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de la Espriella R, Wahlberg KJ, Infeld M, Palau P, Núñez E, Sanchis J, Meyer M, Núñez J. Effect of paced heart rate on quality of life and natriuretic peptides for stage B or C heart failure with preserved ejection fraction: A secondary analysis of the myPACE trial. Eur J Heart Fail 2024; 26:167-176. [PMID: 38124404 DOI: 10.1002/ejhf.3107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
AIM Emerging evidence suggests a beneficial effect of higher heart rates in some patients with heart failure with preserved ejection fraction (HFpEF). This study aimed to evaluate the impact of higher backup pacing rates in HFpEF patients with preexisting pacemaker systems that limit pacemaker-mediated dyssynchrony across left ventricular (LV) volumes and LV ejection fraction (LVEF). METHODS AND RESULTS This is a post-hoc analysis of the myPACE clinical trial that evaluated the effects of personalized accelerated pacing setting (myPACE) versus standard of care on changes in Minnesota Living with Heart Failure Questionnaire (MLHFQ) score, N-terminal pro-brain natriuretic peptide (NT-proBNP), pacemaker-detected activity levels, and atrial fibrillation (AF) burden in patients with HFpEF with preexisting pacemakers. Between-treatment comparisons were performed using linear regression models adjusting for the baseline value of the exposure (ANCOVA design). This study included 93 patients with pre-trial transthoracic echocardiograms available (usual care n = 49; myPACE n = 44). NT-proBNP levels and MLHFQ scores improved in a higher magnitude in the myPACE group at lower indexed LV end-diastolic volumes (iLVEDV) (NT-proBNP-iLVEDV interaction p = 0.006; MLHFQ-iLVEDV interaction p = 0.068). In addition, personalized accelerated pacing led to improved changes in activity levels and NT-proBNP, especially at higher LVEF (activity levels-LVEF interaction p = 0.009; NT-proBNP-LVEF interaction p = 0.058). No evidence of heterogeneity was found across LV volumes or LVEF for pacemaker-detected AF burden. CONCLUSIONS In the post-hoc analysis of the myPACE trial, we observed that the benefits of a personalized accelerated backup pacing on MLHFQ score, NT-proBNP, and pacemaker-detected activity levels appear to be more pronounced in patients with smaller iLVEDV and higher LVEF.
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Affiliation(s)
- Rafael de la Espriella
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Kramer J Wahlberg
- University of Vermont, Larner College of Medicine, Department of Medicine, Burlington, VT, USA
| | - Margaret Infeld
- Cardiovascular Center, Tufts Medical Center and Tufts University School of Medicine, Boston, MA, USA
| | - Patricia Palau
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
| | - Eduardo Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
| | - Juan Sanchis
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Markus Meyer
- Lillehei Heart Institute, Department of Medicine, University of Minnesota College of Medicine, Minneapolis, MN, USA
| | - Julio Núñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia (INCLIVA), Valencia, Spain
- Department of Medicine, Universitat de València, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Sharma A, Zheng Y, Ezekowitz JA, Westerhout CM, Udell JA, Goodman SG, Armstrong PW, Buse JB, Green JB, Josse RG, Kaufman KD, McGuire DK, Ambrosio G, Chuang LM, Lopes RD, Peterson ED, Holman RR. Cluster Analysis of Cardiovascular Phenotypes in Patients With Type 2 Diabetes and Established Atherosclerotic Cardiovascular Disease: A Potential Approach to Precision Medicine. Diabetes Care 2022; 45:204-212. [PMID: 34716214 PMCID: PMC9004312 DOI: 10.2337/dc20-2806] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 09/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Phenotypic heterogeneity among patients with type 2 diabetes mellitus (T2DM) and atherosclerotic cardiovascular disease (ASCVD) is ill defined. We used cluster analysis machine-learning algorithms to identify phenotypes among trial participants with T2DM and ASCVD. RESEARCH DESIGN AND METHODS We used data from the Trial Evaluating Cardiovascular Outcomes with Sitagliptin (TECOS) study (n = 14,671), a cardiovascular outcome safety trial comparing sitagliptin with placebo in patients with T2DM and ASCVD (median follow-up 3.0 years). Cluster analysis using 40 baseline variables was conducted, with associations between clusters and the primary composite outcome (cardiovascular death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina) assessed by Cox proportional hazards models. We replicated the results using the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial. RESULTS Four distinct phenotypes were identified: cluster I included Caucasian men with a high prevalence of coronary artery disease; cluster II included Asian patients with a low BMI; cluster III included women with noncoronary ASCVD disease; and cluster IV included patients with heart failure and kidney dysfunction. The primary outcome occurred, respectively, in 11.6%, 8.6%, 10.3%, and 16.8% of patients in clusters I to IV. The crude difference in cardiovascular risk for the highest versus lowest risk cluster (cluster IV vs. II) was statistically significant (hazard ratio 2.74 [95% CI 2.29-3.29]). Similar phenotypes and outcomes were identified in EXSCEL. CONCLUSIONS In patients with T2DM and ASCVD, cluster analysis identified four clinically distinct groups. Further cardiovascular phenotyping is warranted to inform patient care and optimize clinical trial designs.
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Affiliation(s)
- Abhinav Sharma
- Division of Cardiology, McGill University, Montreal, Quebec, Canada
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Justin A. Ezekowitz
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jacob A. Udell
- Peter Munk Cardiac Centre, University Health Network and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Shaun G. Goodman
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
- St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul W. Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - John B. Buse
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jennifer B. Green
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Robert G. Josse
- St. Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Darren K. McGuire
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Lee-Ming Chuang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Renato D. Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Eric D. Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Rury R. Holman
- Radcliffe Department of Medicine, University of Oxford, Oxford, U.K
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3
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Zhu D, Chen W, Pan Y, Li T, Cui M, Chen B. The correlation between maternal age, parity, cardiac diastolic function and occurrence rate of pre-eclampsia. Sci Rep 2021; 11:8842. [PMID: 33893350 PMCID: PMC8065037 DOI: 10.1038/s41598-021-87953-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 03/17/2021] [Indexed: 01/04/2023] Open
Abstract
To evaluate the effect of age and parity on maternal cardiac diastolic function in second trimester among pregnant women with normal left ventricular ejection fraction. To analyze the correlation between impaired diastolic function and pre-eclampsia. It had been suggested that maternal cardiac adaptations during pregnancy differed between nulliparous and primiparous women and also varied according to age. Impaired cardiac function may precede pre-eclampsia. Therefore, we examined the effects of parity and age on cardiac diastolic function during pregnancy and whether impaired diastolic function during the second trimester correlates with pre-eclampsia. Women with singleton pregnancies at 13 + 0 to 27 + 6 weeks’ gestation and left ventricular ejection fraction (LVEF) ≥ 50% were retrospectively identified. Diastolic function parameters were assessed using transthoracic echocardiography. Pre-eclampsia was identified from medical records. The effect of age and parity on maternal cardiac diastolic function as well as the correlation between impaired diastolic function and occurrence rate of pre-eclampsia were examined. 376 pregnant women were included (median age: 30 years; median gestational age: 14 weeks; 171 primiparous women). LVEF was 66%. Impaired cardiac diastolic function was seen in 7.8% of pregnant women < 35 years compared with 28.6% of those ≥ 35 years (p = 0.000). ROC curve showed women with maternal age over 32 began to have a higher rate of impaired cardiac diastolic function (AUC = 0.704, p = 0.000, sensitivity = 54.5%, specificity = 75.3%). There was no difference in diastolic function indices between maternal women grouped by parity. Higher maternal age was an independent risk factor of declining Em (p < 0.05). Em < 13 cm/s was significantly associated with pre-eclampsia occurrence (HR 8.56; 95% CI 3.40–21.57) after being adjusted for confounders. Maternal age is an independent risk factor for diastolic function decline. There is no difference in cardiac diastolic function between nulliparous women and primiparous women. Pre-eclampsia occurrence is significantly higher in patients with impaired diastolic function at mid-gestation. The application of risk grading using diastolic function at mid-gestation may improve the survival outcomes of pregnant women.
