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Homan EA, Devereux RB, Tak KA, Mitlak HW, Volodarskiy A, Ramasubbu K, Zhang DT, Kushman A, Pollie MP, Agoglia HK, Tafreshi R, Goyal P, Shaw L, Ndhlovu L, RoyChoudhury A, Horn E, Narula N, Safford MM, Weinsaft JW, Kim J. Impact of acute TTE-evidenced cardiac dysfunction on in-hospital and outpatient mortality: A multicenter NYC COVID-19 registry study. PLoS One 2023; 18:e0283708. [PMID: 36972280 PMCID: PMC10042347 DOI: 10.1371/journal.pone.0283708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 03/14/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND COVID-19 is associated with cardiac dysfunction. This study tested the relative prognostic role of left (LV), right and bi- (BiV) ventricular dysfunction on mortality in a large multicenter cohort of patients during and after acute COVID-19 hospitalization. METHODS/RESULTS All hospitalized COVID-19 patients who underwent clinically indicated transthoracic echocardiography within 30 days of admission at four NYC hospitals between March 2020 and January 2021 were studied. Images were re-analyzed by a central core lab blinded to clinical data. Nine hundred patients were studied (28% Hispanic, 16% African-American), and LV, RV and BiV dysfunction were observed in 50%, 38% and 17%, respectively. Within the overall cohort, 194 patients had TTEs prior to COVID-19 diagnosis, among whom LV, RV, BiV dysfunction prevalence increased following acute infection (p<0.001). Cardiac dysfunction was linked to biomarker-evidenced myocardial injury, with higher prevalence of troponin elevation in patients with LV (14%), RV (16%) and BiV (21%) dysfunction compared to those with normal BiV function (8%, all p<0.05). During in- and out-patient follow-up, 290 patients died (32%), among whom 230 died in the hospital and 60 post-discharge. Unadjusted mortality risk was greatest among patients with BiV (41%), followed by RV (39%) and LV dysfunction (37%), compared to patients without dysfunction (27%, all p<0.01). In multivariable analysis, any RV dysfunction, but not LV dysfunction, was independently associated with increased mortality risk (p<0.01). CONCLUSIONS LV, RV and BiV function declines during acute COVID-19 infection with each contributing to increased in- and out-patient mortality risk. RV dysfunction independently increases mortality risk.
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Affiliation(s)
- Edwin A. Homan
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Richard B. Devereux
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Katherine A. Tak
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Hannah W. Mitlak
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | | | - Kumudha Ramasubbu
- New York Presbyterian Hospital–Brooklyn Methodist, New York, New York, United States of America
| | - David T. Zhang
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Arielle Kushman
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Meridith P. Pollie
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Hannah K. Agoglia
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Romina Tafreshi
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Parag Goyal
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital New York, New York, New York, United States of America
| | - Leslee Shaw
- Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Lishomwa Ndhlovu
- Division of Infectious Disease, Department of Medicine, Weill Cornell Medicine, New York, New York, United States of America
| | - Arindam RoyChoudhury
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York, United States of America
| | - Evelyn Horn
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Nupoor Narula
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
| | - Monika M. Safford
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital New York, New York, New York, United States of America
| | - Jonathan W. Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
- New York Presbyterian Hospital–Queens, New York, New York, United States of America
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine / New York Presbyterian Hospital, New York, New York, United States of America
- New York Presbyterian Hospital–Queens, New York, New York, United States of America
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Wang Y, Cao Y, Xiang S, Liang S, Yang X, Zhu N, Fang W, Yu Q. Impact of Myocardial Energy Expenditure and Diastolic Dysfunction on One Year Outcome Patients With HFpEF. Front Physiol 2022; 13:655827. [PMID: 35444562 PMCID: PMC9015097 DOI: 10.3389/fphys.2022.655827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To explore the correlation between characteristics of myocardial energy expenditure (MEE) and the degree of diastolic dysfunction in patients of heart failure with preserved ejection fraction (HFpEF) and its clinical significance.Methods: 125 consecutive patients diagnosed with HFpEF in the Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University from January 2018 to October 2018 were enrolled. According to the degree of diastolic dysfunction, patients were divided into group A (8 ≤ E/e' ≤15) and group B (E/e'> 15), and MEE was calculated, patients finished 1-year clinical follow-up.Results: The level of MEE in group A was significantly lower than that in group B (p < 0.05). During 1-year follow up, MEE over 3145.69 kcal/systole was associated with increased risk of death as compared to patients with MEE less 3145.69 kcal/systole, and in patients with MEE over 101.68 kcal/min than in patients with MEE less than 101.68 kcal/min.Conclusion: There is a significant correlation between MEE and diastolic dysfunction and MEE over 3145.69 kcal/systole as well as MEE over 101.68 kcal/min are linked with increased risk of 1-year mortality in HFpEF.
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Affiliation(s)
- Yu Wang
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- Department of Nephrology, Affiliated Xinhua Hospital of Dalian University, Dalian, China
- Dalian Medical University, Dalian, China
| | - Yalan Cao
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- Zunyi Medical University, Zunyi, China
| | - Shuting Xiang
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- Zunyi Medical University, Zunyi, China
| | - Shunji Liang
- Department of Echocardiogram, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Xiumei Yang
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
| | - Ning Zhu
- Department of Cardiology, The Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Weiyi Fang
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Qin Yu
- Department of Cardiology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China
- *Correspondence: Qin Yu,
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Grymyr LMD, Nadirpour S, Gerdts E, Nedrebø BG, Hjertaas JJ, Matre K, Cramariuc D. Left ventricular myocardial oxygen demand and subclinical dysfunction in patients with severe obesity referred for bariatric surgery. Nutr Metab Cardiovasc Dis 2021; 31:666-674. [PMID: 33257189 DOI: 10.1016/j.numecd.2020.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 10/02/2020] [Accepted: 10/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS Increased myocardial oxygen (O2) demand carries higher cardiovascular risk in hypertension. We hypothesized that myocardial O2 demand is increased in severe obesity and linked to early left ventricular (LV) dysfunction. METHODS AND RESULTS Baseline data from 106 severely obese subjects referred for gastric bypass surgery (42 ± 11 years, 74% women, body mass index [BMI] 41.9 ± 4.8 kg/m2, 32% with hypertension) in the prospective FatWest (Bariatric Surgery on the West Coast of Norway) study was used. LV systolic function was assessed by biplane ejection fraction (EF), midwall shortening (MWS) and endocardial global longitudinal strain (GLS), and LV diastolic function by mitral annular early diastolic velocity (e'). Myocardial O2 demand was estimated from the LV mass-wall stress-heart rate product (high if > 1.62 × 106/2.29 × 106 g kdyne/cm2 bpm in women/men). High myocardial O2 demand was found in 33% and associated with higher BMI and high prevalence of low GLS (65%) and low MWS (63%) despite normal EF. In ROC analyses, higher myocardial O2 demand discriminated between patients with low vs. normal MWS and GLS (area under curve 0.71 and 0.63, p < 0.05). In successive multiple regression analyses, higher myocardial O2 demand was associated with lower LV MWS, GLS and average e', respectively, independent of age, gender, BMI, pulse pressure, diabetes mellitus, and EF (all p < 0.05). CONCLUSION In obese patients without known heart disease and with normal EF referred for bariatric surgery, high myocardial O2 demand is associated with lower myocardial function whether assessed by GLS or MWS independent of confounders. CLINICALTRIALS. GOV IDENTIFIER NCT01533142.
