloss
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Michael Horckmans
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Katrin Nitz
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany Max Delbrueck Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Johan Duchene
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Maik Drechsler
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany Department of Pathology, Amsterdam Medical Center (AMC), Amsterdam, The Netherlands
| | - Kiril Bidzhekov
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Christoph Scheiermann
- Walter-Brendel-Center of Experimental Medicine, Ludwig-Maximilians-University (LMU) Munich, Munich, Germany
| | - Christian Weber
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany Department of Pathology, Amsterdam Medical Center (AMC), Amsterdam, The Netherlands
| | - Sabine Steffens
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-University (LMU) Munich, Munich, Germany German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany
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34
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Fournier S, Muller O. Circadian aspects of myocardial infarction among young STEMI patients. Eur J Intern Med 2016; 27:e5-6. [PMID: 26297336 DOI: 10.1016/j.ejim.2015.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Accepted: 08/04/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Stephane Fournier
- Department of Cardiology, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland.
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35
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Rallidis LS, Triantafyllis AS, Varounis C, Rallidi M, Lekakis J. Circadian aspects of myocardial infarction among young STEMI patients. Eur J Intern Med 2016; 27:e7-8. [PMID: 26419581 DOI: 10.1016/j.ejim.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece.
| | | | - Christos Varounis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
| | - Maria Rallidi
- Department of Nutrition and Dietetics, Harokopio University, Athens, Greece
| | - Jonh Lekakis
- Second Department of Cardiology, University General Hospital Attikon, Athens, Greece
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Fournier S, Muller O. Commentary "Recent advances in circadian rhythms in cardiovascular system". Front Pharmacol 2015; 6:132. [PMID: 26167151 PMCID: PMC4481148 DOI: 10.3389/fphar.2015.00132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 06/15/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephane Fournier
- Department of Cardiology, University of Lausanne Hospital Center Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University of Lausanne Hospital Center Lausanne, Switzerland
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Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction. PLoS One 2015; 10:e0128526. [PMID: 26039059 PMCID: PMC4454698 DOI: 10.1371/journal.pone.0128526] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 04/29/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES There are conflicting data on the relationship between the time of symptom onset during the 24-hour cycle (circadian dependence) and infarct size in ST-elevation myocardial infarction (STEMI). Moreover, the impact of this circadian pattern of infarct size on clinical outcomes is unknown. We sought to study the circadian dependence of infarct size and its impact on clinical outcomes in STEMI. METHODS We studied 6,710 consecutive patients hospitalized for STEMI from 2006 to 2009 in a tropical climate with non-varying day-night cycles. We categorized the time of symptom onset into four 6-hour intervals: midnight-6:00 A.M., 6:00 A.M.-noon, noon-6:00 P.M. and 6:00 P.M.-midnight. We used peak creatine kinase as a surrogate marker of infarct size. RESULTS Midnight-6:00 A.M patients had the highest prevalence of diabetes mellitus (P = 0.03), more commonly presented with anterior MI (P = 0.03) and received percutaneous coronary intervention less frequently, as compared with other time intervals (P = 0.03). Adjusted mean peak creatine kinase was highest among midnight-6:00 A.M. patients and lowest among 6:00 A.M.-noon patients (2,590.8±2,839.1 IU/L and 2,336.3±2,386.6 IU/L, respectively, P = 0.04). Midnight-6:00 A.M patients were at greatest risk of acute heart failure (P<0.001), 30-day mortality (P = 0.03) and 1-year mortality (P = 0.03), while the converse was observed in 6:00 A.M.-noon patients. After adjusting for diabetes, infarct location and performance of percutaneous coronary intervention, circadian variations in acute heart failure incidence remained strongly significant (P = 0.001). CONCLUSION We observed a circadian peak and nadir in infarct size during STEMI onset from midnight-6:00A.M and 6:00A.M.-noon respectively. The peak and nadir incidence of acute heart failure paralleled this circadian pattern. Differences in diabetes prevalence, infarct location and mechanical reperfusion may account partly for the observed circadian pattern of infarct size and acute heart failure.
