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Dos Santos PB, Simões RP, Goulart CL, Arêas GPT, Marinho RS, Camargo PF, Roscani MG, Arbex RF, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Responses to incremental exercise and the impact of the coexistence of HF and COPD on exercise capacity: a follow-up study. Sci Rep 2022; 12:1592. [PMID: 35102201 PMCID: PMC8803920 DOI: 10.1038/s41598-022-05503-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/31/2021] [Indexed: 11/15/2022] Open
Abstract
Our aim was to evaluate: (1) the prevalence of coexistence of heart failure (HF) and chronic obstructive pulmonary disease (COPD) in the studied patients; (2) the impact of HF + COPD on exercise performance and contrasting exercise responses in patients with only a diagnosis of HF or COPD; and (3) the relationship between clinical characteristics and measures of cardiorespiratory fitness; (4) verify the occurrence of cardiopulmonary events in the follow-up period of up to 24 months years. The current study included 124 patients (HF: 46, COPD: 53 and HF + COPD: 25) that performed advanced pulmonary function tests, echocardiography, analysis of body composition by bioimpedance and symptom-limited incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Key CPET variables were calculated for all patients as previously described. The [Formula: see text]E/[Formula: see text]CO2 slope was obtained through linear regression analysis. Additionally, the linear relationship between oxygen uptake and the log transformation of [Formula: see text]E (OUES) was calculated using the following equation: [Formula: see text]O2 = a log [Formula: see text]E + b, with the constant 'a' referring to the rate of increase of [Formula: see text]O2. Circulatory power (CP) was obtained through the product of peak [Formula: see text]O2 and peak systolic blood pressure and Ventilatory Power (VP) was calculated by dividing peak systolic blood pressure by the [Formula: see text]E/[Formula: see text]CO2 slope. After the CPET, all patients were contacted by telephone every 6 months (6, 12, 18, 24) and questioned about exacerbations, hospitalizations for cardiopulmonary causes and death. We found a 20% prevalence of HF + COPD overlap in the studied patients. The COPD and HF + COPD groups were older (HF: 60 ± 8, COPD: 65 ± 7, HF + COPD: 68 ± 7). In relation to cardiac function, as expected, patients with COPD presented preserved ejection fraction (HF: 40 ± 7, COPD: 70 ± 8, HF + COPD: 38 ± 8) while in the HF and HF + COPD demonstrated similar levels of systolic dysfunction. The COPD and HF + COPD patients showed evidence of an obstructive ventilatory disorder confirmed by the value of %FEV1 (HF: 84 ± 20, COPD: 54 ± 21, HF + COPD: 65 ± 25). Patients with HF + COPD demonstrated a lower work rate (WR), peak oxygen uptake ([Formula: see text]O2), rate pressure product (RPP), CP and VP compared to those only diagnosed with HF and COPD. In addition, significant correlations were observed between lean mass and peak [Formula: see text]O2 (r: 0.56 p < 0.001), OUES (r: 0.42 p < 0.001), and O2 pulse (r: 0.58 p < 0.001), lung diffusing factor for carbon monoxide (DLCO) and WR (r: 0.51 p < 0.001), DLCO and VP (r: 0.40 p: 0.002), forced expiratory volume in first second (FEV1) and peak [Formula: see text]O2 (r: 0.52; p < 0.001), and FEV1 and WR (r: 0.62; p < 0.001). There were no significant differences in the occurrence of events and deaths contrasting both groups. The coexistence of HF + COPD induces greater impairment on exercise performance when compared to patients without overlapping diseases, however the overlap of the two diseases did not increase the probability of the occurrence of cardiopulmonary events and deaths when compared to groups with isolated diseases in the period studied. CPET provides important information to guide effective strategies for these patients with the goal of improving exercise performance and functional capacity. Moreover, given our findings related to pulmonary function, body composition and exercise responses, evidenced that the lean mass, FEV1 and DLCO influence important responses to exercise.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
- Sciences of Motricity Institute, Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Cássia L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | | | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Patrícia F Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Claudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of São Carlos - UFSCar, Sao Carlos, São Paulo, Brazil.
