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Grodecki K, Olasińska-Wiśniewska A, Cyran A, Urbanowicz T, Kwieciński J, Geers J, Tamarappoo BK, Perek B, Gocoł R, Nawara-Skipirzepa J, Jemielity M, Kochman J, Wojakowski W, Górnicka B, Slomka PJ, Jilaihawi H, Makkar RR, Huczek Z, Dey D, Panzer A. Quantification of Aortic Valve Fibrotic and Calcific Tissue from CTA: Prospective Comparison with Histology. Radiology 2024; 312:e240229. [PMID: 39136569 PMCID: PMC11366676 DOI: 10.1148/radiol.240229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/12/2024] [Accepted: 04/19/2024] [Indexed: 09/04/2024]
Abstract
Background Quantifying the fibrotic and calcific composition of the aortic valve at CT angiography (CTA) can be useful for assessing disease severity and outcomes of patients with aortic stenosis (AS); however, it has not yet been validated against quantitative histologic findings. Purpose To compare quantification of aortic valve fibrotic and calcific tissue composition at CTA versus histologic examination. Materials and Methods This prospective study included patients who underwent CTA before either surgical aortic valve replacement for AS or orthotopic heart transplant (controls) at two centers between January 2022 and April 2023. At CTA, fibrotic and calcific tissue composition were quantified using automated Gaussian mixture modeling applied to the density of aortic valve tissue components, calculated as [(volume/total tissue volume) × 100]. For histologic evaluation, explanted valve cusps were stained with Movat pentachrome as well as hematoxylin and eosin. For each cusp, three 5-µm slices were obtained. Fibrotic and calcific tissue composition were quantified using a validated artificial intelligence tool and averaged across the aortic valve. Correlations were assessed using the Spearman rank correlation coefficient. Intermodality and interobserver variability were measured using the intraclass correlation coefficient (ICC) and Bland-Altman plots. Results Twenty-nine participants (mean age, 63 years ± 10 [SD]; 23 male) were evaluated: 19 with severe AS, five with moderate AS, and five controls. Fibrocalcific tissue composition strongly correlated with histologic findings (r = 0.92; P < .001). The agreement between CTA and histologic findings for fibrocalcific tissue quantification was excellent (ICC, 0.94; P = .001), with underestimation of fibrotic composition at CTA (bias, -4.9%; 95% limits of agreement [LoA]: -18.5%, 8.7%). Finally, there was excellent interobserver repeatability for fibrotic (ICC, 0.99) and calcific (ICC, 0.99) aortic valve tissue volume measurements, with no evidence of a difference in measurements between readers (bias, -0.04 cm3 [95% LoA: -0.27 cm3, 0.19 cm3] and 0.02 cm3 [95% LoA: -0.14 cm3, 0.19 cm3], respectively). Conclusion In a direct comparison, standardized quantitative aortic valve tissue characterization at CTA showed excellent concordance with histologic findings and demonstrated interobserver reproducibility. Clinical trial registration no. NCT06136689 Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Almeida in this issue.
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Affiliation(s)
- Kajetan Grodecki
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Anna Olasińska-Wiśniewska
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Agata Cyran
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Tomasz Urbanowicz
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Jacek Kwieciński
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Jolien Geers
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Balaji K. Tamarappoo
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Bartłomiej Perek
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Radosław Gocoł
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Joanna Nawara-Skipirzepa
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Marek Jemielity
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Janusz Kochman
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Wojciech Wojakowski
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Barbara Górnicka
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Piotr J. Slomka
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Hasan Jilaihawi
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | - Raj R. Makkar
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
| | | | | | - Ariane Panzer
- From the First Department of Cardiology (K.G., J. Kochman, Z.H.) and
Department of Pathology (A.C., B.G.), Medical University of Warsaw, Warsaw,
Poland; Departments of Biomedical Sciences and Medicine, Biomedical Imaging
Research Institute, Cedars-Sinai Medical Center, 116 N Robertson Blvd, Suite
400, Los Angeles, CA 90048 (K.G., J.G., P.J.S., D.D.); Department of Cardiac
Surgery and Transplantology, Poznan University of Medical Sciences, Poznan,
Poland (A.O.W., T.U., B.P., M.J.); Department of Interventional Cardiology and
Angiology, Institute of Cardiology, Warsaw, Poland (J. Kwieciński);
Department of Cardiology, Centrum voor Hart- en Vaatziekten, Universitair
Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium (J.G.);
Department of Cardiology, Banner University Medical Center, Indianapolis, Ind
(B.K.T.); Department of Cardiac Surgery (R.G.) and Division of Cardiology and
Structural Heart Diseases (J.N.S., W.W.), Medical University of Silesia,
Katowice, Poland; and Smidt Heart Institute, Cedars-Sinai Medical Center, Los
Angeles, Calif (H.J., R.R.M.)
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Li Q, Li P, Xu Z, Lu Z, Yang C, Ning J. Association of diabetes with cardiovascular calcification and all-cause mortality in end-stage renal disease in the early stages of hemodialysis: a retrospective cohort study. Cardiovasc Diabetol 2024; 23:259. [PMID: 39026232 PMCID: PMC11264609 DOI: 10.1186/s12933-024-02318-8] [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: 04/22/2024] [Accepted: 06/16/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND The main goal of this study was to examine how diabetes, cardiovascular calcification characteristics and other risk factors affect mortality in end-stage renal disease (ESRD) patients in the early stages of hemodialysis. METHODS A total of 285 ESRD patients in the early stages of hemodialysis were enrolled in this research, including 101 patients with diabetes. Survival time was monitored, and general data, biochemical results, cardiac ultrasound calcification of valvular tissue, and thoracic CT calcification of the coronary artery and thoracic aorta were recorded. Subgroup analysis and logistic regression were applied to investigate the association between diabetes and calcification. Cox regression analysis and survival between calcification, diabetes, and all-cause mortality. Additionally, the nomogram model was used to estimate the probability of survival for these individuals, and its performance was evaluated using risk stratification, receiver operating characteristic, decision, and calibration curves. RESULTS Cardiovascular calcification was found in 81.2% of diabetic patients (82/101) and 33.7% of nondiabetic patients (62/184). Diabetic patients had lower phosphorus, calcium, calcium-phosphorus product, plasma PTH levels and lower albumin levels (p < 0.001). People with diabetes were more likely to have calcification than people without diabetes (OR 5.66, 95% CI 1.96-16.36; p < 0.001). The overall mortality rate was 14.7% (42/285). The risk of death was notably greater in patients with both diabetes and calcification (29.27%, 24/82). Diabetes and calcification, along with other factors, collectively predict the risk of death in these patients. The nomogram model demonstrated excellent discriminatory power (area under the curve (AUC) = 0.975 at 5 years), outstanding calibration at low to high-risk levels and provided the greatest net benefit across a wide range of clinical decision thresholds. CONCLUSIONS In patients with ESRD during the early period of haemodialysis, diabetes significantly increases the risk of cardiovascular calcification, particularly multisite calcification, which is correlated with a higher mortality rate. The risk scores and nomograms developed in this study can assist clinicians in predicting the risk of death and providing individualised treatment plans to lower mortality rates in the early stages of hemodialysis.
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Affiliation(s)
- Qingxian Li
- Department of Endocrinology, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - Peishan Li
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Zigan Xu
- Department of Nephrology, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China
| | - ZeYuan Lu
- Department of Endocrinology, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, 518033, China
| | - Chuan Yang
- Department of Endocrinology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China.
| | - Jie Ning
- Department of Endocrinology, Shenzhen Longhua District Central Hospital, Shenzhen, 518110, China.
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3
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Frenzel S, Bülow R, Dörr M, Felix SB, Friedrich N, Völzke H, Wittfeld K, Grabe HJ, Bahls M. Left ventricular hypertrophy as a risk factor for accelerated brain aging: Results from the Study of Health in Pomerania. Hum Brain Mapp 2024; 45:e26567. [PMID: 38391110 PMCID: PMC10885183 DOI: 10.1002/hbm.26567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/16/2023] [Accepted: 11/30/2023] [Indexed: 02/24/2024] Open
Abstract
Previous studies provided evidence for the importance of cardiac structure abnormalities, in particular greater left ventricular (LV) mass, for brain aging, but longitudinal studies are lacking to date. We included 926 individuals (median age 48 years; 53% women) from the TREND cohort of the Study of Health in Pomerania (SHIP) without reduced ejection fraction or a history of myocardial infarction. LV mass index (LVMI) was determined by echocardiography at baseline. Brain morphometric measurements were derived from magnetic resonance images at baseline and 7-year follow-up. Direct effects of baseline LVMI on brain morphometry at follow-up were estimated using linear regression models with adjustment for baseline brain morphometry. At baseline, median LVMI was 40 g/m2.7 and 241 individuals (26%) met the criterion of LV hypertrophy. After correction for multiple testing, baseline LVMI was directly associated with reduced global cortical thickness and increased cortical brain age at follow-up independent from hypertension and blood pressure. Exposure-outcome relations were nonlinear and significantly stronger in the upper half of the exposure distribution. Specifically, an increase in baseline LVMI from the 50% quantile to the 95% quantile was associated additional 2.7 years (95% confidence interval = [1.5 years, 3.8 years]) of cortical brain age at follow-up. Additional regional analyses yielded bilateral effects on multiple frontal cortical regions. Our findings highlight the role of cardiac structure in brain aging. LVMI constitutes an easily measurable marker that might help to identify persons at risk for cognitive impairment and dementia.
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Affiliation(s)
- Stefan Frenzel
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Robin Bülow
- Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Marcus Dörr
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Stephan B. Felix
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Nele Friedrich
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- Institute of Clinical Chemistry and Laboratory MedicineUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- Institute for Community MedicineUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Katharina Wittfeld
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Hans J. Grabe
- Department of Psychiatry and PsychotherapyUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Center for Neurodegenerative Disease (DZNE), Partner Site Rostock/GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
| | - Martin Bahls
- Department of Internal Medicine BUniversity Medicine GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
- German Centre for Cardiovascular Research (DZHK), Partner Site GreifswaldGreifswaldMecklenburg‐Western PomeraniaGermany
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4
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Ye W, Li L, Zeng J. Association of Cardiac Valve Calcification and 1-year Mortality after Lower-extremity Amputation in Diabetic Patients: A Retrospective Study. Curr Neurovasc Res 2024; 20:599-607. [PMID: 38083889 DOI: 10.2174/0115672026277348231130112221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/18/2023] [Accepted: 10/24/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Cardiac valve calcification predisposes patients to a higher risk of adverse cardiovascular events. This study aimed to investigate the association between cardiac valve calcification and 1-year mortality in diabetic patients after lower-extremity amputation. METHODS This was a retrospective study conducted on the clinical data of diabetic patients who underwent lower-extremity amputation admitted to the Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong, China for diabetic foot ulcers needed lower extremity amputation surgery between July 2017 and March 2021. Detailed preoperative medical assessments were performed and recorded. Cardiac valve calcification was assessed using echocardiography at baseline. Oneyear follow-up assessments were conducted and included clinical visits, hospital record assessments, and telephone reviews to obtain the survival status of patients. RESULTS Ninety-three diabetic patients participated in the study. The 1-year follow-up mortality rate after amputation was 24.7%. Compared to the survival group, the prevalence of cardiac valve calcification and the Revised Cardiac Risk Index (RCRI) were higher in the mortality group. In the Cox regression analysis, cardiac valvular calcification (HR=3.427, 95% CI=1.125- 10.443, p =0.030) was found to be an independent predictor of all-cause mortality after amputation. In addition, the patients with both aortic valve calcification and mitral annular calcification had a higher all-cause mortality rate (50%). Receiver operator characteristic curve analysis showed a stronger predictive ability when using a combination of calcified valve number and RCRI (AUC=0.786 95%, CI=0.676-0.896, p =0.000). CONCLUSION In diabetic patients after lower-extremity amputation, cardiac valve calcification was associated with all-cause mortality during 1-year follow-up. Combination of calcified valve number and RCRI score showed a stronger predictive value for mortality.
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Affiliation(s)
- Weibin Ye
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Li Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
| | - Jianfeng Zeng
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong 510000, China
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5
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Lin B, Shen Y, Zhang P, Shen Y, Gu Y, He X, Li J, Yang K, Shen W, Zhang Q, Xin Y, Liu Y. Prognostic role of tissue plasminogen activator in coronary artery disease with or without aortic valve sclerosis. ESC Heart Fail 2023. [PMID: 37308095 PMCID: PMC10375160 DOI: 10.1002/ehf2.14420] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS We sought to investigate the relationship between circulating tissue plasminogen activator (t-PA) level and long-term outcomes in stable coronary artery disease patients with or without aortic valve sclerosis (AVSc). METHODS AND RESULTS Serum levels of t-PA were determined in 347 consecutive stable angina patients with (n = 183) or without (n = 164) AVSc. Outcomes were prospectively recorded as planned clinic evaluations every 6 months up to 7 years. The primary endpoint was a composite of cardiovascular death and rehospitalization due to heart failure. The secondary endpoint included all-cause mortality, cardiovascular death, and rehospitalization due to heart failure. Serum t-PA was significantly higher in AVSc than in non-AVSc patients (2131.22 pg/mL vs. 1495.85 pg/mL, P < 0.001). For patients with AVSc, those with t-PA level above the median (>1840.68 pg/mL) were more likely to meet the primary and secondary endpoints (all P < 0.001). After adjusting for potential confounding factors, serum t-PA level remained significantly predictive for each endpoint in the Cox proportional hazard models. The prognostic value of t-PA was good, with an AUC-ROC of 0.753 (P < 0.001). The combination of t-PA with traditional risk factors improved the risk reclassification of AVSc patients, with a net reclassification index of 0.857 and an integrated discrimination improvement of 0.217 (all P < 0.001). However, for patients without AVSc, both primary and secondary endpoints were similar, irrespective of t-PA levels. CONCLUSIONS Elevated circulating t-PA confers an increased risk for poor long-term clinical outcomes in stable coronary artery disease patients with AVSc.