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Ethnic differences in the diurnal variation of symptom onset time for acute ST elevation myocardial infarction — An observational cohort study. Int J Cardiol 2015; 187:414-6. [DOI: 10.1016/j.ijcard.2015.03.371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 03/25/2015] [Indexed: 11/18/2022]
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Fournier S, Taffé P, Radovanovic D, Von Elm E, Morawiec B, Stauffer JC, Erne P, Beggah A, Monney P, Pascale P, Iglesias JF, Eeckhout E, Muller O. Myocardial infarct size and mortality depend on the time of day-a large multicenter study. PLoS One 2015; 10:e0119157. [PMID: 25760988 PMCID: PMC4356554 DOI: 10.1371/journal.pone.0119157] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 01/10/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Different studies have shown circadian variation of ischemic burden among patients with ST-Elevation Myocardial Infarction (STEMI), but with controversial results. The aim of this study was to analyze circadian variation of myocardial infarction size and in-hospital mortality in a large multicenter registry. METHODS This retrospective, registry-based study was based on data from AMIS Plus, a large multicenter Swiss registry of patients who suffered myocardial infarction between 1999 and 2013. Peak creatine kinase (CK) was used as a proxy measure for myocardial infarction size. Associations between peak CK, in-hospital mortality, and the time of day at symptom onset were modelled using polynomial-harmonic regression methods. RESULTS 6,223 STEMI patients were admitted to 82 acute-care hospitals in Switzerland and treated with primary angioplasty within six hours of symptom onset. Only the 24-hour harmonic was significantly associated with peak CK (p = 0.0001). The maximum average peak CK value (2,315 U/L) was for patients with symptom onset at 23:00, whereas the minimum average (2,017 U/L) was for onset at 11:00. The amplitude of variation was 298 U/L. In addition, no correlation was observed between ischemic time and circadian peak CK variation. Of the 6,223 patients, 223 (3.58%) died during index hospitalization. Remarkably, only the 24-hour harmonic was significantly associated with in-hospital mortality. The risk of death from STEMI was highest for patients with symptom onset at 00:00 and lowest for those with onset at 12:00. DISCUSSION As a part of this first large study of STEMI patients treated with primary angioplasty in Swiss hospitals, investigations confirmed a circadian pattern to both peak CK and in-hospital mortality which were independent of total ischemic time. Accordingly, this study proposes that symptom onset time be incorporated as a prognosis factor in patients with myocardial infarction.
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Affiliation(s)
- Stephane Fournier
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Patrick Taffé
- Institute for Social and Preventive Medicine, Lausanne, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Erik Von Elm
- Institute for Social and Preventive Medicine, Lausanne, Switzerland
| | - Beata Morawiec
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | | | - Paul Erne
- AMIS Plus Data Center, Institute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
| | - Ahmed Beggah
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Pierre Monney
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Patrizio Pascale
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | | | - Eric Eeckhout
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital Center (CHUV), Lausanne, Switzerland
- * E-mail:
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Mahmoud KD, Nijsten MW, Wieringa WG, Ottervanger JP, Holmes DR, Hillege HL, van 't Hof AW, Lipsic E. Independent association between symptom onset time and infarct size in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Chronobiol Int 2014; 32:468-77. [PMID: 25524145 DOI: 10.3109/07420528.2014.992527] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recent studies have reported on circadian variation in infarct size in ST-elevation myocardial infarction (STEMI) patients. Controversy remains as to whether this finding indicates circadian dependence of myocardial tolerance to ischemia/reperfusion injury or that it can simply be explained by confounding factors such as baseline profile and ischemic time. We assessed the clinical impact and independent association between symptom onset time and infarct size, accounting for possible subgroup differences. From a multicenter registry, 6799 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI) between 2004 and 2010 were included. Infarct size was measured using peak creatine kinase (CK). Infarct size exhibited circadian variation with largest infarct size in patients with symptom onset around 03:00 at night (estimated peak CK 1322 U/l; 95% confidence interval (CI): 1217-1436) and smallest infarct size around 11:00 in the morning (estimated peak CK 1071 U/l; 95% CI: 1001-1146; relative reduction 19%; p = 0.001). Circadian variation in infarct size followed an inverse pattern in patients with prior myocardial infarction (p-interaction <0.001) and prior PCI (p-interaction = 0.006), although the later did not persist in multivariable analysis. Symptom onset time remained associated with infarct size after accounting for these interactions and adjusting for baseline characteristics and ischemic time. Symptom onset time did not predict one-year mortality (p = 0.081). In conclusion, there is substantial circadian variation in infarct size, which cannot be fully explained by variations in baseline profile or ischemic time. Our results lend support to the hypothesis of circadian myocardial ischemic tolerance and suggest a different mechanism in patients with prior myocardial infarction.
