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DeBerge M, Schroth S, Du F, Yeap XY, Wang JJ, Zhang ZJ, Ansari MJ, Scott EA, Thorp EB. Hypoxia inducible factor 2α promotes tolerogenic macrophage development during cardiac transplantation through transcriptional regulation of colony stimulating factor 1 receptor. Proc Natl Acad Sci U S A 2024; 121:e2319623121. [PMID: 38889142 PMCID: PMC11214057 DOI: 10.1073/pnas.2319623121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Solid organ transplantation mobilizes myeloid cells, including monocytes and macrophages, which are central protagonists of allograft rejection. However, myeloid cells can also be functionally reprogrammed by perioperative costimulatory blockade to promote a state of transplantation tolerance. Transplantation tolerance holds promise to reduce complications from chronic immunosuppression and promote long-term survival in transplant recipients. We sought to identify different mediators of transplantation tolerance by performing single-cell RNA sequencing of acute rejecting or tolerized cardiac allografts. This led to the unbiased identification of the transcription factor, hypoxia inducible factor (HIF)-2α, in a subset of tolerogenic monocytes. Using flow cytometric analyses and mice with conditional loss or gain of function, we uncovered that myeloid cell expression of HIF-2α was required for costimulatory blockade-induced transplantation tolerance. While HIF-2α was dispensable for mobilization of tolerogenic monocytes, which were sourced in part from the spleen, it promoted the expression of colony stimulating factor 1 receptor (CSF1R). CSF1R mediates monocyte differentiation into tolerogenic macrophages and was found to be a direct transcriptional target of HIF-2α in splenic monocytes. Administration of the HIF stabilizer, roxadustat, within micelles to target myeloid cells, increased HIF-2α in splenic monocytes, which was associated with increased CSF1R expression and enhanced cardiac allograft survival. These data support further exploration of HIF-2α activation in myeloid cells as a therapeutic strategy for transplantation tolerance.
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Affiliation(s)
- Matthew DeBerge
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
- Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas Health Science Center, Houston, TX77030
| | - Samantha Schroth
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
| | - Fanfan Du
- Department of Biomedical Engineering, Northwestern University, Evanston, IL60208
| | - Xin Yi Yeap
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
| | - Jiao-Jing Wang
- Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL60611
| | - Zheng Jenny Zhang
- Department of Surgery, Comprehensive Transplant Center, Northwestern University, Chicago, IL60611
| | - Mohammed Javeed Ansari
- Division of Nephrology and Hypertension, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
| | - Evan A. Scott
- Department of Biomedical Engineering, Northwestern University, Evanston, IL60208
| | - Edward B. Thorp
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL60611
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Chamberlain R, Edwards NF, Doyle SN, Wong YW, Scalia GM, Sabapathy S, Chan J. Prognostic Value of Left and right ventricular deformation strain analysis on Acute Cellular rejection in Heart Transplant recipients: A 6-year outcome study. Int J Cardiovasc Imaging 2022; 38:2271-2281. [PMID: 36434347 PMCID: PMC9700648 DOI: 10.1007/s10554-022-02586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/25/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Two-dimensional (2D) strain analysis is a sensitive method for detecting myocardial dysfunction in acute cellular rejection (ACR) from post-transplant complications. This study aims to evaluate the utility of novel left (LV) and right ventricular (RV) strain parameters for prognostic risk stratification associated with ACR burden at 1-year post transplantation. METHODS 128 Heart transplant patients, assessed between 2012 and 2018, underwent transthoracic echocardiography and endomyocardial biopsy. 2D strain analysis was performed and history of rejection burden was assessed and grouped according to ACR burden at 1-year post transplantation. The primary endpoint was all-cause mortality at 6-years follow up. RESULTS 21 patients met primary the endpoint. Multivariate analysis of 6-year all-cause mortality showed LV global longitudinal strain (LV GLS) (Hazard Ratio [HR] = 1.21, CI = 1.06-1.49), LV early diastolic strain rate (LV ESr) (HR = 1.31, CI = 1.12-1.54), RV GLS (HR = 1.12, CI = 1.02-1.25) and RV ESr (HR = 1.26, CI = 1.12-1.47) were significant predictors of outcome. Univariate analysis also showed LV GLS, LV ESr, RV GLS and RV ESr were significant predictors of outcome. Optimal cut-off for predicting 6-year mortality for LV GLS by receive operator characteristic was 15.5% (sensitivity: 92%, specificity: 79%). Significant reductions (p < 0.05) in LV GLS, RV GLS and LV and RV ESr between rejection groups were seen. CONCLUSIONS Non-invasive LV and RV strain parameters are predictors of mortality in post-transplant patient with ACR. LV GLS and LV ESr are superior to other strain and conventional echo parameters.