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Dos Santos PB, Simões RP, Goulart CDL, Roscani MG, Marinho RS, Camargo PF, Arbex RF, Casale G, Oliveira CR, Mendes RG, Arena R, Borghi-Silva A. Eccentric Left Ventricular Hypertrophy and Left and Right Cardiac Function in Chronic Heart Failure with or without Coexisting COPD: Impact on Exercise Performance. Int J Chron Obstruct Pulmon Dis 2021; 16:203-214. [PMID: 33568904 PMCID: PMC7868200 DOI: 10.2147/copd.s285812] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 12/21/2020] [Indexed: 11/23/2022] Open
Abstract
Aim Our aim was to assess: 1) the impact of the eccentric left ventricular hypertrophy (ELVH) on exercise performance in patients diagnosed with chronic heart failure (CHF) alone and in patients with co-existing CHF and chronic obstructive pulmonary disease (COPD) and 2) the relationship between left and right cardiac function measurements obtained by doppler echocardiography, clinical characteristics and primary measures of cardiorespiratory fitness. Methods The current study included 46 patients (CHF:23 and CHF+COPD:23) that performed advanced pulmonary function tests, echocardiography and symptom-limited, incremental cardiopulmonary exercise testing (CPET) on a cycle ergometer. Results Patients with CHF+COPD demonstrated a lower work rate, peak oxygen uptake (VO2), oxygen pulse, rate pressure product (RPP), circulatory power (CP) and ventilatory power (VP) compared to those only diagnosed with CHF. In addition, significant correlations were observed between VP and relative wall thickness (r: 0.45 p: 0.03),VE/VCO2 intercept and Mitral E/e' ratio (r: 0.70 p: 0.003) in the CHF group. Significant correlations were found between indexed left ventricle mass and RPP (r: -0.47; p: 0.02) and relative VO2 and right ventricle diameter (r: -0.62; p: 0.001) in the CHF+COPD group. Conclusion Compared to a diagnosis of CHF alone, a combined diagnosis of CHF+COPD induced further impairments in cardiorespiratory fitness. Moreover, echocardiographic measures of cardiac function are related to cardiopulmonary exercise performance and therefore appear to be an important therapeutic target when attempting to improve exercise performance and functional capacity.
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Affiliation(s)
- Polliana B Dos Santos
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Rodrigo P Simões
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil.,Postgraduate Program in Rehabilitation Sciences, Federal University of Alfenas, Minas Gerais, Brazil
| | - Cássia da L Goulart
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Meliza G Roscani
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renan S Marinho
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Patrícia Faria Camargo
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata F Arbex
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Guilherme Casale
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Cláudio R Oliveira
- Department of Medicine, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Renata G Mendes
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
| | - Ross Arena
- Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Borghi-Silva
- Cardiopulmonary Physical Therapy Laboratory, Federal University of Sao Carlos, Sao Carlos, Brazil
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Budzyń M, Gryszczyńka B, Boruczkowski M, Kaczmarek M, Begier-Krasińska B, Osińska A, Bukowska A, Iskra M, Kasprzak MP. The Potential Role of Circulating Endothelial Cells and Endothelial Progenitor Cells in the Prediction of Left Ventricular Hypertrophy in Hypertensive Patients. Front Physiol 2019; 10:1005. [PMID: 31447695 PMCID: PMC6696897 DOI: 10.3389/fphys.2019.01005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/19/2019] [Indexed: 01/20/2023] Open
Abstract
Background The main aim of present study is to evaluate the potential role of circulating endothelial cells (CECs) and endothelial progenitor cells (CEPCs) – representing specific markers of endothelial damage, in the prediction of left ventricular hypertrophy (LVH) in hypertensive patients categorized into two groups; mild (MH) and resistant hypertension (RH). Materials and Methods Thirty patients with MH and 28 subjects with RH were involved in the study. In both groups, patients were divided into an LVH and non-LVH group. The control group included 33 age and sex-matched normotensive volunteers. Physical examination, laboratory tests and echocardiography were conducted. Results In both the MH and RH group, patients with as well as without LVH demonstrated a higher number of CECs and a lower ratio of CEPCs/CECs as compared to the healthy control. Multiple linear regression analysis showed a positive association of CEPCs with left ventricular mass (LVM) and left ventricular mass index (LVMI), independently of other confounders. Conclusion Our results suggest that endothelial injury observed as an elevated CECs number and its impaired regeneration, reflected by a lowered CEPCs/CECs ratio, precede LVH occurrence and may play a significant role in LVH development regardless of the clinical severity of hypertension. Moreover, independent correlation of CEPCs with echocardiographic (ECG) incidences of LVH suggests their potential use as a screening biomarker to stratify the risk of LVH development.