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Affiliation(s)
- Dan Zhu
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
| | - Weiyu Chen
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Yuchen Pan
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Tingcui Li
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ming Cui
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Baoxia Chen
- Department of Cardiology, NHFPC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
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Multiscale classification of heart failure phenotypes by unsupervised clustering of unstructured electronic medical record data. Sci Rep 2020; 10:21340. [PMID: 33288774 PMCID: PMC7721729 DOI: 10.1038/s41598-020-77286-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/05/2020] [Indexed: 12/13/2022] Open
Abstract
As a leading cause of death and morbidity, heart failure (HF) is responsible for a large portion of healthcare and disability costs worldwide. Current approaches to define specific HF subpopulations may fail to account for the diversity of etiologies, comorbidities, and factors driving disease progression, and therefore have limited value for clinical decision making and development of novel therapies. Here we present a novel and data-driven approach to understand and characterize the real-world manifestation of HF by clustering disease and symptom-related clinical concepts (complaints) captured from unstructured electronic health record clinical notes. We used natural language processing to construct vectorized representations of patient complaints followed by clustering to group HF patients by similarity of complaint vectors. We then identified complaints that were significantly enriched within each cluster using statistical testing. Breaking the HF population into groups of similar patients revealed a clinically interpretable hierarchy of subgroups characterized by similar HF manifestation. Importantly, our methodology revealed well-known etiologies, risk factors, and comorbid conditions of HF (including ischemic heart disease, aortic valve disease, atrial fibrillation, congenital heart disease, various cardiomyopathies, obesity, hypertension, diabetes, and chronic kidney disease) and yielded additional insights into the details of each HF subgroup's clinical manifestation of HF. Our approach is entirely hypothesis free and can therefore be readily applied for discovery of novel insights in alternative diseases or patient populations.
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5
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Bshiebish HAH, Al-Musawi AH, Khudeir SA. Role of global longitudinal strain in assessment of left ventricular systolic function in patients with heart failure with preserved ejection fraction. J Saudi Heart Assoc 2019; 31:100-105. [PMID: 30766004 PMCID: PMC6360320 DOI: 10.1016/j.jsha.2018.12.002] [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: 08/18/2018] [Revised: 11/16/2018] [Accepted: 12/16/2018] [Indexed: 01/19/2023] Open
Abstract
Objectives To detect systolic dysfunction in heart failure with preserved ejection fraction (HFpEF) patients by using global longitudinal strain (GLS). Methods This study included 46 heart failure patients: 24 with heart failure with reduced ejection fraction (HFrEF) and 22 with heart failure with preserved ejection fraction (HFpEF), and 20 patients with similar risk factor but no symptoms or signs of heart failure, matched for age and sex, as controls. All patients were screened by echocardiography. The ejection fraction of left ventricle was measured using Simpson’s method and the GLS of the left ventricle was measured by using two-dimensional speckle tracking. Results Left ventricular ejection fraction (LVEF) was 61.90 ± 2.94% in the controls, 60.45 ± 7.4% in the HFpEF group (p = 0.421), and 32.75 ± 8.45% in the HFrEF group (p = 0.001). The value of left ventricle (LV) GLS (controls = −19.74 ± 1.12%, HFpEF = −15.03 ± 2.03%, HFrEF = −10.72 ± 1.99%, p = 0.0001) was significantly impaired in the HFpEF group despite normal LVEF. Conclusion There is significant left ventricular systolic impairment detected by GLS despite preserved LVEF.
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6
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Park D, Lee HS, Kang JH, Kim SM, Gong JR, Cho KH. Attractor landscape analysis of the cardiac signaling network reveals mechanism-based therapeutic strategies for heart failure. J Mol Cell Biol 2018; 10:180-194. [DOI: 10.1093/jmcb/mjy019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 03/19/2018] [Indexed: 01/02/2023] Open
Affiliation(s)
- Daebeom Park
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Ho-Sung Lee
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
| | - Jun Hyuk Kang
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
| | - Seon-Myeong Kim
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Jeong-Ryeol Gong
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
| | - Kwang-Hyun Cho
- Laboratory for Systems Biology and Bio-inspired Engineering, Department of Bio and Brain Engineering, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- Graduate School of Medical Science and Engineering, KAIST, Daejeon, Republic of Korea
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7
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Otaki Y, Watanabe T, Kubota I. Heart-type fatty acid-binding protein in cardiovascular disease: A systemic review. Clin Chim Acta 2017; 474:44-53. [PMID: 28911997 DOI: 10.1016/j.cca.2017.09.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 09/09/2017] [Accepted: 09/09/2017] [Indexed: 12/12/2022]
Abstract
Fatty acid-binding proteins, whose clinical applications have been studied, are a family of proteins that reflect tissue injury. Heart-type fatty acid-binding protein (H-FABP) is a marker of ongoing myocardial damage and useful for early diagnosis of acute myocardial infarction (AMI). In the past decade, compared to other cardiac enzymes, H-FABP has shown more promise as an early detection marker for AMI. However, the role of H-FABP is being re-examined due to recent refinement in the search for newer biomarkers, and greater understanding of the role of high-sensitivity troponin. We discuss the current role of H-FABP as an early marker for AMI in the era of high sensitive troponin. H-FABP is highlighted as a prognostic marker for a broad spectrum of fatal diseases, viz., AMI, heart failure, arrhythmia, and pulmonary embolism that could be associated with poor clinical outcomes. Because the cut-off value of what constitutes an abnormal H-FABP potentially differs for each cardiovascular event and depends on the clinical setting, an optimal cut-off value has not been clearly established. Of note, several factors such as age, gender, and cardiovascular risk factors, which affect H-FABP levels need to be considered in this context. In this review, we discuss the clinical applications of H-FABP as a prognostic marker in various clinical settings.
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Affiliation(s)
- Yoichiro Otaki
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan.
| | - Isao Kubota
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
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8
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Tyrankiewicz U, Olkowicz M, Skórka T, Jablonska M, Orzylowska A, Bar A, Gonet M, Berkowicz P, Jasinski K, Zoladz JA, Smolenski RT, Chlopicki S. Activation pattern of ACE2/Ang-(1-7) and ACE/Ang II pathway in course of heart failure assessed by multiparametric MRI in vivo in Tgαq*44 mice. J Appl Physiol (1985) 2017; 124:52-65. [PMID: 28970203 DOI: 10.1152/japplphysiol.00571.2017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Here, we analyzed systemic (plasma) and local (heart/aorta) changes in ACE/ACE-2 balance in Tgαq*44 mice in course of heart failure (HF). Tgαq*44 mice with cardiomyocyte-specific Gαq overexpression and late onset of HF were analyzed at different age for angiotensin pattern in plasma, heart, and aorta using liquid chromatography/mass spectrometry, for progression of HF by in vivo magnetic resonance imaging under isoflurane anesthesia, and for physical activity by voluntary wheel running. Six-month-old Tgαq*44 mice displayed decreased ventricle radial strains and impaired left atrial function. At 8-10 mo, Tgαq*44 mice showed impaired systolic performance and reduced voluntary wheel running but exhibited preserved inotropic reserve. At 12 mo, Tgαq*44 mice demonstrated a severe impairment of basal cardiac performance and modestly compromised inotropic reserve with reduced voluntary wheel running. Angiotensin analysis in plasma revealed an increase in concentration of angiotensin-(1-7) in 6- to 10-mo-old Tgαq*44 mice. However, in 12- to 14-mo-old Tgαq*44 mice, increased angiotensin II was noted with a concomitant increase in Ang III, Ang IV, angiotensin A, and angiotensin-(1-10). The pattern of changes in the heart and aorta was also compatible with activation of ACE2, followed by activation of the ACE pathway. In conclusion, mice with cardiomyocyte Gαq protein overexpression develop HF that is associated with activation of the systemic and the local ACE/Ang II pathway. However, it is counterbalanced by a prominent ACE2/Ang-(1-7) activation, possibly allowing to delay decompensation. NEW & NOTEWORTHY Changes in ACE/ACE-2 balance were analyzed based on measurements of a panel of nine angiotensins in plasma, heart, and aorta of Tgαq*44 mice in relation to progression of heart failure (HF) characterized by multiparametric MRI and exercise performance. The early stage of HF was associated with upregulation of the ACE2/angiotensin-(1-7) pathway, whereas the end-stage HF was associated with downregulation of ACE2/angiotensin-(1-7) and upregulation of the ACE/Ang II pathway. ACE/ACE-2 balance seems to determine the decompensation of HF in this model.