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Affiliation(s)
- Robert Chamberlain
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Natalie F.A. Edwards
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Samantha N. Doyle
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia
| | - Yee Weng Wong
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, University of Queensland, Brisbane, Australia
| | - Gregory M. Scalia
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, University of Queensland, Brisbane, Australia
| | - Surendran Sabapathy
- School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Jonathan Chan
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia ,School of Medicine, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia ,The Prince Charles Hospital, Department of Cardiology, Rode Road, 4032 Chermside, Queensland Australia
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Sun W, Shen X, Wang J, Zhu S, Zhang Y, Wu C, Xie Y, Yang Y, Dong N, Wang G, Li Y, Lv Q, Liang B, Zhang L, Xie M. Association Between 2D- and 3D-Speckle-Tracking Longitudinal Strain and Cardiovascular Magnetic Resonance Evidence of Diffuse Myocardial Fibrosis in Heart Transplant Recipients. Front Cardiovasc Med 2021; 8:727745. [PMID: 34917656 PMCID: PMC8669344 DOI: 10.3389/fcvm.2021.727745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 10/21/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to: (1) evaluate the association between myocardial fibrosis (MF) quantified by extracellular volume fraction (ECV) and myocardial strain measured by two-dimensional (2D)- and three-dimensional speckle-tracking echocardiography (3D-STE) and (2) further investigate which strain parameter measured by 2D- and 3D-STE is the more robust predictor of MF in heart transplant (HT) recipients. Methods: A total of 40 patients with HT and 20 healthy controls were prospectively enrolled. Left ventricular (LV)-global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were measured by 2D- and 3D-STE. LV diffuse MF was defined by cardiovascular magnetic resonance (CMR)-ECV. Results: The HT recipients had a significantly higher native T1 and ECV than healthy controls (1043.8 ± 34.0 vs. 999.7 ± 19.7 ms, p < 0.001; 26.6 ± 2.7 vs. 24.3 ± 1.8%, p = 0.02). The 3D- and 2D-STE-LVGLS and LVGCS were lower (p < 0.005) in the HT recipients than in healthy controls. ECV showed a moderate correlation with 2D-LVGLS (r = 0.53, p = 0.002) and 3D-LVGLS (r = 0.60, p < 0.001), but it was not correlated with 2D or 3D-LVGCS, or LVGRS. Furthermore, 3D-LVGLS and 2D-LVGLS had a similar correlation with CMR-ECV (r = 0.60 vs. 0.53, p = 0.670). A separate stepwise multivariate linear analysis showed that both the 2D-LVGLS (β = 0.39, p = 0.019) and 3D-LVGLS (β = 0.54, p < 0.001) were independently associated with CMR-ECV. Conclusion: CMR marker of diffuse MF was present in asymptomatic patients with HT and appeared to be associated with decreased myocardial strain by echocardiography. Both the 2D- and 3D-LVGLS were independently correlated with diffuse LVMF, which may provide an alternative non-invasive tool for monitoring the development of adverse fibrotic remodeling during the follow-up of HT recipients.