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Affiliation(s)
- Magdalena Budzyń
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Bogna Gryszczyńka
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Maciej Boruczkowski
- Department of Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Mariusz Kaczmarek
- Department of Clinical Immunology, Poznań University of Medical Sciences, Poznań, Poland
| | - Beata Begier-Krasińska
- Department of Hypertensiology, Angiology, and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Angelika Osińska
- Department of Hypertensiology, Angiology, and Internal Diseases, Poznań University of Medical Sciences, Poznań, Poland
| | - Alicja Bukowska
- Medical Analysis Laboratory, Regional Blood Center, Poznań, Poland
| | - Maria Iskra
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
| | - Magdalena Paulina Kasprzak
- Department of General Chemistry, Chair of Chemistry and Clinical Biochemistry, Poznań University of Medical Sciences, Poznań, Poland
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Fabiani I, Pugliese NR, Santini C, Miccoli M, D'Agostino A, Rovai I, Mazzola M, Pedrinelli R, Dini FL. The assessment of pressure-volume relationship during exercise stress echocardiography predicts left ventricular remodeling and eccentric hypertrophy in patients with chronic heart failure. Cardiovasc Ultrasound 2019; 17:6. [PMID: 30954080 PMCID: PMC6451304 DOI: 10.1186/s12947-019-0157-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The contractile response of patients with heart failure (HF) may be assessed by exercise stress echocardiography (ESE)-derived indexes. We sought to test whether ESE parameters are useful to identify the risk of adverse left ventricular (LV) remodeling in patients with chronic HF and reduced or mildly reduced LV ejection fraction (EF). METHODS We enrolled 155 stabilized patients (age: 62 ± 11 years, 17% female, coronary artery disease 47%) with chronic HF, LV EF ≤50% and LV end-diastolic volume index > 75 ml/m2. All patients underwent a symptom-limited graded bicycle semi-supine ESE, with evaluation of peak stress LV EF, end-systolic pressure-volume relation (ESPVR, i.e. LV elastance) and cardiac power output to LV mass (CPOM). A complete echocardiographic study was performed at baseline and after 6 ± 3 months. Adverse LV remodeling was defined as the association of eccentric LV hypertrophy (LV mass: ≥115 g/m2 for male and ≥ 95 g/m2 for women, and relative wall thickness < 0.32) with an increase in LV end-systolic volume index ≥10% at six months. RESULTS Adverse LV remodeling was detected in 34 (22%) patients. After adjustment for clinical, biochemical and echocardiographic data, peak ESPVR resulted in the most powerful independent predictor of adverse LV remodeling (OR: 12.5 [95% CI 4.5-33]; p < 0.0001) followed by ischemic aetiology (OR: 2.64 [95% 1.04-6.73]; p = 0.04). CONCLUSION In patients with HF and reduced or mildly reduced EF, a compromised ESE-derived peak ESPVR, that reflects impaired LV contractility, resulted to be the most powerful predictor of adverse LV remodeling.