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Affiliation(s)
- Bowen Lin
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Ying Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Pengfei Zhang
- Department of Cardiovascular Surgery, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yunli Shen
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yuying Gu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Xiaoyan He
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Jimin Li
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Ke Yang
- Institute of Cardiovascular Disease, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Weifeng Shen
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Qi Zhang
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yuanfeng Xin
- Department of Cardiovascular Surgery, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
| | - Yehong Liu
- Department of Cardiology, Shanghai East Hospital, Shanghai Tongji University School of Medicine, Shanghai, China
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6
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Eleid MF, Wang DD, Pursnani A, Kodali SK, George I, Palacios I, Russell H, Makkar RR, Kar S, Satler LF, Rajagopal V, Dangas G, Tang GH, McCabe JM, Whisenant BK, Fang K, Kaptzan T, Lewis B, Douglas P, Hahn R, Thaden J, Oh JK, Leon M, O'Neill W, Rihal CS, Guerrero ME. 2-Year Outcomes of Transcatheter Mitral Valve Replacement in Patients With Annular Calcification, Rings, and Bioprostheses. J Am Coll Cardiol 2022; 80:2171-2183. [DOI: 10.1016/j.jacc.2022.09.037] [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: 07/14/2022] [Revised: 08/25/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
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7
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Scalzo N, Canastar M, Lebovics E. Part 1: Disease of the Heart and Liver: A Relationship That Cuts Both Ways. Cardiol Rev 2022; 30:111-122. [PMID: 33337654 DOI: 10.1097/crd.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
The heart and the liver display multifaceted, complex interactions that can be divided into cardiac effects of liver disease, hepatic effects of heart disease, and disease processes affecting both organs. In part 1 of this 2 part series, we discuss how acute and chronic heart failure can have devastating effects on the liver, such as acute cardiogenic liver injury and congestive hepatopathy. On the other hand, primary liver disease, such as cirrhosis, can lead to a plethora of cardiac insults representative in cirrhotic cardiomyopathy as systolic dysfunction, diastolic dysfunction, and electrophysiological disturbances. Nonalcoholic fatty liver disease has long been associated with cardiovascular events that increase mortality. The management of both disease processes changes when the other organ system becomes involved. This consideration is important with regard to a variety of interventions, most notably transplantation of either organ, as risk of complications dramatically rises in the setting of both heart and liver disease (discussed in part 2). As our understanding of the intricate communication between the heart and liver continues to expand so does our management.
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Affiliation(s)
- Nicholas Scalzo
- From the Department of Medicine, Section of Gastroenterology & Hepatobiliary Diseases, New York Medical College and Westchester Medical Center, Valhalla, NY
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8
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Braisch U, Koenig W, Rothenbacher D, Denkinger M, Friedrich N, Felix SB, Ittermann T, Dörr M, Dallmeier D. N-terminal pro brain natriuretic peptide reference values in community-dwelling older adults. ESC Heart Fail 2022; 9:1703-1712. [PMID: 35199488 PMCID: PMC9065825 DOI: 10.1002/ehf2.13834] [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: 04/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Available upper reference levels (URLs) in older adults for N-terminal pro brain natriuretic peptide (NT-proBNP), an established biomarker for heart failure, are mainly based on small samples. We aimed to identify NT-proBNP URL in a population-based reference sample of individuals aged ≥65 years. METHODS AND RESULTS We analysed established NT-proBNP predictors using quantile regression among 2459 participants of two-independent population-based cohorts located in Germany, the Activity and Function in the Elderly Study (ActiFE, n = 1450) and the Study of Health in Pomerania (SHIP-TREND-0, n = 1009). Based on predictors a reference population of 441 subjects (ActiFE, n = 227; SHIP-TREND-0, n = 214) without history of diabetes, cardiovascular, or pulmonary diseases and with systolic blood pressure (BP) <140 mmHg, diastolic BP ≥60 and ≤90 mmHg, haemoglobin in men ≥14 and ≤18 g/dL and in women ≥12 and ≤16 g/dL, GFR ≥60 mL/min/1.73 m2 , CRP <5 mg/L, BMI ≥18 and ≤33 kg/m2 , and hs-cTnI <40 ng/L were built with NT-proBNP median levels and 97.5% quantiles reported stratified by sex and age. In a secondary analysis the URL among 97 SHIP-TREND-0 participants with a left ventricular ejection fraction (LVEF) ≥50 and no diastolic dysfunction were estimated. The median age in the identified reference sample was 70 years, with 41.9% and 40.2% male participants in ActiFE and SHIP-TREND-0, respectively. We observed an age-dependent increment of NT-proBNP levels with higher values in women compared to men. Notably, NT-proBNP levels were >125 ng/L in 165 participants (37.4%), with NT-proBNP URL (97.5% quantiles) equal to 663, 824, 592, and 697 ng/L in men, and 343, 463, 2641, 1276 ng/L in women for ages 65-69, 70-74, 75-79, and 80+ years, respectively. In the secondary analysis with a LVEF ≥50 and no diastolic dysfunction (35 men and 62 women) NT-proBNP levels >125 ng/L were still observed in 38 (39.2%) participants. CONCLUSIONS This reference sample of apparently healthy asymptomatic older adults showed an age-related increment of NT-proBNP levels with URL markedly higher than the European Society of Cardiology recommended cut-off of 125 ng/L for the diagnosis of heart failure in ambulatory settings. Identifying URL in those ≥80 years remains complex. Our results attempt to provide a frame for the further investigation of age-specific NT-proBNP cut-offs in older adults. Considering the demographic changes, further evaluation of NT-proBNP URL in larger samples of older adults followed by the validation of age-specific cut-off values for the identification of heart failure in those 65 years or older are urgently needed.
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Affiliation(s)
- Ulrike Braisch
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Heart Center Munich, Technical University of Munich, Munich, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Nele Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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9
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Muthiah MD, Cheng Han N, Sanyal AJ. A clinical overview of non-alcoholic fatty liver disease: A guide to diagnosis, the clinical features, and complications-What the non-specialist needs to know. Diabetes Obes Metab 2022; 24 Suppl 2:3-14. [PMID: 34387409 DOI: 10.1111/dom.14521] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/31/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) has a rapidly rising prevalence worldwide and is the most common cause of liver disease in developed countries. In this article, we discuss the spectrum of disease of NAFLD with a focus on the earlier spectrum of the disease that is commonly encountered by non-specialists, as well as the hepatic and extra-hepatic associations of the disease. We discuss in detail the two common presentations of NAFLD, incidentally detected hepatic steatosis and asymptomatic raised liver enzymes, and provide an algorithm for management and continued to follow up for these patients. Considerations for the management of cardiovascular comorbidities in these patients are also discussed. Finally, we cover the topic of screening for NAFLD in high-risk populations.
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Affiliation(s)
- Mark D Muthiah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore, Singapore
| | - Ng Cheng Han
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Arun J Sanyal
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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10
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Kraler S, Blaser MC, Aikawa E, Camici GG, Lüscher TF. Calcific aortic valve disease: from molecular and cellular mechanisms to medical therapy. Eur Heart J 2021; 43:683-697. [PMID: 34849696 DOI: 10.1093/eurheartj/ehab757] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/12/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Calcific aortic valve disease (CAVD) is a highly prevalent condition that comprises a disease continuum, ranging from microscopic changes to profound fibro-calcific leaflet remodelling, culminating in aortic stenosis, heart failure, and ultimately premature death. Traditional risk factors, such as hypercholesterolaemia and (systolic) hypertension, are shared among atherosclerotic cardiovascular disease and CAVD, yet the molecular and cellular mechanisms differ markedly. Statin-induced low-density lipoprotein cholesterol lowering, a remedy highly effective for secondary prevention of atherosclerotic cardiovascular disease, consistently failed to impact CAVD progression or to improve patient outcomes. However, recently completed phase II trials provide hope that pharmaceutical tactics directed at other targets implicated in CAVD pathogenesis offer an avenue to alter the course of the disease non-invasively. Herein, we delineate key players of CAVD pathobiology, outline mechanisms that entail compromised endothelial barrier function, and promote lipid homing, immune-cell infiltration, and deranged phospho-calcium metabolism that collectively perpetuate a pro-inflammatory/pro-osteogenic milieu in which valvular interstitial cells increasingly adopt myofibro-/osteoblast-like properties, thereby fostering fibro-calcific leaflet remodelling and eventually resulting in left ventricular outflow obstruction. We provide a glimpse into the most promising targets on the horizon, including lipoprotein(a), mineral-binding matrix Gla protein, soluble guanylate cyclase, dipeptidyl peptidase-4 as well as candidates involved in regulating phospho-calcium metabolism and valvular angiotensin II synthesis and ultimately discuss their potential for a future therapy of this insidious disease.
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Affiliation(s)
- Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,University Heart Center, Department of Cardiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Mark C Blaser
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 3 Blackfan Street, Boston, MA 02115, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 3 Blackfan Street, Boston, MA 02115, USA.,Center for Excellence in Vascular Biology, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 77 Ave Louis Pasteur, NRB7, Boston, MA 02115, USA
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,University Heart Center, Department of Cardiology, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Research and Education, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Heart Division, Royal Brompton & Harefield Hospitals, Sydney Street, London SW3 6NP, UK.,National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK
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11
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Drzyzga CJ, Bahls M, Ittermann T, Völzke H, Bülow R, Hammer F, Ewert R, Gläser S, Felix SB, Dörr M, Markus MRP. Lower Cardiorespiratory Fitness Is Associated With Right Ventricular Geometry and Function - The Sedentary's Heart: SHIP. J Am Heart Assoc 2021; 10:e021116. [PMID: 34743534 PMCID: PMC8751926 DOI: 10.1161/jaha.120.021116] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Lower cardiorespiratory fitness (CRF) is associated with an increased risk for cardiovascular disease. However, very little information is available about the association between lower CRF and right ventricular (RV) remodeling. We investigated the relationship between CRF and RV structure and function in a large, aging, and largely sedentary adult population–based cohort. Methods and Results We used cross‐sectional data of 2844 subjects (1486 women; median age, 51 years; interquartile range, 40–62 years) from the population‐based cohort SHIP (Study of Health in Pomerania) with echocardiography, of which 941 also had cardiac magnetic resonance imaging. We analyzed the associations of peak oxygen uptake with RV parameters determined by both imaging techniques using multivariable‐adjusted linear regression models. In echocardiography, a 1 L/min lower peak oxygen uptake was associated with a 1.18 mm (95% CI, 0.66–1.71; P<0.001) smaller RV end‐diastolic diameter and a 1.41 mm (95% CI, 0.90–1.92; P<0.001) narrower RV end‐diastolic outflow tract diameter. Similarly, using cardiac magnetic resonance imaging measurements, a 1 L/min lower peak oxygen uptake was associated with a 23.5 mL (95% CI, 18.7–28.4; P<0.001) smaller RV end‐diastolic volume, a 13.0 mL (95% CI, 9.81–16.2; P<0.001) lower RV end‐systolic volume, and a 10.7 mL/beat (95% CI, 8.10–13.3; P<0.001) lower RV stroke volume. Conclusions Our results indicate a significant association between CRF and RV remodeling. Lower CRF was associated with smaller RV chamber and lower RV systolic function, stroke volume, and cardiac output.
