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Molinaro A, Nemet I, Bel Lassen P, Chakaroun R, Nielsen T, Aron-Wisnewsky J, Bergh PO, Li L, Henricsson M, Køber L, Isnard R, Helft G, Stumvoll M, Pedersen O, Smith JG, Tang WHW, Clément K, Hazen SL, Bäckhed F. Microbially Produced Imidazole Propionate Is Associated With Heart Failure and Mortality. JACC. HEART FAILURE 2023; 11:810-821. [PMID: 37115134 DOI: 10.1016/j.jchf.2023.03.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/01/2023] [Accepted: 03/16/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Over the past years, it has become clear that the microbial ecosystem in the gut has a profound capacity to interact with the host through the production of a wide range of bioactive metabolites. The microbially produced metabolite imidazole propionate (ImP) is clinically and mechanistically linked with insulin resistance and type 2 diabetes, but it is unclear how ImP is associated with heart failure. OBJECTIVES The authors aimed to explore whether ImP is associated with heart failure and mortality. METHODS ImP serum measurements in 2 large and independent clinical cohorts of patients (European [n = 1,985] and North American [n = 2,155]) with a range of severity of cardiovascular disease including heart failure. Univariate and multivariate Cox regression analyses were performed to delineate the impact of ImP on 5-year mortality in the North American cohort, independent of other covariates. RESULTS ImP is independently associated with reduced ejection fraction and heart failure in both cohorts, even after adjusting for traditional risk factors. Elevated ImP was a significant independent predictor of 5-year mortality (for the highest quartile, adjusted HR: 1.85 [95% CI: 1.20-2.88]; P < 0.01). CONCLUSIONS The gut microbial metabolite ImP is increased in individuals with heart failure and is a predictor of overall survival.
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Affiliation(s)
- Antonio Molinaro
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Medicine, Gothenburg, Sweden
| | - Ina Nemet
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio, USA; Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Pierre Bel Lassen
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics), Paris, France; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Rima Chakaroun
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden; Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Trine Nielsen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Judith Aron-Wisnewsky
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics), Paris, France; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Per-Olof Bergh
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden
| | - Lin Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio, USA; Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marcus Henricsson
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden
| | - Lars Køber
- Department of Cardiology, Rigshospialet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Richard Isnard
- Assistance Publique Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Cardiology Department, Paris, France
| | - Gerard Helft
- Sorbonne Université, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Michael Stumvoll
- Medical Department III-Endocrinology, Nephrology, Rheumatology, University of Leipzig Medical Center, Leipzig, Germany
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - J Gustav Smith
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden; Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden; Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
| | - W H Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio, USA; Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Karine Clément
- Sorbonne Université, INSERM, Nutrition and Obesities: Systemic Approaches (NutriOmics), Paris, France; Assistance Publique Hôpitaux de Paris, Pitie-Salpêtrière Hospital, Nutrition Department, Paris, France
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland, Ohio, USA; Center for Microbiome and Human Health, Cleveland Clinic, Cleveland, Ohio, USA; Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Fredrik Bäckhed
- Wallenberg Laboratory, Department of Molecular and Clinical Medicine and Sahlgrenska Center for Cardiovascular and Metabolic Research, University of Gothenburg, Gothenburg, Sweden; Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Region Västra Götaland, Sahlgrenska University Hospital, Department of Clinical Physiology, Gothenburg, Sweden.