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Affiliation(s)
- Lisa M D Grymyr
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
| | | | - Eva Gerdts
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bjørn G Nedrebø
- Department of Medicine, Haugesund Hospital, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Knut Matre
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Dana Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
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Kim J, Volodarskiy A, Sultana R, Pollie MP, Yum B, Nambiar L, Tafreshi R, Mitlak HW, RoyChoudhury A, Horn EM, Hriljac I, Narula N, Kim S, Ndhlovu L, Goyal P, Safford MM, Shaw L, Devereux RB, Weinsaft JW. Prognostic Utility of Right Ventricular Remodeling Over Conventional Risk Stratification in Patients With COVID-19. J Am Coll Cardiol 2020; 76:1965-1977. [PMID: 33092732 PMCID: PMC7572068 DOI: 10.1016/j.jacc.2020.08.066] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/20/2020] [Accepted: 08/27/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a growing pandemic that confers augmented risk for right ventricular (RV) dysfunction and dilation; the prognostic utility of adverse RV remodeling in COVID-19 patients is uncertain. OBJECTIVES The purpose of this study was to test whether adverse RV remodeling (dysfunction/dilation) predicts COVID-19 prognosis independent of clinical and biomarker risk stratification. METHODS Consecutive COVID-19 inpatients undergoing clinical transthoracic echocardiography at 3 New York City hospitals were studied; images were analyzed by a central core laboratory blinded to clinical and biomarker data. RESULTS In total, 510 patients (age 64 ± 14 years, 66% men) were studied; RV dilation and dysfunction were present in 35% and 15%, respectively. RV dysfunction increased stepwise in relation to RV chamber size (p = 0.007). During inpatient follow-up (median 20 days), 77% of patients had a study-related endpoint (death 32%, discharge 45%). RV dysfunction (hazard ratio [HR]: 2.57; 95% confidence interval [CI]: 1.49 to 4.43; p = 0.001) and dilation (HR: 1.43; 95% CI: 1.05 to 1.96; p = 0.02) each independently conferred mortality risk. Patients without adverse RV remodeling were more likely to survive to hospital discharge (HR: 1.39; 95% CI: 1.01 to 1.90; p = 0.041). RV indices provided additional risk stratification beyond biomarker strata; risk for death was greatest among patients with adverse RV remodeling and positive biomarkers and was lesser among patients with isolated biomarker elevations (p ≤ 0.001). In multivariate analysis, adverse RV remodeling conferred a >2-fold increase in mortality risk, which remained significant (p < 0.01) when controlling for age and biomarker elevations; the predictive value of adverse RV remodeling was similar irrespective of whether analyses were performed using troponin, D-dimer, or ferritin. CONCLUSIONS Adverse RV remodeling predicts mortality in COVID-19 independent of standard clinical and biomarker-based assessment.
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Affiliation(s)
- Jiwon Kim
- Division of Cardiology, Weill Cornell Medicine, New York, New York; Department of Radiology, Weill Cornell Medicine, New York, New York.
| | | | - Razia Sultana
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | | | - Brian Yum
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Lakshmi Nambiar
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Romina Tafreshi
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Hannah W Mitlak
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Arindam RoyChoudhury
- Division of Biostatistics, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
| | - Evelyn M Horn
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Ingrid Hriljac
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Nupoor Narula
- Division of Cardiology, Weill Cornell Medicine, New York, New York
| | - Sijun Kim
- New York Presbyterian Hospital-Queens, Queens, New York
| | | | - Parag Goyal
- Division of Cardiology, Weill Cornell Medicine, New York, New York; General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Monika M Safford
- General Internal Medicine, Weill Cornell Medicine, New York, New York
| | - Leslee Shaw
- Department of Radiology, Weill Cornell Medicine, New York, New York
| | | | - Jonathan W Weinsaft
- Division of Cardiology, Weill Cornell Medicine, New York, New York; Department of Radiology, Weill Cornell Medicine, New York, New York
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Relationship between myocardial energy expenditure and postoperative ejection fraction in patients with severe mitral regurgitation. Anatol J Cardiol 2020; 24:254-259. [PMID: 33001042 PMCID: PMC7585961 DOI: 10.14744/anatoljcardiol.2020.03835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: This prospective study aimed to investigate the myocardial energy metabolism in severe mitral regurgitation (MR) and explore its effect on postoperative differentiation of ejection fraction (EF). Methods: A total of 85 patients with severe MR were prospectively enrolled from October 2018 to June 2019. During the study period, a total of 50 patients underwent mitral valve surgery and 49 patients were finally enrolled due to 1 missing data. Left ventricular function, circumferential end-systolic stress (cESS), and myocardial energy expenditure (MEE) were measured by transthoracic echocardiography preoperatively and 3 months after surgery. Patients were divided into 2 groups according to absolute difference of postoperative differentiation of EF. Results: Nine patients underwent mitral valve repair and 40 underwent prosthetic valve replacement. Patients with reduced EF had higher MEE demonstrated with cESS and MEE. Negative correlation between preoperative EF and N-terminal pro-brain natriuretic peptide (NT-proBNP), cESS, MEEs, and MEEm and positive correlation between preoperative EF and effective regurgitant orifice area were found. Complications occurred in 12 patients during hospitalization. Basal NT-proBNP, left atrium (LA), and cESS were significantly higher in postoperatively decreased EF group. Taking into consideration the covariates of multiple logistic regression analysis, LA and cESS were found to be independent predictors of EF reduction postoperatively. Conclusion: Higher LA and cESS are independent predictors of postoperative EF reduction. Preoperative high end-systolic stress could predict postoperative EF reduction and hence could be helpful for determining the timing of mitral valve surgery. Although MEE was higher in postoperatively decreased EF group, it did not reach statistical significance.