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Affiliation(s)
- Urszula Tyrankiewicz
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Mariola Olkowicz
- Department of Biochemistry, Medical University of Gdansk , Gdansk , Poland.,Department of Biotechnology, Poznan University of Life Sciences , Poznan , Poland
| | - Tomasz Skórka
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Magdalena Jablonska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Anna Orzylowska
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Anna Bar
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Michal Gonet
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Piotr Berkowicz
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland
| | - Krzysztof Jasinski
- Department of Magnetic Resonance Imaging, Institute of Nuclear Physics, Polish Academy of Sciences , Krakow , Poland
| | - Jerzy A Zoladz
- Department of Muscle Physiology, University School of Physical Education , Krakow , Poland
| | | | - Stefan Chlopicki
- Jagiellonian Centre for Experimental Therapeutics, Jagiellonian University , Krakow , Poland.,Chair of Pharmacology, Jagiellonian University Medical College , Krakow , Poland
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Formiga F. Is heart failure with midrange ejection fraction similar to preserved ejection fraction? Against. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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10
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Formiga F. Is heart failure with midrange ejection fraction similar to preserved ejection fraction? Against. Rev Clin Esp 2017; 217:299-301. [PMID: 28314655 DOI: 10.1016/j.rce.2017.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/11/2017] [Indexed: 01/08/2023]
Abstract
The new European guidelines (2016) for heart failure (HF) include the concept of HF with intermediate left ventricular ejection fraction (LVEF), i.e. an LVEF between 40 and 49%. Although few studies have been carried out, there are claims that HF with intermediate LVEF is not the same as HF with preserved LVEF. Perhaps the most consistent claim is the high percentage of associated ischemic heart disease, which could reflect LVEF recovery after adequate anti-ischemic treatment of HF with depressed LVEF, or even the progressive deterioration of LVEF following an ischemic event.
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Affiliation(s)
- F Formiga
- Programa de Geriatría, Servicio de Medicina Interna, IDIBELL, Hospital de Bellvitge, L'Hospitalet de LLobregat, Barcelona, España.
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Abstract
PURPOSE OF REVIEW Heart failure (HF) is a disease state with great heterogeneity, which complicates the therapeutic process. Identifying more precise HF phenotypes will allow for the development of more targeted therapies and improvement in patient outcomes. This review explores the future for precision medicine in HF treatment. RECENT FINDINGS Rather than a continuous disease spectrum with a uniform pathogenesis, HF has phenotypes with different underlying pathophysiologic features. The challenge is to establish clinical phenotypic characterizations to direct therapy. Phenomapping, a process of using machine learning algorithms applied to clinical data sets, has been used to identify phenotypically distinct and clinically meaningful HF groups. As powerful technologies extend our knowledge, future analyses may be able to compile more comprehensive phenotypic profiles using genetic, epigenetic, proteomic, and metabolomic measurements. Identifying clinical characterizations of particular HF patients that would be uniquely or disproportionately responsive to a specific treatment would allow for more direct selection of optimal therapy, reduce trial-and-error prescribing, and help avoid adverse drug reactions.
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Mantegazza V, Badagliacca R, Nodari S, Parati G, Lombardi C, Di Somma S, Carluccio E, Dini FL, Correale M, Magrì D, Agostoni P. Management of heart failure in the new era. J Cardiovasc Med (Hagerstown) 2016; 17:569-80. [DOI: 10.2459/jcm.0000000000000152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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13
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Kang JH, Lee HS, Kang YW, Cho KH. Systems biological approaches to the cardiac signaling network. Brief Bioinform 2015; 17:419-28. [DOI: 10.1093/bib/bbv039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Indexed: 01/08/2023] Open
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Ferrari R, Böhm M, Cleland JG, Paulus WJ, Pieske B, Rapezzi C, Tavazzi L. Heart failure with preserved ejection fraction: uncertainties and dilemmas. Eur J Heart Fail 2015; 17:665-71. [DOI: 10.1002/ejhf.304] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 03/10/2015] [Accepted: 04/24/2015] [Indexed: 12/18/2022] Open
Affiliation(s)
- Roberto Ferrari
- Department of Cardiology and LTTA Centre; University Hospital of Ferrara and Maria Cecilia Hospital, GVM Care & Research, ES Health Science Foundation; Cotignola Italy
| | - Michael Böhm
- Universitätsklinikum des Saarlandes; Klinik für Innere Medizin III; Homburg/Saar Germany
| | - John G.F. Cleland
- National Heart & Lung Institute; Harefield Hospital, Imperial College; London UK
| | | | - Burkert Pieske
- Department of Cardiology, Medical University Graz, and Ludwig-Boltzmann-Institute; Translational HF Research; Graz Austria
| | - Claudio Rapezzi
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine; Alma Mater-University of Bologna; Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care & Research, ES Health Science Foundation; Cotignola Italy
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15
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Zaky A, Bendjelid K. Appraising cardiac dysfunction in liver transplantation: an ongoing challenge. Liver Int 2015; 35:12-29. [PMID: 24797833 DOI: 10.1111/liv.12582] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/26/2014] [Indexed: 12/26/2022]
Abstract
End-stage liver disease (ESLD) is a multisystemic disease that adversely and mutually aggravates other organs such as the heart. Cardiac dysfunction in ESLD encompasses a spectrum of disease that could be aggravated, precipitated or be occurring hand-in-hand with coexisting aetiological factors precipitating cirrhosis. Additionally and more complexly, liver transplantation, the curative modality of ESLD, is responsible for additional intra- and postoperative short- and long-term cardiac morbidity. The phenotypic distinction of the different forms of cardiac dysfunction in ESLD albeit important prognostically and therapeutically is not allowed by the current societal recommendations, due to conceptual, and methodological limitations in the appraisal of cardiac function and structure in ESLD and in designing studies that are based on this appraisal. This review comprehensively discusses the spectrum of cardiac dysfunction in ESLD, discusses the limitations of the current appraisal of cardiac dysfunction in ESLD, and proposes a hypothetical approach for studying cardiac dysfunction in liver transplant candidates.
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Affiliation(s)
- Ahmed Zaky
- Department of Anesthesiology and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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16
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Clinical implications of chronic heart failure phenotypes defined by cluster analysis. J Am Coll Cardiol 2014; 64:1765-74. [PMID: 25443696 DOI: 10.1016/j.jacc.2014.07.979] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Classification of chronic heart failure (HF) is on the basis of criteria that may not adequately capture disease heterogeneity. Improved phenotyping may help inform research and therapeutic strategies. OBJECTIVES This study used cluster analysis to explore clinical phenotypes in chronic HF patients. METHODS A cluster analysis was performed on 45 baseline clinical variables from 1,619 participants in the HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) study, which evaluated exercise training versus usual care in chronic systolic HF. An association between identified clusters and clinical outcomes was assessed using Cox proportional hazards modeling. Differential associations between clinical outcomes and exercise testing were examined using interaction testing. RESULTS Four clusters were identified (ranging from 248 to 773 patients in each), in which patients varied considerably among measures of age, sex, race, symptoms, comorbidities, HF etiology, socioeconomic status, quality of life, cardiopulmonary exercise testing parameters, and biomarker levels. Differential associations were observed for hospitalization and mortality risks between and within clusters. Compared with cluster 1, risk of all-cause mortality and/or all-cause hospitalization ranged from 0.65 (95% confidence interval [95% CI]: 0.54 to 0.78) for cluster 4 to 1.02 (95% CI: 0.87 to 1.19) for cluster 3. However, for all-cause mortality, cluster 3 had a disproportionately lower risk of 0.61 (95% CI: 0.44 to 0.86). Evidence suggested differential effects of exercise treatment on changes in peak oxygen consumption and clinical outcomes between clusters (p for interaction <0.04). CONCLUSIONS Cluster analysis of clinical variables identified 4 distinct phenotypes of chronic HF. Our findings underscore the high degree of disease heterogeneity that exists within chronic HF patients and the need for improved phenotyping of the syndrome. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; NCT00047437).