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Affiliation(s)
- Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
- Department of Surgical, Medical, Molecular and Critical Care Pathology, Fresno, USA
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
| | - Claudia Santini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Ilaria Rovai
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Matteo Mazzola
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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Dini FL, Galeotti GG, Terlizzese G, Fabiani I, Pugliese NR, Rovai I. Left Ventricular Mass and Thickness: Why Does It Matter? Heart Fail Clin 2019; 15:159-166. [PMID: 30832808 DOI: 10.1016/j.hfc.2018.12.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Several left ventricular geometric patterns have been described both in healthy and pathologic hearts. Left ventricular mass, wall thickness, and the ratio of wall thickness to radius are important measures to characterize the spectrum of left ventricular geometry. For clinicians, an increase in left ventricular mass is the hallmark of left ventricular hypertrophy. Although pathologic hypertrophy initially can be compensatory, eventually it may become maladaptive and evolve toward progressive left ventricular dysfunction and heart failure. In particular, patients who show left ventricular dilation and hypertrophy in association with a low relative wall thickness are likely to carry the highest risk.
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Affiliation(s)
- Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy.
| | | | | | - Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy; Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Ilaria Rovai
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
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Targeting Endothelial Function to Treat Heart Failure with Preserved Ejection Fraction: The Promise of Exercise Training. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:4865756. [PMID: 28706575 PMCID: PMC5494585 DOI: 10.1155/2017/4865756] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 12/22/2022]
Abstract
Although the burden of heart failure with preserved ejection fraction (HFpEF) is increasing, there is no therapy available that improves prognosis. Clinical trials using beta blockers and angiotensin converting enzyme inhibitors, cardiac-targeting drugs that reduce mortality in heart failure with reduced ejection fraction (HFrEF), have had disappointing results in HFpEF patients. A new “whole-systems” approach has been proposed for designing future HFpEF therapies, moving focus from the cardiomyocyte to the endothelium. Indeed, dysfunction of endothelial cells throughout the entire cardiovascular system is suggested as a central mechanism in HFpEF pathophysiology. The objective of this review is to provide an overview of current knowledge regarding endothelial dysfunction in HFpEF. We discuss the molecular and cellular mechanisms leading to endothelial dysfunction and the extent, presence, and prognostic importance of clinical endothelial dysfunction in different vascular beds. We also consider implications towards exercise training, a promising therapy targeting system-wide endothelial dysfunction in HFpEF.
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Pathological Ace2-to-Ace enzyme switch in the stressed heart is transcriptionally controlled by the endothelial Brg1-FoxM1 complex. Proc Natl Acad Sci U S A 2016; 113:E5628-35. [PMID: 27601681 DOI: 10.1073/pnas.1525078113] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Genes encoding angiotensin-converting enzymes (Ace and Ace2) are essential for heart function regulation. Cardiac stress enhances Ace, but suppresses Ace2, expression in the heart, leading to a net production of angiotensin II that promotes cardiac hypertrophy and fibrosis. The regulatory mechanism that underlies the Ace2-to-Ace pathological switch, however, is unknown. Here we report that the Brahma-related gene-1 (Brg1) chromatin remodeler and forkhead box M1 (FoxM1) transcription factor cooperate within cardiac (coronary) endothelial cells of pathologically stressed hearts to trigger the Ace2-to-Ace enzyme switch, angiotensin I-to-II conversion, and cardiac hypertrophy. In mice, cardiac stress activates the expression of Brg1 and FoxM1 in endothelial cells. Once activated, Brg1 and FoxM1 form a protein complex on Ace and Ace2 promoters to concurrently activate Ace and repress Ace2, tipping the balance to Ace2 expression with enhanced angiotensin II production, leading to cardiac hypertrophy and fibrosis. Disruption of endothelial Brg1 or FoxM1 or chemical inhibition of FoxM1 abolishes the stress-induced Ace2-to-Ace switch and protects the heart from pathological hypertrophy. In human hypertrophic hearts, BRG1 and FOXM1 expression is also activated in endothelial cells; their expression levels correlate strongly with the ACE/ACE2 ratio, suggesting a conserved mechanism. Our studies demonstrate a molecular interaction of Brg1 and FoxM1 and an endothelial mechanism of modulating Ace/Ace2 ratio for heart failure therapy.