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Affiliation(s)
- Karim D Mahmoud
- Department of Cardiology, Thorax Center, University of Groningen, University Medical Center Groningen , Groningen , The Netherlands
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Walsh CM, Blackwell T, Tranah GJ, Stone KL, Ancoli-Israel S, Redline S, Paudel M, Kramer JH, Yaffe K. Weaker circadian activity rhythms are associated with poorer executive function in older women. Sleep 2014; 37:2009-16. [PMID: 25337947 DOI: 10.5665/sleep.4260] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 07/03/2014] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Older adults and patients with dementia often have disrupted circadian activity rhythms (CARs). Disrupted CARs are associated with health declines and could affect cognitive aging. We hypothesized that among older women, weaker CARs would be associated with poorer cognitive function 5 y later. DESIGN Prospective observational study. SETTING Three US clinical sites. PARTICIPANTS There were 1,287 community-dwelling older women (82.8 ± 3.1 y) participating in an ongoing prospective study who were free of dementia at the baseline visit. MEASUREMENTS AND RESULTS Baseline actigraphy was used to determine CAR measures (amplitude, mesor, and rhythm robustness, analyzed as quartiles; acrophase analyzed by peak activity time < 13:34 and > 15:51). Five years later, cognitive performance was assessed with the Modified Mini-Mental Status Examination (3MS), California Verbal Learning Task (CVLT), digit span, Trail Making Test B (Trails B), categorical fluency, and letter fluency. We compared cognitive performance with CARs using analyses of covariance adjusted for a number of health factors and comorbidities. Women in the lowest quartile for CAR amplitude performed worse on Trails B and categorical fluency compared to women in the highest quartile (group difference (d) = 30.42 sec, d = -1.01 words respectively, P < 0.05). Women in the lowest quartile for mesor performed worse on categorical fluency (d = -0.86 words, P < 0.05). Women with a later acrophase performed worse on categorical fluency (d = -0.69 words, P < 0.05). Controlling for baseline Mini-Mental State Examination and sleep factors had little effect on our results. CONCLUSION Weaker circadian activity rhythm patterns are associated with worse cognitive function, especially executive function, in older women without dementia. Further investigation is required to determine the etiology of these relationships.
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Affiliation(s)
- Christine M Walsh
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA: San Francisco Veterans Administration, San Francisco, CA
| | - Terri Blackwell
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, CA
| | - Katie L Stone
- California Pacific Medical Center Research Institute, San Francisco, CA
| | | | - Susan Redline
- Harvard Medical School, Division of Sleep Medicine, Boston, MA: Department of Medicine, Brigham and Women's Hospital, Boston, MA: Division of Pulmonary Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Misti Paudel
- School of Public Health, University of Minnesota, Minneapolis, MN
| | - Joel H Kramer
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA: Department of Psychiatry, University of California, San Francisco, CA
| | - Kristine Yaffe
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA: San Francisco Veterans Administration, San Francisco, CA: Department of Psychiatry, University of California, San Francisco, CA
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Rotter D, Grinsfelder DB, Parra V, Pedrozo Z, Singh S, Sachan N, Rothermel BA. Calcineurin and its regulator, RCAN1, confer time-of-day changes in susceptibility of the heart to ischemia/reperfusion. J Mol Cell Cardiol 2014; 74:103-11. [PMID: 24838101 DOI: 10.1016/j.yjmcc.2014.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/25/2014] [Accepted: 05/06/2014] [Indexed: 12/01/2022]
Abstract
Many important components of the cardiovascular system display circadian rhythmicity. In both humans and mice, cardiac damage from ischemia/reperfusion (I/R) is greatest at the transition from sleep to activity. The causes of this window of susceptibility are not fully understood. In the murine heart we have reported high amplitude circadian oscillations in the expression of the cardioprotective protein regulator of calcineurin 1 (Rcan1). This study was designed to test whether Rcan1 contributes to the circadian rhythm in cardiac protection from I/R damage. Wild type (WT), Rcan1 KO, and Rcan1-Tg mice, with cardiomyocyte-specific overexpression of Rcan1, were subjected to 45min of myocardial ischemia followed by 24h of reperfusion. Surgeries were performed either during the first 2h (AM) or during the last 2h (PM) of the animal's light phase. The area at risk was the same for all genotypes at either time point; however, in WT mice, PM-generated infarcts were 78% larger than AM-generated infarcts. Plasma cardiac troponin I levels were likewise greater in PM-operated animals. In Rcan1 KO mice there was no significant difference between the AM- and PM-operated hearts, which displayed greater indices of damage similar to that of PM-operated WT animals. Mice with cardiomyocyte-specific overexpression of human RCAN1, likewise, showed no time-of-day difference, but had smaller infarcts comparable to those of AM-operated WT mice. In vitro, cardiomyocytes depleted of RCAN1 were more sensitive to simulated I/R and the calcineurin inhibitor, FK506, restored protection. FK506 also conferred protection to PM-infarcted WT animals. Importantly, transcription of core circadian clock genes was not altered in Rcan1 KO hearts. These studies identify the calcineurin/Rcan1-signaling cascade as a potential therapeutic target through which to benefit from innate circadian changes in cardiac protection without disrupting core circadian oscillations that are essential to cardiovascular, metabolic, and mental health.