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Affiliation(s)
- Christine J Drzyzga
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany
| | - Martin Bahls
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research Institute for Community Medicine University Medicine Greifswald Greifswald Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany.,Department of Study of Health in Pomerania/Clinical-Epidemiological Research Institute for Community Medicine University Medicine Greifswald Greifswald Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and NeuroradiologyUniversity Medicine Greifswald Greifswald Germany
| | - Fabian Hammer
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany
| | - Ralf Ewert
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany
| | | | - Stephan B Felix
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany
| | - Marcus Dörr
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany
| | - Marcello R P Markus
- Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.,German Centre for Cardiovascular Research (DZHK)partner site Greifswald Greifswald Germany.,German Center for Diabetes Research (DZD)partner site Greifswald Greifswald Germany
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12
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Haensig M, Kuntze T, Gonzalez DL, Lapp H, Lauten P, Owais T. Extensive calcification of the mitral valve annulus in transcatheter aortic valve implants. Interact Cardiovasc Thorac Surg 2021; 34:167-175. [PMID: 34601608 PMCID: PMC8766209 DOI: 10.1093/icvts/ivab235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/13/2021] [Accepted: 07/02/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study sought to report the calcification pattern of the mitral valve annulus and its implications for procedural and safety outcomes in transcatheter aortic valve implantation. METHODS Between November 2018 and September 2019, a total of 305 patients had transcatheter aortic valve implants at our institution. The extent of calcification of the mitral valve annulus was analysed, and the impact on safety outcomes was evaluated. RESULTS The prevalence of mitral annular calcification (MAC) was 43%. Calcification of the mitral valve annulus was either less than or at least one-third of the posterior annulus (34% and 32%), the whole posterior annulus (28%) or the extension to the attachment of the anterior leaflets (7%). Severe circumferential MAC revealed moderate paravalvular leaks in 5/8 (63%) patients and was associated with right branch bundle block [odds ratio (OR) 2.01 (0.39–3.06); P = 0.098] and low cardiac output [OR 3.12 (1.39–7.04); P = 0.033]. Subannular calcification at the anterolateral trigonum represented a risk factor for left ventricular outflow tract injury [OR 3.54 (1.38–8.27); P = 0.001] in balloon-expandable valves, associated with relevant rhythm disorders [OR 2.26 (1.17–5.65); P = 0.014] and female gender (7/8, 88%). The 30-day all-cause mortality in circumferential MAC reaching into the anterior annulus (grade IV) compared to patients with less MAC (grade I–III) was 13% vs 2% with a mean valve size of 24.6 vs 25.7 mm. CONCLUSIONS Extensive MAC was associated with moderate paravalvular leaks, with implications for the prosthesis size and survival in transcatheter aortic valve implants. In severe MAC, we recommend implanting oversized self-expandable prostheses, the goal being to reduce the risk of right branch bundle block and paravalvular leaks. Subj collection 122, 125
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Affiliation(s)
- Martin Haensig
- Corresponding author. Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Rhön AG, Robert-Koch Allee 9, 99438 Bad Berka, Germany. Tel: +49-364585-41137; fax: +49-364585-3510; e-mail: (M. Haensig)
| | - Thomas Kuntze
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - David Lopez Gonzalez
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Harald Lapp
- Department of Cardiology and Internal Medicine, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Philipp Lauten
- Department of Cardiology and Internal Medicine, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
| | - Tamer Owais
- Department of Cardiothoracic Surgery, Central Clinic Hospital of Bad Berka, Bad Berka, Germany
- Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt
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13
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Markus MRP, Ittermann T, Kim S, Schipf S, Siewert-Markus U, Santana CC, Buchmann N, Völzke H, Bülow R, Felix SB, Bahls M, Steinhagen-Thiessen E, Dörr M. Lower muscular strength is associated with smaller left and right chambers and lower cardiac mass in the general population - The Sedentary's Heart. Prog Cardiovasc Dis 2021; 68:36-51. [PMID: 34562438 DOI: 10.1016/j.pcad.2021.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The cardiac muscle has the ability to adapt to different loading conditions. We analyzed the associations of the age-related decreasing handgrip strength (HGS), a marker of muscular fitness, on cardiac structure and function in a community-based sample. METHODS We performed cross-sectional analyses of 4646 subjects (2554 women; 55.0%) aged 20 to 93 years from two independent cohorts of the Study of Health in Pomerania (SHIP-2 and SHIP-TREND-0). We analyzed the associations of HGS with structural and functional left and right ventricular (LV and RV) and left atrial (LA) parameters as determined by echocardiography and magnetic resonance imaging (MRI) as well with log-transformed NT-proBNP values using multivariable-adjusted linear regression models. RESULTS MRI data showed that a 1 kg lower HGS was associated with a 0.40 mL (95% confidence interval: 0.26 to 0.54; p < 0.001) lower LV end-diastolic volume, a 0.011 mm (0.005 to 0.018; p = 0.001) lower LV wall-thickness, a 0.59 g (0.43 to 0.75; p < 0.001) lower LV mass, a 0.58 mL/beat (0.43 to 0.74; p < 0.001) lower LV stroke volume, a 0.03 L/min (0.02 to 0.04; p < 0.001) lower LV cardiac output, a 0.48 mL (0.27 to 0.68; p < 0.001) lower LA end-diastolic volume, and a 1.02 mL (0.71 to 1.32) lower RV end-diastolic volume. Similar findings were observed for echocardiographic parameters. Moreover, lower HGS was associated with higher echocardiographic LV diastolic stiffness and NT-proBNP levels. CONCLUSIONS In this large population-based sample, lower muscular fitness as assessed by HGS was associated with lower LV wall thickness and mass as well as with smaller chamber size, stroke volume and cardiac output of the LV, LA and RV. Moreover, HGS was inversely related to LV diastolic stiffness and NT-proBNP values. These outcomes might demonstrate the effects of an aging-related decrease in physical activity and lower muscular fitness on the heart - "the sedentary's heart".
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany.
| | - Till Ittermann
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Simon Kim
- Center for Hand-and Functional Microsurgery, University Medicine Greifswald, Greifswald, Germany
| | - Sabine Schipf
- German Center for Diabetes Research (DZD), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Ulrike Siewert-Markus
- Institute for Medical Psychology, University Medicine Greifswald, Greifswald, Germany
| | - Camila Campos Santana
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; Faculty of Medical Sciences of Santos, Santos, Brazil; Faculty of Medical Sciences of Santa Casa of São Paulo, São Paulo, Brazil
| | - Nikolaus Buchmann
- Department of Cardiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Henry Völzke
- German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany; Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Robin Bülow
- Institute of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Stephan Burkhard Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
| | | | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany; German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany
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14
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Grodecki K, Tamarappoo BK, Huczek Z, Jedrzejczyk S, Cadet S, Kwiecinski J, Rymuza B, Parma R, Olasinska-Wisniewska A, Fijalkowska J, Protasiewicz M, Walczak A, Nowak A, Gocol R, Slomka PJ, Reczuch K, Jagielak D, Grygier M, Wojakowski W, Filipiak KJ, Dey D. Non-calcific aortic tissue quantified from computed tomography angiography improves diagnosis and prognostication of patients referred for transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2021; 22:626-635. [PMID: 33247903 DOI: 10.1093/ehjci/jeaa304] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/22/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS We aimed to investigate the role of aortic valve tissue composition from quantitative cardiac computed tomography angiography (CTA) in patients with severe aortic stenosis (AS) for the differentiation of disease subtypes and prognostication after transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS Our study included 447 consecutive AS patients from six high-volume centres reporting to a prospective nationwide registry of TAVI procedures (POL-TAVI), who underwent cardiac CTA before TAVI, and 224 matched controls with normal aortic valves. Components of aortic valve tissue were identified using semi-automated software as calcific and non-calcific. Volumes of each tissue component and composition [(tissue component volume/total tissue volume) × 100%] were quantified. Relationship of aortic valve composition with clinical outcomes post-TAVI was evaluated using Valve Academic Research Consortium (VARC)-2 definitions.High-gradient (HG) AS patients had significantly higher aortic tissue volume compared to low-flow low-gradient (LFLG)-AS (1672.7 vs. 1395.3 mm3, P < 0.001) as well as controls (509.9 mm3, P < 0.001), but increased non-calcific tissue was observed in LFLG compared to HG patients (1063.6 vs. 860.2 mm3, P < 0.001). Predictive value of aortic valve calcium score [area under the curve (AUC) 0.989, 95% confidence interval (CI): 0.981-0.996] for severe AS was improved after addition of non-calcific tissue volume (AUC 0.995, 95% CI: 0.991-0.999, P = 0.011). In the multivariable analysis of clinical and quantitative computed tomography parameters of aortic valve tissue, non-calcific tissue volume [odds ratio (OR) 5.2, 95% CI 1.8-15.4, P = 0.003] and history of stroke (OR 2.6, 95% CI 1.1-6.5, P = 0.037) were independent predictors of 30-day major adverse cardiovascular event (MACE). CONCLUSION Quantitative CTA assessment of aortic valve tissue volume and composition can improve detection of severe AS, differentiation between HG and LFLG-AS in patients referred for TAVI as well as prediction of 30-day MACEs post-TAVI, over the current clinical standard.
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Affiliation(s)
- Kajetan Grodecki
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA.,1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | | | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Szymon Jedrzejczyk
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Sebastien Cadet
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Jacek Kwiecinski
- Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42 04-628 Warsaw, Poland
| | - Bartosz Rymuza
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Radoslaw Parma
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Anna Olasinska-Wisniewska
- Department of Cardiac Surgery and Transplantology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Jadwiga Fijalkowska
- 2nd Department of Radiology, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marcin Protasiewicz
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Andrzej Walczak
- Department of Cardiac Surgery, Medical University of Lodz, Pomorska 251, 92-213 Lodz, Poland
| | - Adrianna Nowak
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Radoslaw Gocol
- Department of Cardiac Surgery, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Piotr J Slomka
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
| | - Krzysztof Reczuch
- Department of Cardiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Dariusz Jagielak
- Department of Cardiac Surgery, Medical University of Gdansk, Mariana Smoluchowskiego 17, 80-214 - Gdansk, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Długa 1/2, 61-848 Poznan, Poland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Ziołowa 45/47, 40-635 Katowice, Poland
| | - Krzysztof J Filipiak
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland
| | - Damini Dey
- Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute,116N Robertson Blvd, Suite 400, Los Angeles, CA 90048, USA
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15
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Urena M, Lemann T, Chong-Nguyen C, Brochet E, Ducrocq G, Carrasco JL, Iung B, Vahanian A, Himbert D. Causes and predictors of mortality after transcatheter mitral valve implantation in patients with severe mitral annulus calcification. Catheter Cardiovasc Interv 2021; 98:981-989. [PMID: 34263517 DOI: 10.1002/ccd.29874] [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] [Received: 04/13/2021] [Revised: 06/13/2021] [Accepted: 07/05/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the causes and predictors of mortality after valve-in-mitral annulus calcification (MAC) transcatheter mitral valve implantation (TMVI). BACKGROUND Conventional surgical mitral valve replacement is associated with a high risk in patients with mitral valve disease associated with severe MAC. In this population, TMVI may be an attractive alternative option. However, its prognostic factors are poorly understood. METHODS All patients undergoing valve-in-MAC TMVI from 2013 to 2018 in our center were included. Indication for TMVI relied on the judgment of the local heart team. Patients were followed at 30 days and 1 year. RESULTS A total of 34 patients underwent valve-in-MAC TMVI. The mean age was 79 ± 11 years and 73% of patients were women. Their mean EuroSCORE 2 was 8 ± 7%. The transseptal approach was used in 79% of patients and a hybrid transatrial in 29%. Balloon expandable transcatheter heart valves were used in all the patients. Technical success was achieved in 76% of the patients. Thirty-day and 1-year all-cause mortality rates were 14.7% and 32.4%, respectively. The main two causes of 1-year mortality were congestive heart failure (8.8%) and infective endocarditis (5.9%). In multivariate analysis, the only predictor of 1-year mortality was the presence of periprothetic mitral regurgitation grade 2 (HR, 5.69; 95%CI, 1.59-27.88, p = 0.032). CONCLUSION Early and mid-term mortality remains high after valve-in-MAC TMVI and seems to be associated with the presence of paravalvular mitral regurgitation. However, whether the latter is a prognostic factor or marker remains to be determined to improve clinical outcomes in this high-risk population.
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Affiliation(s)
- Marina Urena
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Thomas Lemann
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Caroline Chong-Nguyen
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Eric Brochet
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France
| | - Grégory Ducrocq
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Jose-Luis Carrasco
- Assistance Publique - Hôpitaux de Paris, Department of Anaesthesiology, Bichat-Claude Bernard Hospital, Paris, France
| | - Bernard Iung
- University of Paris, Paris, France.,Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
| | - Alec Vahanian
- University of Paris, Paris, France.,INSERM U 1148, Paris, France
| | - Dominique Himbert
- Department of Cardiology, Assistance Publique - Hôpitaux de Paris, Bichat-Claude Bernard Hospital, Paris, France.,INSERM U 1148, Paris, France
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16
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Garg PK, Buzkova P, Meyghani Z, Budoff MJ, Lima J, Criqui M, Cushman M, Allison M. Valvular calcification and risk of peripheral artery disease: the Multi-Ethnic Study of Atherosclerosis (MESA). Eur Heart J Cardiovasc Imaging 2021; 21:1152-1159. [PMID: 31740939 DOI: 10.1093/ehjci/jez284] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/20/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS The detection of cardiac valvular calcification on routine imaging may provide an opportunity to identify individuals at increased risk for peripheral artery disease (PAD). We investigated the associations of aortic valvular calcification (AVC) and mitral annular calcification (MAC) with risk of developing clinical PAD or a low ankle-brachial index (ABI). METHODS AND RESULTS AVC and MAC were measured on cardiac computed tomography in 6778 Multi-Ethnic Study of Atherosclerosis participants without baseline PAD between 2000 and 2002. Clinical PAD was ascertained through 2015. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among 5762 individuals who had an ABI >0.9 at baseline and at least one follow-up ABI measurement 3-10 years later. Adjusted Cox proportional hazards and Poisson regression modelling were used to determine the association of valvular calcification with clinical PAD and low ABI, respectively. There were 117 clinical PAD and 198 low ABI events that occurred over a median follow-up of 14 years and 9.2 years, respectively. The presence of MAC was associated with an increased risk of clinical PAD [hazard ratio 1.79; 95% confidence interval (CI) 1.04-3.05] but not a low ABI (rate ratio 1.28; 95% CI 0.75-2.19). No significant associations were noted for the presence of AVC and risk of either clinical PAD. CONCLUSION MAC is associated with an increased risk of developing clinical PAD. Future studies are needed to corroborate our findings and better understand whether MAC holds any predictive value as a risk marker for PAD.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine, 1510 San Pablo St. Suite 322, Los Angeles, CA, USA
| | - Petra Buzkova
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Zahra Meyghani
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Joao Lima
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Criqui
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
| | - Mary Cushman
- Department of Medicine and Pathology & Laboratory Medicine, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego School of Medicine, San Diego, CA, USA
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17
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Hardas S, Titar P, Zanwar I, Phalgune DS. Correlation between echocardiographic calcium score and coronary artery lesion severity on invasive coronary angiography. Indian Heart J 2021; 73:307-312. [PMID: 34154747 PMCID: PMC8322811 DOI: 10.1016/j.ihj.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/13/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES The direct correlation between Echocardiographic non-coronary calcium score (ECS) and lesion severity on invasive coronary angiography (ICA) is not reported. The aim of the present study was to find the correlation between ECS and Gensini score. METHODS One hundred seventy patients aged ≥18 years posted for clinically indicated ICA were included. All the patients underwent standard transthoracic echocardiography. ECS and Gensisni scores were calculated. The primary outcome measure was to find a correlation of ECS with Gensini score, whereas the secondary outcome measure was to correlate ECS with traditional risk factors for coronary artery disease. The Chi-square/Fisher exact test was used to compare qualitative variables. Spearman's correlation analysis was used for assessing the correlation between ECS score and the Gensini score. Receiver-operating characteristic curve analysis was performed to detect the cut-off value of the ECS score. RESULTS The correlation of total ECS with Gensini score was positive and statistically significant (r = 0.550, p-value < 0.0001). As ECS increased, the Gensini score increased. ECS value of >1 detected CAD with 56.5% sensitivity, 79.5% specificity. Eight-nine percent of patients who had ECS >1, had Gensini score ≥18, whereas 44.3% of patients who had ECS ≤1, had Gensini score ≥18. The patients with ECS >1 had significantly higher Gensini scores than the patients with ECS ≤1. CONCLUSIONS The correlation of total ECS with Gensini score was positive and statistically significant.