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Djordjevic Dikic A, Nikcevic G, Raspopovic S, Jovanovic V, Tesic M, Beleslin B, Stepanovic J, Giga V, Milasinovic G. Prognostic role of coronary flow reserve for left ventricular functional improvement after cardiac resynchronization therapy in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 2014; 15:1344-9. [PMID: 25053732 DOI: 10.1093/ehjci/jeu136] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS The aim of the study was to assess the value of coronary flow reserve (CFR) for predicting improvement of left ventricular function after cardiac resynchronization therapy (CRT). METHODS AND RESULTS Study population included 40 patients (mean age 58 ± 9 years) with heart failure (ejection fraction 25, 7 ± 5, 4%) and QRS duration of 158 ± 22 ms, planned for CRT. Before and after CRT implantation, CFR was measured non-invasively during hyperaemia induced with adenosine. Responders were defined by decrease in end-systolic volume ≥15%. Follow-up echocardiography and CFR measurements were obtained after 6 months. At baseline there was no significant difference in left ventricular ejection fraction (LVEF), QRS duration, 6 min walk test distance and coronary flow velocity at rest between responder (n = 26) vs. non-responder group (n = 14, P = ns). Before CRT implantation, responders compared with non-responders, showed a greater increase in coronary flow velocity during hyperaemia, and consequently higher CFR: 2.41 ± 0.60 vs. 1.61 ± 0.45 (P = 0.001). There was significant correlation between CFR before CRT implantation and LVEF after 6 months (r = 0.545, P = 0.001). End-diastolic, end-systolic left ventricular diameter, and CFR before CRT were predictors of LV functional improvement. By multivariate analysis, only CFR before CRT was independent predictor of left ventricular recovery in the follow-up period (P = 0.001). CONCLUSION Our results demonstrate that preserved CFR in patients with dilated cardiomyopathy is predictive of left ventricular improvement after CRT implantation.
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Affiliation(s)
- Ana Djordjevic Dikic
- Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Gabrijela Nikcevic
- Pacemaker Center, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Srdjan Raspopovic
- Pacemaker Center, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Velibor Jovanovic
- Pacemaker Center, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milorad Tesic
- Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Branko Beleslin
- Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Jelena Stepanovic
- Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Vojislav Giga
- Clinical Center of Serbia, Cardiology Clinic, Medical School, University of Belgrade, Koste Todorovica 8, 11000 Belgrade, Serbia
| | - Goran Milasinovic
- Pacemaker Center, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
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Shantsila E, Wrigley BJ, Blann AD, Gill PS, Lip GY. A contemporary view on endothelial function in heart failure. Eur J Heart Fail 2014; 14:873-81. [DOI: 10.1093/eurjhf/hfs066] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Eduard Shantsila
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Benjamin J. Wrigley
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Andrew D. Blann
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
| | - Paramjit S. Gill
- Primary Care Clinical Sciences; University of Birmingham; Birmingham UK
| | - Gregory Y.H. Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital; Birmingham B18 7QH UK
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The ‘Echo Heart Failure Score’: an echocardiographic risk prediction score of mortality in systolic heart failure. Eur J Heart Fail 2014; 15:868-76. [DOI: 10.1093/eurjhf/hft038] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Alba AC, Delgado DH, Rao V, Walter S, Guyatt G, Ross HJ. Are endothelial progenitor cells a prognostic factor in patients with heart failure? Expert Rev Cardiovasc Ther 2014; 10:167-75. [DOI: 10.1586/erc.11.178] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Alba AC, Lalonde SD, Rao V, Walter SD, Guyatt GH, Ross HJ. Changes in circulating progenitor cells are associated with outcome in heart failure patients: a longitudinal study. Can J Cardiol 2013; 29:1657-64. [PMID: 24054922 DOI: 10.1016/j.cjca.