1
|
Tong X, Shen L, Zhou X, Wang Y, Chang S, Lu S. Comparative Efficacy of Different Drugs for the Treatment of Dilated Cardiomyopathy: A Systematic Review and Network Meta-analysis. Drugs R D 2023; 23:197-210. [PMID: 37556093 PMCID: PMC10439079 DOI: 10.1007/s40268-023-00435-5] [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] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVE At present, the therapies of dilated cardiomyopathy concentrated on the symptoms of heart failure and related complications. The study is to evaluate the clinical efficacy of a combination of various conventional and adjuvant drugs in treating dilated cardiomyopathy via network meta-analysis. METHODS The study was reported according to the PRISMA 2020 statement. From inception through 27 June 2022, the PubMed, Embase, Cochrane library, and Web of Science databases were searched for randomized controlled trials on medicines for treating dilated cardiomyopathy. The quality of the included studies was evaluated according to the Cochrane risk of bias assessment. R4.1.3 and Revman5.3 software were used for analysis. RESULTS There were 52 randomized controlled trials in this study, with a total of 25 medications and a sample size of 3048 cases. The network meta-analysis found that carvedilol, verapamil, and trimetazidine were the top three medicines for improving left ventricular ejection fraction (LVEF). Ivabradine, bucindolol, and verapamil were the top 3 drugs for improving left ventricular end-diastolic dimension (LVEDD). Ivabradine, L-thyroxine, and atorvastatin were the top 3 drugs for improving left ventricular end-systolic dimension (LVESD). Trimetazidine, pentoxifylline, and bucindolol were the top 3 drugs for improving the New York Heart Association classification (NYHA) cardiac function score. Ivabradine, carvedilol, and bucindolol were the top 3 drugs for reducing heart rate (HR). CONCLUSION A combination of different medications and conventional therapy may increase the clinical effectiveness of treating dilated cardiomyopathy. Beta-blockers, especially carvedilol, can improve ventricular remodeling, cardiac function, and clinical efficacy in patients with dilated cardiomyopathy (DCM). Hence, they can be used if patients tolerate them. If LVEF and HR do not meet the standard, ivabradine can also be used in combination with other treatments. However, since the quality and number of studies in our research were limited, large sample size, multi-center, and high-quality randomized controlled trials are required to corroborate our findings.
Collapse
Affiliation(s)
- Xinyu Tong
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Lijuan Shen
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaomin Zhou
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yudan Wang
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Sheng Chang
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shu Lu
- Wuxi Traditional Chinese Medicine Hospital, Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
2
|
Xie J, Xu Y, Chen H, Chi M, He J, Li M, Liu H, Xia J, Guan Q, Guo Z, Yan H. Identification of population-level differentially expressed genes in one-phenotype data. Bioinformatics 2020; 36:4283-4290. [PMID: 32428201 PMCID: PMC7520039 DOI: 10.1093/bioinformatics/btaa523] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/15/2020] [Accepted: 05/14/2020] [Indexed: 01/01/2023] Open
Abstract
Motivation For some specific tissues, such as the heart and brain, normal controls are difficult to obtain. Thus, studies with only a particular type of disease samples (one phenotype) cannot be analyzed using common methods, such as significance analysis of microarrays, edgeR and limma. The RankComp algorithm, which was mainly developed to identify individual-level differentially expressed genes (DEGs), can be applied to identify population-level DEGs for the one-phenotype data but cannot identify the dysregulation directions of DEGs. Results Here, we optimized the RankComp algorithm, termed PhenoComp. Compared with RankComp, PhenoComp provided the dysregulation directions of DEGs and had more robust detection power in both simulated and real one-phenotype data. Moreover, using the DEGs detected by common methods as the ‘gold standard’, the results showed that the DEGs detected by PhenoComp using only one-phenotype data were comparable to those identified by common methods using case-control samples, independent of the measurement platform. PhenoComp also exhibited good performance for weakly differential expression signal data. Availability and implementation The PhenoComp algorithm is available on the web at https://github.com/XJJ-student/PhenoComp. Supplementary information Supplementary data are available at Bioinformatics online.