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Romano KA, Nemet I, Prasad Saha P, Haghikia A, Li XS, Mohan ML, Lovano B, Castel L, Witkowski M, Buffa JA, Sun Y, Li L, Menge CM, Demuth I, König M, Steinhagen-Thiessen E, DiDonato JA, Deb A, Bäckhed F, Tang WHW, Naga Prasad SV, Landmesser U, Van Wagoner DR, Hazen SL. Gut Microbiota-Generated Phenylacetylglutamine and Heart Failure. Circ Heart Fail 2023; 16:e009972. [PMID: 36524472 PMCID: PMC9851997 DOI: 10.1161/circheartfailure.122.009972] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/20/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The gut microbiota-dependent metabolite phenylacetylgutamine (PAGln) is both associated with atherothrombotic heart disease in humans, and mechanistically linked to cardiovascular disease pathogenesis in animal models via modulation of adrenergic receptor signaling. METHODS Here we examined both clinical and mechanistic relationships between PAGln and heart failure (HF). First, we examined associations among plasma levels of PAGln and HF, left ventricular ejection fraction, and N-terminal pro-B-type natriuretic peptide in 2 independent clinical cohorts of subjects undergoing coronary angiography in tertiary referral centers (an initial discovery US Cohort, n=3256; and a validation European Cohort, n=829). Then, the impact of PAGln on cardiovascular phenotypes relevant to HF in cultured cardiomyoblasts, and in vivo were also examined. RESULTS Circulating PAGln levels were dose-dependently associated with HF presence and indices of severity (reduced ventricular ejection fraction, elevated N-terminal pro-B-type natriuretic peptide) independent of traditional risk factors and renal function in both cohorts. Beyond these clinical associations, mechanistic studies showed both PAGln and its murine counterpart, phenylacetylglycine, directly fostered HF-relevant phenotypes, including decreased cardiomyocyte sarcomere contraction, and B-type natriuretic peptide gene expression in both cultured cardiomyoblasts and murine atrial tissue. CONCLUSIONS The present study reveals the gut microbial metabolite PAGln is clinically and mechanistically linked to HF presence and severity. Modulating the gut microbiome, in general, and PAGln production, in particular, may represent a potential therapeutic target for modulating HF. REGISTRATION URL: https://clinicaltrials.gov/; Unique identifier: NCT00590200 and URL: https://drks.de/drks_web/; Unique identifier: DRKS00020915.
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Affiliation(s)
- Kymberleigh A Romano
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Ina Nemet
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Prasenjit Prasad Saha
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Arash Haghikia
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; German Center for Cardiovascular Research, Partner Site Berlin, Germany; and Berlin Institute of Health, Germany (A.H., U.L.)
| | - Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Maradumane L Mohan
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Beth Lovano
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Laurie Castel
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Marco Witkowski
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Jennifer A Buffa
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Yu Sun
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Lin Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Christopher M Menge
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Ilja Demuth
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Charitéplatz, Germany (I.D., M.K., E.S.-T.)
- Berlin Institute of Health Center for Regenerative Therapies, Germany (I.D.)
| | - Maximilian König
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Charitéplatz, Germany (I.D., M.K., E.S.-T.)
| | - Elisabeth Steinhagen-Thiessen
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Charitéplatz, Germany (I.D., M.K., E.S.-T.)
| | - Joseph A DiDonato
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Arjun Deb
- Division of Cardiology and Department of Medicine, David Geffen School of Medicine, University of California Los Angeles (A.D.)
| | - Fredrik Bäckhed
- Department of Molecular and Clinical Medicine, Wallenberg Laboratory, Institute of Medicine, University of Gothenburg, Sweden (F.B.)
| | - W H Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.)
| | - Sathyamangla Venkata Naga Prasad
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Ulf Landmesser
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Germany; German Center for Cardiovascular Research, Partner Site Berlin, Germany; and Berlin Institute of Health, Germany (A.H., U.L.)
| | - David R Van Wagoner
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, OH (K.A.R., I.N., P.P.S., A.H., X.S.L., M.L.M., B.L., L.C., M.W., J.A.B., Y.S., L.L., C.M.M., J.A.D., W.H.W.T., S.V.N.P., D.R.V.W., S.L.H.)
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (W.H.W.T., S.L.H.)