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 06/04/2013] [Accepted: 06/18/2013] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Circulating progenitor cells (CPCs) are involved in the process of endothelial repair and are a prognostic factor in cardiovascular diseases. We evaluated the association between serial measurements of CPCs and functional capacity and outcomes in heart failure (HF). METHODS We included 156 consecutive consenting ambulatory HF patients (left ventricular ejection fraction < 40%). We evaluated CPCs and functional capacity (peak VO2) every 6 months for up to 2 years. CPCs were measured as early-outgrowth colony-forming units (EO-CFUs) and circulating CD34+, VEGFR2+ and/or CD133+ cells. We recorded mortality, HF hospital admissions, transplant, and ventricular assist device. RESULTS The mean age was 55 ± 15 years. A decrease in CD34+VEGFR2+ cells was independently associated with increased functional capacity; a 10-cell decrease in CD34+VEGFR2+ cells was associated with an increase of 0.2 mL/kg/min in peak VO2 (P < 0.05). We found an interaction effect (P = 0.02) between EO-CFUs and diabetes: in patients without diabetes, a 10-EO-CFU increase was independently associated with increased peak VO2 of 0.28 mL/kg/min (P = 0.01), and in patients with diabetes, a decrease in EO-CFUs was associated with an increased peak VO2 (P < 0.05). Higher EO-CFUs were associated with reduced mortality (hazard ratio, 0.25; 95% confidence interval, 0.09-0.69). CONCLUSIONS We noted differential relations between CPCs and outcomes in patients with vs without diabetes. Higher EO-CFUs and lower CD34+VEGFR2+ cells were associated with improved functional capacity and reduced mortality in nondiabetic patients. In patients with diabetes, lower EO-CFUs were associated with improved functional capacity. The basis for these differences requires further examination.
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Affiliation(s)
- Ana C Alba
- Heart Failure/Transplant Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
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Alba AC, Lalonde SD, Rao V, Walter S, Guyatt GH, Ross HJ. Circulating Proangiogenic Progenitor Cells Independently Predict Functional Capacity in Heart Failure Patients. Can J Cardiol 2013; 29:664-71. [DOI: 10.1016/j.cjca.2012.08.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 08/07/2012] [Accepted: 08/11/2012] [Indexed: 01/21/2023] Open
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Snoer M, Monk-Hansen T, Olsen RH, Pedersen LR, Nielsen OW, Rasmusen H, Dela F, Prescott E. Coronary flow reserve as a link between diastolic and systolic function and exercise capacity in heart failure. Eur Heart J Cardiovasc Imaging 2012; 14:677-83. [PMID: 23169759 DOI: 10.1093/ehjci/jes269] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS In heart failure, a reduced exercise capacity is the prevailing symptom and an important prognostic marker of future outcome. The purpose of the study was to assess the relation of coronary flow reserve (CFR) to diastolic and systolic function in heart failure and to determine which are the limiting factors for exercise capacity. METHODS AND RESULTS Forty-seven patients with left ventricular ejection fraction (LVEF) <35 [median LVEF 31 (inter-quartile range 26-34)] underwent cardiorespiratory exercise test with measurement of VO2 peak, a dual X-ray absorptiometry scan for body composition, and a full echocardiography with measurement of LVEF using the biplane Simpson model, mitral inflow velocities, and pulsed wave tissue Doppler. Peak coronary flow velocity (CFV) was measured in the LAD, using pulsed-wave Doppler. CFR was calculated as the ratio between peak CFV at rest and during 2 min of adenosine stress. Fat-free-mass-adjusted VO2 peak correlated significantly with CFR (r = 0.48, P = 0.002), E/e' (r = -0.35, P = 0.02), and s' (r = 0.45, P = 0.001) but not with LVEF (r = 0.23, P = 0.11). CFR correlated significantly with E/e' (r = -0.46, P = 0.003) and s' (r = 0.36, P = 0.02), but not with LVEF (r = 0.18, P = 0.26). When adjusting for CFR in a multivariable linear model, s' but not E/e' remained independently associated with VO2 peak. CONCLUSION In this group of heart failure patients, VO2 peak was correlated with CFR, E/e', and s' but not with traditional measures of systolic function. CFR remained associated with VO2 peak independently of diastolic and systolic function and is likely to be a limiting factor in functional capacity of heart failure patients.