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Chen P, Zhan Q, Bai Y, Huang X, Wang P, Pan Y, Li S, Fu S, Lai W, Zeng Q, Ren H, Xu D. Serum Peroxisome Proliferator-activated Receptor Gamma Coactivator-1α Related to Myocardial Energy Expenditure in Patients With Chronic Heart Failure. Am J Med Sci 2019; 357:205-212. [DOI: 10.1016/j.amjms.2018.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 11/29/2022]
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Yokokawa T, Sato T, Suzuki S, Oikawa M, Yoshihisa A, Kobayashi A, Yamaki T, Kunii H, Nakazato K, Suzuki H, Saitoh SI, Ishida T, Shimouchi A, Takeishi Y. Elevated exhaled acetone concentration in stage C heart failure patients with diabetes mellitus. BMC Cardiovasc Disord 2017; 17:280. [PMID: 29145814 PMCID: PMC5689163 DOI: 10.1186/s12872-017-0713-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breath acetone is a noninvasive biomarker of heart failure; however, its significance in heart failure patients with diabetes mellitus has yet to be clarified. The objective of this study is to investigate whether exhaled acetone concentration is a noninvasive biomarker in heart failure patients with diabetes mellitus. METHODS This study prospectively included 35 diabetic patients with stage C heart failure and 20 diabetic patients with or at risk of heart failure (stage A or B). Exhaled breath was collected after an overnight fast. RESULTS The stage C group had significantly higher brain natriuretic peptide levels, larger left ventricular diameter, lower left ventricular ejection fraction, and more frequent use of β-blocker, compared with the stage A or B group. The stage C group had higher exhaled acetone concentrations than the stage A or B group (p = 0.013). Exhaled acetone concentration was correlated with total ketone bodies (r = 0.588, p < 0.001) and brain natriuretic peptide (r = 0.415, p = 0.002). CONCLUSION Stage C heart failure patients with diabetes mellitus have elevated exhaled acetone concentrations. Exhaled acetone concentration could be a noninvasive biomarker in heart failure patients with diabetes mellitus.
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Affiliation(s)
- Tetsuro Yokokawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan.
| | - Takamasa Sato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Satoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Atsushi Kobayashi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Takayoshi Yamaki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hiroyuki Kunii
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Kazuhiko Nakazato
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Hitoshi Suzuki
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Shu-Ichi Saitoh
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Takafumi Ishida
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
| | - Akito Shimouchi
- Department of Lifelong Sports for Health Biochemical Sciences, College of Life and Health Sciences, Chubu University, Kasugai, Aichi, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima, 960-1295, Japan
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Di Franco A, Kim J, Rodriguez-Diego S, Khalique O, Siden JY, Goldburg SR, Mehta NK, Srinivasan A, Ratcliffe MB, Levine RA, Crea F, Devereux RB, Weinsaft JW. Multiplanar strain quantification for assessment of right ventricular dysfunction and non-ischemic fibrosis among patients with ischemic mitral regurgitation. PLoS One 2017; 12:e0185657. [PMID: 28961271 PMCID: PMC5621708 DOI: 10.1371/journal.pone.0185657] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 09/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Ischemic mitral regurgitation (iMR) predisposes to right ventricular (RV) pressure and volume overload, providing a nidus for RV dysfunction (RVDYS) and non-ischemic fibrosis (NIF). Echocardiography (echo) is widely used to assess iMR, but performance of different indices as markers of RVDYS and NIF is unknown. Methods iMR patients prospectively underwent echo and cardiac magnetic resonance (CMR) within 72 hours. Echo quantified iMR, assessed conventional RV indices (TAPSE, RV-S’, fractional area change [FAC]), and strain via speckle tracking in apical 4-chamber (global longitudinal strain [RV-GLS]) and parasternal long axis orientation (transverse strain). CMR volumetrically quantified RVEF, and assessed ischemic pattern myocardial infarction (MI) and septal NIF. Results 73 iMR patients were studied; 36% had RVDYS (EF<50%) on CMR among whom LVEF was lower, PA systolic pressure higher, and MI size larger (all p<0.05). CMR RVEF was paralleled by echo results; correlations were highest for RV-GLS (r = 0.73) and lowest for RV-S’ (r = 0.43; all p<0.001). RVDYS patients more often had CMR-evidenced NIF (54% vs. 7%; p<0.001). Whereas all RV indices were lower among NIF-affected patients (all p≤0.006), percent change was largest for transverse strain (48.3%). CMR RVEF was independently associated with RV-GLS (partial r = 0.57, p<0.001) and transverse strain (r = 0.38, p = 0.002) (R = 0.78, p<0.001). Overall diagnostic performance of RV-GLS and transverse strain were similar (AUC = 0.93[0.87–0.99]|0.91[0.84–0.99], both p<0.001), and yielded near equivalent sensitivity and specificity (85%|83% and 80%|79% respectively). Conclusion Compared to conventional echo indices, RV strain parameters yield stronger correlation with CMR-defined RVEF and potentially constitute better markers of CMR-evidenced NIF in iMR.