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Affiliation(s)
- Wei Sun
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Xuehua Shen
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Radiology, The Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Jing Wang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Zhu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yanting Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Chun Wu
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yuji Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Yun Yang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guohua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Qing Lv
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Bo Liang
- Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Hubei Province Clinical Research Center for Medical Imaging, Wuhan, China.,Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
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Oxygen-sensitive Magnetic Resonance Imaging: A Noninvasive Step Forward for Diagnosing Vasculopathy in the Cardiac Allograft. Transplantation 2021; 105:1664-1665. [PMID: 32804799 DOI: 10.1097/tp.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Myocardial Vascular Function Assessed by Dynamic Oxygenation-sensitive Cardiac Magnetic Resonance Imaging Long-term Following Cardiac Transplantation. Transplantation 2021; 105:1347-1355. [PMID: 32804801 DOI: 10.1097/tp.0000000000003419] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary vascular function is related to adverse outcomes following cardiac transplantation (CTx) in patients with or without cardiac allograft vasculopathy (CAV). The noninvasive assessment of the myocardial vascular response using oxygenation-sensitive cardiac magnetic resonance (OS-CMR has not been investigated in stable long-term CTx recipients). METHODS CTx patients were prospectively recruited to complete a CMR study with a breathing maneuver of hyperventilation followed by a voluntary apnea. Changes in OS-sensitive signal intensity reflecting the myocardial oxygenation response were monitored and expressed as % change in response to these breathing maneuvers. Myocardial injury was further investigated with T2-weighted imaging, native and postcontrast T1 measurements, extracellular volume measurements, and late gadolinium enhancement. RESULTS Forty-six CTx patients with (n = 23) and without (n = 23) CAV, along with 25 healthy controls (HC), were enrolled. The OS response was significantly attenuated in CTx compared with HC at the 30-second time-point into the breath-hold (2.63% ± 4.16% versus 6.40% ± 5.96%; P = 0.010). Compared with HC, OS response was lower in CTx without CAV (2.62% ± 4.60%; P < 0.05), while this response was further attenuated in patients with severe CAV (grades 2-3, -2.24% ± 3.65%). An inverse correlation was observed between OS-CMR, ventricular volumes, and diffuse fibrosis measured by extracellular volume mapping. CONCLUSIONS In heart transplant patients, myocardial oxygenation is impaired even in the absence of CAV suggesting microvascular dysfunction. These abnormalities can be identified by oxygenation-sensitive CMR using simple breathing maneuvers.
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Berndt R, Albrecht M, Rusch R. Strategies to Overcome the Barrier of Ischemic Microenvironment in Cell Therapy of Cardiovascular Disease. Int J Mol Sci 2021; 22:ijms22052312. [PMID: 33669136 PMCID: PMC7956787 DOI: 10.3390/ijms22052312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/21/2021] [Accepted: 02/22/2021] [Indexed: 12/11/2022] Open
Abstract
The transplantation of various immune cell types are promising approaches for the treatment of ischemic cardiovascular disease including myocardial infarction (MI) and peripheral arterial disease (PAD). Major limitation of these so-called Advanced Therapy Medicinal Products (ATMPs) is the ischemic microenvironment affecting cell homeostasis and limiting the demanded effect of the transplanted cell products. Accordingly, different clinical and experimental strategies have been evolved to overcome these obstacles. Here, we give a short review of the different experimental and clinical strategies to solve these issues due to ischemic cardiovascular disease.
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Affiliation(s)
- Rouven Berndt
- Clinic of Cardiovascular Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
- Vascular Research Center, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
- Correspondence: ; Tel.: +49-(0431)-500-22033; Fax: +49-(0431)-500-22024
| | - Martin Albrecht
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
| | - René Rusch
- Clinic of Cardiovascular Surgery, University Hospital Schleswig-Holstein, 24105 Kiel, Germany;
- Vascular Research Center, University Hospital Schleswig-Holstein, 24105 Kiel, Germany
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7
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Babapoor-Farrokhran S, Gill D, Alzubi J, Mainigi SK. Atrial fibrillation: the role of hypoxia-inducible factor-1-regulated cytokines. Mol Cell Biochem 2021; 476:2283-2293. [PMID: 33575876 DOI: 10.1007/s11010-021-04082-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/25/2021] [Indexed: 11/25/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia that has major morbidity and mortality. Hypoxia plays an important role in AF initiation and maintenance. Hypoxia-inducible factor (HIF), the master regulator of oxygen homeostasis in cells, plays a fundamental role in the regulation of multiple chemokines and cytokines that are involved in different physiological and pathophysiological pathways. HIF is also involved in the pathophysiology of AF induction and propagation mostly through structural remodeling such as fibrosis; however, some of the cytokines discussed have even been implicated in electrical remodeling of the atria. In this article, we highlight the association between HIF and some of its related cytokines with AF. Additionally, we provide an overview of the potential diagnostic benefits of using the mentioned cytokines as AF biomarkers. Research discussed in this review suggests that the expression of these cytokines may correlate with patients who are at an increased risk of developing AF. Furthermore, cytokines that are elevated in patients with AF can assist clinicians in the diagnosis of suspect paroxysmal AF patients. Interestingly, some of the cytokines have been elevated specifically when AF is associated with a hypercoagulable state, suggesting that they could be helpful in the clinician's and patient's decision to begin anticoagulation. Finally, more recent research has demonstrated the promise of targeting these cytokines for the treatment of AF. While still in its early stages, tools such as neutralizing antibodies have proved to be efficacious in targeting the HIF pathway and treating or preventing AF.
