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Cheng K, Zhang J, Ye LY, Lin MH, Ding XY, Zheng XE, Zhou XF. Geriatric nutrition risk index in the prediction of all-cause and cardiovascular mortality in older adults with hyperlipidemia: NHANES 1999-2018. BMC Geriatr 2024; 24:634. [PMID: 39068440 PMCID: PMC11282714 DOI: 10.1186/s12877-024-05232-6] [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: 03/01/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Malnutrition is linked to a higher risk of unfavorable outcomes in various illnesses. The present investigation explored the correlation between inadequate nutritional condition and outcomes in older individuals diagnosed with hyperlipidemia. METHODS The geriatric nutritional risk index (GNRI) was used to evaluate the nutritional status. All patients were divided into two groups according to GNRI. A Kaplan-Meier analysis was used to assess the survival rates of different groups at risk of malnutrition. In addition, GNRI was used in COX proportional risk regression models to evaluate its predictive effect on both overall mortality and cardiovascular mortality among patients with hyperlipidemia. Furthermore, the study employed restricted cubic splines (RCS) to examine the nonlinear correlation between GNRI and mortality. RESULTS The study included 4,532 elderly individuals diagnosed with hyperlipidemia. During a median follow-up duration of 139 months, a total of 1498 deaths from all causes and 410 deaths from cardiovascular causes occurred. The Kaplan-Meier analysis demonstrated significantly poorer survival among individuals at risk of malnutrition, as indicated by the GNRI. In the malnutrition risk group, the modified COX proportional hazards model revealed that a decrease in GNRI was associated with a higher risk of all-cause mortality (HR=1.686, 95% CI 1.212-2.347) and cardiovascular mortality (HR=3.041, 95% CI 1.797-5.147). Furthermore, the restricted cubic splines revealed a non-linear association between GNRI and both all-cause mortality and cardiovascular mortality (p-value for non-linearity = 0.0039, p-value for non-linearity=0.0386). CONCLUSIONS In older patients with hyperlipidemia, lower levels of GNRI are associated with mortality. The GNRI could potentially be used to predict all-cause mortality and cardiovascular mortality.
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Affiliation(s)
- Kun Cheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Jing Zhang
- Second Department of Infectious Disease, Shanghai Fifth People's Hospital of Fudan University, Shanghai, 200240, China
| | - Lu-Ya Ye
- Medical Intensive Care Unit, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, 363000, Fujian, China
| | - Mou-Hui Lin
- The School of Clinical Medicine Department, Fujian Medical University, Fuzhou, 350001, Fujian, China
| | - Xiao-Yan Ding
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-E Zheng
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China
| | - Xiao-Fen Zhou
- Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, Fujian, China.
- The Fourth Department of Intensive Care Unit, Fuzhou University Affiliated Provincial Hospital, Fuzhou, 350001, Fujian, China.
- Fujian Provincial Key Laboratory of Emergency Medicine, Fuzhou, 350001, Fujian, China.
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Yin N, Wu X, Ren R, Luo J. The effect of acupoint catgut embedding and drug therapy on hyperlipidemia: a meta-analysis of randomized controlled trials. Biotechnol Genet Eng Rev 2024; 40:664-677. [PMID: 36880486 DOI: 10.1080/02648725.2023.2186559] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
There is no consensus on whether acupoint catgut embedding should be widely used as a treatment for hyperlipidemia. Acupoint catgut embedding is also not included in the guidelines for the treatment of hyperlipidemia. The purpose of this study was of two aspects: 1) to review recent research advances in the relationship between acupoint catgut embedding and hyperlipidemia, 2) to make a meta-analysis of the effects of acupoint catgut embedding on hyperlipidemia. We conducted a meta-analysis of studies extracted from PubMed, the Cochrane Library, Embase CNKI, Wanfang Data and VIP to identify randomized controlled trials (RCTs) evaluating the efficacy of acupoint catgut embedding on hyperlipidemia evaluated through screening, inclusion, data extraction and quality assessment. We performed a meta-analysis using Review Manager 5.3 software. A total of 9 RCTs, involving more than 500 adults over 18 years old, were included. Compared with acupoint catgut embedding, drugs resulted in TC [MD = -0.08, 95% CI (-0.20, 0.05), p = 0.41, I2 = 2%], in TG [MD =-0.04, 95% CI (-0.20, 0.11), p = 0.09, I2 = 43%], in HDL-C [MD = 0.02, 95% CI (-0.12, 0.16), p = 0.07, I2 = 50%], in LDL-C [MD = 0.16, 95% CI (0.02, 0.29), p = 0.17, I2 = 34%]. Based on the current evidence, acupoint catgut embedding is not significantly more effective than drugs in reducing hyperlipidemia. More randomized trials are needed to confirm this conclusion.
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Affiliation(s)
- Na Yin
- Gynaecology and Operating Room, Shanghai University of Traditional Chinese Medicine Taizhou Hospital, Taizhou, Zhejiang, China
| | - Xiaoping Wu
- Taizhou Central Hospital, Neurology department, California Baptist University, Zhejiang, China
| | - Rongrong Ren
- Gynaecology and Operating Room, Shanghai University of Traditional Chinese Medicine Taizhou Hospital, Taizhou, Zhejiang, China
| | - Jing Luo
- Gynaecology and Operating Room, Shanghai University of Traditional Chinese Medicine Taizhou Hospital, Taizhou, Zhejiang, China
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3
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Ibrahim L, Buschmann E, van Loon G, Cornillie P. Morphological evidence of a potential arrhythmogenic substrate in the caudal and cranial vena cava in horses. Equine Vet J 2024. [PMID: 38391272 DOI: 10.1111/evj.14075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Three-dimensional electro-anatomical mapping, previously performed in horses with atrial arrhythmias, has demonstrated the medial region of the caudal vena cava (CaVC), 1-8 cm caudal to the fossa ovalis, as an anatomical predilection site for atrial tachycardia associated with areas of slow conduction and conduction block. Slow conduction has also been recorded in the cranial vena cava (CrVC). OBJECTIVES To investigate the morphological characteristics of the myocardial sleeves (MS) in the CaVC and CrVC, in order to identify a potential substrate of right sided atrial arrhythmias. STUDY DESIGN Cross sectional. METHODS Post-mortem dissection of 37 hearts from adult warmblood horses without known cardiovascular disease. Macroscopic examination of the myocardial distribution, evaluated the MS area, length, width, and shape in the CaVC and the CrVC. At least 2 samples from each vena cava MS were histologically examined using Masson's trichrome staining. RESULTS Myocardial sleeves into the medial CaVC and into the CrVC were observed in all horses and showed variations in distribution, shape, and size between horses. Their mean ± standard deviation length from the limbus into the CaVC reached 5.7 ± 1.0 cm (maximum 8.3 cm), and from the azygos vein into the CrVC 5.3 ± 1.6 cm (maximum 8.6 cm). Myocardium-free islands were observed in the CaVC and CrVC in 30% and 6% of horses, respectively. Histologically, MS showed a non-uniform myocardial fibre arrangement, with presence of fibroadipose tissue, features known to result in slow conduction and pro-arrhythmia. MAIN LIMITATIONS Study only included horses without history of atrial arrhythmia. CONCLUSIONS Myocardial sleeves are present in both CaVC and CrVC, showing anatomical variations between horses. Tissue characteristics known to favour re-entry were identified indicating that these venae cavae MS are a potential substrate for atrial tachyarrhythmias and a target for treatment by ablation.
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Affiliation(s)
- Lara Ibrahim
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Eva Buschmann
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Gunther van Loon
- Equine Cardioteam Ghent, Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - Pieter Cornillie
- Department of Morphology, Imaging, Orthopedics, Rehabilitation and Nutrition, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
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4
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Manolis AA, Manolis TA, Melita H, Manolis AS. Sodium-glucose cotransporter type 2 inhibitors and cardiac arrhythmias. Trends Cardiovasc Med 2023; 33:418-428. [PMID: 35447305 DOI: 10.1016/j.tcm.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/02/2022] [Accepted: 04/15/2022] [Indexed: 02/06/2023]
Abstract
The introduction of sodium-glucose cotransporter 2 (SGLT2) inhibitors as a new and effective class of therapeutic agents for type 2 diabetes (T2D) preventing the reabsorption of glucose in the kidneys and thus facilitating glucose excretion in the urine, but also as agents with cardiovascular benefits, particularly in patients with heart failure (HF), regardless of the diabetic status, has ushered in a new era in treating patients with T2D and/or HF. In addition, data have recently emerged indicating an antiarrhythmic effect of the SGLT2 inhibitors in patients with and without diabetes. Prospective studies, randomized controlled trials and meta-analyses have provided robust evidence for a protective and beneficial effect of these agents against atrial fibrillation, ventricular arrhythmias and sudden cardiac death. The antiarrhythmic mechanisms involved include reverse atrial and ventricular remodeling, amelioration of mitochondrial function, reduction of hypoglycemic episodes with their attendant arrhythmogenic effects, attenuated sympathetic nervous system activity, regulation of sodium and calcium homeostasis, and suppression of prolonged ventricular repolarization. These new data on antiarrhythmic actions of SGLT2 inhibitors are herein reviewed, potential mechanisms involved are discussed and pictorially illustrated, and treatment results on specific arrhythmias are described and tabulated.
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Affiliation(s)
| | | | | | - Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Schram Serban C, de Groot NMS. Impact of Obesity on Atrial Electrophysiological Substrate. J Cardiovasc Dev Dis 2023; 10:342. [PMID: 37623355 PMCID: PMC10455641 DOI: 10.3390/jcdd10080342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/26/2023] Open
Abstract
(1) Background. Obesity is a well-established worldwide recognised risk factor for atrial fibrillation (AF). Prior review papers reported on the associations between obesity and AF development, but not on the relation between obesity and atrial electrophysiology. We therefore conducted a systematic review to describe the current knowledge of the characteristics of the atrial electrophysiological substrate in obese individuals and how they relate to the development of AF. (2) Methods. A search was conducted in Pubmed, Embase, and the Cochrane Library for publications evaluating the impact of obesity on atrial electrophysiology, electrical substrates, and their relation to the development of AF. (3) Results. A systematic literature search retrieved 477 potential publications based on the inclusion criteria; 76 full-text articles were selected for the present systematic review. The literature demonstrated that obesity predisposes to not only a higher AF incidence but also to more extensive atrial electrophysiological abnormalities increasing susceptibility to AF development. (4) Conclusion. Obesity may predispose to an overall increase in atrial electropathology, consisting of an increase in the slowing of the conduction, conduction block, low-voltage areas, and complex fractionated electrograms. To determine the impact of obesity-induced atrial electrical abnormalities on the long-term clinical outcome, further prospective studies are mandatory.
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Affiliation(s)
- Corina Schram Serban
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
| | - Natasja M. S. de Groot
- Department of Cardiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands;
- Department of Microelectronics, Circuits and Systems, Faculty of Electrical Engineering, Mathematics and Computer Sciences, Delft University of Technology, 2628 CD Delft, The Netherlands
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Rosca CI, Lighezan DF, Nisulescu DD, Sharma A, Neagu MN, Nistor D, Georgescu D, Kundnani NR. Metabolic Syndrome: A Strange Companion of Atrial Fibrillation; A Blessing in Disguise from the Neuropsychiatric Point of View. Biomedicines 2023; 11:2012. [PMID: 37509651 PMCID: PMC10377522 DOI: 10.3390/biomedicines11072012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/12/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Background: The concept of metabolic syndrome (MetSy) brings together components that individually represent a risk factor for cardiovascular diseases, which over time can prove to be more harmful if a combined effect of these is exhibited. Method: A single-centre retrospective study in an academic medical unit was conducted. We analysed the link between the MetSy and the occurrence of neuropsychic complications among atrial fibrillation (AF) patients. We sifted through the files of the patients admitted during 2015-2016 to the Municipal Emergency University Hospital Timisoara, Romania, with the diagnosis of AF. We divided these AF patients into two groups: the first group comprised patients with atrial fibrillation and MetSy (267 patients), while the second group comprised AF patients without MetSy (843 patients). We analysed the occurrence of neuropsychic changes (stroke, Parkinson's disease, dementia, cognitive impairment, and silent lacunar infarction) among the two groups. Results: Cognitive impairment (p-value = 0.0081) and dementia (p-value < 0.0001) were less frequent in patients with AF and MetSy than in those with AF without MetSy. Regarding the presence of stroke and Parkinson's disease (PD), we could not demonstrate the existence of any statistically significant difference between the two groups. Using logistic regression (enter test), we found that MetSy might have a protective effect (OR = 0.4040, 95% CI [0.2132; 0.7654], p-value = 0.0054) for the occurrence of dementia in those patients. Furthermore, obesity was the only factor with a possible protective effect from all the constituents of the MetSy when analysed together (with a significance level of p-value = 0.0004 for the logistic regression). The protective effect of MetSy against stroke occurrence was supplementarily proven by a longer period of survival without stroke from the AF diagnosis (3.521 years, p = 0.0304) compared to patients with AF without MetSy (3.286 years to first stroke occurrence). Conclusions: Metabolic syndrome might offer protection against the occurrence of dementia among patients with AF, but no effect was noted when compared with the presence of stroke. Further studies on larger cohorts can help us reach a conclusion regarding the positive effects of the metabolic syndrome.