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Affiliation(s)
- Suhas Hardas
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Pritam Titar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
| | - Ishwar Zanwar
- Dept. of Cardiology, Poona Hospital & Research Centre, Pune, India.
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18
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Jichitu A, Bungau S, Stanescu AMA, Vesa CM, Toma MM, Bustea C, Iurciuc S, Rus M, Bacalbasa N, Diaconu CC. Non-Alcoholic Fatty Liver Disease and Cardiovascular Comorbidities: Pathophysiological Links, Diagnosis, and Therapeutic Management. Diagnostics (Basel) 2021; 11:689. [PMID: 33921359 PMCID: PMC8069361 DOI: 10.3390/diagnostics11040689] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 02/06/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) has a growing prevalence in recent years. Its association with cardiovascular disease has been intensively studied, and certain correlations have been identified. The connection between these two entities has lately aroused interest regarding therapeutic management. In order to find the best therapeutic options, a detailed understanding of the pathophysiology that links (NAFLD) to cardiovascular comorbidities is needed. This review focuses on the pathogenic mechanisms that are behind these two diseases and on the therapeutic management available at this time.
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Affiliation(s)
- Alexandra Jichitu
- Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania; (A.J.); (C.C.D.)
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Ana Maria Alexandra Stanescu
- Department 5, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Cosmin Mihai Vesa
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.M.V.); (C.B.)
| | - Mirela Marioara Toma
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania;
| | - Cristiana Bustea
- Department of Preclinical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.M.V.); (C.B.)
| | - Stela Iurciuc
- Department of Cardiology, Faculty of Medicine, “Victor Babeş” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Rus
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Nicolae Bacalbasa
- Department 13, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- Department of Surgery, “Ion Cantacuzino” Clinical Hospital, 030167 Bucharest, Romania
| | - Camelia Cristina Diaconu
- Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania; (A.J.); (C.C.D.)
- Department 5, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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19
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Urena M, Vahanian A, Brochet E, Ducrocq G, Iung B, Himbert D. Current Indications for Transcatheter Mitral Valve Replacement Using Transcatheter Aortic Valves. Circulation 2021; 143:178-196. [DOI: 10.1161/circulationaha.120.048147] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Use of transcatheter mitral valve replacement (TMVR) using transcatheter aortic valves in clinical practice is limited to patients with failing bioprostheses and rings or mitral valve disease associated with severe mitral annulus calcification. Whereas the use of valve-in-valve TMVR appears to be a reasonable alternative to surgery in patients at high surgical risk, much less evidence supports valve-in-ring and valve-in-mitral annulus calcification interventions. Data on the results of TMVR in these settings are derived from small case series or voluntary registries. This review summarizes the current evidence on TMVR using transcatheter aortic valves in clinical practice from the characteristics of the TMVR candidates, screening process, performance of the procedure, and description of current results and future perspectives. TMVR using dedicated devices in native noncalcified mitral valve diseases is beyond the scope of the article.
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Affiliation(s)
- Marina Urena
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Alec Vahanian
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Eric Brochet
- University of Paris, France (M.U., A.V., G.D., B.I.)
| | - Gregory Ducrocq
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Bernard Iung
- University of Paris, France (M.U., A.V., G.D., B.I.)
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
| | - Dominique Himbert
- Assistance Publique, Hôpitaux de Paris, Department of Cardiology, Bichat Claude Bernard Hospital, France (M.U., E.B., G.D., B.I., D.H.)
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20
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Fernandes LP, Barreto ATF, Neto MG, Câmara EJN, Durães AR, Roever L, Aras-Júnior R. Prognostic power of conventional echocardiography in individuals without history of cardiovascular diseases: A systematic review and meta-analysis. Clinics (Sao Paulo) 2021; 76:e2754. [PMID: 34190849 PMCID: PMC8221562 DOI: 10.6061/clinics/2021/e2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/24/2021] [Indexed: 01/19/2023] Open
Abstract
Echocardiographic abnormalities are associated with a higher incidence of adverse cardiovascular outcomes. This systematic review and meta-analysis aimed to evaluate whether echocardiographic abnormalities are predictors of cardiovascular events in individuals without previous cardiovascular diseases. The PubMed, Scopus, and SciELO databases were searched for longitudinal studies investigating the association between echocardiographic abnormalities and cardiovascular events among individuals without known cardiovascular diseases. Two independent reviewers analyzed data on the number of participants, age and sex, echocardiographic alterations, follow-up time, and cardiovascular outcomes. The meta-analysis estimated the risk ratio (RR) and 95% confidence interval (CI). Heterogeneity was assessed using I2 test. Twenty-two longitudinal studies met the eligibility criteria, comprising a total of 55,603 patients. Left ventricular hypertrophy (LVH) was associated with non-fatal cardiovascular events (RR 2.16; 95% CI 1.22-3.84), death from cardiovascular disease (RR 2.58; 95% CI 1.83- 3.64), and all-cause mortality (RR 2.02; 95% CI 1.34-3.04). Left ventricular diastolic dysfunction (LVDD) and left atrial dilation (LA) were associated with fatal and non-fatal cardiovascular events (RR 2.01; 95% CI 1.32-3.07) and (RR 1.78; 95% CI 1.16-2.73), respectively. Aortic root dilation was associated with non-fatal cardiovascular events (RR 1.25; 95% CI 1.09-1.43). In conclusion, LVH, LVDD, dilations of the LA, and of the aortic root were associated with an increased risk of adverse events in individuals without previous cardiovascular diseases. This study suggests that simple data obtained on conventional echocardiography can be an important predictor of cardiovascular outcomes in a low-risk population.
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Affiliation(s)
- Luciana Pereira Fernandes
- Programa de Pos Graduacao em Medicina e Saude, Universidade Federal da Bahia, Salvador, BA, BR
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
- *Corresponding author. E-mail:
| | - Ana Terra Fonseca Barreto
- Departamento de Ecocardiografia, Hospital Universitario Professor Edgar Santos (HUPES), Universidade Federal da Bahia, Salvador, BA, BR
| | - Mansueto Gomes Neto
- Grupo de Pesquisa em Fisioterapia, Universidade Federal da Bahia, Salvador, BA, BR
| | | | | | - Leonardo Roever
- Departamento de Pesquisa Clinica, Universidade Federal de Uberlandia, Uberlandia, MG, BR
| | - Roque Aras-Júnior
- Departamento de Medicina, Universidade Federal da Bahia, Salvador, BA, BR
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21
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Targher G, Corey KE, Byrne CD. NAFLD, and cardiovascular and cardiac diseases: Factors influencing risk, prediction and treatment. DIABETES & METABOLISM 2020; 47:101215. [PMID: 33296704 DOI: 10.1016/j.diabet.2020.101215] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 11/11/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIM Non-alcoholic fatty liver disease (NAFLD), affecting up to around 30% of the world's adult population, causes considerable liver-related and extrahepatic morbidity and mortality. Strong evidence indicates that NAFLD (especially its more severe forms) is associated with a greater risk of all-cause mortality, and the predominant cause of mortality in this patient population is cardiovascular disease (CVD). This narrative review aims to discuss the strong association between NAFLD and increased risk of cardiovascular, cardiac and arrhythmic complications. Also discussed are the putative mechanisms linking NAFLD to CVD and other cardiac/arrhythmic complications, with a brief summary of CVD risk prediction/stratification and management of the increased CVD risk observed in patients with NAFLD. RESULTS NAFLD is associated with an increased risk of CVD events and other cardiac complications (left ventricular hypertrophy, valvular calcification, certain arrhythmias) independently of traditional CVD risk factors. The magnitude of risk of CVD and other cardiac/arrhythmic complications parallels the severity of NAFLD (especially liver fibrosis severity). There are most likely multiple underlying mechanisms through which NAFLD may increase risk of CVD and cardiac/arrhythmic complications. Indeed, NAFLD exacerbates hepatic and systemic insulin resistance, promotes atherogenic dyslipidaemia, induces hypertension, and triggers synthesis of proatherogenic, procoagulant and proinflammatory mediators that may contribute to the development of CVD and other cardiac/arrhythmic complications. CONCLUSION Careful assessment of CVD risk is mandatory in patients with NAFLD for primary prevention of CVD, together with pharmacological treatment for coexisting CVD risk factors.
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Affiliation(s)
- Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
| | - Kathleen E Corey
- Liver Center, Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Christopher D Byrne
- Nutrition and Metabolism, Faculty of Medicine, University of Southampton, UK; National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
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22
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Okuno T, Brugger N, Asami M, Heg D, Siontis GCM, Winkel MG, Lanz J, Gräni C, Huber A, Stortecky S, George I, Kodali S, Pilgrim T, Windecker S, Khalique OK, Praz F. Clinical impact of mitral calcium volume in patients undergoing transcatheter aortic valve implantation. J Cardiovasc Comput Tomogr 2020; 15:356-365. [PMID: 33121904 DOI: 10.1016/j.jcct.2020.10.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mitral annular calcification (MAC) has been associated with mitral valve (MV) disease and cardiovascular events in patients undergoing transcatheter aortic valve implantation (TAVI). We aimed to investigate the incidence and impact of mitral calcium volume (MCV) quantified by multidetector computed tomography (MDCT) on MV function and clinical outcomes after TAVI. METHODS Consecutive patients with exploitable echocardiography and MDCT performed during TAVI screening were enrolled in this retrospective analysis. Mitral calcium was assessed visually and measured using a semi-automatic tool developed for the aortic valve in an off-label fashion. RESULTS MCV >0 mm3 was found in 65% of the 875 included patients. Patients with calcification were older (82 ± 6 versus 81 ± 7; P = 0.002) and had high prevalence of renal dysfunction (69% versus 61%; P = 0.017) and mitral stenosis (25% versus 4%, P < 0.001). MCV correlated well with visual MAC severity (r = 0.94; P < 0.001), but showed a greater predictive value for mitral stenosis (AUC = 0.804 vs. 0.780, P = 0.012) , while it was not a predictor of mitral regurgitation (AUC = 0.514). Correlations were found between MCV and echocardiographic parameters including MV area, mean transmitral gradient, and pressure half-time (P < 0.001 for all). MCV did not impact on cardiovascular mortality or new permanent pacemaker implantation after TAVI. CONCLUSIONS Calcification of the mitral apparatus is common in TAVI candidates and results in mitral stenosis in 25% of the patients. Increasing MCV predicts mitral stenosis, but had no impact on clinical outcomes following TAVI. CLINICAL TRIAL REGISTRATION NCT01368250.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Masahiko Asami
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- CTU, University of Bern, Bern, Switzerland
| | - George C M Siontis
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Mirjam G Winkel
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Adrian Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Isaac George
- Structural Heart and Valve Center, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Medical Center, New York, USA
| | - Susheel Kodali
- Structural Heart and Valve Center, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Medical Center, New York, USA
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Omar K Khalique
- Structural Heart and Valve Center, Division of Cardiology, New York-Presbyterian Hospital-Columbia University Medical Center, New York, USA
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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23
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Wang TKM, Griffin BP, Xu B, Rodriguez LL, Popovic ZB, Gillinov MA, Pettersson GB, Desai MY. Relationships between mitral annular calcification and cardiovascular events: A meta‐analysis. Echocardiography 2020; 37:1723-1731. [DOI: 10.1111/echo.14861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Tom Kai Ming Wang
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Brian P. Griffin
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Bo Xu
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Leonardo L. Rodriguez
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Zoran B. Popovic
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
| | - Marc A. Gillinov
- Department of Thoracic and Cardiovascular Surgery Heart and Vascular InstituteCleveland Clinic Cleveland OH USA
| | - Gosta B. Pettersson
- Department of Thoracic and Cardiovascular Surgery Heart and Vascular InstituteCleveland Clinic Cleveland OH USA
| | - Milind Y. Desai
- Section of Cardiovascular Imaging Heart and Vascular Institute Cleveland Clinic Cleveland OH USA
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24
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Okuno T, Asami M, Khan F, Praz F, Heg D, Lanz J, Kassar M, Khalique OK, Gräni C, Brugger N, Räber L, Stortecky S, Valgimigli M, Windecker S, Pilgrim T. Does isolated mitral annular calcification in the absence of mitral valve disease affect clinical outcomes after transcatheter aortic valve replacement? Eur Heart J Cardiovasc Imaging 2020; 21:522-532. [PMID: 31408104 DOI: 10.1093/ehjci/jez208] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 10/02/2024] Open
Abstract
AIMS Mitral annular calcification (MAC) has been associated with adverse outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) but has been investigated in isolation of co-existent mitral regurgitation or mitral stenosis, which may represent important confounders. This study sought to investigate the effect of MAC with and without concomitant mitral valve disease (MVD) on clinical outcomes in patients treated with TAVR. METHODS AND RESULTS Computed tomography (CT) and echocardiographic data in consecutive TAVR patients enrolled into a prospective registry were categorized according to presence or absence of severe MAC and significant MVD, respectively. A total of 967 patients with adequate CT and echocardiography data were included between 2007 and 2017. Severe MAC was found in 172 patients (17.8%) and associated with MVD in 87 patients (50.6%). Compared to TAVR patients without severe MAC or MVD, all-cause mortality at 1 year was significantly increased among patients with severe MAC in combination with MVD [adjusted hazard ratio (HRadj): 1.97, 95% confidence interval (CI): 1.12-3.44, P = 0.018] and patients with isolated MVD (HRadj: 2.33, 95% CI: 1.56-3.47, P < 0.001), but not in patients with isolated severe MAC in the absence of MVD (HRadj: 0.52, 95% CI: 0.21-1.33, P = 0.173). CONCLUSION We found no effect of isolated MAC on clinical outcomes following TAVR in patients with preserved mitral valve function. Patients with MVD had an increased risk of death at 1 year irrespective of MAC.