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Affiliation(s)
- Savalan Babapoor-Farrokhran
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Deanna Gill
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Jafar Alzubi
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Sumeet K Mainigi
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Cardiovascular magnetic resonance-derived myocardial strain in asymptomatic heart transplanted patients and its correlation with late gadolinium enhancement. Eur Radiol 2020; 30:4337-4346. [PMID: 32232791 DOI: 10.1007/s00330-020-06763-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To investigate whether cardiovascular magnetic resonance (CMR)-derived myocardial strains were abnormal in asymptomatic heart transplant (HT) patients with normal left ventricular ejection fraction (LVEF) and to detect the relationship between CMR-derived myocardial strain parameters and late gadolinium enhancement (LGE) in asymptomatic HT patients. METHODS A total of 72 HT patients and 35 healthy volunteers underwent 1.5-T MR scanning. The examination protocol included basic cine imaging and LGE. The deformation registration algorithm (DRA) and feature tracking (FT) software were used for the strain analyses. Myocardial strain measurements included left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS) and right ventricular longitudinal strain (RVLS). RESULTS Compared with healthy volunteers, HT patients had significantly decreased DRA- and FT- derived myocardial strain measurements (all p < 0.05). There was a significant correlation and high reproducibility between the DRA- and FT-derived strain parameters. Both CMR-derived LVGLS and LVGRS were significantly related to the presence of LGE, and multivariate logistic regression analyses showed that the LVGLS measurement obtained from both techniques was independently associated with the presence of LGE. The odds ratios (ORs) for DRA- and FT-LVGLS were 1.340 and 1.342, respectively. CONCLUSIONS Asymptomatic HT patients with preserved LVEF exhibited reduced myocardial strain parameters. The CMR-derived LVGLS was independently related to the presence of LGE in HT patients. KEY POINTS • Reduced myocardial strain parameters were found in asymptomatic heart transplanted (HT) patients with normal left ventricular ejection fraction (LVEF). • The deformation registration algorithm (DRA) and feature tracking (FT)-derived strains in asymptomatic HT patients had high reproducibility. • DRA- and FT-derived LVGLS had an independent relationship with late gadolinium enhancement (LGE) in asymptomatic HT patients.
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van Heeswijk RB, Bastiaansen JAM, Iglesias JF, Degrauwe S, Rotman S, Barras JL, Regamey J, Lauriers N, Tozzi P, Yerly J, Ginami G, Stuber M, Hullin R. Quantification of myocardial interstitial fibrosis and extracellular volume for the detection of cardiac allograft vasculopathy. Int J Cardiovasc Imaging 2019; 36:533-542. [DOI: 10.1007/s10554-019-01733-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 11/09/2019] [Indexed: 01/06/2023]
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10
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Lugnier C, Meyer A, Charloux A, Andrès E, Gény B, Talha S. The Endocrine Function of the Heart: Physiology and Involvements of Natriuretic Peptides and Cyclic Nucleotide Phosphodiesterases in Heart Failure. J Clin Med 2019; 8:jcm8101746. [PMID: 31640161 PMCID: PMC6832599 DOI: 10.3390/jcm8101746] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/09/2019] [Accepted: 10/17/2019] [Indexed: 12/12/2022] Open
Abstract
Besides pumping, the heart participates in hydro-sodium homeostasis and systemic blood pressure regulation through its endocrine function mainly represented by the large family of natriuretic peptides (NPs), including essentially atrial natriuretic (ANP) and brain natriuretic peptides (BNP). Under normal conditions, these peptides are synthesized in response to atrial cardiomyocyte stretch, increase natriuresis, diuresis, and vascular permeability through binding of the second intracellular messenger’s guanosine 3′,5′-cyclic monophosphate (cGMP) to specific receptors. During heart failure (HF), the beneficial effects of the enhanced cardiac hormones secretion are reduced, in connection with renal resistance to NP. In addition, there is a BNP paradox characterized by a physiological inefficiency of the BNP forms assayed by current methods. In this context, it appears interesting to improve the efficiency of the cardiac natriuretic system by inhibiting cyclic nucleotide phosphodiesterases, responsible for the degradation of cGMP. Recent data support such a therapeutic approach which can improve the quality of life and the prognosis of patients with HF.