Collapse
Affiliation(s)
- Jiajing Xie
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Yang Xu
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Haifeng Chen
- Department of General Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou 350007, China
| | - Meirong Chi
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Jun He
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Meifeng Li
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Hui Liu
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Jie Xia
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Qingzhou Guan
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Zheng Guo
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| | - Haidan Yan
- Department of Bioinformatics, Key Laboratory of Ministry of Education for Gastrointestinal Cancer, The School of Basic Medical Sciences, Fujian Medical University, Fuzhou 350122, China.,Key Laboratory of Medical Bioinformatics, Fujian Province, Fuzhou 350122, China
| |
Collapse
|
3
|
Yeung HM, Hung MW, Lau CF, Fung ML. Cardioprotective effects of melatonin against myocardial injuries induced by chronic intermittent hypoxia in rats. J Pineal Res 2015; 58:12-25. [PMID: 25369321 DOI: 10.1111/jpi.12190] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 10/30/2014] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea (OSA) associated with chronic intermittent hypoxia (CIH) increases the morbidity and mortality of ischemic heart disease in patients. Yet, there is a paucity of preventive measures targeting the pathogenesis of CIH-induced myocardial injury. We examined the cardioprotective effect of melatonin against the inflammation, fibrosis and the deteriorated sarcoplasmic reticulum (SR) Ca(2+) homeostasis, and ischemia/reperfusion (I/R)-induced injury exacerbated by CIH. Adult male Sprague Dawley rats that had received a daily injection of melatonin (10 mg/kg) or vehicle were exposed to CIH treatment mimicking a severe OSA condition for 4 wk. Systolic pressure, heart weights, and malondialdehyde were significantly increased in hypoxic rats but not in the melatonin-treated group, when compared with the normoxic control. Levels of the expression of inflammatory cytokines (TNF-α, IL-6, and COX-2) and fibrotic markers (PC1 and TGF-β) were significantly elevated in the hypoxic group but were normalized by melatonin. Additionally, infarct size of isolated hearts with regional I/R was substantial in the hypoxic group treated with vehicle but not in the melatonin-treated group. Moreover, melatonin treatment mitigated the SR-Ca(2+) homeostasis in the cardiomyocyte during I/R with (i) Ca(2+) overloading, (ii) decreased SR-Ca(2+) content, (iii) lowered expression and activity of Ca(2+) -handling proteins (SERCA2a and NCX1),and (iv) decreased expressions of CAMKII and phosphorylated eNOS(ser1177). Furthermore, melatonin ameliorated the level of expression of antioxidant enzymes (CAT and MnSOD) and NADPH oxidase (p22 and NOX2). Results support a prophylactic usage of melatonin in OSA patients, which protects against CIH-induced myocardial inflammation and fibrosis with impaired SR-Ca(2+) handling and exacerbated I/R injury.
Collapse
Affiliation(s)
- Hang-Mee Yeung
- Department of Physiology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | | | | | | |
Collapse
|
4
|
Carvedilol Treatment After Myocardial Infarct Decreases Cardiomyocytic Apoptosis in the Peri-infarct Zone During Cardioplegia-Induced Cardiac Arrest. Shock 2013; 39:343-52. [DOI: 10.1097/shk.0b013e31828c588a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
5
|
Sari FR, Arozal W, Watanabe K, Harima M, Veeravedu PT, Thandavarayan RA, Suzuki K, Arumugam S, Soetikno V, Kodama M. Carvedilol Attenuates Inflammatory-Mediated Cardiotoxicity in Daunorubicin-Induced Rats. Pharmaceuticals (Basel) 2011. [PMCID: PMC4053802 DOI: 10.3390/ph4030551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Cardiotoxicity, which results from intense cardiac oxidative stress and inflammation, is the main limiting factor of the anthracyclines. Carvedilol, a beta blocker that is used as a multifunctional neurohormonal antagonist, has been shown to act not only as an anti-oxidant, but also as an anti-inflammatory drug. This study was designed to evaluate whether carvedilol exerts a protective role against inflammation-mediated cardiotoxicity in the daunorubicin (DNR)-induced rats. Carvedilol was administered orally to the rats every day for 6 weeks at a cumulative dose of 9 mg/kg body weight DNR. DNR significantly induced cardiac damage and worsened cardiac function as well as increased cardiac mast cell density, elevating the myocardial protein and mRNA expression levels of tumor necrosis factor-α, vascular cell adhesion molecule-1, inter-cellular adhesion molecule-1, nuclear factor kappa-B, cyclooxygenase-2, monocyte chemotactic protein -1 and interleukin -6 compared to that in the control group. Cotreatment with carvedilol significantly attenuated the myocardial protein and mRNA expression levels of these inflammatory markers, decreased cardiac mast cell density, improved histological cardiac damage and cardiac functions. In conclusion, inflammation plays a significant role in DNR-induced cardiotoxicity, and carvedilol contributes to cardioprotection against inflammation-mediated cardiotoxicity in DNR-induced rats through its anti-inflammatory mechanism.