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Comparison of the red blood cell indices based on accuracy, sensitivity, and specificity to predict one-year mortality in heart failure patients. BMC Cardiovasc Disord 2022; 22:532. [PMID: 36476214 PMCID: PMC9727904 DOI: 10.1186/s12872-022-02987-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Various investigations have specified the role of each RBC indices separately [including hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW)] to predict the prognosis of acute heart failure (AHF) patients. However, in the current study, these variables were compared based on accuracy, sensitivity, and specificity to determine the best prognostic factor. METHODS Of 734 heart failure patients referred to the emergency department, 400 cases were enrolled based on the inclusion and exclusion criteria. Data of them were documented, and patients were followed for one year. Eventually, the association of clinical variables and RBC indices with one-year mortality was explored. RESULTS The study included 226 (56%) men and 174 (44%) women with a median age of 66 years. Body Mass Index (HR 1.098, p = 0.016), Hb (HR 0.728, p = 0.024), HTC (HR 0.875, p = 0.066), MCHC (HR 0.795, p = 0.037), and RDW-CV (HR 1.174, p = 0.006) were confirmed as predictors of long-term mortality. Despite confirming the predictive role of these variables by ROC curves, their sensitivity and specificity were reported as follows: [72% and 50% for Hb], [75% and 52% for HCT], [88% and 27% for MCHC], and [49% and 81% for RDW]. In addition, stratified groups of patients, based on normal cut-off values obtained from scientific literature, had significantly different survival in Kaplan-Meier analyses. CONCLUSION Whilst proving the predictive role of Hb, HCT, MCHC, and RDW in AHF patients, the most sensitive measurement was MCHC and the most specific one was RDW; therefore, these variables should be considered for risk stratification purposes of AHF patients in daily clinical practice.
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Clinical and Laboratory Biomarkers in Paroxysmal Atrial Fibrillation: A Single Center Cross-Sectional Study. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7012377. [PMID: 35845733 PMCID: PMC9259273 DOI: 10.1155/2022/7012377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 11/18/2022]
Abstract
The clinical risk profile of paroxysmal atrial fibrillation (pAF) patients is inconclusive. We aimed to identify clinical and laboratory biomarkers in patients with pAF and the differences in biomarkers among genders. A cross-sectional study was conducted with a total of 181 participants in a single center in Beijing Anzhen Hospital. The participants were grouped according to the presence of pAF and sex differences, and clinical and laboratory results were collected and compared. The 181 participants had a mean age of 52.9 ± 15.1 years (pAF group, 60.4 ± 9.9 years, SR group, 48.3 ± 15.9 years, P < 0.05). Patients with pAF had significantly higher rates of age, left atrial (LA) diameter, haemoglobin (Hb) levels, tissue inhibitor of metalloproteinase-1 (TIMP-1), soluble tumour suppressor-2 (sST2), B-type natriuretic peptide (BNP) and indirect bilirubin (Ibil), mean haemoglobin concentration (MCHC), and hypertension (HTN) and smoking (P < 0.05). Multivariable logistic regression analysis revealed that age (OR = 1.075, 95% CI: 1.035–1.118, P < 0.0001), smoking (OR = 4.538, 95% CI: 1.559–13.205, P = 0.006), and MCHC (OR = 1.062, 95% CI: 1.019–1.106, P = 0.004) were independent predictive factors for pAF. Multivariable logistic regression analysis found that age (OR = 1.107, 95% CI: 1.016–1.206, P = 0.02) and Ibil level (OR = 2.303, 95% CI: 1.158–4.582, P = 0.017) were independent predictive factors of the occurrence of pAF in females; BNP (OR = 1.015, 95% CI: 1.002–1.029, P = 0.029) was an independent predictive variable of pAF in males. Age, smoking, and MCHC were independent predictive factors of pAF. BNP was an independent predictive biomarker of pAF in males, while in females, age and Ibil were independent predictive factors.