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Affiliation(s)
- Claire Lugnier
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
| | - Alain Meyer
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Anne Charloux
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Emmanuel Andrès
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Internal Medicine and Metabolic Diseases, Medical Clinic B, Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Bernard Gény
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
| | - Samy Talha
- Institute of Physiology, FMTS-EA 3072, Faculty of Medicine, University of Strasbourg, 11 Humann Street, 67000 Strasbourg, France.
- Department of Physiology and Functional Explorations, New Civil Hospital, University Hospitals of Strasbourg, 1 Place de l'Hôpital, CEDEX 67091 Strasbourg, France.
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Hughes A, Okasha O, Farzaneh-Far A, Kazmirczak F, Nijjar PS, Velangi P, Akçakaya M, Martin CM, Shenoy C. Myocardial Fibrosis and Prognosis in Heart Transplant Recipients. Circ Cardiovasc Imaging 2019; 12:e009060. [PMID: 31610691 DOI: 10.1161/circimaging.119.009060] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Myocardial fibrosis is a well-described histopathologic feature in heart transplant recipients. Whether myocardial fibrosis in heart transplant recipients is independently associated with clinical outcomes is unclear. We sought to determine whether myocardial fibrosis on late gadolinium enhancement cardiovascular magnetic resonance imaging in heart transplant recipients was independently associated with all-cause death or major adverse cardiac outcomes in the long-term. METHODS Using a cohort of consecutive heart transplant recipients that had cardiovascular magnetic resonance imaging, we determined the prevalence and the patterns of myocardial fibrosis and analyzed associations between myocardial fibrosis and a composite end point of all-cause death or major adverse cardiac events: retransplantation, nonfatal myocardial infarction, coronary revascularization, and heart failure hospitalization. RESULTS One hundred and fifty-two heart transplant recipients (age, 54±15 years; 29% women; 5.0±5.4 years after heart transplantation) were included. Myocardial fibrosis was present in 18% (37% infarct pattern, 41% noninfarct pattern, and 22% both). Its prevalence was positively associated with cardiac allograft vasculopathy grade. With a median follow-up of 2.6 years, myocardial fibrosis was independently associated with all-cause death or major adverse cardiac events (hazard ratio, 2.88; 95% CI, 1.59-5.23; P<0.001) after adjustment for cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume. Every 1% increase in myocardial fibrosis was independently associated with a 6% higher hazard for all-cause death or major adverse cardiac events (hazard ratio, 1.06; 95% CI, 1.03-1.09; P<0.001). The addition of myocardial fibrosis variables to models with cardiac allograft vasculopathy, history of rejection, time since transplantation, left ventricular ejection fraction, and indexed right ventricular end-diastolic volume resulted in significant improvements in model fit, suggesting incremental prognostic value. CONCLUSIONS In heart transplant recipients, myocardial fibrosis is seen on late gadolinium enhancement cardiovascular magnetic resonance imaging in 18%. Both the presence and the extent of myocardial fibrosis are independently associated with the long-term risk of all-cause death or major adverse cardiac events.
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Affiliation(s)
- Andrew Hughes
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Afshin Farzaneh-Far
- Section of Cardiology, Department of Medicine, University of Illinois at Chicago, Chicago, IL (A.F.-F.)
| | - Felipe Kazmirczak
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Pratik Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Mehmet Akçakaya
- Department of Electrical and Computer Engineering and Center for Magnetic Resonance Research, University of Minnesota, Minneapolis, MN (M.A.)
| | - Cindy M Martin
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN (A.H., O.O., F.K., P.S.N., P.V., C.M.M., C.S.)