Collapse
Affiliation(s)
- Flori R. Sari
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
- Department of Pharmacology, Faculty of Medicine and Health Sciences, Syarif Hidayatullah Jakarta, State Islamic University, South Jakarta 15412, Indonesia
| | - Wawaimuli Arozal
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
- Department of Pharmacology, Faculty of Medicine, University of Indonesia, Jakarta 10430, Indonesia
| | - Kenichi Watanabe
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
- Author to whom correspondence should be addressed; E-mail address: ; Tel.: +81 250 25 5267; Fax: +81 250 25 5021
| | - Meilei Harima
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
| | - Punniyakoti T. Veeravedu
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
| | - Rajarajan A. Thandavarayan
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
| | - Kenji Suzuki
- Department of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| | - Somasundaram Arumugam
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
| | - Vivian Soetikno
- Department of Clinical Pharmacology, Faculty of Pharmaceutical Sciences, Niigata University of Pharmacy and Applied Life Sciences, Niigata City 956-8603, Japan
| | - Makoto Kodama
- First Department of Internal Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8510, Japan
| |
Collapse
|
6
|
Rengo G, Leosco D, Zincarelli C, Marchese M, Corbi G, Liccardo D, Filippelli A, Ferrara N, Lisanti MP, Koch WJ, Lymperopoulos A. Adrenal GRK2 lowering is an underlying mechanism for the beneficial sympathetic effects of exercise training in heart failure. Am J Physiol Heart Circ Physiol 2010; 298:H2032-8. [PMID: 20304818 DOI: 10.1152/ajpheart.00702.2009] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Exercise training has been reported to exert beneficial effects on cardiac function and to reduce morbidity and mortality of chronic heart failure (HF). Augmented sympathetic nervous system (SNS) activity, leading to elevated circulating catecholamine (CA) levels, is a hallmark of chronic HF that significantly aggravates this disease. Exercise training has been shown to also reduce SNS overactivity in HF, but the underlying molecular mechanism(s) remain unidentified. We recently reported that adrenal G protein-coupled receptor kinase-2 (GRK2), an enzyme that regulates the sympathoinhibitory alpha(2)-adrenoceptors (alpha(2)-ARs) present in the CA-producing adrenal medulla, is upregulated in HF, contributing to the chronically elevated CA levels and SNS activity of the disease. In the present study, we tested whether exercise training can affect the adrenal GRK2-alpha(2)-AR-CA production system in the context of HF. For this purpose, a 10-wk-long exercise training regimen of adult male Sprague-Dawley rats starting at 4 wk postmyocardial infarction (post-MI) was employed, and examination at the end of this treatment period revealed significant amelioration of beta-AR-stimulated contractility in response to exercise training, accompanied by cardiac GRK2 reduction and restoration of circulating plasma CA levels. Importantly, adrenal GRK2 expression (72 + or - 5% reduction vs. post-MI untrained) and alpha(2)-AR number were also restored after exercise training in post-MI animals. These results suggest that exercise training restores the adrenal GRK2-alpha(2)-AR-CA production axis, and this might be part of the mechanism whereby this therapeutic modality normalizes sympathetic overdrive and impedes worsening of the failing heart.
Collapse
Affiliation(s)
- Giuseppe Rengo
- Cardiology Division, "Salvatore Maugeri" Foundation, IRCCS, Via Bagni Vecchi, 1-82037 Telese Terme, Italy.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Riegel B, Moser DK, Anker SD, Appel LJ, Dunbar SB, Grady KL, Gurvitz MZ, Havranek EP, Lee CS, Lindenfeld J, Peterson PN, Pressler SJ, Schocken DD, Whellan DJ. State of the Science. Circulation 2009; 120:1141-63. [DOI: 10.1161/circulationaha.109.192628] [Citation(s) in RCA: 638] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
8
|
The influence of heart failure self-care on health outcomes: hypothetical cardioprotective mechanisms. J Cardiovasc Nurs 2009; 24:179-87; quiz 188-9. [PMID: 19279494 DOI: 10.1097/jcn.0b013e31819b5419] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Lapses in self-care are commonly cited as a major cause of poor outcomes in persons with heart failure (HF). Not surprisingly, self-care is assumed to be central to improving health outcomes in this patient population. Empirically, however, this assumption is not well supported, and mechanistically, relationships between self-care and outcomes in HF have not yet been described. In this review, it is proposed that effective self-care maintenance (adherence) and self-care management (symptom evaluation and management) practices are complementary to optimal medical management in delaying HF progression and improving health outcomes in this population. Potential mechanisms through which effective HF self-care practices are complementary to pharmacological therapy in improving outcomes include (a) facilitating partial blockade and partial deactivation of deleterious neurohormones, (b) limiting inflammatory processes, (c) decreasing the need for administration of detrimental pharmacological agents, and (d) minimizing myocardial hibernation. Because these mechanisms are hypothetical, research findings are required to establish their validity. Several strategic research questions are proposed.