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Affiliation(s)
- Ciprian Ilie Rosca
- Department of Internal Medicine I-Medical Semiotics I, Centre for Advanced Research in Cardiovascular Pathology and Haemostasis, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
| | - Daniel Florin Lighezan
- Department of Internal Medicine I-Medical Semiotics I, Centre for Advanced Research in Cardiovascular Pathology and Haemostasis, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
| | | | - Abhinav Sharma
- Department of Cardiology-Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 3000041 Timișoara, Romania
| | - Marioara Nicula Neagu
- Faculty of Bioengineering of Animal Resources, Discipline of Physiology, University of Life Sciences "King Mihai I" from Timisoara, 300645 Timisoara, Romania
| | - Daciana Nistor
- Department of Functional Sciences, Physiology, Centre of Imuno-Physiology and Biotechnologies (CIFBIOTEH), Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Centre for Gene and Cellular Therapies in Cancer, 3000723 Timisoara, Romania
| | - Doina Georgescu
- Department of Internal Medicine I-Medical Semiotics I, Centre for Advanced Research in Cardiovascular Pathology and Haemostasis, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
| | - Nilima Rajpal Kundnani
- Department of Cardiology-Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, "Victor Babeș" University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 3000041 Timișoara, Romania
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7
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Leutner M, Dervic E, Bellach L, Klimek P, Thurner S, Kautzky A. Obesity as pleiotropic risk state for metabolic and mental health throughout life. Transl Psychiatry 2023; 13:175. [PMID: 37248222 DOI: 10.1038/s41398-023-02447-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
Obesity, a highly prevalent disorder and central diagnosis of the metabolic syndrome, is linked to mental health by clinical observations and biological pathways. Patients with a diagnosis of obesity may show long-lasting increases in risk for receiving psychiatric co-diagnoses. Austrian national registry data of inpatient services from 1997 to 2014 were analyzed to detect associations between a hospital diagnosis of obesity (ICD-10: E66) and disorders grouped by level-3 ICD-10 codes. Data were stratified by age decades and associations between each pair of diagnoses were computed with the Cochran-Mantel-Haenszel method, providing odds ratios (OR) and p values corrected for multiple testing. Further, directions of the associations were assessed by calculating time-order-ratios. Receiving a diagnosis of obesity significantly increased the odds for a large spectrum of psychiatric disorders across all age groups, including depression, psychosis-spectrum, anxiety, eating and personality disorders (all pcorr < 0.01, all OR > 1.5). For all co-diagnoses except for psychosis-spectrum, obesity was significantly more often the diagnosis received first. Further, significant sex differences were found for most disorders, with women showing increased risk for all disorders except schizophrenia and nicotine addiction. In addition to the well-recognized role in promoting disorders related to the metabolic syndrome and severe cardiometabolic sequalae, obesity commonly precedes severe mental health disorders. Risk is most pronounced in young age groups and particularly increased in female patients. Consequently, thorough screening for mental health problems in patients with obesity is urgently called for to allow prevention and facilitate adequate treatment.
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Affiliation(s)
- Michael Leutner
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Elma Dervic
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Luise Bellach
- Department of Internal Medicine III, Clinical Division of Endocrinology and Metabolism, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Stefan Thurner
- Section for Science of Complex Systems, CeMSIIS, Medical University of Vienna, Spitalgasse 23, A-1090, Vienna, Austria
- Complexity Science Hub Vienna, Josefstaedter Straße 39, 1080, Vienna, Austria
| | - Alexander Kautzky
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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Samouillan V, Garcia E, Benitez-Amaro A, La Chica Lhoëst MT, Dandurand J, Actis Dato V, Guerra JM, Escolà-Gil JC, Chiabrando G, Enrich C, Llorente-Cortes V. Inhibitory Effects of LRP1-Based Immunotherapy on Cardiac Extracellular Matrix Biophysical Alterations Induced by Hypercholesterolemia. J Med Chem 2023; 66:6251-6262. [PMID: 37116069 PMCID: PMC10184115 DOI: 10.1021/acs.jmedchem.2c02103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The accumulation of lipids in cardiomyocytes contributes to cardiac dysfunction. The specific blockage of cardiomyocyte cholesteryl ester (CE) loading by antibodies (Abs) against the P3 sequence (Gly1127-Cys1140) of the LRP1 receptor improves cardiac insulin sensitivity. The impact of anti-P3 Abs on high-fat diet (HFD)-induced cardiac extracellular matrix (ECM) biophysical alterations was analyzed. Both IrP (without Abs) and P3-immunized rabbits (with Abs) were randomized into groups fed either HFD or a standard chow diet. Cardiac lipids, proteins, and carbohydrates were characterized by Fourier transform infrared spectroscopy in the attenuated total reflectance mode. The hydric organization and physical structure were determined by differential scanning calorimetry. HFD increased the levels of esterified lipids, collagen, and α-helical structures and upregulated fibrosis, bound water, and ECM plasticization in the heart. The inhibitory effect of anti-P3 Abs on cardiac CE accumulation was sufficient to reduce the collagen-filled extracellular space, the level of fibrosis, and the amount of bound water but did not counteract ECM plasticization in the heart of hypercholesterolemic rabbits.
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Affiliation(s)
- Valerie Samouillan
- CIRIMAT, Université de Toulouse, Université Paul Sabatier, Equipe PHYPOL, 31062 Toulouse, France
| | - Eduardo Garcia
- Biomedical Research Institute Sant Pau (IIB SANTPAU), Universitat Autonoma de Barcelona, 08041 Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), 08036 Barcelona, Spain
| | - Aleyda Benitez-Amaro
- Biomedical Research Institute Sant Pau (IIB SANTPAU), Universitat Autonoma de Barcelona, 08041 Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), 08036 Barcelona, Spain
| | - Maria Teresa La Chica Lhoëst
- Biomedical Research Institute Sant Pau (IIB SANTPAU), Universitat Autonoma de Barcelona, 08041 Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), 08036 Barcelona, Spain
| | - Jany Dandurand
- CIRIMAT, Université de Toulouse, Université Paul Sabatier, Equipe PHYPOL, 31062 Toulouse, France
| | - Virginia Actis Dato
- Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, X5000HUA Córdoba, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), Godoy Cruz, 2290 Buenos Aires, Argentina
| | - Jose Maria Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB-SANTPAU), Universitat Autonoma de Barcelona, 08025 Barcelona, Spain
- CIBERCV, Institute of Health Carlos III, 28029 Madrid, Spain
| | - Joan Carles Escolà-Gil
- Metabolic Basis of Cardiovascular Risk, Biomedical Research Institute Sant Pau (IIB Sant Pau), 08041 Barcelona, Spain
- CIBER de Diabetes y enfermedades Metabólicas Asociadas (CIBERDEM), 28029 Madrid, Spain
| | - Gustavo Chiabrando
- Instituto Universitario de Ciencias Biomédicas de Córdoba (IUCBC), Centro de Investigación en Medicina Translacional Severo R. Amuchástegui (CIMETSA), G. V. al Instituto de Investigación Médica Mercedes y Martín Ferreyra (INIMEC-CONICET-UNC), X5016KEJ Córdoba, Argentina
| | - Carlos Enrich
- Unitat de Biologia Cellular, Departament de Biomedicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, 08036 Barcelona, Spain
- Centre de Recerca Biomèdica CELLEX, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
| | - Vicenta Llorente-Cortes
- Biomedical Research Institute Sant Pau (IIB SANTPAU), Universitat Autonoma de Barcelona, 08041 Barcelona, Spain
- Institute of Biomedical Research of Barcelona (IIBB)-Spanish National Research Council (CSIC), 08036 Barcelona, Spain
- CIBERCV, Institute of Health Carlos III, 28029 Madrid, Spain
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9
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Volpe M, Gallo G. Obesity and cardiovascular disease: An executive document on pathophysiological and clinical links promoted by the Italian Society of Cardiovascular Prevention (SIPREC). Front Cardiovasc Med 2023; 10:1136340. [PMID: 36993998 PMCID: PMC10040794 DOI: 10.3389/fcvm.2023.1136340] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
The prevalence of obesity worldwide has increased in recent decades not only among adults, but also in children and adolescents. This phenomenon contributes to an increased risk of cardiovascular diseases (CVD), also after the adjustment for conventional risk factors such as hypertension, diabetes and dyslipidemia. Indeed, obesity contributes to the development of insulin resistance, endothelial dysfunction, sympathetic nervous system activation, increased vascular resistance and inflammatory and prothrombotic state which promote the incidence of major cardiovascular events. On the basis of this evidence, in 2021 obesity has been acknowledged as a definite pathological identity and identified as a recurrent, chronic non-communicable disease. Therapeutic strategies for the pharmacological treatment of obesity include the combination of naltrexone and bupropione and the lipase inhibitor orlistat and they have been recently implemented with the glucagon like peptide-1 receptor agonists semaglutide and liraglutide, which have produced positive and sustained effects on body weight reduction. If drug interventions are not effective, bariatric surgery may be considered, representing an efficacious treatment option for extreme obesity or obesity with comorbidities. The present executive paper is aimed to increase knowledge on the relationships between obesity and CVD, to raise the perception of this condition which is currently insufficient and to support the clinical practice management.
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Affiliation(s)
- Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
- IRCCS San Raffaele, Rome, Italy
- Correspondence: Massimo Volpe
| | - Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
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10
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Hereijgers MJM, van der Velden RMJ, Simons S, Linz D. Respiratory function assessment in patients with atrial fibrillation: A needed extension of combined comorbidity management? Can J Cardiol 2023; 39:623-624. [PMID: 36781104 DOI: 10.1016/j.cjca.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/06/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023] Open
Affiliation(s)
- Maartje J M Hereijgers
- Department of Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Sami Simons
- Department of Pulmonology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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11
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Skovgaard D, Haahr PM, Lester R, Clark K, Paglialunga S, Finer N, Friedrichsen MH, Hjerpsted JB, Engelmann MDM. Prevalence of Baseline Cardiac Arrhythmias in Participants with Overweight or Obesity in Phase 1 Clinical Trials: Analysis of 24-Hour Holter Electrocardiogram Recordings. J Clin Pharmacol 2022; 63:539-543. [PMID: 36524539 DOI: 10.1002/jcph.2193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Although estimates of the prevalence of cardiac arrhythmias in healthy volunteers exist, there is a lack of baseline data in other specific populations, such as people living with overweight and obesity, who are increasingly involved in clinical trials. This study investigated the baseline prevalence of arrhythmias in participants with overweight or obesity in 2 phase 1 trials of weight management medications (NCT03661879, NCT03308721). Participants aged 18-55 years, without a history of cardiovascular disease, and with body mass index (BMI) of 25.0-39.9 kg/m2 , were screened for abnormalities in vital signs, electrocardiogram (ECG) recordings, and electrolytes. Baseline 24-hour ECG (Holter) data were collected and manually reviewed by a cardiologist. The primary endpoint was the proportion of participants with ≥1 episode of the predefined cardiac arrhythmias. Continuous 12-lead ECG data were obtained from 207 participants. Most arrhythmias occurred in <3% of participants. Atrioventricular blocks and other potentially malignant arrhythmias were uncommon. There were no associations with age, sex, or BMI. Prevalence of atrioventricular blocks, nonsustained ventricular tachycardia, and other potentially malignant arrhythmias mirrored those reported in healthy participants with normal weight. In clinical trials of weight management medication, knowledge of the baseline prevalence of arrhythmias in people with overweight and obesity may inform trial eligibility criteria, improve on-trial decisions, and could be useful in discussions with health authorities. Baseline Holter readings and real-time ECG telemetry monitoring should be considered in such trials if arrhythmia risk is intrinsic to the molecule, or when signals have been observed in preclinical studies.