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Affiliation(s)
- Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Masahiko Asami
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Faisal Khan
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Dik Heg
- Clinical Trials Unit, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Mohammad Kassar
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Omar K Khalique
- Division of Cardiology, Structural Heart and Valve Center, Columbia University Medical Center, 177 Fort Washington Avenue, New York, NY 10032, USA
| | - Christoph Gräni
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Marco Valgimigli
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland
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25
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Karger AB, Steffen BT, Nomura SO, Guan W, Garg PK, Szklo M, Budoff MJ, Tsai MY. Association Between Homocysteine and Vascular Calcification Incidence, Prevalence, and Progression in the MESA Cohort. J Am Heart Assoc 2020; 9:e013934. [PMID: 32013703 PMCID: PMC7033888 DOI: 10.1161/jaha.119.013934] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background While elevated homocysteine has been associated with calcification in several studies, its importance as a cardiovascular risk factor remains unclear. This study examines the relationship between homocysteine and vascular and valve calcification in the MESA (Multi-ethnic Study of Atherosclerosis) cohort. Methods and Results MESA participants with baseline homocysteine measurements and cardiac computed tomography scans were included (N=6789). Baseline and follow-up assessment of vascular (coronary artery [CAC], descending thoracic aorta [DTAC]) and valve (aortic valve [AVC], mitral annular [MAC]) calcification was performed. Prevalence ratio/relative risk regression was used to assess the relationship of homocysteine with prevalent and incident calcification, and multivariable logistic regression was used to assess associations between homocysteine and calcification progression. Elevated homocysteine was associated with greater relative risk of prevalent and incident CAC and incident DTAC. We also identified a strong association between elevated homocysteine and CAC and DTAC progression. Elevated homocysteine was found to confer a >2-fold increased risk of severe CAC progression (defined as ΔCAC ≥100/year) and an ≈1.5-fold increased risk for severe DTAC progression (defined as ΔDTAC ≥100/year). Conclusions To our knowledge, this is the first study demonstrating an association between elevated homocysteine and both incidence and progression of coronary and extra-coronary vascular calcification. Our findings suggest a potential role for elevated homocysteine as a risk factor for severe vascular calcification progression. Future studies are warranted to further assess the utility of homocysteine as a biomarker for vascular calcification incidence and progression. Clinical Trial Registration https://www.clinicaltrials.gov/. Unique identifier: NCT00005487.
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Affiliation(s)
- Amy B Karger
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Brian T Steffen
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Sarah O Nomura
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
| | - Weihua Guan
- Division of Biostatistics School of Public Health University of Minnesota Minneapolis MN
| | - Parveen K Garg
- Division of Cardiology University of Southern California Los Angeles CA
| | - Moyses Szklo
- Department of Epidemiology Johns Hopkins Bloomberg School of Public Health Baltimore MD
| | - Matthew J Budoff
- Los Angeles Biomedical Research Center at Harbor-UCLA Torrance CA
| | - Michael Y Tsai
- Department of Laboratory Medicine & Pathology University of Minnesota Minneapolis MN
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26
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Kim D, Shim CY, Hong GR, Jeong H, Ha JW. Morphological and functional characteristics of mitral annular calcification and their relationship to stroke. PLoS One 2020; 15:e0227753. [PMID: 31929595 PMCID: PMC6957171 DOI: 10.1371/journal.pone.0227753] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/27/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Mitral annular calcification (MAC) is associated with risk of stroke. This study aimed to define the morphological and functional characteristics of MAC that are related to stroke. METHODS A total of 460 subjects with MAC from transthoracic echocardiography in a single center from 2012 to 2016 was retrospectively reviewed. Subjects were classified into two groups according to history of stroke [Group 1 (n = 366): without stroke; Group 2 (n = 94): with stroke]. Morphological and functional features of MAC on echocardiogram were scored from 0 to 3 according to MAC mobility, presence of echodense mass with central echolucencies in the periannular region suggesting caseous necrosis, and functional stenosis. RESULTS Significantly more patients in group 2 were men and had history of diabetes mellitus, dyslipidemia, atrial fibrillation, or infective endocarditis. Although MAC thickness and extent did not differ between the two groups, group 2 showed a considerably higher MAC score than group 1 (0.50 ± 0.77 vs. 0.23 ±0.52 p<0.001) as a result of the higher prevalence of each component in group 2 [mobility (22 vs. 11%, p = 0.003), echodense mass with central areas of echolucencies suggesting caseous necrosis (23 vs. 7%, p<0.001), and functional mitral stenosis (12 vs. 7%, p = 0.042)]. On logistic regression analysis, MAC score was independently associated with stroke and showed significant incremental value to demographic factors and comorbidities in association with stroke in a consecutive manner. CONCLUSIONS In conclusion, morphological and functional characteristics of MAC had incremental value in association with stroke over traditional risk factors. MAC score consisting of MAC mobility, typical echodense mass with central echolucencies suggesting caseous necrosis, and functional mitral stenosis was independently associated with stroke. MAC with high-risk features may act as a source of stroke or more potent composite surrogate markers for stroke-related risk factors.
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Affiliation(s)
- Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Geu-Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyeonju Jeong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong-Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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27
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Brain-derived neurotrophic factor is related with adverse cardiac remodeling and high NTproBNP. Sci Rep 2019; 9:15421. [PMID: 31659205 PMCID: PMC6817886 DOI: 10.1038/s41598-019-51776-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 10/08/2019] [Indexed: 12/12/2022] Open
Abstract
The brain-derived neurotrophic factor (BDNF) is a neuronal growth factor essential for normal cardiac contraction and relaxation. Alterations in BDNF signaling are related to the development of cardiovascular disease. Whether BDNF is related to subclinical cardiac remodeling is unclear. We related BDNF with echocardiographic parameters and NTproBNP in a large population-based cohort (n = 2,976, median age 48 years; 45% male). Transthoracic echocardiography was performed on all subjects and BDNF was measured by ELISA. Study participants with severe kidney dysfunction, previous myocardial infarction, and LV ejection fraction <40% were excluded. Linear regression models were adjusted for age, sex, lean mass, fat mass, current smoking, systolic blood pressure and depression. Low BDNF was associated with high NTproBNP. A 10,000 pg/ml lower BDNF was related with a 2.5 g higher (95%-confidence interval [CI]: 0.2 to 4.9; p = 0.036) LV mass, 0.01 cm posterior wall thickness (0.003 to 0.022; p = 0.007) and 0.02 E/A ratio (0.003 to 0.042, p = 0.026). Here we show that low BDNF levels are related with adverse cardiac remodeling and higher levels of NTproBNP. Further research is warranted to assess if BDNF may be used to monitor neuronal-cardiac damage during CVD progression.
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28
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Schmalhofer ML, Markus MRP, Gras JC, Kopp J, Janowitz D, Grabe HJ, Groß S, Ewert R, Gläser S, Albrecht D, Eiffler I, Völzke H, Friedrich N, Nauck M, Steveling A, Könemann S, Wenzel K, Felix SB, Dörr M, Bahls M. Sex-Specific Associations of Brain-Derived Neurotrophic Factor and Cardiorespiratory Fitness in the General Population. Biomolecules 2019; 9:biom9100630. [PMID: 31635145 PMCID: PMC6843272 DOI: 10.3390/biom9100630] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 02/07/2023] Open
Abstract
The brain-derived neurotrophic factor (BDNF) was initially considered to be neuron-specific. Meanwhile, this neurotrophin is peripherally also secreted by skeletal muscle cells and increases due to exercise. Whether BDNF is related to cardiorespiratory fitness (CRF) is currently unclear. We analyzed the association of serum BDNF levels with CRF in the general population (Study of Health in Pomerania (SHIP-TREND) from Northeast Germany; n = 1607, 51% female; median age 48 years). Sex-stratified linear regression models adjusted for age, height, smoking, body fat, lean mass, physical activity, and depression analyzed the association between BDNF and maximal oxygen consumption (VO2peak), maximal oxygen consumption normalized for body weight (VO2peak/kg), and oxygen consumption at the anaerobic threshold (VO2@AT). In women, 1 mL/min higher VO2peak, VO2peak/kg, and VO2@AT were associated with a 2.43 pg/mL (95% confidence interval [CI]: 1.16 to 3.69 pg/mL; p = 0.0002), 150.66 pg/mL (95% CI: 63.42 to 237.90 pg/mL; p = 0.0007), and 2.68 pg/mL (95% CI: 0.5 to 4.8 pg/mL; p = 0.01) higher BDNF serum concentration, respectively. No significant associations were found in men. Further research is needed to understand the sex-specific association between CRF and BDNF.
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Affiliation(s)
- Marie-Lena Schmalhofer
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Marcello R P Markus
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Jan C Gras
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Juliane Kopp
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Deborah Janowitz
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Hans-Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZNE (German Centre for Neurodegenerative Diseases), partner site Greifswald, 17475 Greifswald, Germany.
| | - Stefan Groß
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Ralf Ewert
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Sven Gläser
- Department of Internal Medicine, Vivantes Klinikum Spandau, 13407 Berlin, Germany.
| | - Diana Albrecht
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany.
- Leibniz Institute for Plasma Science and Technology, 17489 Greifswald, Germany.
| | - Ina Eiffler
- Institute for Cell Biology and Anatomy, University Medicine Greifswald, 17487 Greifswald, Germany.
| | - Henry Völzke
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
- Institute for Community Medicine, University Medicine, 17475 Greifswald, Germany.
| | - Nele Friedrich
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Matthias Nauck
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Antje Steveling
- Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany.
| | - Stephanie Könemann
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Kristin Wenzel
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany.
- DZHK (German Centre for Cardiovascular Research), partner site Greifswald, 17475 Greifswald, Germany.
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Ismaiel A, Dumitraşcu DL. Cardiovascular Risk in Fatty Liver Disease: The Liver-Heart Axis-Literature Review. Front Med (Lausanne) 2019; 6:202. [PMID: 31616668 PMCID: PMC6763690 DOI: 10.3389/fmed.2019.00202] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/27/2019] [Indexed: 12/14/2022] Open
Abstract
According to the World Health Organization, cardiovascular disease (CVD) remains the leading cause of death worldwide, accounting for approximately 18 million deaths per year. Nevertheless, the worldwide prevalence of metabolic diseases, such as type 2 diabetes mellitus, obesity, and non-alcoholic fatty liver disease (NAFLD), also known to be common risk factors for CVD, have dramatically increased over the last decades. Chronic alcohol consumption is a major cause of chronic liver diseases (CLD) as well as being a major health care cost expenditure accounting for the spending of tremendous amounts of money annually. NAFLD has become one of the major diseases plaguing the world while standing as the most common cause of liver disease in the Western countries by representing about 75% of all CLD. Currently, the most common cause of death in NAFLD remains to be CVD. Several mechanisms have been suggested to be responsible for associating FLD with CVD through several mechanisms including low-grade systemic inflammation, oxidative stress, adipokines, endoplasmic reticulum stress, lipotoxicity and microbiota dysbiosis which may also be influenced by other factors such as genetic and epigenetic variations. Despite of all this evidence, the exact mechanisms of how FLD can causally contribute to CVD are not fully elucidated and much remains unknown. Moreover, the current literature supports the increasing evidence associating FLD with several cardiovascular (CV) adverse events including coronary artery disease, increased subclinical atherosclerosis risk, structural alterations mainly left ventricular hypertrophy, increased epicardial fat thickness, valvular calcifications including aortic valve sclerosis and mitral annular calcification and functional cardiac modifications mainly diastolic dysfunction in addition to cardiac arrhythmias such as atrial fibrillation and ventricular arrythmias and conduction defects including atrioventricular blocks and bundle branch blocks. Patients with FLD should be evaluated and managed accordingly in order to prevent further complications. Possible management methods include non-pharmacological strategies including life style modifications, pharmacological therapies as well as surgical management. This review aims to summarize the current state of knowledge regarding the pathophysiological mechanisms linking FLD with an increased CV risk, in addition to associated CV adverse events and current management modalities.