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17
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Dusch MN, Thadani SR, Dhillon GS, Hope MD. Diastolic function assessed by cardiac MRI using longitudinal left ventricular fractional shortening. Clin Imaging 2014; 38:666-8. [PMID: 25034401 DOI: 10.1016/j.clinimag.2014.06.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 05/07/2014] [Accepted: 06/02/2014] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Diastolic dysfunction contributes significantly to diastolic heart failure. We examined the use of cardiac magnetic resonance imaging (CMR) using midwall longitudinal fractional shortening (MLFS) in the evaluation of transthoracic echocardiogram (TTE)-evidenced diastolic dysfunction. METHODS A total of 80 patients with CMR within 6 months of TTE and normal ejection fraction were identified. MLFS was calculated as percentage change in distance from the anterior mitral leaflet base to the apical endocardium in systole and diastole. RESULTS MLFS of grade II/III [0.14 (0.12-0.16)] was significantly lower than that of grade 0/I [0.20 (0.19-0.21)], P=.001. MLFS detected age-related changes with grade 0 [0.22 (0.21-0.23)] significantly lower than grade I [0.18 (0.16-0.20)], P=.001. CONCLUSION TTE-evidenced diastolic dysfunction can be reliably identified by CMR using MLFS.
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Affiliation(s)
- Marie N Dusch
- Department of Radiology, University of California, San Francisco, USA
| | - Samir R Thadani
- Department of Radiology, University of California, San Francisco, USA
| | - Gupreet S Dhillon
- Department of Radiology, University of California, San Francisco, USA
| | - Michael D Hope
- Department of Radiology, University of California, San Francisco, USA.
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18
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Abstract
Normal cardiac function requires high and continuous supply with ATP. As mitochondria are the major source of ATP production, it is apparent that mitochondrial function and cardiac function need to be closely related to each other. When subjected to overload, the heart hypertrophies. Initially, the development of hypertrophy is a compensatory mechanism, and contractile function is maintained. However, when the heart is excessively and/or persistently stressed, cardiac function may deteriorate, leading to the onset of heart failure. There is considerable evidence that alterations in mitochondrial function are involved in the decompensation of cardiac hypertrophy. Here, we review metabolic changes occurring at the mitochondrial level during the development of cardiac hypertrophy and the transition to heart failure. We will focus on changes in mitochondrial substrate metabolism, the electron transport chain and the role of oxidative stress. We will demonstrate that, with respect to mitochondrial adaptations, a clear distinction between hypertrophy and heart failure cannot be made because most of the findings present in overt heart failure can already be found in the various stages of hypertrophy.
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19
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Le VP, Stoka KV, Yanagisawa H, Wagenseil JE. Fibulin-5 null mice with decreased arterial compliance maintain normal systolic left ventricular function, but not diastolic function during maturation. Physiol Rep 2014; 2:e00257. [PMID: 24760511 PMCID: PMC4002237 DOI: 10.1002/phy2.257] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The large arteries serve as compliant vessels that store energy during systole and return it during diastole. This function is made possible by the elastic fibers in the arterial wall that are assembled during late embryonic and early postnatal development from various proteins, including fibulin‐5. Mice and humans with insufficient amounts of fibulin‐5 have reduced arterial compliance as adults. Reduced compliance of the large arteries is correlated with hypertension, reduced cardiac function, and an increased risk of death from cardiac and cardiovascular disease. The goal of this study was to quantify arterial compliance, blood pressure, and left ventricular (LV) function from early postnatal development to young adulthood in fibulin‐5 null (Fbln5−/−) mice to determine the effects of reduced arterial compliance during this critical period of elastic fiber assembly. We find that ascending aorta compliance is reduced as early as postnatal day (P) 7 and carotid artery compliance is reduced by P21 in Fbln5−/− mice. We did not find significant increases in systolic blood pressure by P60, but pulse pressures are increased by P21 in Fbln5−/− mice. LV systolic function, as measured by ejection fraction and fractional shortening, is unaffected in Fbln5−/− mice. However, LV diastolic function, as measured by tissue Doppler imaging, is compromised at all ages in Fbln5−/− mice. We propose that Fbln5−/− mice represent a suitable model for further studies to determine mechanistic relationships between arterial compliance and LV diastolic function.
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Affiliation(s)
- Victoria P Le
- Department of Biomedical Engineering, Saint Louis University, St. Louis, Missouri
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20
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Pieske B. Heart failure with preserved ejection fraction-a growing epidemic or ‘The Emperor's New Clothes?’. Eur J Heart Fail 2014; 13:11-3. [DOI: 10.1093/eurjhf/hfq215] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Burkert Pieske
- Department of Cardiology; Medical University Graz; Auenbruggerplatz 15, 8010 Graz Austria
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21
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Affiliation(s)
- Dirk L. Brutsaert
- University of Antwerp; Antwerp Belgium
- Beekboshoek 204 2550 Kontich-Waarloos Belgium
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22
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Electrocardiographic left ventricular hypertrophy Cornell product is a feasible predictor of cardiac prognosis in patients with chronic heart failure. Clin Res Cardiol 2013; 103:275-84. [DOI: 10.1007/s00392-013-0646-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/22/2013] [Indexed: 10/26/2022]
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23
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Role of Echocardiography in the Diagnosis of Heart Failure with Preserved Left Ventricular Systolic Function: Update 2013. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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24
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Voelkel NF, Natarajan R, Drake JI, Bogaard HJ. Right ventricle in pulmonary hypertension. Compr Physiol 2013; 1:525-40. [PMID: 23737184 DOI: 10.1002/cphy.c090008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
During heart development chamber specification is controlled and directed by a number of genes and a fetal heart gene expression pattern is revisited during heart failure. In the setting of chronic pulmonary hypertension the right ventricle undergoes hypertrophy, which is likely initially adaptive, but often followed by decompensation, dilatation and failure. Here we discuss differences between the right ventricle and the left ventricle of the heart and begin to describe the cellular and molecular changes which characterize right heart failure. A prevention and treatment of right ventricle failure becomes a treatment goal for patients with severe pulmonary hypertension it follows that we need to understand the pathobiology of right heart hypertrophy and the transition to right heart failure.
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Affiliation(s)
- Norbert F Voelkel
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, The Victoria Johnson Center for Pulmonary Obstructive Disease Research, Virginia Commonwealth University, Richmond, Virginia, USA.