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Ruan Z, Li D, Hu Y, Qiu Z, Chen X. The Association Between Mean Corpuscular Hemoglobin Concentration and Prognosis in Patients with Acute Pulmonary Embolism: A Retrospective Cohort Study. Clin Appl Thromb Hemost 2022; 28:10760296221103867. [PMID: 35642292 PMCID: PMC9163730 DOI: 10.1177/10760296221103867] [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] [Indexed: 01/02/2023] Open
Abstract
Introduction Acute pulmonary embolism (APE) is a typical cardiovascular emergency worldwide. Mean hemoglobin concentration (MCHC) is a standard indicator of anemia. Studies on the association between MCHC and APE are scarce. We aimed to investigate the relationship between MCHC and APE. Methods Clinical data were extracted from the Medical Information Bank for Intensive Care (MIMIC)-III. Adult (≥18 years) patients with APE admitted for the first time were included in this study. An analysis was conducted to evaluate the association between MCHC and the prognosis of patients by the Cox regression analysis, generalized additives models and Kaplan–Meier survival curves. The primary outcome was 30-day mortality, and the secondary outcomes were 1-year and 3-year mortality. Results A total of 813 patients who met the selection criteria were enrolled, of whom 130 (16.0%) died within 30 days of admission. Univariate Cox regression indicated that MCHC was significantly associated with mortality (30-day: HR = 0.74, 95% CI = 0.66–0.82, P < 0.001; 1-year: HR = 0.80, 95% CI = 0.74–0.86, P < 0.001; 3-year: HR = 0.82, 95% CI = 0.77–0.88, P < 0.001). MCHC remains stable after adjusting multiple models. Kaplan-Meier survival curves showed that patients with lower MCHC had a poorer 30-day prognosis. Conclusions Lower MCHC is an independent risk factor for increased mortality in patients with APE. As an inexpensive biomarker, MCHC should receive more attention.
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Affiliation(s)
- Zhishen Ruan
- The First Clinical College, 74738Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Dan Li
- The First Clinical College, 74738Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Yuanlong Hu
- The First Clinical College, 74738Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Zhanjun Qiu
- Department of Pulmonary and Critical Care Medicine, 159393The First Affiliated Hospital of Shandong Chinese Medical University, Ji Nan, People's Republic of China
| | - Xianhai Chen
- Department of Pulmonary and Critical Care Medicine, 159393The First Affiliated Hospital of Shandong Chinese Medical University, Ji Nan, People's Republic of China
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Yamaguchi S, Hamano T, Oka T, Doi Y, Kajimoto S, Shimada K, Matsumoto A, Sakaguchi Y, Matsui I, Suzuki A, Isaka Y. Mean corpuscular hemoglobin concentration: an anemia parameter predicting cardiovascular disease in incident dialysis patients. J Nephrol 2021; 35:535-544. [PMID: 34213761 DOI: 10.1007/s40620-021-01107-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Hemoglobin levels usually decline before dialysis initiation. The influence of overhydration on anemia progression and iron sequestration is poorly documented. Furthermore, clinical implications of anemia at dialysis initiation remain to be elucidated. METHODS This multicenter retrospective cohort study enrolled incident dialysis patients. The patients were stratified by tertiles of overhydration rate (OH-R) defined by (BW - DW)/DW*100 (BW: body weight just before dialysis initiation, DW: dry weight). Time courses (6 months before, to 1 month after, dialysis initiation) of hemoglobin, C-reactive protein (CRP), and iron sequestration index (ISI) were examined using mixed effects models. We used Cox models to identify anemia parameters predicting subsequent cardiovascular disease (CVD). RESULTS Among the 905 enrolled patients, hemoglobin levels gradually decreased before dialysis initiation and rapidly increased thereafter. An inverse V-shaped time course was observed for CRP and ISI with an increase during dialysis initiation. Patients with a higher OH-R showed lower hemoglobin levels along with higher CRP and ISI levels before dialysis initiation. Mean corpuscular hemoglobin concentration (MCHC) was more stable before dialysis initiation than were mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH). Low MCHC (< 32 g/dL) was independently associated with the incidence of nonatherosclerotic CVD. Patients with low MCHC tended to have increased left ventricular wall thickness and left atrial diameter. CONCLUSIONS Progression of anemia before dialysis among overhydrated patients may mainly occur through hemodilution and iron sequestration partly induced by inflammation. Low MCHC reflects left atrial overload and left ventricular hypertrophy and hence may predict nonatherosclerotic CVD.