Collapse
|
9
|
Sampat U, Varadarajan P, Turk R, Kamath A, Khandhar S, Pai RG. Effect of Beta-Blocker Therapy on Survival in Patients With Severe Aortic Regurgitation. J Am Coll Cardiol 2009; 54:452-7. [DOI: 10.1016/j.jacc.2009.02.077] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2008] [Revised: 02/13/2009] [Accepted: 02/24/2009] [Indexed: 10/20/2022]
|
10
|
Lin PY, Shen HC, Chen CJ, Wu SE, Kao HL, Huang JH, Wang DL, Chen SC. The inhibition in tumor necrosis factor-α-induced attenuation in endothelial thrombomodulin expression by carvedilol is mediated by nuclear factor-κB and reactive oxygen species. J Thromb Thrombolysis 2009; 29:52-9. [DOI: 10.1007/s11239-009-0318-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 02/23/2009] [Indexed: 10/21/2022]
|
11
|
Varadarajan P, Joshi N, Appel D, Duvvuri L, Pai RG. Effect of Beta-blocker therapy on survival in patients with severe mitral regurgitation and normal left ventricular ejection fraction. Am J Cardiol 2008; 102:611-5. [PMID: 18721522 DOI: 10.1016/j.amjcard.2008.04.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 04/17/2008] [Accepted: 04/17/2008] [Indexed: 12/01/2022]
Abstract
Chronic volume overload from chronic severe mitral regurgitation (MR) results in neuroendocrine activation similar to the heart failure syndrome despite normal left ventricular (LV) ejection fraction (EF). Hence, the hypothesis that beta-blocker (BB) therapy may have a beneficial effect in these patients was tested using a large observational cohort. Our echocardiographic database was searched for patients with severe MR and normal LVEF. Full chart reviews were conducted for clinical and pharmacologic data. Survival was analyzed as a function of BB therapy. The search produced 895 patients aged 68 +/- 17 years, 44% men, with LVEF 66 +/- 7%. Of these, 32% were on BB therapy. Use of a BB was associated with a significantly decreased mortality hazard of 0.62 (95% confidence interval 0.46 to 0.83, p = 0.002), which was unchanged after adjusting for age, gender, LVEF, coronary artery disease, diabetes mellitus, hypertension, and cardiac valve surgery. The independent beneficial effect of BBs was seen in patients with or without coronary artery disease, those with or without hypertension, and patients managed both medically and surgically. In conclusion, use of BB therapy was associated with a significant independent survival benefit in patients with chronic severe MR with normal LVEF. This benefit was seen in patients with or without coronary artery disease, as well as patients managed both medically and surgically. Use of BBs in patients with severe MR despite normal LVEF is suggested.