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Affiliation(s)
- Abdulrahman Ismaiel
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,2nd Department of Internal Medicine, Cluj-Napoca, Romania
| | - Dan L Dumitraşcu
- Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,2nd Department of Internal Medicine, Cluj-Napoca, Romania
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Singh S, Torzewski M. Fibroblasts and Their Pathological Functions in the Fibrosis of Aortic Valve Sclerosis and Atherosclerosis. Biomolecules 2019; 9:biom9090472. [PMID: 31510085 PMCID: PMC6769553 DOI: 10.3390/biom9090472] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/02/2019] [Accepted: 09/04/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases, such as atherosclerosis and aortic valve sclerosis (AVS) are driven by inflammation induced by a variety of stimuli, including low-density lipoproteins (LDL), reactive oxygen species (ROS), infections, mechanical stress, and chemical insults. Fibrosis is the process of compensating for tissue injury caused by chronic inflammation. Fibrosis is initially beneficial and maintains extracellular homeostasis. However, in the case of AVS and atherosclerosis, persistently active resident fibroblasts, myofibroblasts, and smooth muscle cells (SMCs) perpetually remodel the extracellular matrix under the control of autocrine and paracrine signaling from the immune cells. Myofibroblasts also produce pro-fibrotic factors, such as transforming growth factor-β1 (TGF-β1), angiotensin II (Ang II), and interleukin-1 (IL-1), which allow them to assist in the activation and migration of resident immune cells. Post wound repair, these cells undergo apoptosis or become senescent; however, in the presence of unresolved inflammation and persistence signaling for myofibroblast activation, the tissue homeostasis is disturbed, leading to excessive extracellular matrix (ECM) secretion, disorganized ECM, and thickening of the affected tissue. Accumulating evidence suggests that diverse mechanisms drive fibrosis in cardiovascular pathologies, and it is crucial to understand the impact and contribution of the various mechanisms for the control of fibrosis before the onset of a severe pathological consequence.
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Affiliation(s)
- Savita Singh
- Dr. Margarete Fischer-Bosch-Institute of Clinical Pharmacology and University of Tuebingen, 70376 Stuttgart, Germany.
| | - Michael Torzewski
- Department of Laboratory Medicine and Hospital Hygiene, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.
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31
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Aortic Valve Sclerosis Adds to Prediction of Short-Term Mortality in Patients with Documented Coronary Atherosclerosis. J Clin Med 2019; 8:jcm8081172. [PMID: 31387275 PMCID: PMC6722808 DOI: 10.3390/jcm8081172] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 07/15/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
Aims: Aortic valve sclerosis (AVSc), a non-uniform thickening of leaflets with an unrestricted opening, is characterized by inflammation, lipoprotein deposition, and matrix degradation. In the general population, AVSc predicts long-term cardiovascular mortality (+50%) even after adjustment for vascular risk factors and clinical atherosclerosis. We have hypothesized that AVSc is a risk-multiplier able to predict even short-term mortality. To address this issue, we retrospectively analyzed 90-day mortality of all patients who underwent isolated coronary artery bypass grafting (CABG) at Centro Cardiologico Monzino over a ten-year period (2006–2016). Methods: We analyzed 2246 patients and 90-day all-cause mortality was 1.5% (31 deaths). We selected only patients deceased from cardiac causes (n = 29) and compared to alive patients (n = 2215). A cardiologist classified the aortic valve as no-AVSc (n = 1352) or AVSc (n = 892). Cox linear regression and integrated discrimination improvement (IDI) analyses were used to evaluate AVSc in predicting 90-day mortality. Results: AVSc 90-day survival (97.6%) was lower than in no-AVSc (99.4%; p < 0.0001) with a hazard ratio (HR) of 4.0 (95%CI: 1.78, 9.05; p < 0.0001). The HR for AVSc, adjusted for propensity score, was 2.7 (95%CI: 1.17, 6.23; p = 0.02) and IDI statistics confirmed that AVSc significantly adds (p < 0.001) to the identification of high-risk patients than EuroSCORE II alone. Conclusion: Our data supports the hypothesis that a risk stratification strategy based on AVSc, added to ESII, may allow better recognition of patients at high-risk of short-term mortality after isolated surgical myocardial revascularization. Results from this study warrant further confirmation.
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Dursun I, Kul S, Bayraktar A, Erkan H, Turan T, Sayin MR, Korkmaz L. Association of Aortic Valve Sclerosis and Clinical Factors in Patients With Acute Myocardial Infarction. Am J Med Sci 2019; 357:474-482. [PMID: 31000422 DOI: 10.1016/j.amjms.2019.03.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Since aortic valve sclerosis (AVS) and coronary artery disease (CAD) share similar cardiovascular risk factors, we hypothesized that the clinical profile of patients with acute myocardial infarction (AMI) would be worse in the presence of AVS. The aim of this study was to investigate the association between AVS and clinical factors in patients with AMI. METHODS Three hundred and fifteen patients with AMI were consecutively enrolled in the study. Echocardiography was used to assess the aortic valve morphology and left ventricular function. The extent and severity of CAD were assessed by Gensini score and the number of obstructed vessels. The patients were divided into 2 groups according to presence or absence of AVS. RESULTS The overall number of patients with AVS was 132 (41.9%). Patients with AVS were older (69.5 ± 11 vs. 59.5 ± 12 years, P < 0.00001). They also had a higher prevalence of hypertension (61% vs. 45%, P = 0.006), prior CAD (33% vs. 23%, P = 0.041), prior AMI (20% vs. 11%, P = 0.019) and a higher percentage were female (32% vs. 19%, P = 0.007) compared with AMI patients without AVS. There was no significant difference between the 2 groups with respect to the Gensini score (P = 0.372). Prior AMI was associated with AVS on age-adjusted logistic regression analyses. A multivariate analysis showed an independent association between the AVS and prior AMI and age (P < 0.0000001, P = 0.022, respectively). CONCLUSIONS Our results showed that the presence of AVS is associated with AMI recurrence.
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Affiliation(s)
- Ihsan Dursun
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey.
| | - Selim Kul
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Ali Bayraktar
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Hakan Erkan
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Turhan Turan
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Muhammet Rasit Sayin
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
| | - Levent Korkmaz
- Department of Cardiology, Saglik Bilimleri University, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, Turkey
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Masuch A, Pietzner M, Bahls M, Budde K, Kastenmüller G, Zylla S, Artati A, Adamski J, Völzke H, Dörr M, Felix SB, Nauck M, Friedrich N. Metabolomic profiling implicates adiponectin as mediator of a favorable lipoprotein profile associated with NT-proBNP. Cardiovasc Diabetol 2018; 17:120. [PMID: 30153838 PMCID: PMC6112131 DOI: 10.1186/s12933-018-0765-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/23/2018] [Indexed: 12/11/2022] Open
Abstract
Background The N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is an important biomarker for the diagnosis of heart failure. Apart from this and only recently recognized, NT-proBNP levels associate with higher HDL- and lower LDL-cholesterol levels comprising a favorable blood lipid profile. To further examine this observation, the lipoprotein profile in relation to NT-proBNP was examined in-depth by proton nuclear magnetic resonance spectroscopy (1H-NMR). We complemented this investigation with a state-of-the-art untargeted metabolomics approach. Methods Lipoprotein particles were determined by 1H-NMR spectroscopy in 872 subjects without self-reported diabetes from the population-based Study of Health in Pomerania (SHIP)-TREND with available NT-proBNP measurements. Comprehensive metabolomics data for plasma and urine samples were obtained. Linear regression models were performed to assess the associations between serum concentrations of NT-proBNP and the metabolites/lipoprotein particles measured in plasma or urine. Results An increase in serum NT-proBNP was associated with a benefical lipoprotein profile, including a decrease in VLDL, IDL and LDL-particles along with an increase in large HDL particles. These findings were replicated in a second independent cohort. Serum concentrations of NT-proBNP showed significant inverse associations with seven plasma metabolites while associations with 39 urinary metabolites, mostly comprising amino acids and related intermediates, were identified. Mediation analyses revealed adiponection as mediating factor for the associations observed with lipoproteins particles. Conclusions Most of the metabolic changes associated with NT-proBNP implicate significant influence on the blood lipid profile besides vasodilatory and the diuretic action of BNP signaling. Our data suggest that the more favorable lipoprotein profile as associated with elevated NT-proBNP concentrations in mainly cardiac healthy individuals might relate to adiponectin signaling indicating even indirect cardio-protective effects for NT-proBNP. Electronic supplementary material The online version of this article (10.1186/s12933-018-0765-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Annette Masuch
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.
| | - Maik Pietzner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Martin Bahls
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Gabi Kastenmüller
- Institute of Bioinformatics and Systems Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Anna Artati
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jerzy Adamski
- Institute of Experimental Genetics, Genome Analysis Center, Helmholtz Zentrum München, Neuherberg, Germany.,Lehrstuhl für Experimentelle Genetik, Technische Universität München, Freising-Weihenstephan, Germany.,DZD (German Center for Diabetes Research), München-Neuherberg, Germany
| | - Henry Völzke
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Institute for Community Medicine, University Medicine Greifswald, Greifswald, 17475, Germany.,DZD (German Center for Diabetes Research), Site Greifswald, Greifswald, 17475, Germany
| | - Marcus Dörr
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
| | - Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Str, 17475, Greifswald, Germany.,German Center for Cardiovascular Research (DZHK e.V.), Partner Site Greifswald, Greifswald, Germany
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Hirschberg K, Reinhart M, Mereles D, Uhlmann L, André F, Riffel J, Ochs M, Katus HA. Echocardiographic calcification score in patients with low/intermediate cardiovascular risk. Clin Res Cardiol 2018; 108:194-202. [PMID: 30083858 DOI: 10.1007/s00392-018-1343-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/19/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Calcification of aortic valve and mitral annulus is associated with cardiovascular risk factors, morbidity and mortality. Assessment of cardiac calcification with echocardiography is feasible, however, only few structured scoring systems have been established so far with limited prognostic data. This study aimed to evaluate an echocardiographic calcification score (echo-CCS) in patients with low/intermediate cardiovascular risk. METHODS Digitally stored echocardiography studies of 151 patients (median age 64, 49.7% male) from February 2008 to December 2009 were retrospectively reviewed for calcifications of the aortic valve, aortic root, mitral annulus, papillary muscles and ventricular septum. A calcification score ranging from 0 to 5 was assigned to every patient and its relation to computed tomography calcium score, coronary stenosis and ESC SCORE was assessed. Follow-up data were collected from 149 patients (98.7%) with a median of 6.2 years. Logistic regression and Kaplan-Meier analysis were performed to assess the association of the echo-CCS with significant coronary artery disease (≥ 50% stenosis) and risk for cardiac events and all-cause mortality. RESULTS An association of the echo-CCS with the ESC SCORE (ρ = 0.5; p < 0.001) and a good correlation of the echo-CCS with the Agatston score (ρ = 0.73; p < 0.001) can be observed. Univariate regressions revealed that echo-CCS is a significant predictor for cardiac events [OR = 5.1 (CI: 1.7-15.0); p = 0.003], coronary intervention [OR = 2.8 (CI: 1.3-5.7); p = 0.006], hospitalisation for cardiac symptoms [OR = 2.0 (CI: 1.2-3.4); p = 0.007], all-cause mortality [OR = 2.6 (CI: 1.3-5.5); p = 0.01] and significant CAD [OR = 3.2 (CI: 1.9-5.4); p < 0.001]. CONCLUSIONS We demonstrated the prevalence of an easily obtainable, radiation-free calcification score in patients with low/intermediate cardiovascular risk. The strong association with CT-calcium scoring may evoke its potential as an alternative method in CV risk assessment.