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25
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LeGrice IJ, Pope AJ, Sands GB, Whalley G, Doughty RN, Smaill BH. Progression of myocardial remodeling and mechanical dysfunction in the spontaneously hypertensive rat. Am J Physiol Heart Circ Physiol 2012; 303:H1353-65. [PMID: 23001837 DOI: 10.1152/ajpheart.00748.2011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The progression of hypertensive heart disease (HHD) to heart failure (HF) is associated with myocardial remodeling. Corresponding changes in three-dimensional organization of cardiac extracellular matrix have not been quantified or related fully to the development of HF. Spontaneously hypertensive rats (SHRs) and Wistar-Kyoto controls were studied at 3, 12, 18, and 24 mo. Hemodynamic and morphological data, brain natriuretic peptide levels, and echocardiography demonstrate four distinct disease stages: systemic hypertension, diastolic dysfunction, early systolic failure, and decompensated HF. Passive left ventricular (LV) pressure-volume relationships were determined in vitro. Transmural specimens from the anterior LV free wall were imaged using extended-volume confocal microscopy, and three-dimensional myocardial architecture was quantified. In SHRs, LV compliance was reduced at 12 mo and increased progressively thereafter. However, it was less than in controls for filling pressures <10 mmHg and not significantly different at ≥10 mmHg. Myocyte cross section was enlarged, with increased variability from 12 mo, while collagen fraction increased progressively. Perimysial collagen fraction remained unchanged with age, although endomysial collagen increased from 12 mo. Perimysial collagen between adjacent muscle layers fused at 12 mo and continued to thicken subsequently, while muscle layers became more dispersed and disordered. We conclude that LV dilatation, which accompanies decompensated HF in this model of HHD, is not due to LV "softening." While perimysial (and endomysial) collagen networks are substantially remodeled, they are not dissolved, as has been proposed. We argue that progressive disruption of the laminar organization of LV myocardium may contribute to impaired systolic function in HHD.
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Affiliation(s)
- Ian J LeGrice
- Department of Physiology, University of Auckland, Auckland, New Zealand
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26
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Bernard S, Maurer MS. Heart Failure With a Normal Ejection Fraction: Treatments for a Complex Syndrome? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:305-18. [DOI: 10.1007/s11936-012-0187-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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27
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Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study. Brain Behav Immun 2012; 26:642-9. [PMID: 22366689 PMCID: PMC3322304 DOI: 10.1016/j.bbi.2012.02.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Revised: 02/07/2012] [Accepted: 02/08/2012] [Indexed: 11/23/2022] Open
Abstract
Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n=979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β=.09, p=.01) and at five-year follow-up (β=.09, p=.03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.
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Leonard BL, Smaill BH, LeGrice IJ. Structural remodeling and mechanical function in heart failure. MICROSCOPY AND MICROANALYSIS : THE OFFICIAL JOURNAL OF MICROSCOPY SOCIETY OF AMERICA, MICROBEAM ANALYSIS SOCIETY, MICROSCOPICAL SOCIETY OF CANADA 2012; 18:50-67. [PMID: 22258722 DOI: 10.1017/s1431927611012438] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The cardiac extracellular matrix (ECM) is the three-dimensional scaffold that defines the geometry and muscular architecture of the cardiac chambers and transmits forces produced during the cardiac cycle throughout the heart wall. The cardiac ECM is an active system that responds to the stresses to which it is exposed and in the normal heart is adapted to facilitate efficient mechanical function. There are marked differences in the short- and medium-term changes in ventricular geometry and cardiac ECM that occur as a result of volume overload, hypertension, and ischemic cardiomyopathy. Despite this, there is a widespread view that a common remodeling "phenotype" governs the final progression to end-stage heart failure in different forms of heart disease. In this review article, we make the case that this interpretation is not consistent with the clinical and experimental data on the topic. We argue that there is a need for new theoretical and experimental models that will enable stresses acting on the ECM and resultant deformations to be estimated more accurately and provide better spatial resolution of local signaling mechanisms that are activated as a result. These developments are necessary to link the effects of structural remodeling with altered cardiac mechanical function.
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Affiliation(s)
- Bridget Louise Leonard
- Auckland Bioengineering Institute, University of Auckland, Private Bag 92019, Auckland 1023, New Zealand.
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29
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de Denus S, Lavoie J, Ducharme A, O'Meara E, Racine N, Sirois MG, Neagoe PE, Zhu L, Rouleau JL, White M. Differences in biomarkers in patients with heart failure with a reduced vs a preserved left ventricular ejection fraction. Can J Cardiol 2011; 28:62-8. [PMID: 22104539 DOI: 10.1016/j.cjca.2011.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 09/01/2011] [Accepted: 09/01/2011] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The differences in concentrations of biomarkers between heart failure (HF) patients with a preserved left ventricular ejection fraction (LVEF), or HF-PEF, and patients with HF with reduced LVEF (HF-REF) have yet to be defined. The objectives of this study were to compare the concentrations and correlation of biomarkers of inflammation, extracellular matrix (ECM) turnover and neurohormonal activation between these populations. METHODS We performed a cross-sectional study of 29 subjects with symptomatic HF-REF (LVEF = 25.6 ± 5.1%) and 29 subjects with symptomatic HF-PEF (LVEF = 63.3 ± 5.3%). Concentrations of N-terminal proB-type natriuretic peptide (NT-proBNP), high sensitivity C-reactive protein (hsCRP), procollagen type III amino-terminal peptide (PIIINP), matrix metalloproteinase (MMP)-2, MMP-9, and tissue inhibitor of MMP (TIMP)-1 were measured. RESULTS Although NT-proBNP and PIIINP concentrations were higher in patients with HF-REF compared with patients with HF-PEF (both P < 0.05), the only significant difference between the groups remaining after adjusting for possible confounding variables was NT-proBNP (P = 0.02). In patients with HF-REF, NT-proBNP correlated with PIIINP (P < 0.05), TIMP-1 (P < 0.05), and MMP-2 (P = 0.002), while PIIINP correlated with TIMP-1 (P < 0.05) and MMP-2 (P < 0.0001). In patients with a HF-PEF, only high sensitivity C-reactive protein correlated significantly with MMP-2 (P = 0.002). CONCLUSIONS Patients with HF-REF or HF-PEF presenting similar symptoms and functional limitations exhibit similar concentrations of biomarkers of ECM and inflammation. However, patients with HF-REF exhibit significantly higher NT-proBNP concentrations than patients with HF-PEF. The differences in the correlations observed between the biomarkers between these 2 populations suggest some heterogeneity and differences in the mechanisms related to the release or clearance of biomarkers in HF-REF vs HF-PEF.
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Affiliation(s)
- Simon de Denus
- Research Center, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada
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30
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Pacileo G, Baldini L, Limongelli G, Di Salvo G, Iacomino M, Capogrosso C, Rea A, D'Andrea A, Russo MG, Calabro R. Prolonged left ventricular twist in cardiomyopathies: a potential link between systolic and diastolic dysfunction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:841-9. [DOI: 10.1093/ejechocard/jer148] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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31
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Phan TT, Shivu GN, Abozguia K, Sanderson JE, Frenneaux M. The pathophysiology of heart failure with preserved ejection fraction: from molecular mechanisms to exercise haemodynamics. Int J Cardiol 2011; 158:337-43. [PMID: 21794933 DOI: 10.1016/j.ijcard.2011.06.113] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Revised: 06/24/2011] [Accepted: 06/25/2011] [Indexed: 12/27/2022]
Abstract
The pathophysiology of HfpEF is complex. In this review we discuss the molecular aspects of HfpEF as well as the profoundly disturbed haemodynamics with particular focus on exercise haemodynamic abnormalities.
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Affiliation(s)
- Thanh T Phan
- The James Cook University Hospital, Middlesbrough, UK.
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32
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De Keulenaer GW, Brutsaert DL. Systolic and diastolic heart failure are overlapping phenotypes within the heart failure spectrum. Circulation 2011; 123:1996-2004; discussion 2005. [PMID: 21555722 DOI: 10.1161/circulationaha.110.981431] [Citation(s) in RCA: 97] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Gilles W De Keulenaer
- Center for Heart Failure and Cardiac Rehabilitation, AZ Middelheim, University of Antwerp, Belgium.