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Affiliation(s)
- Antonino Di Franco
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Jiwon Kim
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Sara Rodriguez-Diego
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Omar Khalique
- Department of Medicine, Columbia University, New York, New York, United States of America
| | - Jonathan Y. Siden
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Samantha R. Goldburg
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Neil K. Mehta
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Aparna Srinivasan
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Mark B. Ratcliffe
- Department of Surgery, University of California San Francisco, San Francisco, California, United States of America
| | - Robert A. Levine
- Department of Cardiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Filippo Crea
- Department of Cardiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Richard B. Devereux
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
| | - Jonathan W. Weinsaft
- Department of Medicine, Weill Cornell Medical College, New York City, New York, United States of America
- * E-mail:
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Cetin MS, Ozcan Cetin EH, Canpolat U, Sasmaz H, Temizhan A, Aydogdu S. Prognostic significance of myocardial energy expenditure and myocardial efficiency in patients with heart failure with reduced ejection fraction. Int J Cardiovasc Imaging 2017; 34:211-222. [PMID: 28808841 DOI: 10.1007/s10554-017-1226-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
Abstract
In heart failure with reduced ejection fraction (HFrEF) patients, myocardial blood flow (MBF), myocardial energy expenditure (MEE), myocardial efficiency has been poorly evaluated because of the necessity of invasive procedures in the determination of these parameters. Transthoracic echocardiography (TTE) can provide reliable data for MEE, MBF (via coronary sinus (CS) flows). Also, myocardial efficiency can be evaluated by the MEE to MBF ratio. We aim to assess MBF, MEE and energy efficiency and the prognostic value of these parameters in HFrEF. In this prospective study, a total of 80 patients with HFrEF due to either ischemic or non-ischemic etiology and 20 healthy control subjects were included. Median follow-up duration was 901 (27-1004) days. MBF was calculated via coronary sinus blood flow. MEE was measured from circumferential end-systolic stress, stroke volume and left ventricular ejection time. MEE to MBF ratio was determined as MEf. Primary composite end-point (CEP) was cardiovascular mortality, heart transplantation or mechanical circulatory support. MEE and MEf were lower and MBF per minute was higher in HF group compared to control subjects whereas MBF per 100 g left ventricular mass was not different. MEE and MEf have significantly negative correlation with troponin I, BNP, uric acid and positive correlation with epicardial fat thickness. In Cox regression analysis, per one calorie decrease of MEE was associated 4.3 times increased risk [HR 4.396 (95% CI 1.230-15.716)] and per one percent decrease of MEf was associated 3.3 times increased risk of CEP [HR 3.343 (95% CI 1.025-10.905)]. Our study demonstrated that while MEE and MEf diminished in HFrEF, MBF preserved with the symptomatic progression of HF. MEE and MEf were found to be associated with important prognostic markers and independent predictors of CEP in HFrEF. Evaluation of MEE, MBF and MEf with echocardiography may provide an additional data regarding prognostic assessment of HFrEF population.
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Affiliation(s)
- Mehmet S Cetin
- Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey.
| | - Elif H Ozcan Cetin
- Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey
| | - Ugur Canpolat
- Cardiology Department, Hacettepe University School of Medicine, Ankara, Turkey
| | - Hatice Sasmaz
- Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey
| | - Ahmet Temizhan
- Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey
| | - Sinan Aydogdu
- Cardiology Department, Turkey Yuksek Ihtisas Training and Research Hospital, Kizilay Street, Ankara, 06100, Turkey
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10
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Kim J, Di Franco A, Seoane T, Srinivasan A, Kampaktsis PN, Geevarghese A, Goldburg SR, Khan SA, Szulc M, Ratcliffe MB, Levine RA, Morgan AE, Maddula P, Rozenstrauch M, Shah T, Devereux RB, Weinsaft JW. Right Ventricular Dysfunction Impairs Effort Tolerance Independent of Left Ventricular Function Among Patients Undergoing Exercise Stress Myocardial Perfusion Imaging. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005115. [PMID: 27903538 DOI: 10.1161/circimaging.116.005115] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/19/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Right ventricular (RV) and left ventricular (LV) function are closely linked due to a variety of factors, including common coronary blood supply. Altered LV perfusion holds the potential to affect the RV, but links between LV ischemia and RV performance, and independent impact of RV dysfunction on effort tolerance, are unknown. METHODS AND RESULTS The population comprised 2051 patients who underwent exercise stress myocardial perfusion imaging and echo (5.5±7.9 days), among whom 6% had echo-evidenced RV dysfunction. Global summed stress scores were ≈3-fold higher among patients with RV dysfunction, attributable to increments in inducible and fixed LV perfusion defects (all P≤0.001). Regional inferior and lateral wall ischemia was greater among patients with RV dysfunction (both P<0.01), without difference in corresponding anterior defects (P=0.13). In multivariable analysis, inducible inferior and lateral wall perfusion defects increased the likelihood of RV dysfunction (both P<0.05) independent of LV function, fixed perfusion defects, and pulmonary artery pressure. Patients with RV dysfunction demonstrated lesser effort tolerance whether measured by exercise duration (6.7±2.8 versus 7.9±2.9 minutes; P<0.001) or peak treadmill stage (2.6±0.9 versus 3.1±1.0; P<0.001), paralleling results among patients with LV dysfunction (7.0±2.9 versus 8.0±2.9; P<0.001|2.7±1.0 versus 3.1±1.0; P<0.001 respectively). Exercise time decreased stepwise in relation to both RV and LV dysfunction (P<0.001) and was associated with each parameter independent of age or medication regimen. CONCLUSIONS Among patients with known or suspected coronary artery disease, regional LV ischemia involving the inferior and lateral walls confers increased likelihood of RV dysfunction. RV dysfunction impairs exercise tolerance independent of LV dysfunction.
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Affiliation(s)
- Jiwon Kim
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Antonino Di Franco
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Tania Seoane
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Aparna Srinivasan
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Polydoros N Kampaktsis
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Alexi Geevarghese
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Samantha R Goldburg
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Saadat A Khan
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Massimiliano Szulc
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Mark B Ratcliffe
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Robert A Levine
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Ashley E Morgan
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Pooja Maddula
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Meenakshi Rozenstrauch
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Tara Shah
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Richard B Devereux
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.)
| | - Jonathan W Weinsaft
- From the Greenberg Cardiology Division, Department of Medicine (J.K., T.S., A.S., P.N.K., A.G., S.R.G., S.A.K., M.S., P.M., M.R., T.S., R.B.D., J.W.W.) and Department of Cardiothoracic Surgery (A.D.F.), Weill Cornell Medical College, New York, NY; Division of Cardiology, Department of Surgery (M.B.R., A.E.M.), and Department of Bioengineering (M.B.R., A.E.M.), University of California, San Francisco; Veterans Affairs Medical Center, San Francisco, CA (M.B.R., A.E.M.); and Massachusetts General Hospital, Harvard Medical School, Boston (R.A.L.).