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Affiliation(s)
- Kristof Hirschberg
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Manuel Reinhart
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Derliz Mereles
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lorenz Uhlmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Johannes Riffel
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Marco Ochs
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine III, Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
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Low-Circulating Homoarginine is Associated with Dilatation and Decreased Function of the Left Ventricle in the General Population. Biomolecules 2018; 8:biom8030063. [PMID: 30061520 PMCID: PMC6165018 DOI: 10.3390/biom8030063] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/10/2018] [Accepted: 07/19/2018] [Indexed: 01/20/2023] Open
Abstract
Low homoarginine is an independent marker of mortality in heart failure patients and incident cardiovascular events. Whether homoarginine is related with healthier cardiac structure and function is currently unclear. We used data of the population-based "Study of Health in Pomerania" (SHIP-Trend) to assess this relation. Homoarginine was measured in serum using liquid chromatography-tandem mass spectrometry. Linear regression models assessed the relation between homoarginine and several structural as well as functional parameters and N-terminal pro B-type natriuretic peptide (NTproBNP). All models were adjusted for age, sex, body mass index, and renal function. A total of 3113 subjects (median age 48 (25th percentile 37 to 75th percentile 60) years, 46% male) were included. A standard deviation decrease in homoarginine was associated with a larger left ventricular diastolic diameter (0.3; 95%-confidence interval (CI): 0.2 to 0.5 mm; p < 0.001), left ventricular systolic diameter (0.38; 95%-CI: -0.22 to 0.54 mm; p < 0.001) as well as a less relative wall thickness (⁻0.003 95%-CI: -0.006 to -0.0008; p = 0.01), left ventricular ejection fraction (⁻0.47; 95%-CI: ⁻0.79 to -0.15%; p < 0.01) and fractional shortening (-0.35; 95%-CI: -0.62 to 0.07%; p = 0.01). Low homoarginine was also related to higher NTproBNP (-0.02 95%-CI: -0.034 to -0.009 log pg/mL; p < 0.01). Lower serum homoarginine is associated with dilatation of the heart and decreased function. Prospective clinical studies should assess if homoarginine supplementation improves cardiac health in subjects with low serum concentrations.
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36
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Risk of cardiomyopathy and cardiac arrhythmias in patients with nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2018; 15:425-439. [PMID: 29713021 DOI: 10.1038/s41575-018-0010-0] [Citation(s) in RCA: 174] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is a common, progressive liver disease that affects up to one-quarter of the adult population worldwide. The clinical and economic burden of NAFLD is mainly due to liver-related morbidity and mortality (nonalcoholic steatohepatitis, cirrhosis or hepatocellular carcinoma) and an increased risk of developing fatal and nonfatal cardiovascular disease, chronic kidney disease and certain types of extrahepatic cancers (for example, colorectal cancer and breast cancer). Additionally, there is now accumulating evidence that NAFLD adversely affects not only the coronary arteries (promoting accelerated coronary atherosclerosis) but also all other anatomical structures of the heart, conferring an increased risk of cardiomyopathy (mainly left ventricular diastolic dysfunction and hypertrophy, leading to the development of congestive heart failure), cardiac valvular calcification (mainly aortic-valve sclerosis), cardiac arrhythmias (mainly atrial fibrillation) and some cardiac conduction defects. This Review focuses on the association between NAFLD and non-ischaemia-related cardiac disease, discusses the putative pathophysiological mechanisms and briefly summarizes current treatment options for NAFLD that might also beneficially affect cardiac disease.
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37
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Abramowitz Y, Kazuno Y, Chakravarty T, Kawamori H, Maeno Y, Anderson D, Allison Z, Mangat G, Cheng W, Gopal A, Jilaihawi H, Mack MJ, Makkar RR. Concomitant mitral annular calcification and severe aortic stenosis: prevalence, characteristics and outcome following transcatheter aortic valve replacement. Eur Heart J 2018; 38:1194-1203. [PMID: 28039339 DOI: 10.1093/eurheartj/ehw594] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 11/21/2016] [Indexed: 11/13/2022] Open
Abstract
Aims Calcified aortic stenosis (AS) and mitral annular calcification (MAC) have certain similar etiology and pathophysiological mechanisms. MAC is frequently encountered in pre-procedural computed tomography (CT) imaging of patients that undergo transcatheter aortic valve replacement (TAVR), but its prognostic implications for these patients have not been thoroughly investigated. This study sought to evaluate the prevalence of MAC among patients with severe AS and to assess the clinical implications of MAC on these patients during and following TAVR. Methods and results Consecutive patients that underwent TAVR were compared according to the existence of MAC and its severity in pre-TAVR CT scans. From the entire cohort of 761 patients, 49.3% had MAC, and 50.7% did not have MAC. Mild MAC was present in 231 patients (30.4%), moderate MAC in 72 patients (9.5%), and severe MAC in 72 patients (9.5%). Thirty-day mortality and major complications were similar between patients with and without MAC. In a multivariable survival analysis, severe MAC was found to be an independent strong predictor of overall mortality following TAVR (all-cause mortality: hazards ratio [HR] 1.95, 95% confidence interval [CI] 1.24-3.07, P = 0.004; cardiovascular mortality: HR 2.35, 95% CI 1.19-4.66; P = 0.01). Severe MAC was also found to be an independent strong predictor of new permanent pacemaker implantation (PPI) after TAVR (OR 2.83, 95% CI 1.08-7.47; P = 0.03). Conclusion Half of the patients with severe AS evaluated for TAVR were found to have MAC. Severe MAC is associated with increased all-cause and cardiovascular mortality and with conduction abnormalities following TAVR and should be included in future risk stratification models for TAVR.
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Affiliation(s)
- Yigal Abramowitz
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yoshio Kazuno
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tarun Chakravarty
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Hiroyuki Kawamori
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Yoshio Maeno
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Anderson
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zev Allison
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Geeteshwar Mangat
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Wen Cheng
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ambarish Gopal
- Advanced Cardiovascular Imaging, the Heart Hospital Baylor Plano (Baylor Scott and White Healthcare System), Plano, TX, USA
| | - Hasan Jilaihawi
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael J Mack
- Department of Cardiovascular Surgery, the Heart Hospital Baylor Plano (Baylor Scott and White Healthcare System), Plano, TX, USA
| | - Raj R Makkar
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Wu G, Xian J, Yang X, Li J, Liu J, Dong W, Su S, Li J, Tu Y, Peng J, Xu D, Zeng Q. Association between homocysteine levels and calcific aortic valve disease: a systematic review and meta-analysis. Oncotarget 2018; 9:8665-8674. [PMID: 29492225 PMCID: PMC5823577 DOI: 10.18632/oncotarget.23938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 11/08/2017] [Indexed: 12/05/2022] Open
Abstract
Previous studies have reported inconsistent results regarding the association between homocysteine (Hcy) levels and calcific aortic valve disease (CAVD). We investigate the association between Hcy levels in patients with CAVD and controls by conducting a systematic review and meta-analysis. We conducted a systematic search of studies published prior to the end of March 2017 in the PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials and the Chinese Biomedical Literature databases. Eligible studies evaluating plasma Hcy levels in CAVD patients and controls were identified by two independent investigators. Standardized mean difference (SMD) and the corresponding 95% confidence intervals (95% CIs) were estimated using the random-effects model. Ten studies involving 6349 participants were included. Pooled analysis demonstrated that Hcy levels were significantly elevated in patients with CAVD compared with controls (pooled SMD: 0.57, 95% CI: 0.36–0.79). This elevation was more obvious in American and Asian populations than in Turkish populations. Furthermore, Hcy levels were significantly elevated in patients with mild-to-moderate CAVD and severe CAVD. Our results demonstrate that CAVD is associated with elevated Hcy levels.
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Affiliation(s)
- Guandi Wu
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jiayi Xian
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xi Yang
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Jiaying Li
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Jichen Liu
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Wenhui Dong
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shuwen Su
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jun Li
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Tu
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jian Peng
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Dingli Xu
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Qingchun Zeng
- Department of Cardiology, First Clinical Medical College, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
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Creation of disease-inspired biomaterial environments to mimic pathological events in early calcific aortic valve disease. Proc Natl Acad Sci U S A 2017; 115:E363-E371. [PMID: 29282325 DOI: 10.1073/pnas.1704637115] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An insufficient understanding of calcific aortic valve disease (CAVD) pathogenesis remains a major obstacle in developing treatment strategies for this disease. The aim of the present study was to create engineered environments that mimic the earliest known features of CAVD and apply this in vitro platform to decipher relationships relevant to early valve lesion pathobiology. Glycosaminoglycan (GAG) enrichment is a dominant hallmark of early CAVD, but culture of valvular interstitial cells (VICs) in biomaterial environments containing pathological amounts of hyaluronic acid (HA) or chondroitin sulfate (CS) did not directly increase indicators of disease progression such as VIC activation or inflammatory cytokine production. However, HA-enriched matrices increased production of vascular endothelial growth factor (VEGF), while matrices displaying pathological levels of CS were effective at retaining lipoproteins, whose deposition is also found in early CAVD. Retained oxidized low-density lipoprotein (oxLDL), in turn, stimulated myofibroblastic VIC differentiation and secretion of numerous inflammatory cytokines. OxLDL also increased VIC deposition of GAGs, thereby creating a positive feedback loop to further enrich GAG content and promote disease progression. Using this disease-inspired in vitro platform, we were able to model a complex, multistep pathological sequence, with our findings suggesting distinct roles for individual GAGs in outcomes related to valve lesion progression, as well as key differences in cell-lipoprotein interactions compared with atherosclerosis. We propose a pathogenesis cascade that may be relevant to understanding early CAVD and envision the extension of such models to investigate other tissue pathologies or test pharmacological treatments.
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Afshar M, Luk K, Do R, Dufresne L, Owens DS, Harris TB, Peloso GM, Kerr KF, Wong Q, Smith AV, Budoff MJ, Rotter JI, Cupples LA, Rich SS, Engert JC, Gudnason V, O'Donnell CJ, Post WS, Thanassoulis G. Association of Triglyceride-Related Genetic Variants With Mitral Annular Calcification. J Am Coll Cardiol 2017; 69:2941-2948. [PMID: 28619195 PMCID: PMC5538134 DOI: 10.1016/j.jacc.2017.04.051] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 04/05/2017] [Accepted: 04/08/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mitral annular calcium (MAC), commonly identified by cardiac imaging, is associated with cardiovascular events and predisposes to the development of clinically important mitral valve regurgitation and mitral valve stenosis. However, its biological determinants remain largely unknown. OBJECTIVES The authors sought to evaluate whether a genetic predisposition to elevations in plasma lipids is associated with the presence of MAC. METHODS The authors used 3 separate Mendelian randomization techniques to evaluate the associations of lipid genetic risk scores (GRS) with MAC in 3 large patient cohorts: the Framingham Health Study, MESA (Multiethnic European Study of Atherosclerosis), and the AGE-RS (Age, Gene/Environment Susceptibility-Reykjavik Study). The authors provided cross-ethnicity replication in the MESA Hispanic-American participants. RESULTS MAC was present in 1,149 participants (20.4%). In pooled analyses across all 3 cohorts, a triglyceride GRS was significantly associated with the presence of MAC (odds ratio [OR] per triglyceride GRS unit: 1.73; 95% confidence interval [CI]: 1.24 to 2.41; p = 0.0013). Neither low- nor high-density lipoprotein cholesterol GRS was significantly associated with MAC. Results were consistent in cross-ethnicity analyses among the MESA Hispanic-Americans cohort (OR per triglyceride GRS unit: 2.04; 95% CI: 1.03 to 4.03; p = 0.04). In joint meta-analysis across all included cohorts, the triglyceride GRS was associated with MAC (OR per triglyceride GRS unit: 1.79; 95% CI: 1.32 to 2.41; p = 0.0001). The results were robust to several sensitivity analyses that limit both known and unknown forms of genetic pleiotropy. CONCLUSIONS Genetic predisposition to elevated triglyceride levels was associated with the presence of MAC, a risk factor for clinically significant mitral valve disease, suggesting a causal association. Whether reducing triglyceride levels can lower the incidence of clinically significant mitral valve disease requires further study.
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Affiliation(s)
- Mehdi Afshar
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Kevin Luk
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Ron Do
- The Charles Bronfman Institute for Personalized Medicine, Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Line Dufresne
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - David S Owens
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Gina M Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Quenna Wong
- Department of Biostatistics, University of Washington, Seattle, Washington
| | - Albert V Smith
- Icelandic Heart Association, Kopavogur, Iceland; 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Mathew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Los Angeles, California
| | - Jerome I Rotter
- Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Los Angeles, California
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts; Framingham Heart Study, Framingham, Massachusetts
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, Virginia
| | - James C Engert
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada
| | - Vilmundur Gudnason
- Icelandic Heart Association, Kopavogur, Iceland; 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Christopher J O'Donnell
- Framingham Heart Study, Framingham, Massachusetts; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; NHLBI Cardiovascular Epidemiology and Human Genomics Branch, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Wendy S Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - George Thanassoulis
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Preventive and Genomic Cardiology, McGill University Health Center and Research Institute, Montreal, Quebec, Canada.
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Markus MRP, Werner N, Schipf S, Siewert-Markus U, Bahls M, Baumeister SE, Völzke H, Felix SB, Ittermann T, Dörr M. Changes in Body Weight and Composition Are Associated With Changes in Left Ventricular Geometry and Function in the General Population. Circ Cardiovasc Imaging 2017; 10:e005544. [DOI: 10.1161/circimaging.116.005544] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 12/20/2016] [Indexed: 01/19/2023]
Abstract
Background—
The different effects of total body weight (TBW), fat-free mass (FFM), and fat mass (FM) on left ventricular (LV) geometry and function are complex. We investigated the associations of changes over time in TBW, FM, and FFM with changes in LV geometry and function.
Methods and Results—
We analyzed data from 1189 subjects (694 women), aged 44 to 86 years, from the baseline and the 5-year follow-up examination of the population-based SHIP (Study of Health in Pomerania). TBW was measured, and FFM and FM were calculated based on height-weight models derived from bioelectrical impedance studies. Echocardiographic measurements of LV geometry and function were performed according to the guidelines of the American Society of Echocardiography. Changes in body composition measures were associated with changes in LV geometry and function by multivariable-adjusted linear regression models. A 1-kg increase/decrease in TBW or FM was associated, respectively, with an increase/decrease of 0.89 g or 1.84 g in LV mass, whereas there was no such association on changes in FFM. Moreover, an increase in FM was associated with LV concentric remodeling and impairment of systolic and diastolic function parameters, whereas an increase in FFM was associated with LV eccentric remodeling and improved systolic and diastolic functional variables.