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33
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Naab K. Perioperative care of the patient with diastolic heart failure. AORN J 2011; 93:782-91. [PMID: 21624531 DOI: 10.1016/j.aorn.2011.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 02/16/2011] [Indexed: 10/18/2022]
Affiliation(s)
- Kim Naab
- Piedmont Hospital, Atlanta, GA, USA
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34
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Norgard NB, Prescott GM. Future of personalized pharmacotherapy in chronic heart failure patients. Future Cardiol 2011; 7:357-79. [DOI: 10.2217/fca.11.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is a significant amount of diversity among heart failure (HF) patients. Contemporary HF regimens often do not take into consideration many of the factors that might influence an individual’s response to treatment. Clinical recommendations based on trial data derived from mainly younger Caucasian male study populations have, in most cases, been applied equally to women and African–Americans. Subgroup analyses of randomized HF trials and results of retrospective cohort studies have been used for customizing HF regimens in women and African–Americans. Pharmacogenetics is an emerging strategy for personalizing HF therapy. Genetic biomarkers may play an important role in predicting a patient’s response to treatment and in predicting those at risk of toxicity. HF pharmacotherapy has improved over the last two decades; however, substantial work remains in order to personalize HF management and maximize the benefit of pharmacologic interventions, while limiting adverse events.
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Affiliation(s)
| | - Gina M Prescott
- University at Buffalo, School of Pharmacy & Pharmaceutical Sciences, New York State Center of Excellence in Bioinformatics & Life Sciences, B3–322, 701 Ellicott Street, Buffalo, NY 1420, USA
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Acute Heart Failure Syndromes: Emergency Department Presentation, Treatment, and Disposition: Current Approaches and Future Aims. Circulation 2010; 122:1975-96. [DOI: 10.1161/cir.0b013e3181f9a223] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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36
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Lam CSP, Liu X, Yang Q, Larson MG, Pencina MJ, Aragam J, Redfield MM, Benjamin EJ, Vasan RS. Familial aggregation of left ventricular geometry and association with parental heart failure: the Framingham Heart Study. ACTA ACUST UNITED AC 2010; 3:492-8. [PMID: 20884845 DOI: 10.1161/circgenetics.110.941088] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data regarding the familial aggregation of left ventricular (LV) geometry and its relations to parental heart failure (HF) are limited. METHODS AND RESULTS We evaluated concordance of LV geometry within 1093 nuclear families in 5758 participants of the original (parents) (n=2351) and offspring (n=3407) cohorts of the Framingham Heart Study undergoing routine echocardiography in mid- to late adulthood. LV geometry was categorized based on cohort- and sex-specific 80th percentile cutoffs of LV mass and relative wall thickness (RWT) into normal (both <80th percentile), concentric remodeling (LV mass <80th percentile; RWT >80th percentile), concentric hypertrophy (both >80th percentile), and eccentric hypertrophy (LV mass >80th percentile; RWT <80th percentile). Within nuclear families, LV geometry was concordant among related pairs (parent-child, sibling-sibling) (P=0.0015) but not among unrelated spousal pairs (P=0.60), a finding that remained unchanged after adjusting for clinical covariates known to influence LV remodeling (age, systolic blood pressure, body mass index), excluding individuals with prevalent HF and myocardial infarction, and varying the thresholds for defining LV geometry. The prevalence of abnormal LV geometry was higher in family members of affected individuals, with recurrence risks of 1.4 for concentric remodeling (95% CI, 1.2 to 1.7) and eccentric hypertrophy (95% CI, 1.1 to 1.8) and 3.9 (95% CI, 3.2 to 4.6) for concentric hypertrophy. In a subset of 1497 offspring, we observed an association between parental HF (n=458) and eccentric hypertrophy in offspring (P<0.0001). CONCLUSIONS Our investigation of a 2-generational community-based sample demonstrates familial aggregation of LV geometry, with the greatest recurrence risk for concentric LV geometry, and establishes an association between eccentric LV geometry and parental HF.
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Affiliation(s)
- Carolyn S P Lam
- National Heart, Lung, and Blood Institute Framingham Heart Study, 73 Mt Wayte Ave, Framingham, MA 01702, USA
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37
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Cuadrado-Godia E, Ois A, Roquer J. Heart failure in acute ischemic stroke. Curr Cardiol Rev 2010; 6:202-13. [PMID: 21804779 PMCID: PMC2994112 DOI: 10.2174/157340310791658776] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2010] [Revised: 04/10/2010] [Accepted: 05/25/2010] [Indexed: 01/19/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Due to the aging of the population it has become a growing public health problem in recent decades. Diagnosis of HF is clinical and there is no diagnostic test, although some basic complementary testing should be performed in all patients. Depending on the ejection fraction (EF), the syndrome is classified as HF with low EF or HF with normal EF (HFNEF). Although prognosis in HF is poor, HFNEF seems to be more benign. HF and ischemic stroke (IS) share vascular risk factors such as age, hypertension, diabetes mellitus, coronary artery disease and atrial fibrillation. Persons with HF have higher incidence of IS, varying from 1.7% to 10.4% per year across various cohort studies. The stroke rate increases with length of follow-up. Reduced EF, independent of severity, is associated with higher risk of stroke. Left ventricular mass and geometry are also related with stroke incidence, with concentric hypertrophy carrying the greatest risk. In HF with low EF, the stroke mechanism may be embolism, cerebral hypoperfusion or both, whereas in HFNEF the mechanism is more typically associated with chronic endothelial damage of the small vessels. Stroke in patients with HF is more severe and is associated with a higher rate of recurrence, dependency, and short term and long term mortality. Cardiac morbidity and mortality is also high in these patients. Acute stroke treatment in HF includes all the current therapeutic options to more carefully control blood pressure. For secondary prevention, optimal control of all vascular risk factors is essential. Antithrombotic therapy is mandatory, although the choice of a platelet inhibitor or anticoagulant drug depends on the cardiac disease. Trials are ongoing to evaluate anticoagulant therapy for prevention of embolism in patients with low EF who are at sinus rhythm.
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Affiliation(s)
- Elisa Cuadrado-Godia
- Neurology Department, Hospital Universitari del Mar. Program on Research on Inflammatory and Cardiovascular Disorders, IMIM, Barcelona, Spain
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38
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MacIver DH. Current controversies in heart failure with a preserved ejection fraction. Future Cardiol 2010; 6:97-111. [DOI: 10.2217/fca.09.56] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Heart failure with a preserved ejection fraction is a fascinating and multifaceted condition that has provoked enormous debate and a wealth of mechanistic studies. Controversies exist with regard to its nomenclature. If its nomenclature is questioned, one can be certain the pathogenesis is ill understood. If the pathogenesis is disputed, the diagnosis becomes difficult and inconsistent. These diagnostic challenges result in inappropriate recruitment to clinical trials. Therefore, the trials may be underpowered and difficult to interpret. This paper examines contemporary theories of heart failure with a preserved ejection fraction, clarifies the controversies and attempts to resolve the divergences of opinion.
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Affiliation(s)
- David H MacIver
- Consultant cardiologist, Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton, TA1 5DA, UK
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Wachter R, Schmidt-Schweda S, Westermann D, Post H, Edelmann F, Kasner M, Lüers C, Steendijk P, Hasenfuß G, Tschöpe C, Pieske B. Blunted frequency-dependent upregulation of cardiac output is related to impaired relaxation in diastolic heart failure. Eur Heart J 2009; 30:3027-36. [PMID: 19720638 PMCID: PMC2792717 DOI: 10.1093/eurheartj/ehp341] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 05/13/2009] [Accepted: 07/13/2009] [Indexed: 01/08/2023] Open
Abstract
AIMS We tested the hypothesis that, in heart failure with normal ejection fraction (HFNEF), diastolic dysfunction is accentuated at increasing heart rates, and this contributes to impaired frequency-dependent augmentation of cardiac output. METHODS AND RESULTS In 17 patients with HFNEF (median age 69 years, 13 female) and seven age-matched control patients, systolic and diastolic function was analysed by pressure-volume loops at baseline heart rate and during atrial pacing to 100 and 120 min(-1). At baseline, relaxation was prolonged and end-diastolic left ventricular stiffness was higher in HFNEF, whereas all parameters of systolic function were not different from control patients. This resulted in smaller end-diastolic volumes, higher end-diastolic pressure, and a lower stroke volume and cardiac index in HFNEF vs. control patients. During pacing, frequency-dependent upregulation of contractility indices (+dP/dt(max) and Ees) occurred similarly in HFNEF and control patients, but frequency-dependent acceleration of relaxation (dP/dt(min)) was blunted in HFNEF. In HFNEF, end-diastolic volume and stroke volume decreased with higher heart rates while both remained unchanged in control patients. CONCLUSION In HFNEF, frequency-dependent upregulation of cardiac output is blunted. This results from progressive volume unloading of the left ventricle due to limited relaxation reserve in combination with increased LV passive stiffness, despite preserved force-frequency relation.