Collapse
Affiliation(s)
- Padmini Varadarajan
- Division of Cardiology, Loma Linda University Medical Center, Loma Linda, California, USA
| | | | | | | | | |
Collapse
|
12
|
Abstract
OBJECTIVE To summarize findings regarding the association of inflammatory processes with chronic heart failure (HF). DATA SOURCES We conducted PubMed/MEDLINE searches (1966-January 2008) of primary literature using the following key words: ACE inhibitors, allopurinol, angiotensin-receptor antagonists, cardiomyopathy, chemokines, cytokines, diuretics, heart failure, inflammation, interleukins, HMG-CoA reductase inhibitors, immunotherapy, medications used in heart failure, thalidomide, tumor necrosis factor, and uric acid. STUDY SELECTION AND DATA EXTRACTION All articles that appeared to be relevant were read; of 305 articles examined, 87 were selected for discussion. Articles were selected if they were written in English and focused on any of the key words or appeared to have substantial content addressing inflammation in HF. DATA SYNTHESIS Cytokines, uric acid, and other inflammatory mediators are associated with physiologic effects that are also prominent features of HF (eg, reduced contractility and cardiac output, endothelial dysfunction, hypercoagulability, autonomic dysfunction as evidenced by reduced resting heart rate variability, insulin resistance). With the exception of elevated tumor necrosis factor-alpha as a cause of insulin resistance, it is not clear whether elevated inflammatory mediators directly cause HF signs and symptoms or whether they are incidental markers. Awareness of these associations has occurred relatively recently; there have been few clinical studies of efforts to directly modify inflammatory mediators. Most currently accepted drug therapies of HF reduce concentrations of circulating cytokines, but the significance of these findings awaits directed study. CONCLUSIONS Loss of myocardial function, autonomic dysfunction, and glucose intolerance are interrelated and linked by underlying chronic low-grade inflammation. Drug therapy with statins, pentoxifylline, and perhaps urate-lowering agents, in addition to current therapies, holds promise for treatment of HF.
Collapse
Affiliation(s)
- Roy C Parish
- Department of Clinical and Administrative Sciences, College of Pharmacy, The University of Louisiana, Monroe, LA, USA.
| | | |
Collapse
|
13
|
Norozi K, Buchhorn R, Wessel A, Bahlmann J, Raab B, Geyer S, Kuehne T, Beibei L, Werdan K, Loppnow H. Beta-Blockade Does Not Alter Plasma Cytokine Concentrations and Ventricular Function in Young Adults With Right Ventricular Dysfunction Secondary to Operated Congenital Heart Disease. Circ J 2008; 72:747-52. [DOI: 10.1253/circj.72.747] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Kambiz Norozi
- Department of Paediatric Cardiology and Intensive Care, Medical School Hannover
| | - Reiner Buchhorn
- Department of Paediatrics, Caritas Krankenhaus Bad Mergentheim
- Department of Paediatric Cardiology and Intensive Care, Georg-August-University
| | - Armin Wessel
- Department of Paediatric Cardiology and Intensive Care, Medical School Hannover
| | - Jens Bahlmann
- Department of Paediatric Cardiology and Intensive Care, Georg-August-University
| | - Björn Raab
- Department of Radiology, Georg-August-University
| | | | - Titus Kuehne
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Institute
| | - Li Beibei
- Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg
| | - Karl Werdan
- Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg
| | - Harald Loppnow
- Universitätsklinik und Poliklinik für Innere Medizin III, Martin-Luther-Universität Halle-Wittenberg
| |
Collapse
|
14
|
Gademan MGJ, Swenne CA, Verwey HF, van der Laarse A, Maan AC, van de Vooren H, van Pelt J, van Exel HJ, Lucas CMHB, Cleuren GVJ, Somer S, Schalij MJ, van der Wall EE. Effect of exercise training on autonomic derangement and neurohumoral activation in chronic heart failure. J Card Fail 2007; 13:294-303. [PMID: 17517350 DOI: 10.1016/j.cardfail.2006.12.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Revised: 12/15/2006] [Accepted: 12/27/2006] [Indexed: 01/25/2023]
Abstract
BACKGROUND In chronic heart failure (CHF), persistent autonomic derangement and neurohumoral activation cause structural end-organ damage, decrease exercise capacity, and reduce quality of life. Beneficial effects of pharmacotherapy and of exercise training in CHF have been documented at various functional and structural levels. However, pharmacologic treatment can not yet reduce autonomic derangement and neurohumoral activation in CHF to a minimum. Various studies suggest that exercise training is effective in this respect. METHODS AND RESULTS After reviewing the available evidence we conclude that exercise training increases baroreflex sensitivity and heart rate variability, and reduces sympathetic outflow, plasma levels of catecholamines, angiotensin II, vasopressin, and brain natriuretic peptides at rest. CONCLUSIONS Exercise training has direct and reflex sympathoinhibitory beneficial effects in CHF. The mechanism by which exercise training normalizes autonomic derangement and neurohumoral activation is to elucidate for further development of CHF-related training programs aimed at maximizing efficacy while minimizing workload.