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11
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Cetin MS, Ozcan Cetin EH, Aras D, Topaloglu S, Aydogdu S. Coronary slow flow phenomenon: Not only low in flow rate but also in myocardial energy expenditure. Nutr Metab Cardiovasc Dis 2015; 25:931-936. [PMID: 26174038 DOI: 10.1016/j.numecd.2015.06.004] [Citation(s) in RCA: 3] [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: 12/27/2014] [Revised: 06/04/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIM Coronary slow flow phenomenon (CSFP) is a miscellaneous clinical entity leading to angina-like symptoms, and electrocardiographic and scintigraphic evidence of ischemia. The impact of this syndrome on myocardial performance has not been comprehensively evaluated. In this study, we sought to evaluate the myocardial energy expenditure (MEE) in patients with CSFP and its relationship with exercise capacity. METHODS AND RESULTS A total of 64 patients (64.1% male, mean age 53.2 ± 10.3 years) with CSFP and 64 patients (60.9% male, mean age 52.2 ± 10.9 years) with normal coronary artery as control group were included. MEE was calculated by a validated formula that uses transthoracic echocardiography (TTE) parameters, including left ventricular circumferential end-systolic stress, stroke volume, and ejection time CSFP patients had significantly lower MEE (0.79 cal/systole ± 0.15 vs. 0.91 cal/systole ± 0.09, p < 0.001). In correlation analysis, MEE had a significant negative correlation with mean corrected TIMI frame count (mTFC) (β = -0.523; p < 0.001) and positive correlations with metabolic equivalents (METs) (β = 0.560; p < 0.001), rate pressure product (β = 0.649; p < 0.001), and exercise duration (β = 0.408; p < 0.001). At multivariate analysis, MEE was demonstrated as an independent predictor of CSFP (OR 1.863, CI 95% 1.485-2.338 p < 0.001). CONCLUSION Myocardial energy consumption, as a calculation obtained from TTE parameters, was reduced in patients with CSFP, and it had a significant relationship with exercise capacity. Considering its significant correlation with exercise capacity, myocardial energy consumption seemed to use evaluation of myocardial performance and functional status in another cardiovascular disease.
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Affiliation(s)
- M S Cetin
- Yuksek Ihtisas Education and Research Hospital, Cardiology Department, Ankara, Turkey
| | - E H Ozcan Cetin
- Yuksek Ihtisas Education and Research Hospital, Cardiology Department, Ankara, Turkey.
| | - D Aras
- Yuksek Ihtisas Education and Research Hospital, Cardiology Department, Ankara, Turkey
| | - S Topaloglu
- Yuksek Ihtisas Education and Research Hospital, Cardiology Department, Ankara, Turkey
| | - S Aydogdu
- Yuksek Ihtisas Education and Research Hospital, Cardiology Department, Ankara, Turkey
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12
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Zhao Z, Luo J, Ma L, Luo X, Huang L. Effect of granulocyte colony stimulating EPC on cardiac function and myocardial energy expenditure in patients with heart failure after myocardial infarction. Int J Clin Exp Med 2015; 8:16578-16584. [PMID: 26629187 PMCID: PMC4659075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/01/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the changes of cardiac function and myocardial energy expenditure following treatment with granulocyte colony stimulating factor (G-CSF) in patients with heart failure after myocardial infarction. METHODS Thirty-eight patients with heart failure after myocardial infarction were randomized into G-CSF treatment group and control group. All the patients received conventional treatment (medication and interventional therapy), and the patients in treatment group were given additional G-CSF (600 μg/day) for 7 consecutive days. The plasma level of brain-type natriuretic peptide (BNP) and the number of endothelial progenitor cells (EPC) in the peripheral blood were detected before and at 7 days and 4 months after the treatment. The cardiac functions (LVEF, FS, LVIDs, PWTs, EDV, SV, ET) was evaluated by ultrasonic imaging before and at 2 weeks and 4 months after the treatment. The MEE and circumferential end-systolic wall stress (cESS) were calculated by correlation formula. RESULTS The number of EPC was significantly higher in the treatment group than in the control group after the treatment especially at 7 days (P<0.01). In both groups, BNP level was lowered significantly after the treatment to recover the normal level (P<0.01). The cardiac functions and myocardial energy expenditure were improved in all the patients at 2 weeks and 4 months after the treatment, and the improvement was more obvious in the treatment group (P<0.05), especially in terms of the MEE and cESS was significantly lowered in the treatment group than in the control group after the treatment at 2 weeks (P<0.01), the LVEF and FS was significantly increased in the treatment group than in the control group after the treatment at 4 months (P<0.01). CONCLUSION EPC mobilization by G-CSF can effectively improve the cardiac functions, lessen ventricular remodeling and reduce myocardial energy expenditure in patients with heart failure after myocardial infarction.
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Affiliation(s)
- Zilin Zhao
- Department of Cardiology, PLA 303 Hospital China
| | - Jianchun Luo
- Department of Cardiology, PLA 303 Hospital China
| | - Lixian Ma
- Department of Cardiology, PLA 303 Hospital China
| | - Xia Luo
- Department of Cardiology, PLA 303 Hospital China
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13
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Farr M, Schulze PC. Recent advances in the diagnosis and management of cirrhosis-associated cardiomyopathy in liver transplant candidates: advanced echo imaging, cardiac biomarkers, and advanced heart failure therapies. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 8:67-74. [PMID: 25657603 PMCID: PMC4310615 DOI: 10.4137/cmc.s15722] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 11/09/2014] [Accepted: 11/09/2014] [Indexed: 12/15/2022]
Abstract
Patients with end-stage liver disease in need of liver transplantation increasingly are older with a greater burden of cardiac disease and other co-morbidities, which may increase perioperative risk and adversely affect long-term prognosis. Cirrhosis of any etiology manifests hemodynamically as a state of low systemic vascular resistance, with high peripheral, but low central blood volume, leading to a state of neurohormonal activation and high cardiac output, which may adversely affect cardiac reserve under extreme perioperative stress, aptly termed cirrhosis-associated or cirrhotic cardiomyopathy. Evidence of asymptomatic cirrhotic cardiomyopathy may be found in subtle electrocardiographic and echocardiographic changes, but may progress to severe heart failure under the demands of bleeding and transfusions, vasopressors, rebounding peripheral vascular resistance, withdrawal of cardioprotective beta-blockers and mineralocorticoid antagonists, exacerbated by sepsis or systemic inflammatory response syndrome. This review will add to the current body of literature on cirrhotic cardiomyopathy by focusing on the role of advanced echocardiographic imaging techniques, cardiac biomarkers, and advanced heart failure therapies available to manage patients with cirrhotic cardiomyopathy while waiting for liver transplant and during the perioperative period.