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Affiliation(s)
- Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | | | - Dirk Westermann
- Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
| | - Heiner Post
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Mario Kasner
- Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
| | - Claus Lüers
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Paul Steendijk
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Carsten Tschöpe
- Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité University Hospital, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
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Joshi D, Shiwalkar A, Cross MR, Sharma SK, Vachhani A, Dutt C. Continuous, non-invasive measurement of the haemodynamic response to submaximal exercise in patients with diabetes mellitus: evidence of impaired cardiac reserve and peripheral vascular response. Heart 2009; 96:36-41. [PMID: 19850585 PMCID: PMC3272706 DOI: 10.1136/hrt.2009.177113] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reduced exercise capacity in diabetics has been attributed to limitations in cardiac function and microvascular dysfunction leading to impaired oxygen supply and nutritive perfusion to exercising muscles. OBJECTIVE To study changes in cardiac function and microvascular utilisation during exercise in diabetic individuals compared to age-matched controls. METHODS Diabetics with glycosylated haemoglobin (HbA(1c)) < 8 (n = 31), diabetics with HbA(1c) > or = 8 (n = 38) and age-matched non-diabetic controls (n = 32) performed exercise at 50 W for 10 minutes followed by recovery, with continuous monitoring of cardiac function by impedance cardiography and regional flow and oxygen saturation by laser Doppler and white light spectroscopy. RESULTS In the diabetics, cardiac reserve during exercise and cardiac overshoot during recovery are significantly reduced because of reduction in capacity to increase stroke volume. Regional flow to the exercising muscle is reduced and there is also disproportionately greater desaturation of the regional flow. Abnormalities in cardiac function and regional perfusion are related to the severity of diabetes. CONCLUSION Cardiac response to exercise is attenuated significantly in diabetic individuals. Simultaneously, there is impairment in the regional distribution. These changes could be the harbinger of reduced exercise capacity in diabetics.
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Affiliation(s)
- D Joshi
- Torrent Research Centre, Village Bhat, Gandhinagar, Gujarat, India
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41
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Bench T, Burkhoff D, O'Connell JB, Costanzo MR, Abraham WT, St John Sutton M, Maurer MS. Heart failure with normal ejection fraction: consideration of mechanisms other than diastolic dysfunction. Curr Heart Fail Rep 2009; 6:57-64. [PMID: 19265594 DOI: 10.1007/s11897-009-0010-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
More than half of patients with heart failure (HF) have a normal ejection fraction (EF). These patients are typically elderly, are predominantly female, and have a high incidence of multiple comorbid conditions associated with development of ventricular hypertrophy and/or interstitial fibrosis. Thus, the cause of HF has been attributed to diastolic dysfunction. However, the same comorbidities may also impact myocardial systolic, ventricular, vascular, renal, and extracardiovascular properties in ways that can also contribute to symptoms of HF by way of mechanisms not related to diastolic dysfunction. Accordingly, the descriptive term HF with normal EF has been suggested as an alternative to the mechanistic term diastolic HF. In this article, we review the current understanding of nondiastolic mechanisms that may contribute to the HF with normal EF syndrome to highlight potential pathways for research that may lead to new targets for therapy.
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Affiliation(s)
- Travis Bench
- Division of Cardiology, Columbia University, 177 Fort Washington Avenue, New York, NY 10032, USA.
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42
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TRC4186, a Novel AGE-breaker, Improves Diabetic Cardiomyopathy and Nephropathy in Ob-ZSF1 Model of Type 2 Diabetes. J Cardiovasc Pharmacol 2009; 54:72-81. [DOI: 10.1097/fjc.0b013e3181ac3a34] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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43
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Liu YW, Tsai WC, Su CT, Lin CC, Chen JH. Evidence of left ventricular systolic dysfunction detected by automated function imaging in patients with heart failure and preserved left ventricular ejection fraction. J Card Fail 2009; 15:782-9. [PMID: 19879465 DOI: 10.1016/j.cardfail.2009.05.006] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Revised: 05/05/2009] [Accepted: 05/11/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left ventricular ejection fraction (LVEF) cannot reflect cardiac contractile function in patients with heart failure and preserved LVEF (HFPEF). LV systolic impairment is actually debated in HFPEF patients. Automated function imaging (AFI) is a novel algorithm of speckle-tracking echocardiography and efficiently to assess global LV peak systolic longitudinal strain (PSLS), an index for systolic function. The purpose of the study is to examine whether contractile function is impaired in HFPEF patients. METHODS AND RESULTS This study included 49 heart failure patients (23 with systolic dysfunction [SHF] and 26 with HFPEF), and 40 patients, matched for age, sex, as well as concomitant disease and without heart failure as controls. All patients underwent transthoracic echocardiography. LVEF was measured by Simpson's method. Two-dimensional speckle tracking imaging with AFI assessment was applied to measure longitudinal strain. LVEF was 66+/-5% in the controls, 63+/-8% in the HFPEF group (P=.14), and 34+/-10% in the SHF group (P < .001). The value of LV global PSLS (controls: -20%, HFPEF: -14%, SHF: -8%, P < .001) was significantly less negative in both heart failure groups. CONCLUSIONS Deteriorated LV systolic function is demonstrated by decreased global PSLS in HFPEF patients. AFI is an effective and facile method for assessing LV systolic abnormalities.
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Affiliation(s)
- Yen-Wen Liu
- Department of Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan
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44
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Left Ventricular Mechanics in Idiopathic Dilated Cardiomyopathy: Systolic-Diastolic Coupling and Torsion. J Am Soc Echocardiogr 2009; 22:486-93. [DOI: 10.1016/j.echo.2009.02.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Indexed: 11/24/2022]
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45
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He KL, Burkhoff D, Leng WX, Liang ZR, Fan L, Wang J, Maurer MS. Comparison of ventricular structure and function in Chinese patients with heart failure and ejection fractions >55% versus 40% to 55% versus <40%. Am J Cardiol 2009; 103:845-51. [PMID: 19268743 DOI: 10.1016/j.amjcard.2008.11.050] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2008] [Revised: 11/13/2008] [Accepted: 11/13/2008] [Indexed: 01/20/2023]
Abstract
Subjects with heart failure (HF) and a preserved ejection fraction (EF) are heterogenous and the EF used to define this syndrome varies considerably among studies. We sought to determine if physiologic differences exist between subjects with a normal EF (>55%) or mildly decreased EF (40% to 55%). 357 consecutive Chinese patients who were healthy (n = 93) or had HF (n = 264) underwent comprehensive echocardiography, Doppler analysis, and measurement of neurohormones. Subjects with HF were stratified by EF into those with normal EF (>55%, n = 128), mildly decreased EF (40% to 55%, n = 38), or moderate to severely decreased EF (<40%, n = 100). Employing noninvasive pressure-volume analysis, estimated end-systolic and end-diastolic pressure-volume relations were calculated. Subjects with HF and an EF 40% to 55% more often had a previous myocardial infarction and diabetes than those with HF and an EF >55%. Physiologically, the cohort with a mildly decreased EF had eccentrically enlarged ventricles with evidence of remodeling (rightward shifted end-diastolic pressure-volume relation) and decreased chamber contractility (downward shifted end-systolic pressure-volume relation) most comparable to subjects with overt systolic HF. In conclusion, in subjects with HF and a preserved EF, there are distinct physiologic differences between those with a normal (>55%) and a mildly decreased (40% to 55%) EF.