Conclusions—
Our findings indicate that changes in LV morphology and function depend on the type of body mass composition. Prospective data need to address whether specific changes in body composition over time may affect the risk for heart dysfunction more precisely than the change in TBW.
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Affiliation(s)
- Marcello Ricardo Paulista Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Nicole Werner
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sabine Schipf
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Ulrike Siewert-Markus
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Martin Bahls
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Sebastian Edgar Baumeister
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Henry Völzke
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Stephan Burkhard Felix
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Till Ittermann
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
| | - Marcus Dörr
- From the Department of Internal Medicine B (M.R.P.M., M.B., S.B.F., M.D.) and Department of Study of Health in Pomerania/Clinical-Epidemiological Research, Institute for Community Medicine (M.R.P.M., N.A., S.S., S.E.B., H.V., T.I.), University Medicine Greifswald, Germany; DZHK (German Centre for Cardiovascular Research) (M.R.P.M., M.B., H.V., S.B.F., T.I., M.D.) and DZD (German Center for Diabetes Research) (M.R.P.M., S.S., H.V., T.I.), partner site Greifswald, Germany; Institut für Psychologie,
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La Non Alcoholic Fatty Liver Disease (NAFLD) et la Non Alcoholic Steato-Hepatitis (NASH) des pathologies de système : revue pour le réanimateur. MEDECINE INTENSIVE REANIMATION 2016. [DOI: 10.1007/s13546-016-1253-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lu MLR, Gupta S, Romero-Corral A, Matejková M, De Venecia T, Obasare E, Bhalla V, Pressman GS. Cardiac Calcifications on Echocardiography Are Associated with Mortality and Stroke. J Am Soc Echocardiogr 2016; 29:1171-1178. [DOI: 10.1016/j.echo.2016.08.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Indexed: 10/20/2022]
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Senguttuvan NB, Kumar S, Lee WS, Mishra S, Cho JH, Kwon JE, Hyeon SH, Jeong YS, Won H, Shin SY, Lee KJ, Kim TH, Kim CJ, Kim SW. Plaque Vulnerability as Assessed by Radiofrequency Intravascular Ultrasound in Patients with Valvular Calcification. PLoS One 2016; 11:e0165885. [PMID: 27806099 PMCID: PMC5091909 DOI: 10.1371/journal.pone.0165885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 09/29/2016] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac valvular calcification is associated with the overall coronary plaque burden and considered an independent cardiovascular risk and prognostic factor. The purpose of this study was to evaluate the relationship between the presence of valvular calcification and plaque morphology and/or vulnerability. Methods Transthoracic echocardiography was used to assess valvular calcification in 280 patients with coronary artery disease who underwent radiofrequency intravascular ultrasound (Virtual Histology IVUS, VH-IVUS). A propensity score–matched cohort of 192 patients (n = 96 in each group) was analyzed. Thin-capped fibroatheroma (TCFA) was defined as a necrotic core (NC) >10% of the plaque area with a plaque burden >40% and NC in contact with the lumen for ≥3 image slices. A remodeling index (lesion/reference vessel area) >1.05 was considered to be positive. Results Patients were divided into two groups: any calcification in at least one valve (152 patients) vs. no detectable valvular calcification (128 patients). Groups were similar in terms of age, risk factors, clinical diagnosis, and angiographic analysis after propensity score-matched analysis. Gray-scale IVUS analysis showed that the vessel size, plaque burden, minimal lumen area, and remodeling index were similar. By VH-IVUS, % NC and % dense calcium (DC) were greater in patients with valvular calcification (p = 0.024, and p = 0.016, respectively). However, only % DC was higher at the maximal NC site by propensity score-matched analysis (p = 0.029). The frequency of VH-TCFA occurrence was higher depending on the complexity (p = 0.0064) and severity (p = 0.013) of valvular calcification. Conclusions There is a significant relationship between valvular calcifications and VH-IVUS assessment of TCFAs. Valvular calcification indicates a greater atherosclerosis disease complexity (increased calcification of the coronary plaque) and vulnerable coronary plaques (higher incidence of VH-TCFA).
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Affiliation(s)
| | - Sharath Kumar
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Wang-Soo Lee
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
- * E-mail:
| | - Sundeep Mishra
- All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Jun Hwan Cho
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Jee Eun Kwon
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Seong Hyeop Hyeon
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Yun Sang Jeong
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Hoyoun Won
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Seung Yong Shin
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Kwang Je Lee
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Tae Ho Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Chee Jeong Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
| | - Sang-Wook Kim
- Heart Research Institute, Chung-Ang University Hospital, Seoul, 06973, Korea
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Calcific Aortic Valve Disease Is Associated with Layer-Specific Alterations in Collagen Architecture. PLoS One 2016; 11:e0163858. [PMID: 27685946 PMCID: PMC5042542 DOI: 10.1371/journal.pone.0163858] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 09/15/2016] [Indexed: 11/20/2022] Open
Abstract
Disorganization of the valve extracellular matrix (ECM) is a hallmark of calcific aortic valve disease (CAVD). However, while microarchitectural features of the ECM can strongly influence the biological and mechanical behavior of tissues, little is known about the ECM microarchitecture in CAVD. In this work, we apply advanced imaging techniques to quantify spatially heterogeneous changes in collagen microarchitecture in CAVD. Human aortic valves were obtained from individuals between 50 and 75 years old with no evidence of valvular disease (healthy) and individuals who underwent valve replacement surgery due to severe stenosis (diseased). Second Harmonic Generation microscopy and subsequent image quantification revealed layer-specific changes in fiber characteristics in healthy and diseased valves. Specifically, the majority of collagen fiber changes in CAVD were found to occur in the spongiosa, where collagen fiber number increased by over 2-fold, and fiber width and density also significantly increased. Relatively few fibrillar changes occurred in the fibrosa in CAVD, where fibers became significantly shorter, but did not otherwise change in terms of number, width, density, or alignment. Immunohistochemical staining for lysyl oxidase showed localized increased expression in the diseased fibrosa. These findings reveal a more complex picture of valvular collagen enrichment and arrangement in CAVD than has previously been described using traditional analysis methods. Changes in fiber architecture may play a role in regulating the pathobiological events and mechanical properties of valves during CAVD. Additionally, characterization of the ECM microarchitecture can inform the design of fibrous scaffolds for heart valve tissue engineering.
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Cardiovascular Disease and Myocardial Abnormalities in Nonalcoholic Fatty Liver Disease. Dig Dis Sci 2016; 61:1246-67. [PMID: 26809873 DOI: 10.1007/s10620-016-4040-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Accepted: 01/11/2016] [Indexed: 02/08/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in many developed countries, affecting an estimated 30 % of the adult population. In this updated clinical review, we summarize the current knowledge regarding the strong association between NAFLD and the risk of coronary heart disease (CHD) and other functional, structural, and arrhythmic cardiac complications (e.g., left ventricular dysfunction, heart valve diseases and atrial fibrillation). We also briefly discuss the putative biological mechanisms linking NAFLD with these important extra-hepatic complications. To date, a large body of evidence has suggested that NAFLD is not simply a marker of CHD and other functional, structural, and arrhythmic cardiac complications, but also may play a part in the development and progression of these cardiac complications. The clinical implication of these findings is that patients with NAFLD may benefit from more intensive surveillance and early treatment interventions aimed at decreasing the risk of CHD and other cardiac and arrhythmic complications.
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Xie C, Shen Y, Hu W, Chen Z, Li Y. Angiotensin II promotes an osteoblast-like phenotype in porcine aortic valve myofibroblasts. Aging Clin Exp Res 2016. [PMID: 26197716 DOI: 10.1007/s40520-015-0408-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The mechanisms for pathogenesis of cardiac valve calcification were explored by studying the regulation of the Wnt signaling pathway during the transformation from cardiac valvular myofibroblasts to osteoblast-like phenotype. METHODS Studies were carried on primary cultured porcine aortic valvular myofibroblasts. The cells were randomly divided into four groups and treated with angiotensin II (Ang II) according to the following: Ang II (10(-6) mol/l), Valsartan (Val) (10(-5) mol/l), Ang II plus Val (Ang II 10(-6) mol/l + Val 10(-5) mol/l) or mock treated as the control. Protein expression of Bone morphogenetic protein 2 (BMP2), Alkaline phosphatase (ALP), and Wnt pathway components, Wnt3a and β-catenin, was investigated to assess the activation of the Wnt signaling pathway and determine whether cells undergo the transformation to osteoblast-like phenotype. RESULT Ang II treatment of myofibroblasts led to significant up-regulation of α-SMA expression and activation of the cells. Neither the BMP2 or ALP proteins, nor the mRNA was detectable in the control group or the Val-treated group; however, there was a significant increase in Ang II-treated group (P < 0.01). The Wnt/β-catenin signaling ligand, Wnt3a, was not expressed in the control or Val-treated groups, whereas in Ang II-treated cells, both Wnt3a and β-catenin gene expression were enhanced (P < 0.01).The effect of Ang II can be inhibited by the addition of Val (P < 0.05). CONCLUSION Ang II might act on the Ang II receptor on valvular interstitial cells (VICs) and lead to activation of the Wnt/β-catenin pathway and hence cause the activation, differentiation and proliferation of myofibroblasts, and finally, osteoblast-like phenotype transformation, leading to calcification of heart valves.
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Affiliation(s)
- Cuihong Xie
- Departments of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yingnian Shen
- Departments of Geriatric, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Weilin Hu
- Departments of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Zhengping Chen
- Departments of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China
| | - Yongsheng Li
- Departments of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, Hubei, China.
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Lazaros G, Drakopoulou M, Toutouzas K, Tousoulis D. Left-Sided Cardiac Valve Calcification: Another Rubik's Cube Puzzle? Cardiology 2016; 134:34-6. [DOI: 10.1159/000444009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
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Markus MRP, Meffert PJ, Baumeister SE, Lieb W, Siewert U, Schipf S, Koch M, Kors JA, Felix SB, Dörr M, Targher G, Völzke H. Association between hepatic steatosis and serum liver enzyme levels with atrial fibrillation in the general population. Atherosclerosis 2016; 245:123-31. [DOI: 10.1016/j.atherosclerosis.2015.12.023] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/08/2015] [Accepted: 12/15/2015] [Indexed: 02/07/2023]
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Porras AM, Shanmuganayagam D, Meudt JJ, Krueger CG, Hacker TA, Rahko PS, Reed JD, Masters KS. Development of Aortic Valve Disease in Familial Hypercholesterolemic Swine: Implications for Elucidating Disease Etiology. J Am Heart Assoc 2015; 4:e002254. [PMID: 26508741 PMCID: PMC4845146 DOI: 10.1161/jaha.115.002254] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Familial hypercholesterolemia (FH) is a prevalent hereditary disease associated with increased atherosclerosis and calcific aortic valve disease (CAVD). However, in both FH and non‐FH individuals, the role of hypercholesterolemia in the development of CAVD is poorly understood. This study used Rapacz FH (RFH) swine, an established model of human FH, to investigate the role of hypercholesterolemia alone in the initiation and progression of CAVD. The valves of RFH swine have not previously been examined. Methods and Results Aortic valve leaflets were isolated from wild‐type (0.25‐ and 1‐year‐old) and RFH (0.25‐, 1‐, 2‐, and 3‐year‐old) swine. Adult RFH animals exhibited numerous hallmarks of early CAVD. Significant leaflet thickening was found in adult RFH swine, accompanied by extensive extracellular matrix remodeling, including proteoglycan enrichment, collagen disorganization, and elastin fragmentation. Increased lipid oxidation and infiltration of macrophages were also evident in adult RFH swine. Intracardiac echocardiography revealed mild aortic valve sclerosis in some of the adult RFH animals, but unimpaired valve function. Microarray analysis of valves from adult versus juvenile RFH animals revealed significant upregulation of inflammation‐related genes, as well as several commonalities with atherosclerosis and overlap with human CAVD. Conclusions Adult RFH swine exhibited several hallmarks of early human CAVD, suggesting potential for these animals to help elucidate CAVD etiology in both FH and non‐FH individuals. The development of advanced atherosclerotic lesions, but only early‐stage CAVD, in RFH swine supports the hypothesis of an initial shared disease process, with additional stimulation necessary for further progression of CAVD.
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Affiliation(s)
- Ana M. Porras
- Department of Biomedical EngineeringUniversity of Wisconsin–MadisonMadisonWI
| | | | - Jennifer J. Meudt
- Department of Animal SciencesUniversity of Wisconsin–MadisonMadisonWI
| | | | - Timothy A. Hacker
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Wisconsin–MadisonMadisonWI
| | - Peter S. Rahko
- Division of Cardiovascular MedicineDepartment of MedicineUniversity of Wisconsin–MadisonMadisonWI
| | - Jess D. Reed
- Department of Animal SciencesUniversity of Wisconsin–MadisonMadisonWI
| | - Kristyn S. Masters
- Department of Biomedical EngineeringUniversity of Wisconsin–MadisonMadisonWI
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