Collapse
Affiliation(s)
- Maaike G J Gademan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Mizuochi Y, Okajima K, Harada N, Molor-Erdene P, Uchiba M, Komura H, Tsuda T, Katsuya H. Carvedilol, a nonselective beta-blocker, suppresses the production of tumor necrosis factor and tissue factor by inhibiting early growth response factor-1 expression in human monocytes in vitro. Transl Res 2007; 149:223-30. [PMID: 17383596 DOI: 10.1016/j.trsl.2006.11.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Revised: 10/11/2006] [Accepted: 11/21/2006] [Indexed: 11/16/2022]
Abstract
Tumor necrosis factor (TNF) and tissue factor (TF) produced by monocytes and macrophages have been shown to be among the aggravating factors for chronic heart failure (CHF), because they induce cardiac dysfunction and thrombotic complications, respectively. Carvedilol, a nonselective beta-adrenoceptor antagonist with alpha(1)- adrenoceptor blockade action, has been demonstrated to improve the outcome of patients with severe CHF, suggesting that carvedilol might inhibit the production of TNF and TF. In this study, this possibility is examined using isolated human monocytes stimulated with lipopolysaccharide (LPS) in vitro. Carvedilol (10 muM) significantly inhibited LPS-induced production of TNF and TF by monocytes, whereas prazosin (a selective alpha(1)-adrenoceptor antagonist), bisoprolol (a selective beta(1)-adrenoceptor antagonist), ICI-118,551 (a selective beta(2)-adrenoceptor antagonist), and arotinolol (a nonselective beta-adrenoceptor antagonist with alpha(1)-adrenoceptor blockade action) did not. Carvedilol inhibited both expression of early growth response factor-1 (Egr-1) and phosphorylation of extracellular signal-regulated kinase (ERK) 1/2, but it did not inhibit activation of either nuclear factor-kappaB or activator protein-1 in monocytes stimulated with LPS. These results suggest that carvedilol inhibits LPS-induced production of TNF and TF by inhibiting activation of the ERK1/2-Egr-1 pathway independent of its adrenoceptor inhibitory activities in monocytes.
Collapse
Affiliation(s)
- Yuichiro Mizuochi
- Department of Anesthesiology and Medical Crisis Management, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Kojima M, Sato K, Kimura G, Ueda R, Dohi Y. Carvedilol Reduces Elevated B-type Natriuretic Peptide in Dialyzed Patients Without Heart Failure: Cardioprotective Effect of the β-blocker. J Cardiovasc Pharmacol 2007; 49:191-6. [PMID: 17438403 DOI: 10.1097/fjc.0b013e318031f07f] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Elevated plasma B-type natriuretic peptide (BNP) predicts future cardiovascular events in dialyzed patients without heart failure. We investigated whether carvedilol reduces the elevated BNP in these patients. Asymptomatic patients on chronic hemodialysis with elevated BNP but without clinical signs of heart failure were randomly assigned to receive either carvedilol (n = 10) or nothing (control group, n = 10). BNP and malondialdehyde-low density lipoprotein (MDA-LDL) were measured, and ultrasound cardiography was performed at baseline and at 3 months. Carvedilol reduced the concentrations of BNP (551 +/- 90 to 237 +/- 174 ng/L, P < 0.01) and MDA-LDL (174 +/- 63 to 85 +/- 23 U/L, P < 0.01) and increased the velocity ratio of E to A waves of the transmitral flow (E/A: 0.59 +/- 0.04 to 0.71 +/- 0.05, P < 0.05), while no such alterations were observed in the control group. The reduction in BNP concentration was correlated with that in MAD-LDL and the increase in the E/A. There was a significant correlation between the increase in the E/A and the reduction in MDA-LDL concentration. Thus, carvedilol reduces the elevated BNP by improving left ventricular diastolic function in dialyzed patients without heart failure, which may be attributable to the antioxidant property of the beta-blocker. Administering carvedilol may improve the prognosis in this population.
Collapse
Affiliation(s)
- Masayoshi Kojima
- Department of Internal Medicine, Komono Kosei Hospital, Komono, Japan
| | | | | | | | | |
Collapse
|
17
|
Abstract
Myocardial infarction is associated with an immune response. Physiological inflammation response causes self-repair and protection, while pathological autoimmune response leads to ventricular remodeling and heart failure. Laying emphasis on regulating the immune function may become a new target for the prevention of heart failure after myocardial infarction. This review focuses on the mechanism of immune-mediated ventricular remodeling and the immune therapy after myocardial infarction.
Collapse
Affiliation(s)
- Yu-Hua Liao
- Laboratory of Cardiovascular Immunology, Institute of Cardiology, Union Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China.
| | | |
Collapse
|