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Enhancement of the endothelial NO synthase attenuates experimental diastolic heart failure. Basic Res Cardiol 2009; 104:499-509. [PMID: 19255799 DOI: 10.1007/s00395-009-0014-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2008] [Revised: 02/03/2009] [Accepted: 02/04/2009] [Indexed: 01/04/2023]
Abstract
BACKGROUND Diastolic heart failure is a rising problem with a high incidence and similar mortality and morbidity compared to patients with systolic heart failure. Nevertheless, the underlying pathophysiology is still debated. AIM We investigated the effect of pharmacological enhancement of endothelial nitric oxide synthase (eNOS) on experimental diastolic heart failure (DHF). METHODS DHF was induced in 60 DAHL salt-sensitive rats by salt diet in 8-week-old animals. 30 were treated with the eNOS enhancer AVE3085 (DHFeNOS) and 30 with placebo (DHF). Rats with normal salt intake served as controls. RESULTS AND CONCLUSION Diastolic dysfunction with increased diastolic stiffness constant and increased left ventricular (LV) pressure was analyzed by invasive pressure-volume loop measurements in the DHF group compared to controls. Cardiac hypertrophy as indicated by LV mass measurements by echocardiography, and increased cardiac collagen content as measured by immunohistochemistry were associated with an increased activation state of calcineurin, AKT, ERK(1/2), but not JNK and p38 kinases. Titin isoforms were not altered in this model of DHF. Treatment with AVE3085 significantly increased eNOS mRNA and protein levels in the cardiac tissue and decreases NAD(P)H oxidase subunits p22phox and gp91phox. Diastolic dysfunction was attenuated and cardiac hypertrophy and fibrosis were improved in comparison with untreated DHF animals. This was associated with a normalized activation state of calcineurin, AKT and ERK(1/2). Therefore, we suggest that targeting the NO system might yield a future therapeutic aim for the treatment of DHF.
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Porciani MC, Lilli A, Perfetto F, Cappelli F, Massimiliano Rao C, Del Pace S, Ciaccheri M, Castelli G, Tarquini R, Romagnani L, Pastorini T, Padeletti L, Bergesio F. Tissue Doppler and strain imaging: a new tool for early detection of cardiac amyloidosis. Amyloid 2009; 16:63-70. [PMID: 20536397 DOI: 10.1080/13506120902879681] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Using traditional echocardiography, the diagnosis of cardiac amyloidosis (CA) is often only possible in advanced stage when recommended therapies may have adverse effects. The aim of our study was to evaluate whether additional information can be derived from Tissue and strain Doppler imaging (TDI and SDI). Forty patients with systemic amyloidosis and 24 healthy subjects underwent traditional, tissue and strain Doppler echocardiography. Patients were classified having CA if mean wall thickness (mT), was half of the sum septum and posterior wall thickness, was > or =12 mm. The following parameters were evaluated: peak early diastolic velocity (Em) as index of ventricular relaxation, mitral E-wave to Em ratio (E/Em) as index of left ventricular (LV) filling pressure and mean LV strain peak curves (mSt) as global long-axis contraction index. In non cardiac amyloidosis (NCA), both Em and mSt were lower than in age matched controls (p < 0.01, p < 0.05, respectively) and higher than in CA (p < 0.01 and p < 0.01, respectively). Both Em and mSt were related to mT (p < 0.001). A significant (p < 0.01) nonlinear relation was observed between plasma terminal of pro B-natriuretic peptide and mT, Em, E/Em and mSt. TDI and SDI are able to detect amyloid myocardial involvement in such an early stage that cannot be evidenced by using traditional echocardiography.
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McManus DD, Shah SJ, Fabi MR, Rosen A, Whooley MA, Schiller NB. Prognostic value of left ventricular end-systolic volume index as a predictor of heart failure hospitalization in stable coronary artery disease: data from the Heart and Soul Study. J Am Soc Echocardiogr 2008; 22:190-7. [PMID: 19084372 DOI: 10.1016/j.echo.2008.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Left ventricular (LV) end-systolic volume indexed to body surface area (ESVI) is a simple yet powerful echocardiographic marker of LV remodeling that can be measured easily. The prognostic value of ESVI and its merit relative to other markers of LV remodeling in patients with coronary heart disease are unknown. METHODS We examined the association of ESVI with hospitalization for heart failure (HF) and mortality in a prospective study of patients with coronary heart disease. RESULTS Of the 989 participants, 110 (11%) were hospitalized for HF during 3.6 +/- 1.1 years of follow-up. Among participants in the highest ESVI quartile (> 25 mL/m(2)), 67 of 248 (27%) developed HF compared with 8 of 248 (3%) among those in the lowest quartile. The association between ESVI and HF hospitalization persisted after adjustment for potential confounders (hazard ratio 5.0, 95% confidence interval, 1.5-16.9; P = .01). CONCLUSION ESVI > 25 mL/m(2) is an independent predictor of hospitalization for HF in patients with stable coronary heart disease.
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Affiliation(s)
- David D McManus
- Division of Cardiology, Department of Medicine, University of California, San Francisco, California 94143, USA
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The nature of heart failure as a challenge to the integration of palliative care services. Curr Opin Support Palliat Care 2008; 1:249-54. [PMID: 18685370 DOI: 10.1097/spc.0b013e3282f283b6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Despite its increasing prevalence and high mortality risk, heart failure is widely regarded as 'treatable'. Aggressive measures are employed even in its end stages. This review explores the clinical characteristics of heart failure, patterns of clinician response, and new data that may help to surmount current barriers to palliative approaches. RECENT FINDINGS The 'treatment imperative' that has helped to reduce overall cardiovascular mortality marginalizes palliative approaches in heart failure. The possibility of dying remains unacknowledged, and communication about palliative options tends not to occur. Both the apparently benign nature of heart failure and its inherent unpredictability discourage end-of-life considerations. Recent studies, however, provide evidence that these barriers may be surmountable, and also furnish tools to help with prognosis. A true heart failure continuum including palliative care would be desirable, although structural barriers exist. SUMMARY Therapeutic successes have encouraged clinicians to pursue heart failure treatment through the end stages of disease. These very successes, however, have made the course of advanced heart failure easier to predict. What is needed now is courage among clinicians to open early dialog about disease process, prognosis and palliative options with the growing number of patients with advanced disease.
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Arterial stiffness and arterial wave reflections are associated with systolic and diastolic function in patients with normal ejection fraction. Am J Hypertens 2008; 21:1194-202. [PMID: 18787521 DOI: 10.1038/ajh.2008.277] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Increased arterial stiffness and early wave reflections have been observed in patients with heart failure and normal ejection fraction (HFNEF). We investigated, whether impaired arterial function is associated with impaired systolic and diastolic function and symptomatic status. METHODS We prospectively enrolled 336 patients (mean age 63.5 years) undergoing coronary angiography, and assessed pulse wave velocity (PWV) invasively, arterial wave reflections (augmentation index (AIx); pressure augmentation (AP)) noninvasively using radial applanation tonometry and a validated transfer function, and characteristic impedance (Zc) using echocardiography with tonometry. In addition, echocardiography including tissue Doppler of the mitral annulus was performed. RESULTS Peak systolic velocity (S') varied inversely with AIx (R = -0.38, P < 0.001), AP (R = -0.48, P < 0.0001), PWV (R = -0.39, P < 0.001), and Zc (R = -0.29, P < 0.01). Likewise, early diastolic velocity (E') showed a strong, negative correlation with AP (R = -0.32, P < 0.01), PWV (R = -0.64, P < 0.0001), and Zc (R = -0.50, P < 0.0001). Higher filling pressures were associated with increased wave reflections (AIx, AP) and arterial stiffness (PWV, Zc). All associations were independent of age and gender. Patients suffering from exertional dyspnea had increased AIx, AP, and PWV. CONCLUSIONS In middle-aged and elderly patients, increased arterial stiffness and wave reflections are consistently and independently associated with impaired systolic and diastolic function and with functional limitations.
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