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Affiliation(s)
- David Rotter
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - D Bennett Grinsfelder
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Valentina Parra
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Zully Pedrozo
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Sarvjeet Singh
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Nita Sachan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Beverly A Rothermel
- Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Department of Molecular Biology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Wieringa WG, Lexis CPH, Mahmoud KD, Ottervanger JP, Burgerhof JGM, Pundziute G, van ‘t Hof AWJ, van Gilst WH, Lipsic E. Time of symptom onset and value of myocardial blush and infarct size on prognosis in patients with ST-elevation myocardial infarction. Chronobiol Int 2014; 31:797-806. [DOI: 10.3109/07420528.2014.908897] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Klinkenberg LJJ, van Dijk JW, Tan FES, van Loon LJC, van Dieijen-Visser MP, Meex SJR. Circulating cardiac troponin T exhibits a diurnal rhythm. J Am Coll Cardiol 2014; 63:1788-95. [PMID: 24583293 DOI: 10.1016/j.jacc.2014.01.040] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 12/17/2013] [Accepted: 01/22/2014] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The goal of this study was to test the unverified assumption that chronically elevated cardiac troponin T (cTnT) levels fluctuate randomly around a homeostatic set point. BACKGROUND The introduction of high-sensitivity cardiac troponin (cTn) assays has improved sensitivity for acute myocardial infarction (AMI). However, many patients with a single positive cTn test result do not have AMI. Therefore, the diagnosis of AMI relies strongly on serial testing and interpretation of cTn kinetics. Essential in this regard is a profound understanding of the biological variation of cTn. METHODS Two studies were conducted to assess biological cTnT variation and to investigate the presence of a diurnal rhythm of cTnT. Study 1 comprised 23 male subjects with type 2 diabetes, with no acute cardiovascular disease. Serial venous blood samples were drawn over an 11-h period (8:30 am to 7:30 pm). In study 2, the presence of a diurnal cTnT rhythm was investigated by hourly sampling of 7 subjects from study 1 over 25 h. RESULTS In study 1, we observed a gradual decrease in cTnT concentrations during the day (24 ± 2%). This decrease was present in all participants and was most prominent in subjects with the highest baseline cTnT values (Pearson's R 0.93). Diurnal variation of cTnT, as assessed in study 2, was characterized by peak concentrations during morning hours (8:30 am, 17.1 ± 2.9 ng/l), gradually decreasing values during daytime (8:30 pm, 11.9 ± 1.6 ng/l), and rising concentrations during nighttime (8:30 am the next day, 16.9 ± 2.8 ng/l). CONCLUSIONS A diurnal cTnT rhythm substantiates the recommendation that all dynamic changes in cTnT should be interpreted in relation to the clinical presentation. Epidemiological studies and risk-stratification protocols with the use of cTnT may benefit from standardized sampling times. (Exercise and Glycemic Control in Type 2 Diabetes; NCT00945165).
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Affiliation(s)
- Lieke J J Klinkenberg
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Jan-Willem van Dijk
- Department of Human Movement Sciences, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Frans E S Tan
- Department of Methodology and Statistics, Maastricht University, Maastricht, the Netherlands
| | - Luc J C van Loon
- Department of Human Movement Sciences, School for Nutrition, Toxicology and Metabolism (NUTRIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Marja P van Dieijen-Visser
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands
| | - Steven J R Meex
- Department of Clinical Chemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC), Maastricht, the Netherlands.