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12
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Yao Y, Xue J, Li B. Obesity and sudden cardiac death: Prevalence, pathogenesis, prevention and intervention. Front Cell Dev Biol 2022; 10:1044923. [PMID: 36531958 PMCID: PMC9757164 DOI: 10.3389/fcell.2022.1044923] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/24/2022] [Indexed: 02/04/2024] Open
Abstract
Obesity and sudden cardiac death (SCD) share common risk factors. Obesity, in and of itself, can result in the development of SCD. Numerous epidemiologic and clinical studies have demonstrated the close relationships between obesity and SCD, however, the underlying mechanisms remain incompletely understood. Various evidences support the significance of excess adiposity in determining the risk of SCD, including anatomical remodeling, electrical remodeling, metabolic dysfunction, autonomic imbalance. Weight reduction has improved obesity related comorbidities, and reversed abnormal cardiac remodeling. Indeed, it is still unknown whether weight loss contributes to decreased risk of SCD. Further high-quality, prospective trials are needed to strengthen our understanding on weight management and SCD.
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Affiliation(s)
- Yan Yao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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13
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Hung WC, Yu TH, Wu CC, Lee TL, Tang WH, Chen CC, Lu IC, Chung FM, Lee YJ, Hsu CC. Nonalcoholic Fatty Liver Disease Is Related to Abnormal Corrected QT Interval and Left Ventricular Hypertrophy in Chinese Male Steelworkers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14555. [PMID: 36361436 PMCID: PMC9657484 DOI: 10.3390/ijerph192114555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Nonalcoholic fatty liver disease (NAFLD) has been associated with an increased risks of corrected QT (QTc) prolongation and left ventricular hypertrophy (LVH), both of which are associated with the development of cardiovascular disease. Rotating night shift work and a higher risk of incident NAFLD have been reported in male steelworkers. This study aimed to investigate the association of the severity of NAFLD with a prolonged QTc interval and LVH in a large cohort of Chinese male steelworkers. METHODS We examined baseline data of 2998 male steel workers aged 26 to 71 years at two plants. All workers at both plants received regular health assessments, including 12-lead ECG and echocardiography. Abdominal ultrasonography was performed to evaluate the severity of NAFLD. QTc prolongation was defined as follows: normal ≤ 430 ms, borderline 431-450 ms, and abnormal ≥ 451 ms. LVH was defined as a left ventricular mass index (LVMI) >131 g/m2. Associations of NAFLD with an abnormal QTc interval and LVH were examined using univariate and multivariate analyses. RESULTS The QTc interval and the LVMI were significantly correlated with the NAFLD fibrosis score, and the severity of NAFLD was correlated with an abnormal QTc interval and LVH (p for trend < 0.05). Multivariate analysis showed that in comparison to the workers without NAFLD, the odds ratios of having an abnormal QTc interval and LVH were 2.54 (95% CI: 1.22-5.39, p = 0.013) times and 2.23 (95% CI: 1.02-5.01, p = 0.044) times higher in the workers with moderate/severe NAFLD. CONCLUSIONS NAFLD may be closely associated with the risks of an abnormal QTc interval and LVH, suggesting that regular electrocardiogram and echocardiogram monitoring could be used to evaluate the risk of arrhythmia and LVH in male steelworkers with NAFLD.
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Affiliation(s)
- Wei-Chin Hung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Teng-Hung Yu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Cheng-Ching Wu
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
- Division of Cardiology, Department of Internal Medicine, E-Da Cancer Hospital, Kaohsiung 82445, Taiwan
| | - Thung-Lip Lee
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - Wei-Hua Tang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Yuli Branch, Hualien 98142, Taiwan
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chia-Chi Chen
- Department of Pathology, E-Da Hospital, Kaohsiung 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
| | - I-Cheng Lu
- Department of Occupational Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
| | - Fu-Mei Chung
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
| | | | - Chia-Chang Hsu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, E-Da Hospital, Kaohsiung 82445, Taiwan
- Health Examination Center, E-Da Dachang Hospital, Kaohsiung 80794, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, College of Medicine, I-Shou University, Kaohsiung 82445, Taiwan
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14
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Grassi S, Campuzano O, Coll M, Cazzato F, Iglesias A, Ausania F, Scarnicci F, Sarquella-Brugada G, Brugada J, Arena V, Oliva A, Brugada R. Eosinophilic Infiltration of the Sino-Atrial Node in Sudden Cardiac Death Caused by Long QT Syndrome. Int J Mol Sci 2022; 23:11666. [PMID: 36232963 PMCID: PMC9569895 DOI: 10.3390/ijms231911666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Sudden death is defined as the unexpected death of a healthy person that occurs within the first hour of the onset of symptoms or within 24 h of the victim being last seen alive. In some of these cases, rare deleterious variants of genes associated with inherited cardiac disorders can provide a highly probable explanation for the fatal event. We report the case of a 21-year-old obese woman who lost consciousness suddenly in a public place and was pronounced dead after hospital admission. Clinical autopsy showed an inconclusive gross examination, while in the histopathological analysis an eosinophilic inflammatory focus and interstitial fibrosis in the sino-atrial node were found. Molecular autopsy revealed an intronic variant in the KCNQ1 gene (c.683 + 5G > A), classified as likely pathogenic for long QT syndrome according to the guidelines provided by the American College of Medical Genetics and Genomics. Therefore, there were many anomalies that could have played a role in the causation of the sudden death, such as the extreme obesity, the cardiac anomalies and the KNCQ1 variant. This case depicts the difficult interpretation of rare cardiac structural abnormalities in subjects carrying rare variants responsible for inherited arrhythmic disorders and the challenge for the forensic pathologist to make causal inferences in the determinism of the unexpected decease.
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Affiliation(s)
- Simone Grassi
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Health Sciences, Section of Forensic Medical Sciences, University of Florence, Largo Brambilla 3, 50134 Florence, Italy
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Mònica Coll
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Francesca Cazzato
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Anna Iglesias
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
| | - Francesco Ausania
- Department of Diagnostics and Public Health, Section of Forensic Medicine, University of Verona, 37122 Verona, Italy
| | - Francesca Scarnicci
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Georgia Sarquella-Brugada
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Josep Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Cardiology Department, Sant Joan de Déu Hospital de Barcelona, 08950 Barcelona, Spain
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Vincenzo Arena
- Area of Pathology, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00147 Rome, Italy
| | - Antonio Oliva
- Department of Health Surveillance and Bioethics, Section of Legal Medicine, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Cardiovascular Genetics Center, Institut d’Investigació Biomèdica Girona (IDIBGI), University of Girona, 17190 Girona, Spain
- Medical Science Department, School of Medicine, University of Girona, 17003 Girona, Spain
- Cardiology Service, Hospital Josep Trueta, University of Girona, 17007 Girona, Spain
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15
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Dong W, Zhang F, Lian D, Chen X, Zhou H, Gong T, Wang C. Efficacy and safety of tai chi for hyperlipidaemia: a protocol for systematic review and meta-analysis. BMJ Open 2022; 12:e053867. [PMID: 36215161 PMCID: PMC9438025 DOI: 10.1136/bmjopen-2021-053867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION The prevalence of hyperlipidaemia is increasing, and patients with hyperlipidaemia are at increased risk of cardiovascular disease and atherosclerosis. In recent years, there has been a growing number of studies on tai chi for hyperlipidaemia. However, a systematic review on its efficacy and safety is not available. Therefore, this study aims to evaluate the efficacy and safety of tai chi for hyperlipidaemia. METHODS AND ANALYSIS Four English databases and four Chinese databases will be searched from their inception to May 2021: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, VIP Database and Wanfang Database. Chinese and English randomised controlled trials related to tai chi for hyperlipidaemia will be included. Two reviewers should independently carry out study selection, data extraction and risk assessment of bias. The risk of bias in the study will be assessed by the Cochrane risk of bias tool. RevMan (V.5.4) statistical software will be applied for meta-analysis. The Grading of Recommendations Assessment, Development and Evaluation system approach will be employed to assess the quality of evidence. ETHICS AND DISSEMINATION Ethical approval is not required because this protocol will not involve patients' individual information and jeopardise the rights of patients. The meta-analysis result will be reported in peer-reviewed journals or disseminated at related conferences. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/79D2S.
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Affiliation(s)
- Weitao Dong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Feng Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Daoshi Lian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Xingliang Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Hongchi Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Tingting Gong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
| | - Chao Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine-Shierqiao Campus, Chengdu, Sichuan, China
- Sub-Health Center, Sichuan Integrative Medicine Hospital, Chengdu, China
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16
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Wang L, Liu C. Melatonin Plus Sitagliptin Reduces Ischemia/Reperfusion-Induced Myocardial Arrhythmias Through Mitochondrial K-ATP Channels in Obese Rats. INT J PHARMACOL 2022. [DOI: 10.3923/ijp.2022.657.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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17
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Podzolkov VI, Pokrovskaya AE, Bazhanova US, Vanina DD, Vargina TS. Impact Of Obesity On Cardiac Structural And Functional Changes. RUSSIAN OPEN MEDICAL JOURNAL 2022. [DOI: 10.15275/rusomj.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
The urgency of obesity issue is undeniable. Obesity is now considered the most important risk factor of cardiovascular diseases. Numerous studies have demonstrated the negative effect of excessive adipose tissue on structural and functional changes in the heart that lead to development of left ventricular hypertrophy, arrhythmias and conduction abnormalities, as well as progression of diastolic and systolic heart failure. High prevalence of obesity – so high that it can be called a pandemic – greatly contributes to the increased incidence of cardiovascular diseases. Studying the problem of obesity is a priority area of focus for modern medicine. This article describes hormonal, metabolic and hemodynamic features of obesity impact on cardiovascular system and describes pathogenetic mechanisms of cardiovascular pathology development.
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Affiliation(s)
- Valery I. Podzolkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna E. Pokrovskaya
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Ulyana S. Bazhanova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Daria D. Vanina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Tatiana S. Vargina
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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18
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Cumberland MJ, Riebel LL, Roy A, O’Shea C, Holmes AP, Denning C, Kirchhof P, Rodriguez B, Gehmlich K. Basic Research Approaches to Evaluate Cardiac Arrhythmia in Heart Failure and Beyond. Front Physiol 2022; 13:806366. [PMID: 35197863 PMCID: PMC8859441 DOI: 10.3389/fphys.2022.806366] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/10/2022] [Indexed: 12/20/2022] Open
Abstract
Patients with heart failure often develop cardiac arrhythmias. The mechanisms and interrelations linking heart failure and arrhythmias are not fully understood. Historically, research into arrhythmias has been performed on affected individuals or in vivo (animal) models. The latter however is constrained by interspecies variation, demands to reduce animal experiments and cost. Recent developments in in vitro induced pluripotent stem cell technology and in silico modelling have expanded the number of models available for the evaluation of heart failure and arrhythmia. An agnostic approach, combining the modalities discussed here, has the potential to improve our understanding for appraising the pathology and interactions between heart failure and arrhythmia and can provide robust and validated outcomes in a variety of research settings. This review discusses the state of the art models, methodologies and techniques used in the evaluation of heart failure and arrhythmia and will highlight the benefits of using them in combination. Special consideration is paid to assessing the pivotal role calcium handling has in the development of heart failure and arrhythmia.