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Affiliation(s)
- Satoshi Yamaguchi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Takayuki Hamano
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan. .,Department of Nephrology, Nagoya City University Graduate School of Medical Sciences, 1-Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8602, Japan.
| | - Tatsufumi Oka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yohei Doi
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Sachio Kajimoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Karin Shimada
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ayumi Matsumoto
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yusuke Sakaguchi
- Department of Inter-Organ Communication Research in Kidney Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Isao Matsui
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akira Suzuki
- Department of Internal Medicine, Japan Community Health care Organization Osaka Hospital, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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7
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Sato K, Inoue S, Ishibashi Y, Ota T, Murano H, Furuyama K, Yang S, Machida H, Nakano H, Sato M, Nemoto T, Nishiwaki M, Yamauchi K, Igarashi A, Watanabe M. Association between low mean corpuscular hemoglobin and prognosis in patients with exacerbation of chronic obstructive pulmonary disease. Respir Investig 2021; 59:498-504. [PMID: 33642232 DOI: 10.1016/j.resinv.2021.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/20/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several studies have demonstrated the association between mean corpuscular hemoglobin concentration (MCHC), a hematological index used for the assessment of anemia, and the prognosis of patients with heart disease. While the red cell distribution width (RDW) is known to be related to the prognosis of patients with chronic obstructive pulmonary disease (COPD), few studies have focused on the association between the MCHC and COPD. Therefore, we examined the association between the MCHC and prognosis in patients with exacerbation of COPD. METHODS We examined the association between the 30-day mortality and clinical findings in patients with COPD exacerbation who were hospitalized between October 2008 and December 2018. RESULTS We enrolled 195 patients with COPD exacerbation (average age: 76.4 years; 181 men, 14 women). The MCHC was significantly lower, while the RDW was significantly higher in the 27 patients (13.8%) who died during the 30-day observation period compared to those in the patients who survived. Multivariate logistic regression analysis revealed that the MCHC was independently associated with 30-day mortality. The area under the curve calculated from the MCHC obtained from peripheral blood was 0.688 and the cutoff value was 31.6 g/dL, with a sensitivity of 0.593 and specificity of 0.810 (p = 0.0001). CONCLUSION The MCHC might be a valuable biomarker for evaluating the prognosis of patients with COPD exacerbation.
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Affiliation(s)
- Kento Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sumito Inoue
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan.
| | - Yu Ishibashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takahito Ota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroaki Murano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Kodai Furuyama
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Sujeong Yang
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroyoshi Machida
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Nakano
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masamichi Sato
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Takako Nemoto
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiko Nishiwaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Keiko Yamauchi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Akira Igarashi
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Masafumi Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University Faculty of Medicine, Yamagata, Japan
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8
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Kleber M, Kozhuharov N, Sabti Z, Glatz B, Isenreich R, Wussler D, Nowak A, Twerenbold R, Badertscher P, Puelacher C, du Fay de Lavallaz J, Nestelberger T, Boeddinghaus J, Wildi K, Flores D, Walter J, Rentsch K, von Eckardstein A, Goudev A, Breidthardt T, Mueller C. Relative hypochromia and mortality in acute heart failure. Int J Cardiol 2019; 286:104-110. [PMID: 30853296 DOI: 10.1016/j.ijcard.2019.02.060] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 02/07/2019] [Accepted: 02/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Relative hypochromia of erythrocytes defined as a reduced mean corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We aimed to evaluate the prevalence and prognostic impact of relative hypochromia in acute heart failure (AHF). METHODS We prospectively characterized 1574 patients presenting with an adjudicated diagnosis of AHF to the emergency department. Relative hypochromia was defined as a MCHC ≤330 g/l and determined at presentation. The presence of AHF was adjudicated by two independent cardiologists. All-cause mortality and AHF-rehospitalization were the primary prognostic end-points. RESULTS Overall, 455 (29%) AHF patients had relative hypochromia. Patients with relative hypochromia had higher hemodynamic cardiac stress as quantified by NT-proBNP concentrations (p < 0.001), more extensive cardiomyocyte injury as quantified by high-sensitive cardiac troponin T (hs-cTnT) concentrations (p < 0.001), and lower estimated glomerular filtration rate (eGFR; p < 0.001) as compared to AHF patients without hypochromia. Cumulative incidences for all-cause mortality and AHF-rehospitalization at 720-days were 50% and 55% in patients with relative hypochromia as compared to 33% and 39% in patients without hypochromia, respectively (both p < 0.0001). The association between relative hypochromia and increased mortality (HR 1.7, 95% CI 1.4-2-0) persisted after adjusting for anemia (HR 1.5, 95% CI 1.3-1.8), and after adjusting for hemodynamic cardiac stress (HR 1.46, 95% CI 1.21-1.76) and eGFR (HR 1.5, 95% CI 1.3-1.8, p < 0.001). CONCLUSIONS Relative hypochromia is common and a strong and independent predictor of increased mortality in AHF. Given the direct link to diagnostic (endoscopy) and therapeutic interventions to treat functional iron deficiency, relative hypochromia deserves increased attention as an inexpensive and universally available biomarker.