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Affiliation(s)
- Maryjane Farr
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Paul Christian Schulze
- Center for Advanced Cardiac Care, Division of Cardiology, Columbia University Medical Center, New York, NY, USA
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14
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O'Meara E, Thibodeau-Jarry N, Ducharme A, Rouleau JL. The Epidemic of Heart Failure: A Lucid Approach to Stemming the Rising Tide. Can J Cardiol 2014; 30:S442-54. [DOI: 10.1016/j.cjca.2014.09.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 09/30/2014] [Accepted: 09/30/2014] [Indexed: 01/11/2023] Open
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15
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Chen PA, Xu ZH, Huang YL, Luo Y, Zhu DJ, Wang P, Du ZY, Yang Y, Wu DH, Lai WY, Ren H, Xu DL. Increased serum 2-oxoglutarate associated with high myocardial energy expenditure and poor prognosis in chronic heart failure patients. Biochim Biophys Acta Mol Basis Dis 2014; 1842:2120-5. [PMID: 25078469 DOI: 10.1016/j.bbadis.2014.07.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 06/26/2014] [Accepted: 07/22/2014] [Indexed: 10/25/2022]
Abstract
Myocardial energy expenditure (MEE) and 2-oxoglutarate are elevated in chronic heart failure (CHF) patients compared with healthy controls. To explore whether 2-oxoglutarate could reflect the levels of MEE and predict the prognosis of CHF, 219 CHF patients and 66 healthy controls were enrolled. 2-Oxoglutarate was assayed with Liquid Chromatography-Mass Spectrometry/Mass Spectrometry (LC/MS/MS). CHF patients were divided into 4 groups according to interquartile range of MEE and followed for death or recurrent hospital admission due to CHF for the mean follow-up time 6.64±0.16months. 2-Oxoglutarate was increased in CHF patients compared with controls (P<0.01) and correlated with estimated glomerular filtration rate (r=0.142, P=0.036), age (r=-0.269, P<0.01) and MEE levels (r=0.307, P<0.01) in a multiple linear correlation analysis in CHF patients. Furthermore, 2-oxoglutarate (OR=3.470, 95% CI=1.557 to 7.730, P=0.002), N-terminal pro-B-type natriuretic peptide (OR=4.013, 95% CI=1.553 to 10.365, P=0.004), age (OR=1.611, 95% CI=1.136 to 2.283, P=0.007) and left ventricular ejection fraction (OR=7.272, 95% CI=3.110 to 17.000, P<0.001) were independently associated with MEE on multiple logistic regression analysis. Kaplan-Meier event curves showed that high 2-oxoglutarate levels were associated with adverse outcomes (Log Rank, Chi(2)=4.026, P=0.045). This study showed that serum 2-oxoglutarate is associated with MEE levels, which can be used as potential biomarkers for MEE, and it can reflect the clinical severity and short-term outcome of CHF.
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Affiliation(s)
- Ping-An Chen
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Zhi-Hao Xu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu-Li Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yi Luo
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou, China
| | - Ding-Ji Zhu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Peng Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zhi-Yong Du
- Department of Cardiology, General Hospital of Guangzhou Military Command, Guangzhou, China
| | - Yang Yang
- Department of Cardiology, Guangzhou First People's Hospital, Guangzhou, China
| | - Dai-Hong Wu
- Ultrasonic Department, Guangzhou First People's Hospital, Guangzhou, China
| | - Wen-Yan Lai
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Hao Ren
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China; Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Ding-Li Xu
- State Key Laboratory of Organ Failure Research, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China; Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China.
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16
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Dedkova EN, Blatter LA. Role of β-hydroxybutyrate, its polymer poly-β-hydroxybutyrate and inorganic polyphosphate in mammalian health and disease. Front Physiol 2014; 5:260. [PMID: 25101001 PMCID: PMC4102118 DOI: 10.3389/fphys.2014.00260] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 06/19/2014] [Indexed: 12/14/2022] Open
Abstract
We provide a comprehensive review of the role of β-hydroxybutyrate (β-OHB), its linear polymer poly-β-hydroxybutyrate (PHB), and inorganic polyphosphate (polyP) in mammalian health and disease. β-OHB is a metabolic intermediate that constitutes 70% of ketone bodies produced during ketosis. Although ketosis has been generally considered as an unfavorable pathological state (e.g., diabetic ketoacidosis in type-1 diabetes mellitus), it has been suggested that induction of mild hyperketonemia may have certain therapeutic benefits. β-OHB is synthesized in the liver from acetyl-CoA by β-OHB dehydrogenase and can be used as alternative energy source. Elevated levels of PHB are associated with pathological states. In humans, short-chain, complexed PHB (cPHB) is found in a wide variety of tissues and in atherosclerotic plaques. Plasma cPHB concentrations correlate strongly with atherogenic lipid profiles, and PHB tissue levels are elevated in type-1 diabetic animals. However, little is known about mechanisms of PHB action especially in the heart. In contrast to β-OHB, PHB is a water-insoluble, amphiphilic polymer that has high intrinsic viscosity and salt-solvating properties. cPHB can form non-specific ion channels in planar lipid bilayers and liposomes. PHB can form complexes with polyP and Ca(2+) which increases membrane permeability. The biological roles played by polyP, a ubiquitous phosphate polymer with ATP-like bonds, have been most extensively studied in prokaryotes, however polyP has recently been linked to a variety of functions in mammalian cells, including blood coagulation, regulation of enzyme activity in cancer cells, cell proliferation, apoptosis and mitochondrial ion transport and energy metabolism. Recent evidence suggests that polyP is a potent activator of the mitochondrial permeability transition pore in cardiomyocytes and may represent a hitherto unrecognized key structural and functional component of the mitochondrial membrane system.