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Affiliation(s)
- Martin Snoer
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, Copenhagen, Denmark.
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15
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Snoer M, Monk-Hansen T, Olsen RH, Pedersen LR, Simonsen L, Rasmusen H, Dela F, Prescott E. Insulin resistance and exercise tolerance in heart failure patients: linkage to coronary flow reserve and peripheral vascular function. Cardiovasc Diabetol 2012; 11:97. [PMID: 22889317 PMCID: PMC3444364 DOI: 10.1186/1475-2840-11-97] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/08/2012] [Indexed: 12/19/2022] Open
Abstract
Background Insulin resistance has been linked to exercise intolerance in heart failure patients. The aim of this study was to assess the potential role of coronary flow reserve (CFR), endothelial function and arterial stiffness in explaining this linkage. Methods 39 patients with LVEF < 35% (median LV ejection fraction (LVEF) 31 (interquartile range (IQ) 26–34), 23/39 of ischemic origin) underwent echocardiography with measurement of CFR. Peak coronary flow velocity (CFV) was measured in the LAD and coronary flow reserve was calculated as the ratio between CFV at rest and during a 2 minutes adenosine infusion. All patients performed a maximal symptom limited exercise test with measurement of peak oxygen uptake (VO2peak), digital measurement of endothelial function and arterial stiffness (augmentation index), dual X-ray absorptiometry scan (DEXA) for body composition and insulin sensitivity by a 2 hr hyperinsulinemic (40 mU/min/m2) isoglycemic clamp. Results Fat free mass adjusted insulin sensitivity was significantly correlated to VO2peak (r = 0.43, p = 0.007). Median CFR was 1.77 (IQ 1.26-2.42) and was correlated to insulin sensitivity (r 0.43, p = 0.008). CFR (r = 0.48, p = 0.002), and arterial stiffness (r = −0.35, p = 0.04) were correlated to VO2peak whereas endothelial function and LVEF were not (all p > 0.15). In multivariable linear regression adjusting for age, CFR remained independently associated with VO2peak (standardized coefficient (SC) 1.98, p = 0.05) whereas insulin sensitivity (SC 1.75, p = 0.09) and arterial stiffness (SC −1.17, p = 0.29) were no longer associated with VO2peak. Conclusions The study confirms that insulin resistance is associated with exercise intolerance in heart failure patients and suggests that this is partly through reduced CFR. This is the first study to our knowledge that shows an association between CFR and exercise capacity in heart failure patients and links the relationship between insulin resistance and exercise capacity to CFR.