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Affiliation(s)
- Max J. Cumberland
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Leto L. Riebel
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Ashwin Roy
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Christopher O’Shea
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Andrew P. Holmes
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Chris Denning
- Stem Cell Biology Unit, Biodiscovery Institute, British Heart Foundation Centre for Regenerative Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Paulus Kirchhof
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Blanca Rodriguez
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Katja Gehmlich
- Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford and British Heart Foundation Centre of Research Excellence Oxford, Oxford, United Kingdom
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19
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Schenker N, von Blumenthal F, Hakmi S, Lemes C, Mathew S, Rottner L, Wohlmuth P, Reißmann B, Rillig A, Metzner A, Willems S, Ouyang F, Kuck KH, Maurer T. Impact of obesity on acute complications of catheter ablation for cardiac arrhythmia. J Cardiovasc Electrophysiol 2022; 33:654-663. [PMID: 35118743 DOI: 10.1111/jce.15400] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 12/28/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence of obesity is increasing. However, data on the periprocedural complication rate of catheter ablation for arrhythmia in patients stratified by body mass index (BMI) is scarce. METHODS AND RESULTS This study included 1000 consecutive patients (age 62.0±14.4 years) undergoing catheter ablation for cardiac arrhythmia. The primary study endpoint was any periprocedural major complication (cardiac tamponade, pseudoaneurysm, arteriovenous fistula, transient ischemic attack, stroke, valve damage, myocardial infarction or death). The mean BMI was 27.6±5.1 kg/m2 and the majority of patients were overweight (BMI 25.0-29.9 kg/m2 , 43.4%). A BMI of 30.0-34.9 kg/m2 (Class I obesity) was present in 177 (17.7%) of patients, a BMI of 35.0-39.9 kg/m2 (Class II obesity) in 67 (6.7%) and a BMI ≥40 kg/m2 (Class III obesity) in 16 (1.6%). There were 31 major complications (3.1%) and one fatality (0.1%) due to terminal heart failure in a patient undergoing palliative ventricular tachycardia ablation. There was no significant impact of the BMI on the rate of major complications (p= 0.495). Compared to normal weight patients, odds ratios for complications in overweight patients, as well as class I, II and III obesity were 1.1 (95% confidence interval (CI) 0.8; 1.7), 1.3 (CI 0.6; 2.6), 1.4 (CI 0.5; 4.1) and 1.6 (CI 0.4; 6.3), respectively. Radiation exposure and procedure duration were significantly increased in obese patients (p<0.001 and p=0.001 respectively). CONCLUSION In this study, obesity did not have a significant impact on the incidence of periprocedural complications after CA for cardiac arrhythmia. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Niklas Schenker
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Samer Hakmi
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Laura Rottner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wohlmuth
- Proresearch, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bruno Reißmann
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Rillig
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Metzner
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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20
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Remme CA. Sudden cardiac death in diabetes and obesity: mechanisms and therapeutic strategies. Can J Cardiol 2022; 38:418-426. [PMID: 35017043 DOI: 10.1016/j.cjca.2022.01.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 02/07/2023] Open
Abstract
Ventricular arrhythmias and sudden cardiac death (SCD) occur most frequently in the setting of coronary artery disease, cardiomyopathy and heart failure, but are also increasingly observed in individuals suffering from diabetes mellitus and obesity. The incidence of these metabolic disorders is rising in Western countries, but adequate prevention and treatment of arrhythmias and SCD in affected patients is limited due to our incomplete knowledge of the underlying disease mechanisms. Here, an overview is presented of the prevalence of electrophysiological disturbances, ventricular arrhythmias and SCD in the clinical setting of diabetes and obesity. Experimental studies are reviewed, which have identified disease pathways and associated modulatory factors, in addition to pro-arrhythmic mechanisms. Key processes are discussed, including mitochondrial dysfunction, oxidative stress, cardiac structural derangements, abnormal cardiac conduction, ion channel dysfunction, prolonged repolarization and dysregulation of intracellular sodium and calcium homeostasis. In addition, the recently identified pro-arrhythmic effects of dysregulated branched chain amino acid metabolism, a common feature in patients with metabolic disorders, are addressed. Finally, current management options are discussed, in addition to the potential development of novel preventive and therapeutic strategies based on recent insight gained from translational studies.
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Affiliation(s)
- Carol Ann Remme
- Department of Experimental Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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21
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OUP accepted manuscript. Eur J Prev Cardiol 2022; 29:1744-1755. [DOI: 10.1093/eurjpc/zwac083] [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: 12/20/2021] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022]
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22
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Association between the APOE gene polymorphism and lipid profile and the risk of atrial fibrillation. Lipids Health Dis 2021; 20:123. [PMID: 34587962 PMCID: PMC8482687 DOI: 10.1186/s12944-021-01551-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/10/2021] [Indexed: 12/19/2022] Open
Abstract
Background The relationship between the APOE gene polymorphism and lipid profiles and atrial fibrillation (AF) remains controversial. The current study purposed to investigate how the APOE gene SNPs (rs429358 and rs7412) and lipid profile are associated with the risk for AF among the Hakka population in southern China. Methods Finally, 1367 patients were enrolled in this study, including 706 participants with AF (41 ~ 98 years old, 58.64 % male) and 661 non-AF subjects (28 ~ 95 years old, 59.46 % male). The collected data included baseline characteristics, medical history, laboratory tests and echocardiography parameters. A general linear model (two-way analysis of variance (ANOVA)) and Tukey post-hoc tests were applied to identify an APOE allele, AF group, and interaction effect on lipid profiles. Logistic regression analysis was performed to identify risk factors for AF. Results For AF group, the most common genotype was E3/E3 (53.82 %), followed by E3/E4 (28.19 %), E2/E3 (13.60 %), E4/E4 (1.98 %), E2/E4 (1.84 %) and E2/E2 (0.57 %). The two-way ANOVA followed by the Tukey procedure showed the following: the lipid levels depended significantly on AF and APOE allele groups for TG, TC, LDL-C and Apo-B (all P < 0.001), and statistically significant interactions between AF and APOE allele were observed in the above 4 variables (all P < 0.05). Multivariate regression analysis indicated that age ≥ 65years (P < 0.001), high diastolic blood pressure (DBP ≥ 90mm Hg, P = 0.018), a high levels of total cholesterol (TC ≥ 5.2mmol/L, P < 0.001) and triglyceride (TG ≥ 1.7mmol/L, P = 0.028), but not the two SNPs of the APOE gene (rs7412 and rs429358) (OR 1.079, P = 0.683), were significant independent risk factors for AF in the study population. Conclusions The principal findings of this study showed that individuals at high risk for AF were those over 65 years of age, higher DBP as well as high levels of TC and TG among the southern China Hakka population. The levels of TG, TC, LDL-C and Apo-B depended significantly on AF and APOE allele groups, and statistically significant interactions between AF and APOE allele were observed in the above 4 variables, although the APOE gene SNPs (rs429358 and rs7412) were no significant risk for AF incidence. Further investigation is needed to elucidate whether other SNPs of the APOE gene have a bearing on AF incidents.
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Peigh G, Wasserlauf J, Vogel K, Kaplan RM, Pfenniger A, Marks D, Mehta A, Chicos AB, Arora R, Kim S, Lin A, Verma N, Patil KD, Knight BP, Passman RS. Impact of pre-ablation weight loss on the success of catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2021; 32:2097-2104. [PMID: 34191371 PMCID: PMC9305992 DOI: 10.1111/jce.15141] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Obesity is an established risk factor for recurrent atrial fibrillation (AF) after ablation. The impact of pre-procedure weight changes on freedom from AF (FFAF) after ablation in obese and nonobese patients is unknown. METHODS A single-center retrospective cohort study of patients undergoing pulmonary vein isolation was performed. Before ablation, all candidates were encouraged to adopt healthy lifestyle habits according to American Heart Association guidelines, including weight loss, by their physician. The primary endpoint was FFAF through 1-year after completion of the 3-month blanking period. RESULTS Of the 601 patients (68% male; average age 62.1 ± 10.3 years) included in analysis, 234 patients (38.9%) were obese (body mass index ≥ 30) and 315 (52.4%) had paroxysmal AF. FFAF was observed in 420 patients (69.9%) at 15 months. Percent change in weight that occurred during the year before ablation independently predicted FFAF through 15-months in all patients (adjusted odds ratio = 1.17, 95% confidence interval: 1.11-1.23). Subgroup analyses based on paroxysmal vs persistent AF, presence of obesity, and history of prior ablation were performed. Percent change in weight over the year before ablation was independently associated with FFAF in all subgroups except nonobese patients with persistent AF. CONCLUSION Pre-ablation weight loss was associated with FFAF in both obese and nonobese patients. Further studies are needed to define the optimal approach to weight loss before AF ablation.
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Affiliation(s)
- Graham Peigh
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Kelly Vogel
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel M Kaplan
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Anna Pfenniger
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Daniel Marks
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Arjun Mehta
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alexandru B Chicos
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rishi Arora
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan Kim
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Albert Lin
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nishant Verma
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kaustubha D Patil
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley P Knight
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rod S Passman
- Division of Cardiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
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24
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Ibisoglu E, Boyraz B, Güneş ST, Savur Ü, Naki Tekin DD, Erdoğan A, Özdenkaya Y, Erdoğan E, Çeğilli E, Olgun FE, Güneş HM. Impact of surgical weight loss on novel P-wave-related variables which are nominated as predictors of atrial arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1516-1522. [PMID: 34312874 DOI: 10.1111/pace.14327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 06/30/2021] [Accepted: 07/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Bariatric surgery has been associated with reduced cardiovascular mortality and morbidity in obese patients. In this study, we aimed to evaluate the alterations of novel P-wave related atrial arrhythmia predictors in patients who achieved effective weight loss with bariatric surgery. METHODS The study included 58 patients who underwent bariatric surgery. We measured heart rate, PR, P wave (PW) max, PW min, Average P axis, P wave peak time (PWPT) in lead D2 and lead V1, terminal force in lead V1 (V1TF), and we estimated P wave dispersion (PWdis) interval both pre-operation and 6 months after operation. RESULTS Heart rate, PR, PW max, PW min, PWdis, Average P axis, PWPTD2, PWPTV1 and V1TF values, which were close to the upper limit in the pre-op period, showed statistically significant decreases at 6 months after the operation. The most prominent changes were observed in PW dis (51.15 ± 9.70 ms vs. 48.79 ± 9.50 ms, p = .010), PWPTD2 (55.75 ± 6.91 ms vs. 50.59 ± 7.67 ms, p < .001), PWPTV1 (54.10 ± 7.06 ms vs. 48.05 ± 7.64 ms, p < .001) and V1TF (25 [43.1%] vs. 12 [20.7%], p < .001). CONCLUSIONS The results of our study indicated that bariatric surgery has positive effects on the regression of ECG parameters which are predictors of atrial arrhythmias, particularly atrial fibrillation (AF).
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Affiliation(s)
- Ersin Ibisoglu
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | | | - Saime Turgut Güneş
- Radiology Department, İstanbul Training and Research Hospital, İstanbul, Turkey
| | - Ümeyir Savur
- İstanbul Gaziosmanpaşa Training and Research Hospital, İstanbul, Turkey
| | | | - Aslan Erdoğan
- Cardiology Department, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Yaşar Özdenkaya
- General Surgery Department, İstanbul Medipol University, İstanbul, Turkey
| | - Emrah Erdoğan
- Cardiology Department, Van Yüzüncüyıl University, İstanbul, Turkey
| | - Ercan Çeğilli
- Cardiology Department, Arnavutköy State Hospital, İstanbul, Turkey
| | - Fatih Erkam Olgun
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
| | - Hacı Murat Güneş
- Cardiology Department, İstanbul Medipol University, İstanbul, Turkey
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25
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Richter C, Hinkel R. Research('s) Sweet Hearts: Experimental Biomedical Models of Diabetic Cardiomyopathy. Front Cardiovasc Med 2021; 8:703355. [PMID: 34368257 PMCID: PMC8342758 DOI: 10.3389/fcvm.2021.703355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/28/2021] [Indexed: 11/13/2022] Open
Abstract
Diabetes and the often accompanying cardiovascular diseases including cardiomyopathy represent a complex disease, that is reluctant to reveal the molecular mechanisms and underlying cellular responses. Current research projects on diabetic cardiomyopathy are predominantly based on animal models, in which there are not only obvious advantages, such as genetics that can be traced over generations and the directly measurable influence of dietary types, but also not despisable disadvantages. Thus, many studies are built up on transgenic rodent models, which are partly comparable to symptoms in humans due to their genetic alterations, but on the other hand are also under discussion regarding their clinical relevance in the translation of biomedical therapeutic approaches. Furthermore, a focus on transgenic rodent models ignores spontaneously occurring diabetes in larger mammals (such as dogs or pigs), which represent with their anatomical similarity to humans regarding their cardiovascular situation appealing models for testing translational approaches. With this in mind, we aim to shed light on the currently most popular animal models for diabetic cardiomyopathy and, by weighing the advantages and disadvantages, provide decision support for future animal experimental work in the field, hence advancing the biomedical translation of promising approaches into clinical application.