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Affiliation(s)
- Martina Kleber
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Hematology, University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Zaid Sabti
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Bettina Glatz
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Rahel Isenreich
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Desiree Wussler
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Albina Nowak
- Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Christian Puelacher
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland
| | - Jasper Boeddinghaus
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Karin Wildi
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Critical Care Research Group, The Prince Charles Hospital and the University of Queensland, Brisbane, Australia
| | - Dayana Flores
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Joan Walter
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Switzerland
| | | | | | - Tobias Breidthardt
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland; Department of Internal Medicine, University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Switzerland.
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9
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Goh VJ, Tromp J, Teng THK, Tay WT, Van Der Meer P, Ling LH, Siswanto BB, Hung CL, Shimizu W, Zhang S, Narasimhan C, Yu CM, Park SW, Ngarmukos T, Liew HB, Reyes E, Yap J, MacDonald M, Richards MA, Anand I, Lam CSP. Prevalence, clinical correlates, and outcomes of anaemia in multi-ethnic Asian patients with heart failure with reduced ejection fraction. ESC Heart Fail 2018; 5:570-578. [PMID: 29604185 PMCID: PMC6073031 DOI: 10.1002/ehf2.12279] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 12/14/2022] Open
Abstract
Aims Recent international heart failure (HF) guidelines recognize anaemia as an important comorbidity contributing to poor outcomes in HF, based on data mainly from Western populations. We sought to determine the prevalence, clinical correlates, and prognostic impact of anaemia in patients with HF with reduced ejection fraction across Asia. Methods and results We prospectively studied 3886 Asian patients (60 ± 13 years, 21% women) with HF (ejection fraction ≤40%) from 11 regions in the Asian Sudden Cardiac Death in Heart Failure study. Anaemia was defined as haemoglobin <13 g/dL (men) and <12 g/dL (women). Ethnic groups included Chinese (33.0%), Indian (26.2%), Malay (15.1%), Japanese/Korean (20.2%), and others (5.6%). Overall, anaemia was present in 41%, with a wide range across ethnicities (33–54%). Indian ethnicity, older age, diabetes, and chronic kidney disease were independently associated with higher odds of anaemia (all P < 0.001). Ethnicity modified the association of chronic kidney disease with anaemia (Pinteraction = 0.045), with the highest adjusted odds among Japanese/Koreans [2.86; 95% confidence interval (CI) 1.96–4.20]. Anaemic patients had lower Kansas City Cardiomyopathy Questionnaire scores (P < 0.001) and higher risk of all‐cause mortality and HF hospitalization at 1 year (hazard ratio = 1.28, 95% CI 1.08–1.50) compared with non‐anaemic patients. The prognostic impact of anaemia was modified by ethnicity (Pinteraction = 0.02), with the greatest hazard ratio in Japanese/Koreans (1.82; 95% CI 1.14–2.91). Conclusions Anaemia is present in a third to more than half of Asian patients with HF and adversely impacts quality of life and survival. Ethnic differences exist wherein prevalence is highest among Indians, and survival is most severely impacted by anaemia in Japanese/Koreans.
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Affiliation(s)
| | - Jasper Tromp
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Peter Van Der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bambang B Siswanto
- National Cardiovascular Center Universitas Indonesia, Jakarta, Indonesia
| | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shu Zhang
- Fuwai Cardiovascular Hospital, Beijing, China
| | | | | | | | | | - Houng Bang Liew
- Queen Elizabeth II Hospital, Clinical Research Center, Sabah, Malaysia
| | | | | | | | - Mark A Richards
- National University Heart Centre, Singapore.,Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Inder Anand
- Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Carolyn S P Lam
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.,National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
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