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Affiliation(s)
- Elena N Dedkova
- Department of Molecular Biophysics and Physiology, Rush University Medical Center Chicago, IL, USA
| | - Lothar A Blatter
- Department of Molecular Biophysics and Physiology, Rush University Medical Center Chicago, IL, USA
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Du Z, Shen A, Huang Y, Su L, Lai W, Wang P, Xie Z, Xie Z, Zeng Q, Ren H, Xu D. 1H-NMR-based metabolic analysis of human serum reveals novel markers of myocardial energy expenditure in heart failure patients. PLoS One 2014; 9:e88102. [PMID: 24505394 PMCID: PMC3914925 DOI: 10.1371/journal.pone.0088102] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 01/07/2014] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Elevated myocardial energy expenditure (MEE) is related with reduced left ventricular ejection fraction, and has also been documented as an independent predictor of cardiovascular mortality. However, the serum small-molecule metabolite profiles and pathophysiological mechanisms of elevated MEE in heart failure (HF) are still lacking. Herein, we used 1H-NMR-based metabolomics analysis to screen for potential biomarkers of MEE in HF. METHODS A total of 61 subjects were enrolled, including 46 patients with heart failure and 15 age-matched controls. Venous serum samples were collected from subjects after an 8-hour fast. An INOVA 600 MHz nuclear magnetic resonance spectrometer with Carr-Purcell-Melboom-Gill (CPMG) pulse sequence was employed for the metabolomics analysis and MEE was calculated using colored Doppler echocardiography. Metabolomics data were processed using orthogonal signal correction and regression analysis was performed using the partial least squares method. RESULTS The mean MEE levels of HF patients and controls were 139.61±58.18 cal/min and 61.09±23.54 cal/min, respectively. Serum metabolomics varied with MEE changed, and 3-hydroxybutyrate, acetone and succinate were significantly elevated with the increasing MEE. Importantly, these three metabolites were independent of administration of angiotensin converting enzyme inhibitor, β-receptor blockers, diuretics and statins (P>0.05). CONCLUSIONS These results suggested that in patients with heart failure, MEE elevation was associated with significant changes in serum metabolomics profiles, especially the concentration of 3-hydroxybutyrate, acetone and succinate. These compounds could be used as potential serum biomarkers to study myocardial energy mechanism in HF patients.
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Affiliation(s)
- Zhiyong Du
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Anna Shen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Department of Cardiology, The Third Hospital of Southern Medical University, Guangzhou, China
| | - Yuli Huang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Liang Su
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Wenyan Lai
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Peng Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Zhibing Xie
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Zhiquan Xie
- Department of Cardiology, Guangzhou General Hospital of PLA, Guangzhou, China
| | - Qingchun Zeng
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
| | - Hao Ren
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
- Department of Rheumatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail: (HR); (DX)
| | - Dingli Xu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
- Key Laboratory For Organ Failure Research, Ministry of Education of the People's Republic of China, Guangzhou, China
- * E-mail: (HR); (DX)
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Thierer J, Acosta A, Vainstein N, Sultan M, Francesia A, Marino J, Prado AH, Guglielmone R, Trivi M, Boero L, Brites F, Anker S. Relation of left ventricular ejection fraction and functional capacity with metabolism and inflammation in chronic heart failure with reduced ejection fraction (from the MIMICA Study). Am J Cardiol 2010; 105:977-83. [PMID: 20346316 DOI: 10.1016/j.amjcard.2009.11.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 11/28/2022]
Abstract
Catabolism and inflammation play a role in the physiopathology of heart failure with reduced ejection fraction and are more pronounced in the advanced stages of the disease. Our aim was to demonstrate that in patients with stable heart failure with reduced ejection fraction adequately treated, a direct relation exists between functional impairment, as evaluated by left ventricular ejection fraction (LVEF) and the 6-minute walking distance (6MWD), and catabolic and inflammatory markers. In 151 outpatients with heart failure and a LVEF of < or =40% (median age 64 years, LVEF 29%, and 6MWD 290 m) we measured the laboratory and body composition parameters that indicate directly or indirectly inflammatory activation, anabolic-catabolic balance, and nutritional status. We performed an analysis stratified by quartiles of LVEF and 6MWD and linear regression analysis to explore our hypothesis. In the linear regression analysis, after adjusting for age, gender, and etiology, LVEF was not related to the metabolic, inflammatory, or nutritional parameters. The 6MWD was directly related to albumin (p = 0.002) and log transformation of dehydroepiandrosterone (p = 0.013) and inversely to adiponectin (p = 0.001) and the log-transformation of high-sensitivity C-reactive protein (p = 0.037). In conclusion, in a population with stable heart failure with reduced ejection fraction, the 6MWD was related to the degree of inflammatory activity and catabolism, but LVEF was not. Even a slightly diminished functional capacity implies underlying inflammation and catabolic activation.
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Affiliation(s)
- Jorge Thierer
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina.