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Affiliation(s)
- Claudia Richter
- Laboratory Animal Science Unit, German Primate Center, Leibniz Institute for Primate Research, Goettingen, Germany.,Partnersite Goettingen, German Center for Cardiovascular Research (DZHK e.V.), Goettingen, Germany
| | - Rabea Hinkel
- Laboratory Animal Science Unit, German Primate Center, Leibniz Institute for Primate Research, Goettingen, Germany.,Partnersite Goettingen, German Center for Cardiovascular Research (DZHK e.V.), Goettingen, Germany.,Stiftung Tierärztliche Hochschule Hannover, University of Veterinary Medicine, Hanover, Germany
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26
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Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, Lear SA, Ndumele CE, Neeland IJ, Sanders P, St-Onge MP. Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation 2021; 143:e984-e1010. [PMID: 33882682 PMCID: PMC8493650 DOI: 10.1161/cir.0000000000000973] [Citation(s) in RCA: 1083] [Impact Index Per Article: 361.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The global obesity epidemic is well established, with increases in obesity prevalence for most countries since the 1980s. Obesity contributes directly to incident cardiovascular risk factors, including dyslipidemia, type 2 diabetes, hypertension, and sleep disorders. Obesity also leads to the development of cardiovascular disease and cardiovascular disease mortality independently of other cardiovascular risk factors. More recent data highlight abdominal obesity, as determined by waist circumference, as a cardiovascular disease risk marker that is independent of body mass index. There have also been significant advances in imaging modalities for characterizing body composition, including visceral adiposity. Studies that quantify fat depots, including ectopic fat, support excess visceral adiposity as an independent indicator of poor cardiovascular outcomes. Lifestyle modification and subsequent weight loss improve both metabolic syndrome and associated systemic inflammation and endothelial dysfunction. However, clinical trials of medical weight loss have not demonstrated a reduction in coronary artery disease rates. In contrast, prospective studies comparing patients undergoing bariatric surgery with nonsurgical patients with obesity have shown reduced coronary artery disease risk with surgery. In this statement, we summarize the impact of obesity on the diagnosis, clinical management, and outcomes of atherosclerotic cardiovascular disease, heart failure, and arrhythmias, especially sudden cardiac death and atrial fibrillation. In particular, we examine the influence of obesity on noninvasive and invasive diagnostic procedures for coronary artery disease. Moreover, we review the impact of obesity on cardiac function and outcomes related to heart failure with reduced and preserved ejection fraction. Finally, we describe the effects of lifestyle and surgical weight loss interventions on outcomes related to coronary artery disease, heart failure, and atrial fibrillation.
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27
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Štolbová K, Novodvorský P, Jakubíková I, Dvořáková I, Mráz M, Wichterle D, Kautzner J, Haluzík M. Effect of Complex Weight-Reducing Interventions on Rhythm Control in Obese Individuals with Atrial Fibrillation Following Catheter Ablation: A Study Protocol. Adv Ther 2021; 38:2007-2016. [PMID: 33710588 PMCID: PMC7953371 DOI: 10.1007/s12325-021-01667-0] [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] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/11/2021] [Indexed: 01/30/2023]
Abstract
Introduction Obesity and atrial fibrillation (AF) pose a significant burden on healthcare systems worldwide. Reduction of body weight has been documented to reduce the risk of AF. Little is known about the effect of different weight-reducing interventions including bariatric surgery in obese individuals on the risk of arrhythmia recurrence following catheter ablation (CA) for AF, and about the pathophysiological mechanisms linking these two conditions. Methods The Effect of complex weigHt-reducing interventiOns on rhythm control in oBese subjects wITh Atrial Fibrillation (HOBIT-AF) is a single-blinded, parallel-group randomised controlled trial with 18-month follow-up to assess the effect of complex weight-reducing interventions supported by the use of smart technologies and bariatric surgery on the arrhythmia burden in obese individuals following CA for AF. One hundred and sixty individuals (age 18–70 years, body mass index ≥ 30 kg/m2) will be randomised in a 1:1 fashion to undergo a structured weight reduction programme and sleeve gastrectomy (when indicated and preferred by the patient) aiming to achieve greater than 10% weight reduction from baseline (intervention group) or standard post-ablation medical care (control group). Two-week continuous ECG monitoring will be used 3 and 18 months after CA to assess the arrhythmia burden. Other investigations will include transthoracic echocardiography with quantification of epicardial adipose tissue, and markers of low-grade inflammation and circulating adipokines. Planned Outcomes The main objective is to assess the effect of complex weight-reducing interventions on the arrhythmia burden and quality of life. Subgroup analyses to identify patient subgroups preferentially benefiting from weight loss related to a decrease in arrhythmia burden will be performed. Exploratory objectives will include investigation of potential mechanisms linking weight reduction with amelioration of arrhythmia burden such as changes in markers of low-grade inflammation, circulating adipokines, cytokines, monocytes or reduction of epicardial adipose tissue volume. Trial Registration NCT04560387
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Affiliation(s)
- Kristýna Štolbová
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Peter Novodvorský
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Iva Jakubíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
| | - Iveta Dvořáková
- Centre for Experimental Medicine, IKEM, Prague, Czech Republic
| | - Miloš Mráz
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Martin Haluzík
- Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Vídeňská 1958, 140 21, Prague 4, Czech Republic.
- First Faculty of Medicine, Charles University, Prague, Czech Republic.
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Aguilar M, Rose RA, Takawale A, Nattel S, Reilly S. New aspects of endocrine control of atrial fibrillation and possibilities for clinical translation. Cardiovasc Res 2021; 117:1645-1661. [PMID: 33723575 PMCID: PMC8208746 DOI: 10.1093/cvr/cvab080] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/25/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
Hormones are potent endo-, para-, and autocrine endogenous regulators of the function of multiple organs, including the heart. Endocrine dysfunction promotes a number of cardiovascular diseases, including atrial fibrillation (AF). While the heart is a target for endocrine regulation, it is also an active endocrine organ itself, secreting a number of important bioactive hormones that convey significant endocrine effects, but also through para-/autocrine actions, actively participate in cardiac self-regulation. The hormones regulating heart-function work in concert to support myocardial performance. AF is a serious clinical problem associated with increased morbidity and mortality, mainly due to stroke and heart failure. Current therapies for AF remain inadequate. AF is characterized by altered atrial function and structure, including electrical and profibrotic remodelling in the atria and ventricles, which facilitates AF progression and hampers its treatment. Although features of this remodelling are well-established and its mechanisms are partly understood, important pathways pertinent to AF arrhythmogenesis are still unidentified. The discovery of these missing pathways has the potential to lead to therapeutic breakthroughs. Endocrine dysfunction is well-recognized to lead to AF. In this review, we discuss endocrine and cardiocrine signalling systems that directly, or as a consequence of an underlying cardiac pathology, contribute to AF pathogenesis. More specifically, we consider the roles of products from the hypothalamic-pituitary axis, the adrenal glands, adipose tissue, the renin–angiotensin system, atrial cardiomyocytes, and the thyroid gland in controlling atrial electrical and structural properties. The influence of endocrine/paracrine dysfunction on AF risk and mechanisms is evaluated and discussed. We focus on the most recent findings and reflect on the potential of translating them into clinical application.
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Affiliation(s)
- Martin Aguilar
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada
| | - Robert A Rose
- Department of Cardiac Sciences, Department of Physiology and Pharmacology, Libin Cardiovascular Institute, Cumming School of Medicine, Health Research Innovation Center, University of Calgary, AB, Canada
| | - Abhijit Takawale
- Department of Medicine and Research Center, Montreal Heart Institute and Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Physiology/Institute of Biomedical Engineering, Université de Montréal, Montréal, QC, Canada.,Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stanley Nattel
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada.,Faculty of Medicine, Department of Pharmacology and Physiology, and Research Centre, Montreal Heart Institute and University of Montreal, Montreal, QC, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Germany.,IHU LIRYC and Fondation Bordeaux Université, Bordeaux, France
| | - Svetlana Reilly
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, British Heart Foundation Centre of Research Excellence, University of Oxford, John Radcliffe Hospital, Oxford, UK
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29
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Bienias P, Rymarczyk Z, Domienik-Karłowicz J, Lisik W, Sobieraj P, Pruszczyk P, Ciurzyński M. Assessment of arrhythmias and cardiac autonomic tone at a relatively young age patients with obesity class III. Clin Obes 2021; 11:e12424. [PMID: 33128430 DOI: 10.1111/cob.12424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/17/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Abstract
There is no sufficient data on arrhythmias occurrence in obesity class III. The influence of hyperinsulinemia and insulin resistance on arrhythmias and cardiac autonomic tone is also of ongoing interest in these subjects. We prospectively studied 81 selected patients with body mass index >40 kg/m2 , aged 34 (18-65) years. Among other examinations all subjects underwent electrocardiography and Holter monitoring with heart rate variability (HRV) and turbulence (HRT) evaluation. Controls consisted of 45 healthy, sex- and aged-matched lean volunteers. In patients median BMI was 44.5 kg/m2 (40.1-58.1), benign arterial hypertension was present in 43.2% and dysglycemia in 27.2% of cases. In the group with obesity longer PR interval (P < .001) and corrected QT interval (P < .001) were observed, while in Holter monitoring no significant differences in supraventricular or ventricular arrhythmias and also bradyarrhythmias prevalence were observed in comparison to controls. In individuals with obesity HRV indices associated with sympathetic tone were significantly impaired and also abnormal HRT values (21.9 vs 0%, P = .04) were more frequently observed. There were no significant correlations between anthropometric obesity parameters and fasting insulin concentration, insulin resistance index and also HRV/HRT parameters in studied individuals. Univariate regression analysis revealed that only age influenced abnormal HRT occurrence (OR 1.69, 95%CI 1.08-2.98, P = .04). In conclusions, patients with obesity class III at a relatively young age who reported they felt healthy, do not present increased prevalence of arrhythmias, including life-threatening ones. Cardiac autonomic dysfunction is observed in these patients, however it has not been shown to be associated with anthropometric measurements.
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Affiliation(s)
- Piotr Bienias
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Rymarczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Wojciech Lisik
- Department of General Surgery and Transplantology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Sobieraj
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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30
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Pathak RK, Abhilash SP, Hendriks JM. A Team-Based Approach Toward Risk Factors of Atrial Fibrillation. Card Electrophysiol Clin 2021; 13:257-262. [PMID: 33516404 DOI: 10.1016/j.ccep.2020.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF), being the most common arrhythmia, the service of primary care physicians and internists in preventing, identifying, and treating AF is of paramount importance. There are nonmodifiable, modifiable, and reversible risk factors for AF. The modifiable risk factors include hypertension, obesity, coronary artery disease, heart failure, diabetes mellitus etc. These risk factors should be screened and adequately treated to prevent occurrence of AF at the primary care level itself. This will reduce recurrence rates of AF and will treat underlying conditions predisposing to AF.