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Karmarkar SW, Tischkau SA. Influences of the circadian clock on neuronal susceptibility to excitotoxicity. Front Physiol 2013; 4:313. [PMID: 24204346 PMCID: PMC3817863 DOI: 10.3389/fphys.2013.00313] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 10/12/2013] [Indexed: 11/13/2022] Open
Abstract
Stroke is the third leading cause of death and the primary cause of morbidity in the United States, thus posing an enormous burden on the healthcare system. The factors that determine the risk of an individual toward precipitation of an ischemic event possess a strong circadian component as does the ischemic event itself. This predictability provided a window of opportunity toward the development of chronopharmaceuticals which provided much better clinical outcomes. Experiments from our lab showed for the first time that neuronal susceptibility to ischemic events follows a circadian pattern; hippocampal neurons being most susceptible to an ischemic insult occurring during peak activity in a rodent model of global cerebral ischemia. We also demonstrated that the SCN2.2 cells (like their in vivo counterpart) are resistant to excitotoxicity by glutamate and that this was dependent on activation of ERK signaling. We are currently working on elucidating the complete neuroprotective pathway that provides a barricade against glutamate toxicity in the SCN2.2 cells. Our future experiments will be engaged in hijacking the neuroprotective mechanism in the SCN2.2 cells and applying it to glutamate-susceptible entities in an effort to prevent their death in the presence of excitotoxicity. Despite the advancement in chronopharmaceuticals, optimal clinical outcome with minimal adverse events are difficult to come by at an affordable price. Superior treatment options require a better understanding of molecular mechanisms that define the disease, including the role of the circadian clock.
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Affiliation(s)
- Sumedha W Karmarkar
- Department of Pharmacology, Southern Illinois University School of Medicine Springfield, IL, USA
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46
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Fournier S, Puricel S, Morawiec B, Eeckhout E, Mangiacapra F, Trana C, Tapponnier M, Iglesias JF, Michiels V, Stauffer JC, Beggah A, Monney P, Gobet S, Vogt P, Cook S, Muller O. Relationship between time of day and periprocedural myocardial infarction after elective angioplasty. Chronobiol Int 2013; 31:206-13. [DOI: 10.3109/07420528.2013.839561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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47
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Suzuki S, Ishii H, Ichimiya S, Kanashiro M, Watanabe J, Uchida Y, Yoshikawa D, Maeda K, Matsubara T, Murohara T. Impact of the circadian rhythm on microvascular function in patients with ST-elevation myocardial infarction. Int J Cardiol 2013; 168:4948-9. [DOI: 10.1016/j.ijcard.2013.07.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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Fijorek K, Puskulluoglu M, Polak S. Circadian models of serum potassium, sodium, and calcium concentrations in healthy individuals and their application to cardiac electrophysiology simulations at individual level. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:429037. [PMID: 24078832 PMCID: PMC3775438 DOI: 10.1155/2013/429037] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/25/2013] [Indexed: 11/17/2022]
Abstract
In the article a brief description of the biological basis of the regulation of human biological clocks was presented in order to introduce the role of circadian rhythms in physiology and specifically in the pharmacological translational tools based on the computational physiology models to motivate the need to provide models of circadian fluctuation in plasma cations. The main aim of the study was to develop statistical models of the circadian rhythm of potassium, sodium, and calcium concentrations in plasma. The developed ion models were further tested by assessing their influence on QT duration (cardiac endpoint) as simulated by the biophysically detailed models of human left ventricular cardiomyocyte. The main results are model equations along with an electronic supplement to the article that contains a fully functional implementation of all models.
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Affiliation(s)
- Kamil Fijorek
- Department of Statistics, Cracow University of Economics, 27 Rakowicka Street, 31-510 Krakow, Poland
| | - Miroslawa Puskulluoglu
- Department of Oncology, Jagiellonian University Medical College, 20 Grzegorzecka Street, 31-531 Krakow, Poland
| | - Sebastian Polak
- Unit of Pharmacoepidemiology and Pharmacoeconomics, Faculty of Pharmacy, Jagiellonian University Medical College, Medyczna 9 Street, 30-688 Krakow, Poland
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Ammirati E, Maseri A, Cannistraci CV. Still Need for Compelling Evidence to Support the Circadian Dependence of Infarct Size After ST-Elevation Myocardial Infarction. Circ Res 2013; 113:e43-4. [DOI: 10.1161/circresaha.113.301908] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Enrico Ammirati
- Cardiovascular Department, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy
| | | | - Carlo V. Cannistraci
- Computational Bioscience Research Center, King Abdullah University for Science and Technology (KAUST), Thuwal, Kingdom of Saudi Arabia
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50
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Fournier S, Taffé P, Muller O. Ischemic Burden in ST Elevation Myocardial Infarction and Circadian Rhythms. Circ Res 2013; 113:e42. [DOI: 10.1161/circresaha.113.301883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Olivier Muller
- Department of Cardiology, University of Lausanne Hospital Center (CHUV), Lausanne, Switzerland
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