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Affiliation(s)
- Martin Snoer
- Dept Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
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Sundell J, Engblom E, Koistinen J, Ylitalo A, Laine H, Kalliokoski R, Airaksinen KEJ, Bax JJ, Knuuti J. Increased B-type natriuretic Peptide concentration is associated with reduced coronary vasoreactivity in patients with dilated cardiomyopathy but not in healthy young subjects. ISRN CARDIOLOGY 2012; 2011:638764. [PMID: 22347648 PMCID: PMC3262516 DOI: 10.5402/2011/638764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 03/23/2011] [Indexed: 11/23/2022]
Abstract
Background/Aims. Natriuretic peptides are associated with the cardiovascular disease risk under a range of different circumstances. However, less is known about whether this association is found also in young healthy subjects. Methods. 9 patients with dilated cardiomyopathy and 26 healthy young subjects were studied. The myocardial blood flow measurements were performed basally and during adenosine infusion using PET. Results. S-proBNP concentrations were significantly higher (2153 ± 1964 versus 28 ± 17 ng/L, P = .000002) and adenosine-stimulated flow lower (1.6 ± 0.8 versus 3.6 ± 1.1 mL·g(-1)·min(-1), P = .00001) in patients with dilated cardiomyopathy when compared to healthy subjects. S-proBNP concentration was inversely associated with adenosine stimulated flow in patients with dilated cardiomyopathy (r = -0.75, P = .019) but not in healthy subjects (r = -0.06, P = .84). Conclusions. Natriuretic peptides are inversely associated with coronary vasoreactivity in patients with dilated cardiomyopathy but not in healthy young subjects. Since reduced coronary vasoreactivity seems to be one of the earliest abnormalities in the development of coronary artery disease, this might indicate that natriuretic peptides are not predictor of cardiovascular disease risk in healthy young subjects.
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Affiliation(s)
- Jan Sundell
- Turku PET Centre, University of Turku, P.O. Box 52, 20521 Turku, Finland
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Butt M, Khair OA, Dwivedi G, Shantsila A, Shantsila E, Lip GY. Myocardial Perfusion by Myocardial Contrast Echocardiography and Endothelial Dysfunction in Obstructive Sleep Apnea. Hypertension 2011; 58:417-24. [DOI: 10.1161/hypertensionaha.111.170910] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mehmood Butt
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
| | - Omer A. Khair
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
| | - Girish Dwivedi
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
| | - Alena Shantsila
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
| | - Eduard Shantsila
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
| | - Gregory Y.H. Lip
- From the University of Birmingham Centre for Cardiovascular Sciences (M.B., G.D., A.S., E.S., G.Y.H.L.), Birmingham, United Kingdom; Department of Respiratory Medicine (O.A.K.), City Hospital, Birmingham, United Kingdom
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Meimoun P, Sayah S, Luycx-Bore A, Boulanger J, Elmkies F, Benali T, Zemir H, Doutrelan L, Clerc J. Comparison Between Non-Invasive Coronary Flow Reserve and Fractional Flow Reserve to Assess the Functional Significance of Left Anterior Descending Artery Stenosis of Intermediate Severity. J Am Soc Echocardiogr 2011; 24:374-81. [DOI: 10.1016/j.echo.2010.12.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Indexed: 11/25/2022]
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Picano E, Morales MA, del Ry S, Sicari R. Innate inflammation in myocardial perfusion and its implication for heart failure. Ann N Y Acad Sci 2010; 1207:107-15. [PMID: 20955433 DOI: 10.1111/j.1749-6632.2010.05724.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Heart failure is characterized by a chronic inflammatory status, with high circulating levels of inflammatory cytokines significantly correlated with deterioration of functional capacity, cardiac performance, and coronary flow reserve--the latter occurring even with normal systemic endothelial function. Impaired coronary flow reserve in heart failure is poorly related to systemic inflammation levels and somewhat matched by a reduction in myocardial contractile reserve. Both coronary flow and myocardial functional reserve can be imaged noninvasively and can be useful clinically for disease severity titration, diagnostic anticipation, and prognostic stratification. Coronary microcirculatory dysfunction can be a trigger of disease and a potential target for therapeutic intervention in heart failure patients. Clinical observational studies showed a striking beneficial effect of endogenous adenosine accumulation on symptoms, exercise capacity, and left ventricular function in chronic heart failure, but this needs to be confirmed in prospective randomized large-scale trials.
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