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Crawford GB, Robinson JA, Hunt RW, Piller NB, Esterman A. Estimating Survival in Patients with Cancer Receiving Palliative Care: Is Analysis of Body Composition Using Bioimpedance Helpful? J Palliat Med 2009; 12:1009-14. [DOI: 10.1089/jpm.2009.0093] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Gregory Brian Crawford
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Julie Ann Robinson
- School of Psychology, Flinders University, Bedford Park, South Australia, Australia
| | - Roger Wayne Hunt
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Neil Brenton Piller
- School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Adrian Esterman
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
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Palmieri V, Russo C, Palmieri EA, Pezzullo S, Celentano A. Changes in components of left ventricular mechanics under selective beta-1 blockade: insight from traditional and new technologies in echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 10:745-52. [DOI: 10.1093/ejechocard/jep055] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Palmieri V, Migliaresi P, Orefice M, Lupo T, Di Minno MND, Valentini G, Celentano A. High prevalence of subclinical cardiovascular abnormalities in patients with systemic lupus erythematosus in spite of a very low clinical damage index. Nutr Metab Cardiovasc Dis 2009; 19:234-240. [PMID: 19157818 DOI: 10.1016/j.numecd.2008.09.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2008] [Revised: 06/25/2008] [Accepted: 09/29/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIM To evaluate the prevalence of subclinical cardiovascular (CV) abnormalities in systemic lupus erythematosus (SLE) stratified according to SLE-related organ damage using the Systemic Lupus International Collaborating Clinics (SLICC) damage index. METHODS AND RESULTS We selected SLE patients without clinically overt CV events (n=45, 56% with SLICC=0, 44% with SLICC=1-4). CV evaluation was performed using cardiac and vascular echo-Doppler techniques. Post-ischemic flow-mediated dilation (FMD) over nitroglycerine-mediated dilation (NMD) of the brachial artery <0.70 defined endothelial dysfunction. The prevalence of preclinical CV abnormalities (CVAbn, including at least one of the following-carotid atherosclerosis, left ventricular (LV) hypertrophy, low arterial compliance, LV wall motion abnormalities, aortic regurgitation, FMD/NMD<0.70)-was 64% (16/25) in patients with SLICC=0 and 80% (16/20) in those with SLICC>0 (p=not significant (NS)). In particular, the prevalence of carotid atherosclerosis (28% vs. 16%), of LV hypertrophy (12% vs. 6%) and of LV wall motion abnormalities (15% vs. 12%), of low global arterial compliance (18% vs. 10%), prevalence of aortic regurgitation (30% vs. 18%) and/or aortic valve fibrosclerosis (10% vs. 8%), FMD<10% (14+/-5% vs. 14%+/-6) and prevalence of FMD/NMD<0.70 (53% vs. 52%) were comparable in SLE patients with SLICC>0 and in those with SLICC=0 (all p=NS). Of the SLE patients without carotid atherosclerosis, LV hypertrophy, low arterial compliance, LV wall motion abnormalities and aortic regurgitation (n=17), endothelial dysfunction was detected in 50% of those with SLICC=0 (6/12) and in 40% of those with SLICC>0 (2/5, p=NS). CONCLUSIONS SLE patients with SLICC=0 often have an elevated CV risk profile due to subclinical manifestations of CV disease detectable by cardiac and vascular echo-Doppler evaluations.
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MESH Headings
- Adolescent
- Adult
- Aortic Valve Insufficiency/epidemiology
- Aortic Valve Insufficiency/etiology
- Aortic Valve Insufficiency/physiopathology
- Brachial Artery/diagnostic imaging
- Brachial Artery/physiopathology
- Cardiovascular Diseases/diagnostic imaging
- Cardiovascular Diseases/epidemiology
- Cardiovascular Diseases/etiology
- Cardiovascular Diseases/physiopathology
- Carotid Artery Diseases/epidemiology
- Carotid Artery Diseases/etiology
- Carotid Artery Diseases/physiopathology
- Compliance
- Echocardiography, Doppler, Color
- Endothelium, Vascular/diagnostic imaging
- Endothelium, Vascular/physiopathology
- Female
- Humans
- Hypertrophy, Left Ventricular/epidemiology
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/physiopathology
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/epidemiology
- Lupus Erythematosus, Systemic/physiopathology
- Male
- Middle Aged
- Nitroglycerin
- Prevalence
- Risk Assessment
- Severity of Illness Index
- Ultrasonography, Doppler
- Vasodilation
- Vasodilator Agents
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/physiopathology
- Young Adult
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Affiliation(s)
- V Palmieri
- Unit of Cardiology, Ospedale dei Pellegrini, ASL Napoli 1, Naples, Italy.
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Le DSNT, Miles R, Savage PJ, Cornell E, Tracy RP, Knowler WC, Krakoff J. The association of plasma fibrinogen concentration with diabetic microvascular complications in young adults with early-onset of type 2 diabetes. Diabetes Res Clin Pract 2008; 82:317-23. [PMID: 18922595 DOI: 10.1016/j.diabres.2008.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Revised: 08/21/2008] [Accepted: 08/26/2008] [Indexed: 11/29/2022]
Abstract
AIMS Diabetic nephropathy is an important risk factor for cardiovascular diseases (CVD). The underlying etiology is not fully understood but may be related to changes in inflammatory and hemostatic markers with kidney disease. We investigated the associations of the markers with microvascular complications in Pima Indians (PI) with early-onset type 2 diabetes (T2DM). METHODS C-reactive protein, interleukine-6, fibrinogen, D-dimer, plasmin-antiplasmin complex and plasminogen activator inhibitor-1 were measured in 104 PI (age: 32+/-4 y) with diabetes and 59 (32+/-4 y) with fasting glucose <110 mg/dl and 2-h glucose <140 mg/dl. Urine albumin to creatinine ratio (ACR) was used as marker of nephropathy. Severity of retinopathy was classified in the worse eye by direct ophthalmoscopy as none, background and proliferative. RESULTS Of these markers, only fibrinogen was associated with ACR (r=0.25, p<0.01). After adjustment for age, sex, percentage Pima heritage, smoking status, diabetes duration, blood pressure and use of aspirin, antihypertensive and antihyperglycemic agents, general linear models (with natural log-transformed values of fibrinogen and ACR as dependent and independent variables, respectively) revealed that a one percent increase in ACR would yield a 0.02% increase in the fibrinogen (beta=0.02, p<0.05). Plasma fibrinogen was also significantly increased with severity of diabetic retinopathy (p<0.05). CONCLUSIONS Increased plasma fibrinogen concentration was associated with diabetic microvascular disease, in particular with nephropathy. This may help to explain the etiologic link between nephropathy and CVD.
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Affiliation(s)
- Duc Son N T Le
- Obesity and Diabetes Clinical Research Section, NIDDK-NIH, DHHS, 4212 N. 16th Street, Room 5-35, Phoenix, AZ, USA.
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Palmieri V, Migliaresi P, Di Minno G, Valentini G, Celentano A. Preclinical and prognostically relevant cardiovascular disease burden in systemic lupus erythematosus with low clinical damage index. Nutr Metab Cardiovasc Dis 2008; 18:e23-e25. [PMID: 18455378 DOI: 10.1016/j.numecd.2008.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/27/2022]
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