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Affiliation(s)
- Rajeev Kumar Pathak
- Australian National University and Canberra Hospital, Canberra, Australian Capital Territory, Australia.
| | | | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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31
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Gul M, Inci S, Ozkan N, Alsancak Y. Favorable electrocardiographic changes after substantial weight loss in patients with morbid obesity : Results of a prospective study. Herz 2021; 46:567-574. [PMID: 33502574 DOI: 10.1007/s00059-020-05019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/16/2020] [Accepted: 12/29/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obese patients have an increased risk of arrhythmias and sudden death, even in the absence of structural heart disease and cardiac dysfunction. This study aimed to determine whether weight loss by bariatric surgery has an effect on arrhythmia-related electrocardiographic (ECG) variables in morbidly obese patients. METHODS In this prospective study, the data of 48 patients were analyzed. All ECG variables that have the potential to predict ventricular arrhythmia were evaluated before surgery, and were compared with the 1‑month and 6‑month follow-up results. RESULTS The mean body mass index was 45.74 ± 5.60 kg/m2 before surgery. There was a statistically significant decline in body mass index in the first and sixth month after surgery (39.26 ± 5.00 kg/m2 and 31.71 ± 4.49 kg/m2, respectively; p < 0.001). Furthermore, notable reduction was found in terms of heart rate measurements-QTc‑d, JTc, JTc‑d, Tp‑e, TP-e/QT, TP-e/QTc-in the first month and sixth month compared with baseline (p < 0.001 for all comparisons). Several ECG variables, such as heart rate (r = 0.369, p = 0.001), QTc‑d (r = 0.449, p = 0.001), JTc‑d (r = 0.324, p = 0.002), Tp‑e (r = 0.592, p = 0.001), Tp-e/QTc (r = 0.543, p = 0.001), Tp-e/JTc (r = 0.515, p = 0.001), exhibited a positive and significant correlation with weigh loss. Moreover, a negative and weakly significant correlation was found between the index of cardiac electrophysiological balance (r = -0.239, p = 0.004) and body mass index. CONCLUSION Substantial weight loss following laparoscopic sleeve gastrectomy in obese patients is accompanied by a significant improvement in ventricular repolarization. Therefore, this effect may lead to a decrease in the incidence of lethal ventricular arrhythmia and sudden cardiac death.
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Affiliation(s)
- Murat Gul
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey.
| | - Sinan Inci
- Medical Faculty, Department of Cardiology, Aksaray University, Aksaray, Turkey
| | - Namik Ozkan
- Medical Faculty, Department of General Surgery, Aksaray University, Aksaray, Turkey
| | - Yakup Alsancak
- Meram Medical Faculty, Department of Cardiology, Necmettin Erbakan University, Konya, Turkey
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32
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Li CY, Zhang JR, Hu WN, Li SN. Atrial fibrosis underlying atrial fibrillation (Review). Int J Mol Med 2021; 47:9. [PMID: 33448312 PMCID: PMC7834953 DOI: 10.3892/ijmm.2020.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/07/2020] [Indexed: 01/17/2023] Open
Abstract
Atrial fibrillation (AF) is one of the most common tachyarrhythmias observed in the clinic and is characterized by structural and electrical remodelling. Atrial fibrosis, an emblem of atrial structural remodelling, is a complex multifactorial and patient-specific process involved in the occurrence and maintenance of AF. Whilst there is already considerable knowledge regarding the association between AF and fibrosis, this process is extremely complex, involving intricate neurohumoral and cellular and molecular interactions, and it is not limited to the atrium. Current technological advances have made the non-invasive evaluation of fibrosis in the atria and ventricles possible, facilitating the selection of patient-specific ablation strategies and upstream treatment regimens. An improved understanding of the mechanisms and roles of fibrosis in the context of AF is of great clinical significance for the development of treatment strategies targeting the fibrous region. In the present review, a focus was placed on the atrial fibrosis underlying AF, outlining its role in the occurrence and perpetuation of AF, by reviewing recent evaluations and potential treatment strategies targeting areas of fibrosis, with the aim of providing a novel perspective on the management and prevention of AF.
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Affiliation(s)
- Chang Yi Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Jing Rui Zhang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
| | - Wan Ning Hu
- Department of Cardiology, Laboratory of Molecular Biology, Head and Neck Surgery, Tangshan Gongren Hospital, Tangshan, Hebei 063000, P.R. China
| | - Song Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, P.R. China
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Bahloul A, Bouattour N, Triki F, Hammami R, Charfeddine S, Ellouze T, Mhiri C, Abid L, Kammoun S. [Observational study of the prevalence of non-valvular atrial fibrillation and ischemic stroke and the factors associated with non-valvular atrial fibrillation in hypertensive patients: about 2887 cases]. Pan Afr Med J 2021; 38:31. [PMID: 33777299 PMCID: PMC7955596 DOI: 10.11604/pamj.2021.38.31.25569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/20/2020] [Indexed: 01/18/2023] Open
Abstract
Introduction high blood pressure (HBP), atrial fibrillation (AF) and ischemic stroke are three public health problems. The purpose of this study was to determine the prevalence of AF and ischemic stroke in hypertensive patients and the factors associated with the occurrence of non-valvular AF in these patients. Methods we used data collected in the Department of Cardiology at the University Hospital of Sfax as a part of National Tunisian Registry of Hypertension. We examined the associations between different socio-demographic, clinical, paraclinical, and therapeutic variables and AF in hypertensive patients using logistic regression models. Results our sample consisted of 2887 patients with a sex ratio of 0.95. The average age of patients was 65 years (±11). AF was found in 230 patients (8%), while ischemic stroke was found in 152 patients (5.3%). Multivariate analysis highlighted that independent factors associated with an increase in the prevalence of AF were: advanced age (p = 0,001, Odds Ratio (OR) = 1,647, 95% confidence interval ( CI): 1,1227-2,213), the detection of left ventricular hypertrophy (LVH) on cardiac ultrasound (p= 0,004, OR= 2,140, 5%CI 9: 1,281-3,576), and left ventricular ejection fraction (LVEF) < 50% (p<0,001, OR=4,677, 95% CI: 2,715 and 8.057). Conclusion this study confirms that there is a direct and independent relationship between high blood pressure, advanced age, LVH and AF. AF in patients with high blood pressure is a disease progression leading to an increased risk of ischemic stroke. Optimal high blood pressure control is a priority in hypertensive patients, especially in the elderly, aiming at preventing the risk of AF and ischemic stroke.
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Affiliation(s)
- Amine Bahloul
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Nadia Bouattour
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Faten Triki
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Rania Hammami
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Selma Charfeddine
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Tarek Ellouze
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Chokri Mhiri
- Service de Neurologie, Centre Hospitalo-Universitaire Habib Bourguiba, Sfax, Tunisie
| | - Leila Abid
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
| | - Samir Kammoun
- Service de Cardiologie, Centre Hospitalo-Universitaire Hèdi Chaker, Sfax, Tunisie
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Watanabe H, Kabutoya T, Hoshide S, Kario K. Atrial fibrillation is associated with cardiovascular events in obese Japanese with one or more cardiovascular risk factors: The Japan Morning Surge Home Blood Pressure (J‐HOP) Study. J Clin Hypertens (Greenwich) 2021; 23:665-671. [PMID: 33405296 PMCID: PMC8029557 DOI: 10.1111/jch.14170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/28/2023]
Abstract
The impacts of atrial fibrillation (AF) and home blood pressure (BP) on the cardiovascular prognosis of obese individuals have not been clarified. We analyzed the differences in the prognosis (including the effect of the home BP of AF patients with/without obesity) in a Japanese population with cardiovascular risk factors. We enrolled 3,586 patients from the J‐HOP study who had at least one cardiovascular risk factor. We conducted 12‐lead electrocardiography, and the group of AF patients was determined as those whose electrocardiography revealed AF. Obesity was defined as a body mass index >25 kg/m2. The primary end points were fatal/nonfatal cardiovascular events (myocardial infarction, stroke, hospitalization for heart failure, and aortic dissection). Among the obese patients, those with AF (n = 36) suffered more significantly cardiovascular events (log rank 7.17, p = .007) compared to the patients with sinus rhythm (n = 1,282), but among the non‐obese patients, the rates of cardiovascular events were similar (log rank 0.006, p = .94) in the AF patients (n = 48) and sinus rhythm patients (n = 2220). After adjusting for age, sex, office/home BP, smoking, diabetes, and creatinine level, AF was an independent predictor of cardiovascular events in the obese group (hazard ratio [HR] 3.05, 95%CI: 1.17‐7.97, p = .023). Home systolic BP was also a predictor of cardiovascular events in the obese group independent of the risk of AF (per 10 mm Hg: HR 1.36, 95%CI: 1.02‐1.83, p = .039). In conclusion, AF was an independent predictor of cardiovascular events in obese patients after adjusting for home BP.
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Affiliation(s)
- Hiroaki Watanabe
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Tomoyuki Kabutoya
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Satoshi Hoshide
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Shimotsuke, Tochigi Japan
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Kamil-Rosenberg S, Kokkinos P, Grune de Souza e Silva C, Yee WLS, Abella J, Chan K, Myers J. Association between cardiorespiratory fitness, obesity, and incidence of atrial fibrillation. IJC HEART & VASCULATURE 2020; 31:100663. [PMID: 33145394 PMCID: PMC7596185 DOI: 10.1016/j.ijcha.2020.100663] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/29/2020] [Accepted: 10/12/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The interaction between cardiorespiratory fitness (CRF) and incidence of atrial fibrillation (AF) and the interaction between obesity and incidence of AF have been explored separately. Therefore, we evaluated the association between CRF, body mass index (BMI), and risk of developing AF in a cohort of middle-aged and older US Veterans. METHODS Symptom limited exercise tests (ETT) were conducted among 16,397 Veterans (97% male) from January 9,1987 to December 31,2017. No history of AF was evident at the time of the ETTs. CRF was expressed as quartiles of peak metabolic equivalents (METs) achieved within each age decile. Weight status was classified as normal (BMI < 25 kg/m2), overweight (BMI 25-30 kg/m2), obese (BMI 30-35 kg/m2), or severely obese (BMI > 35 kg/m2). Multivariable Cox proportional hazards regression models were used to compare the association between BMI, CRF categories, and incidence of AF. RESULTS Over a median follow-up of 10.7 years, 2,155 (13.1%) developed AF. Obese and severely obese subjects had 13% and 32% higher risks for incidence of AF, respectively, vs. normal weight subjects. Overweight and obese subjects in the most fit quartile had 50% decline in AF risk compared to the least-fit subjects. Severely obese subjects had marked increases in AF risk (~50-60%) regardless of fitness level. Risk of developing AF increases with higher BMI and lower CRF. CONCLUSION Improving CRF should be advocated when assessing those at risk for developing AF.
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Key Words
- AF, Atrial fibrillation
- Arrhythmias
- BMI
- BMI, Body mass index
- CPRS, Computerized patient record system
- CRF, Cardiorespiratory fitness
- CVD, Cardiovascular disease
- Cardiopulmonary fitness
- DM, Diabetes mellitus
- ETT, Exercise tolerance test
- HR, Hazard ratio
- HTN, Hypertension
- MET, Metabolic equivalent
- PA, Physical activity
- Risk factors
- VA, Veterans affairs
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Affiliation(s)
- Shirit Kamil-Rosenberg
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Peter Kokkinos
- Cardiology Division, Veterans Affairs Medical Center, Washington, DC and Georgetown University School of Medicine, Washington, DC, United States
| | | | - Win Leth Shwe Yee
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Joshua Abella
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Khin Chan
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Stanford, CA, United States
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Zacher J, Dillschnitter K, Freitag N, Kreutz T, Bjarnason-Wehrens B, Bloch W, Predel HG, Schumann M. Exercise training in the treatment of paroxysmal atrial fibrillation: study protocol of the Cologne ExAfib Trial. BMJ Open 2020; 10:e040054. [PMID: 33130570 PMCID: PMC7783621 DOI: 10.1136/bmjopen-2020-040054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Atrial fibrillation (AF) is the most common form of cardiac arrhythmia and is associated with a number of comorbidities such as coronary artery disease and heart failure. While physical activity is already implemented in current international guidelines for the prevention and treatment of AF, the precise role of different types of exercise in the management of AF remains to be elucidated. The primary aim of the Cologne ExAfib Trial is to assess the feasibility and safety of different exercise modes in patients diagnosed with paroxysmal AF. Secondary outcomes include assessments of physical function, AF burden, quality of life and inflammation, as well as morphological and cardiac adaptations. METHODS AND ANALYSIS The study opened for recruitment in September 2019. In the initial pilot phase of this four-armed randomised controlled trial, we aim to enrol 60 patients between 60 years and 80 years of age with paroxysmal AF. After screening and pretesting, patients are randomised into one of the following groups: high-intensity interval training (4×4 min at 75%-85% peak power output (PPO)), moderate-intensity continuous training (25 min at 55%-65% PPO), strength training (whole body, 3 sets of 6-12 repetitions at 70%-90% one repetition maximum [1RM]) or a usual-care control group. Training is performed two times per week for 12 weeks. If the feasibility and safety can be confirmed through the initial pilot phase, the recruitment will be continued and powered for a clinical endpoint.Feasibility and safety are assessed by measures of recruitment and completion, programme tolerance and adherence as well as reported adverse events, including hospitalisation rates. Secondary endpoints are assessed by measures of peak oxygen consumption and the 1RM of selected muscle groups, questionnaires concerning quality of life and AF burden, serum blood samples for the analysis of C reactive protein, interleukin-6, tumour necrosis factor alpha and N-terminal pro-brain natriuretic peptide concentrations and ultrasound for muscle and heart morphology as well as cardiac function. ETHICS AND DISSEMINATION Ethics approval was obtained from the ethics committee of the German Sport University Cologne (No.: 175/2018). All procedures performed in studies involving human participants are in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Manuscripts will be written based on international authorship guidelines. No professional writers will be commissioned for manuscript drafting. The findings of this study will be published in peer-reviewed journals and presented at leading exercise and medicine conferences TRIAL REGISTRATION NUMBER: The study is registered both at the German and at the WHO trial registers (DRKS00016637); Pre-results.
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Affiliation(s)
- Jonas Zacher
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Katrin Dillschnitter
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Nils Freitag
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | | | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Hans-Georg Predel
- Department of Preventive and Rehabilitative Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
| | - Moritz Schumann
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiovascular Research and Sports Medicine, German Sport University, Cologne, Germany
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Couselo-Seijas M, Lopez-Canoa JN, Fernandez ÁL, González-Melchor L, Seoane LM, Duran-Muñoz D, Rozados-Luis A, González-Juanatey JR, Rodríguez-Mañero M, Eiras S. Inflammatory and lipid regulation by cholinergic activity in epicardial stromal cells from patients who underwent open-heart surgery. J Cell Mol Med 2020; 24:10958-10969. [PMID: 32767737 PMCID: PMC7521153 DOI: 10.1111/jcmm.15727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/26/2020] [Accepted: 07/18/2020] [Indexed: 01/14/2023] Open
Abstract
The modulation of acetylcholine (ACh) release by botulinum toxin injection into epicardial fat diminishes atrial fibrillation (AF) recurrence. These results suggest an interaction between autonomic imbalance and epicardial fat as risk factors of AF. Our aim was to study the inflammatory, lipidic and fibroblastic profile of epicardial stroma from patients who underwent open‐heart surgery, their regulation by cholinergic activity and its association with AF. We performed in vitro and ex vivo assays from paired subcutaneous and epicardial stromal cells or explants from 33 patients. Acute ACh effects in inflammation and lipid‐related genes were analysed by qPCR, in intracellular calcium mobilization were performed by Fluo‐4 AM staining and in neutrophil migration by trans‐well assays. Chronic ACh effects on lipid accumulation were visualized by AdipoRed. Plasma protein regulation by parasympathetic denervation was studied in vagotomized rats. Our results showed a higher pro‐inflammatory profile in epicardial regarding subcutaneous stromal cells. Acute ACh treatment up‐regulated monocyte chemoattractant protein 1 levels. Chronic ACh treatment improved lipid accumulation within epicardial stromal cells (60.50% [22.82‐85.13] vs 13.85% [6.17‐23.16], P < .001). Additionally, patients with AF had higher levels of fatty acid‐binding protein 4 (1.54 ± 0.01 vs 1.47 ± 0.01, P = .005). Its plasma levels were pronouncedly declined in vagotomized rats (2.02 ± 0.21 ng/mL vs 0.65 ± 0.23 ng/mL, P < .001). Our findings support the characterization of acute or chronic cholinergic activity on epicardial stroma and its association with AF.
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Affiliation(s)
- Marinela Couselo-Seijas
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,University of Santiago de Compostela, Santiago de Compostela, Spain
| | - José N Lopez-Canoa
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,Cardiovascular Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - Ángel L Fernandez
- University of Santiago de Compostela, Santiago de Compostela, Spain.,Heart Surgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Laila González-Melchor
- Cardiology Group, Health Research Institute, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Luisa M Seoane
- Endocrine Physiopathology Group, Health Research Institute, Santiago de Compostela, Spain.,CIBERobn, Madrid, Spain
| | - Darío Duran-Muñoz
- Heart Surgery Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Adriana Rozados-Luis
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain
| | - José Ramón González-Juanatey
- University of Santiago de Compostela, Santiago de Compostela, Spain.,Cardiovascular Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,Cardiology Group, Health Research Institute, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Moisés Rodríguez-Mañero
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,Cardiovascular Department, University Hospital of Santiago de Compostela, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
| | - Sonia Eiras
- Translational Cardiology group, Health Research Institute, Santiago de Compostela, Spain.,CIBERCV, Madrid, Spain
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Abstract
This review addresses the interplay between obesity, type 2 diabetes mellitus, and cardiovascular diseases. It is proposed that obesity, generally defined by an excess of body fat causing prejudice to health, can no longer be evaluated solely by the body mass index (expressed in kg/m2) because it represents a heterogeneous entity. For instance, several cardiometabolic imaging studies have shown that some individuals who have a normal weight or who are overweight are at high risk if they have an excess of visceral adipose tissue-a condition often accompanied by accumulation of fat in normally lean tissues (ectopic fat deposition in liver, heart, skeletal muscle, etc). On the other hand, individuals who are overweight or obese can nevertheless be at much lower risk than expected when faced with excess energy intake if they have the ability to expand their subcutaneous adipose tissue mass, particularly in the gluteal-femoral area. Hence, excessive amounts of visceral adipose tissue and of ectopic fat largely define the cardiovascular disease risk of overweight and moderate obesity. There is also a rapidly expanding subgroup of patients characterized by a high accumulation of body fat (severe obesity). Severe obesity is characterized by specific additional cardiovascular health issues that should receive attention. Because of the difficulties of normalizing body fat content in patients with severe obesity, more aggressive treatments have been studied in this subgroup of individuals such as obesity surgery, also referred to as metabolic surgery. On the basis of the above, we propose that we should refer to obesities rather than obesity.
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Affiliation(s)
- Marie-Eve Piché
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Medicine, Faculty of Medicine (M.-E.P.), Université Laval, Québec, QC, Canada
| | - André Tchernof
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,School of Nutrition (A.T.), Université Laval, Québec, QC, Canada
| | - Jean-Pierre Després
- From the Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec - Université Laval (M.-E.P., A.T., J.-P.D.), Université Laval, Québec, QC, Canada.,Vitam - Centre de recherche en santé durable, CIUSSS - Capitale-Nationale (J.-P.D.), Université Laval, Québec, QC, Canada.,Department of Kinesiology, Faculty of Medicine (J.-P.D.), Université Laval, Québec, QC, Canada
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Dietary and Lifestyle Patterns are Associated with Heart Rate Variability. J Clin Med 2020; 9:jcm9041121. [PMID: 32295262 PMCID: PMC7230664 DOI: 10.3390/jcm9041121] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/31/2020] [Accepted: 04/10/2020] [Indexed: 12/28/2022] Open
Abstract
Assessment of heart rate variability (HRV) and cardiac ectopic beats is a clinically relevant topic. The present exploratory observational study aimed to inspect the relationships of lifestyle, dietary patterns, and anthropometrics with HRV, premature ventricular complexes (PVCs), and supraventricular premature complexes (SVPCs). A cross-sectional study enrolling subjects undergoing Holter monitoring was performed. Sociodemographic and clinical characteristics, body composition (full-body bio-impedentiometry), dietary patterns (validated food frequency questionnaire and 24 h dietary recall), and quality of life were assessed. Generalized additive models were estimated to evaluate the relationships between outcomes of interest and variables collected. The study enrolled 121 consecutive patients undergoing 24 h Holter monitoring. Upon univariable analysis, HRV was found to have an inverse association with mass of body fat (MBF) (p-value 0.015), while doing physical activity was associated with a significantly higher HRV (p-value 0.036). Upon multivariable analysis, fruit consumption in the 24 h dietary recall was found to be directly associated with HRV (p-value 0.044). The present findings might be useful for improving the management of patients attending cardiac rhythm labs, and to tailor ad hoc prevention strategies (modification of lifestyle and eating habits) based on Holter parameters.
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40
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Yao YS, Li TD, Zeng ZH. Mechanisms underlying direct actions of hyperlipidemia on myocardium: an updated review. Lipids Health Dis 2020; 19:23. [PMID: 32035485 PMCID: PMC7007679 DOI: 10.1186/s12944-019-1171-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 12/09/2019] [Indexed: 02/02/2023] Open
Abstract
Hyperlipidemia is a common metabolic disorder and one of risk factors for cardiovascular disease. Clinical studies have shown that hyperlipidemia increases the risk of non-ischemic heart failure, while decreasing serum lipids can reverse heart dysfunction. Apart from indirectly affecting the function of the heart by promoting the development of atherosclerosis, hyperlipidemia also affects the systolic function and cardiac electrophysiological response of the heart directly, which may be related to gradual accumulation of cardiac lipids and consequent systemic oxidative stress, proinflammatory state and mitochondrial dysfunction. However, the mechanism underlying direct effects of hyperlipidemia on the heart are not fully understood. In this review, we provide an updated summary of recent experimental and clinical studies that focus on elucidating the mechanisms of the action of hyperlipidemia on cardiac function, the relationship between heart failure and serum lipids, and protective effects of lipid-lowering drugs on the heart. The exciting progress in this field supports the prospect of guiding early protection of the heart to benefit the patients with chronic hyperlipidemia and familial hyperlipidemia.
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Affiliation(s)
- Yu Si Yao
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 People’s Republic of China
| | - Tu Di Li
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 People’s Republic of China
| | - Zhi Huan Zeng
- Department of Cardiovascular Diseases, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, Guangdong 510080 People’s Republic of China
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41
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Abstract
Atrial fibrillation carries a markedly increased risk of stroke and left ventricular dysfunction, and is associated with reduced quality of life
In light of the potential for poor outcomes and the likely understated presence of silent atrial fibrillation, opportunistic screening should be carried out in general practice
Modifying the risk factors for atrial fibrillation is the cornerstone of management with adjuvant drug therapy to help maintain sinus rhythm, control the ventricular rate and reduce the risk of cerebral thromboembolism
The need for anticoagulant therapy can be assessed by using the revised CHA2DS2-VASc score. Direct oral anticoagulants are now preferred to warfarin in those who qualify for their use
Catheter ablation is an effective option to improve survival in patients with left ventricular dysfunction. It also improves quality of life and reduces arrhythmia-related hospital admissions
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Affiliation(s)
- Craig J McCallum
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital and Health Services, Australian National University
| | - Deep Chandh Raja
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital and Health Services, Australian National University
| | - Rajeev Kumar Pathak
- Cardiac Electrophysiology Unit, Department of Cardiology, Canberra Hospital and Health Services, Australian National University
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Castañeda D, Gabani M, Choi SK, Nguyen QM, Chen C, Mapara A, Kassan A, Gonzalez AA, Ait-Aissa K, Kassan M. Targeting Autophagy in Obesity-Associated Heart Disease. Obesity (Silver Spring) 2019; 27:1050-1058. [PMID: 30938942 DOI: 10.1002/oby.22455] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Accepted: 01/30/2019] [Indexed: 01/18/2023]
Abstract
Over the past three decades, the increasing rates of obesity have led to an alarming obesity epidemic worldwide. Obesity is associated with an increased risk of cardiovascular diseases; thus, it is essential to define the molecular mechanisms by which obesity affects heart function. Individuals with obesity and overweight have shown changes in cardiac structure and function, leading to cardiomyopathy, hypertrophy, atrial fibrillation, and arrhythmia. Autophagy is a highly conserved recycling mechanism that delivers proteins and damaged organelles to lysosomes for degradation. In the hearts of patients and mouse models with obesity, this process is impaired. Furthermore, it has been shown that autophagy flux restoration in obesity models improves cardiac function. Therefore, autophagy may play an important role in mitigating the adverse effects of obesity on the heart. Throughout this review, we will discuss the benefits of autophagy on the heart in obesity and how regulating autophagy might be a therapeutic tool to reduce the risk of obesity-associated cardiovascular diseases.
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Affiliation(s)
- Diana Castañeda
- Department of Biological Sciences, California State University, Los Angeles, California, USA
| | - Mohanad Gabani
- Cardiovascular Division, Department of Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Soo-Kyoung Choi
- Department of Physiology, College of Medicine, Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Korea
| | - Quynh My Nguyen
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
| | - Cheng Chen
- Department of Emergency and Critical Care, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China, Shanghai
| | - Ayesha Mapara
- Department of Biology, Northeastern Illinois University, Chicago, Illinois, USA
| | - Adam Kassan
- School of Pharmacy, West Coast University, Los Angeles, California, USA
| | - Alexis A Gonzalez
- Instituto de Química, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Karima Ait-Aissa
- Cardiovascular Division, Department of Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Modar Kassan
- Cardiovascular Division, Department of Medicine, Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Nattel S. Atrial Fibrillation and Body Composition: Is it Fat or Lean That Ultimately Determines the Risk? J Am Coll Cardiol 2019; 69:2498-2501. [PMID: 28521887 DOI: 10.1016/j.jacc.2017.03.566] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada; Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Essen, Germany.
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44
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Abstract
BACKGROUND Amiodarone and acupuncture (AA) are commonly used to treat cardiac arrhythmia (CA). The objective of this systematic review is to assess the efficacy and safety of AA for patients with CA. METHODS Randomized controlled trials (RCTs) of AA for CC will be searched from 9 databases including PubMed, EMBASE, Cochrane Library, Web of Science, Scopus, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, VIP Information, and Wanfang Data from inception to February 1, 2019 without any limitations. Two reviewers will independently screen the relevant papers, extract data, and evaluate the risk of bias for each included study. RevMan 5.3 software will be used for meta-analysis. The primary outcome includes arrhythmic episodes (including time and frequency domain parameters). The secondary outcomes consist of health-related quality of life, oxygen saturation, and safety. RESULTS The protocol of this proposed study will provide evidence to judge whether AA is an effective treatment for patients with CA. CONCLUSION The findings of this proposed study will summarize the up-to-date evidence of AA for CA. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019120962.
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Park HS, Jeong DS, Yu HT, Pak HN, Shim J, Kim JY, Kim J, Lee JM, Kim KH, Roh SY, Cho YJ, Kim YH, Yoon NS. 2018 Korean Guidelines for Catheter Ablation of Atrial Fibrillation: Part I. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2018. [DOI: 10.18501/arrhythmia.2018.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lewis M, Whang W, Biviano A, Hickey K, Garan H, Rosenbaum M. Predictors and rates of recurrence of atrial arrhythmias following catheter ablation in adults with congenital heart disease. CONGENIT HEART DIS 2018; 14:207-212. [PMID: 30451375 DOI: 10.1111/chd.12695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/12/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Catheter ablation is commonly performed to treat atrial arrhythmias in adult congenital heart disease (ACHD). Despite the frequency of ablations in the ACHD population, predictors of recurrence remain poorly defined. OBJECTIVE We sought to determine predictors of arrhythmia recurrence in ACHD patients following catheter ablation for atrial arrhythmias. METHODS We performed a retrospective study of all catheter ablations for atrial arrhythmias performed in ACHD patients between January 12, 2005 and February 11, 2015 at our institution. Prespecified exposures of interest and time from ablation to recurrence were determined via chart review. RESULTS Among 124 patients (mean age: 45 years) who underwent catheter ablation, 96 (77%) were treated for macro-reentrant atrial tachycardia, 10 (7%) for focal atrial tachycardia, 9 (7%) for atrial fibrillation, 7 (6%) for atrioventricular nodal reentrant tachycardia, and 2 (2%) for atrioventricular reentrant tachycardia. 15 (12%) required transseptal/transbaffle puncture. Fifty-one percent of patients recurred with a median time to recurrence of 1639 days. By univariate and multivariable analysis, body mass index (BMI) and Fontan status were the only variables associated with recurrence. Dose-dependent effect was observed with overweight (HR = 2.37, P = .012), obese (HR = 2.67, P = .009), and morbidly obese (HR = 4.23, P = .003) patients demonstrating an increasing risk for arrhythmia recurrence postablation. There was no significant different in recurrence rates by gender, age, non-Fontan diagnosis, or need for transseptal puncture. CONCLUSIONS In our cohort of ACHD patients, BMI was a significant risk factor for arrhythmia recurrence postablation, independent of Fontan status. These findings may help guide treatment decisions for persistent arrhythmias in the ACHD population.
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Affiliation(s)
- Matthew Lewis
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
| | - William Whang
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Angelo Biviano
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Kathleen Hickey
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Hasan Garan
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, Electrophysiology Service, New York, New York
| | - Marlon Rosenbaum
- Division of Cardiology, Department of Medicine, Schneeweiss Adult Congenital Heart Center, Columbia University Medical Center, New York, New York
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Egan Benova T, Viczenczova C, Szeiffova Bacova B, Knezl V, Dosenko V, Rauchova H, Zeman M, Reiter RJ, Tribulova N. Obesity-associated alterations in cardiac connexin-43 and PKC signaling are attenuated by melatonin and omega-3 fatty acids in female rats. Mol Cell Biochem 2018; 454:191-202. [PMID: 30446908 DOI: 10.1007/s11010-018-3463-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/17/2018] [Indexed: 12/14/2022]
Abstract
We aimed to explore whether specific high-sucrose intake in older female rats affects myocardial electrical coupling protein, connexin-43 (Cx43), protein kinase C (PKC) signaling, miR-1 and miR-30a expression, and susceptibility of the heart to malignant arrhythmias. Possible benefit of the supplementation with melatonin (40 µg/ml/day) and omega-3 polyunsaturated fatty acids (Omacor, 25 g/kg of rat chow) was examined as well. Results have shown that 8 weeks lasting intake of 30% sucrose solution increased serum cholesterol, triglycerides, body weight, heart weight, and retroperitoneal adipose tissues. It was accompanied by downregulation of cardiac Cx43 and PKCε signaling along with an upregulation of myocardial PKCδ and miR-30a rendering the heart prone to ventricular arrhythmias. There was a clear benefit of melatonin or omega-3 PUFA supplementation due to their antiarrhythmic effects associated with the attenuation of myocardial Cx43, PKC, and miR-30a abnormalities as well as adiposity. The potential impact of these findings may be considerable, and suggests that high-sucrose intake impairs myocardial signaling mediated by Cx43 and PKC contributing to increased susceptibility of the older obese female rat hearts to malignant arrhythmias.
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Affiliation(s)
- Tamara Egan Benova
- Center of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Dúbravská cesta 9, 841 04, Bartislava, Slovakia
| | - Csilla Viczenczova
- Center of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Dúbravská cesta 9, 841 04, Bartislava, Slovakia
| | - Barbara Szeiffova Bacova
- Center of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Dúbravská cesta 9, 841 04, Bartislava, Slovakia
| | - Vladimir Knezl
- Center of Experimental Medicine, Institute of Experimental Pharmacology and Toxicology, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Victor Dosenko
- State Key Laboratory of Molecular and Cellular Biology, Bogomoletz Institute of Physiology, Kyiv, Ukraine
| | - Hana Rauchova
- Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Michal Zeman
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, Bratislava, Slovakia
| | - Russel J Reiter
- Department of Cellular and Structural Biology, UT Health Science Center, San Antonio, 78229, TX, USA
| | - Narcis Tribulova
- Center of Experimental Medicine, Institute for Heart Research, Slovak Academy of Sciences, Dúbravská cesta 9, 841 04, Bartislava, Slovakia.
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LC-MS Method for Determining Amiodarone and Desethylaminodarone in Rat Plasma Used in Endogenous Overdosing Conditions Following Lipolysis. ACTA MEDICA MARISIENSIS 2018. [DOI: 10.2478/amma-2018-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective: The purpose of this study was to develop a LC-MS method to determine amiodarone (AMI) and its major metabolite desethylamiodarone (DEA) from rat plasma released from the adipose tissue of AMI treated rats subjected to a weight gain/weight loss cycle. Methods: Separation of the compounds was performed on a Kinetex 2.6 μm C18 100 x 4.6 mm column under isocratic conditions using a mixture of acetonitrile: 0.1% formic acid 65:35 at a flow rate of 0.5 ml/min. Detection of the analyte was performed by electrospray positive ionization, the monitored ions being 135 m/z from 646 for AMI and 135 m/z of 618 for DEA. Analytes were extracted after plasma protein precipitation with methanol. Results: The developed method presented specificity and linearity on the concentration range of 25-2500 ng/ml plasma for AMI and 2.5-1250 ng/ml plasma for DEA and the precision and accuracy of the method at all of quality control concentration levels including LLOQ were according to official guidelines for validating analytical methods. Conclusions: A sensitive and accurate LC-MS method has been developed with a much lower LLOQ than literature data to detect the plasma concentration differences of the studied analytes that result from forced lipolysis and mobilization from the adipose tissue.
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Jae SY, Franklin BA, Kurl S, Fernhall B, Kunutsor SK, Kauhanen J, Laukkanen JA. Effect of Cardiorespiratory Fitness on Risk of Sudden Cardiac Death in Overweight/Obese Men Aged 42 to 60 Years. Am J Cardiol 2018; 122:775-779. [PMID: 30037425 DOI: 10.1016/j.amjcard.2018.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/09/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to examine the subject and combined associations of cardiorespiratory fitness (fitness) and body mass index (BMI) with the risk of sudden cardiac death (SCD) in middle-aged men. This prospective study was based on a population sample of 2,357 men aged 42 to 60 years, who were followed up in the Kuopio Ischemic Heart Disease cohort study. Fitness was directly measured by peak oxygen uptake (VO2peak) during progressive exercise testing to volitional fatigue. Participants were divided into 4 groups (fit-normal weight, unfit-normal weight, fit-overweight/obese, and unfit-overweight/obese) based on the median values of fitness and BMI. A total of 253 (10.7%) SCDs occurred during an average follow-up of 22 years. After adjusting for potential confounders, the hazard ratio (HR) and 95% confidence interval (CI) for SCD was 1.80 (95% CI 1.21 to 2.68) for BMI ≥30.0 kg/m2 versus normal weight cohort, that is, BMI corresponding to 18.5 to 24.9 kg/m2. However, these associations were no longer statistically significant after adjusting for VO2peak (1.49, 95% CI 0.98 to 2.24). Compared with the lower levels of fitness, upper levels of fitness had a 39% lower risk of SCD (HR 0.61, 95% CI 0.40 to 0.92) after adjusting for potential confounders, including BMI. In the combined associations of fitness and BMI with the risk of SCD, unfit-overweight/obese men had 1.80 times (95% CI 1.06 to 3.06) increased risk of SCD, but fit-overweight/obese men were not at increased risk of SCD (HR 1.22, 95% CI 0.66 to 2.25) as compared with their fit-normal weight counterparts. In conclusion, both overweight/obesity and fitness were independently associated with the risk of SCD; however, fitness appears to attenuate the risk of SCD in overweight/obese men, suggesting that improving fitness may reduce the risk of SCD in this population.
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Emdin M, Aimo A, Mirizzi G, Piacenti M. Is fat good for arrhythmias in ischemic heart failure? Another face of the obesity paradox. Int J Cardiol 2018; 265:169-170. [PMID: 29885682 DOI: 10.1016/j.ijcard.2018.04.113] [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: 04/20/2018] [Accepted: 04/23/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Michele Emdin
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy.
| | - Alberto Aimo
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianluca Mirizzi
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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