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12
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c-Jun promotes the survival of H9c2 cells under hypoxia via PTEN/Akt signaling pathway. J Physiol Biochem 2019; 75:433-441. [DOI: 10.1007/s13105-019-00695-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022]
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13
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Beitzke D, Wielandner A, Wollenweber T, Vraka C, Pichler V, Uyanik-Uenal K, Zuckermann A, Greiser A, Hacker M, Loewe C. Assessment of sympathetic reinnervation after cardiac transplantation using hybrid cardiac PET/MRI: A pilot study. J Magn Reson Imaging 2019; 50:1326-1335. [PMID: 30892777 PMCID: PMC6766915 DOI: 10.1002/jmri.26722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 03/01/2019] [Accepted: 03/02/2019] [Indexed: 12/12/2022] Open
Abstract
Background Sympathetic reinnervation after heart transplantation (HTX) is a known phenomenon, which has an impact on patient heart rate variability and exercise capacity. The impact of reinnervation on myocardial structure has not been evaluated yet. Propose To evaluate the feasibility of simultaneous imaging of cardiac reinnervation and cardiac structure using a hybrid PET/MRI system. Study type Prospective / pilot study. Subjects Ten patients, 4–21 years after cardiac transplantation. Field Strength/Sequence 3 T hybrid PET/MRI system. Cine SSFP, T1 mapping (modified Look–Locker inversion recovery sequence) pre/postcontrast as well as dynamic [11C]meta‐hydroxyephedrine ([11C]mHED) PET. Assessment All MRI and PET parameters were evaluated by experienced readers using dedicated postprocessing software packages for cardiac MRI and PET. For all parameters a 16‐segment model for the left ventricle was applied. Statistical Tests Mann–Whitney U‐test; Spearman correlations. Results Thirty‐six of 160 myocardial segments showed evidence of reinnervation by PET. On a segment‐based analysis, mean native T1 relaxation times were nonsignificantly altered in segments with evidence of reinnervation (1305 ± 151 msec vs. 1270 ± 112 msec; P = 0.1), whereas mean extracellular volume (ECV) was significantly higher in segments with evidence of reinnervation (35.8 ± 11% vs. 30.9 ± 7%; P = 0.019). There were no significant differences in wall motion (WM) and wall thickening (WT) between segments with or without reinnervation (mean WM: 7.6 ± 4 mm vs. group B: 9.3 ± 7 mm [P = 0.13]; WT: 79 ± 63% vs. 94 ± 74% [P = 0.27]) under resting conditions. Data Conclusion The assessment of cardiac reinnervation using a hybrid PET/MRI system is feasible. Segments with evidence of reinnervation by PET showed nonsignificantly higher T1 relaxation times and a significantly higher ECV, suggesting a higher percentage of diffuse fibrosis in these segments, without impairment of rest WM and WT. Level of Evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1326–1335.
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Affiliation(s)
- Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Alice Wielandner
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Tim Wollenweber
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Chrysoula Vraka
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Verena Pichler
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Keziban Uyanik-Uenal
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Surgery, Division of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Marcus Hacker
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
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14
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Glinton K, DeBerge M, Yeap XY, Zhang J, Forbess J, Luo X, Thorp EB. Acute and chronic phagocyte determinants of cardiac allograft vasculopathy. Semin Immunopathol 2018; 40:593-603. [PMID: 30141073 DOI: 10.1007/s00281-018-0699-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/03/2018] [Indexed: 01/09/2023]
Abstract
Post-transplant immunosuppression has reduced the incidence of T cell-mediated acute rejection, yet long-term cardiac graft survival rates remain a challenge. An important determinant of chronic solid organ allograft complication is accelerated vascular disease of the transplanted graft. In the case of cardiac allograft vasculopathy (CAV), the precise cellular etiology remains inadequately understood; however, histologic evidence hints at the accumulation and activation of innate phagocytes as a causal contributing factor. This includes monocytes, macrophages, and immature dendritic cell subsets. In addition to crosstalk with adaptive T and B immune cells, myeloid phagocytes secrete paracrine signals that directly activate fibroblasts and vascular smooth muscle cells, both of which contribute to fibrous intimal thickening. Though maladaptive phagocyte functions may promote CAV, directed modulation of myeloid cell function, at the molecular level, holds promise for tolerance and prolonged cardiac graft function.
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Affiliation(s)
- Kristofor Glinton
- Department of Pathology, The Feinberg School of Medicine, Northwestern University, 300 East Superior St, Chicago, IL, 60611, USA.,Feinberg Cardiovascular and Renal Research Institute, The Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Matthew DeBerge
- Department of Pathology, The Feinberg School of Medicine, Northwestern University, 300 East Superior St, Chicago, IL, 60611, USA.,Feinberg Cardiovascular and Renal Research Institute, The Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Xin-Yi Yeap
- Department of Pathology, The Feinberg School of Medicine, Northwestern University, 300 East Superior St, Chicago, IL, 60611, USA.,Feinberg Cardiovascular and Renal Research Institute, The Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611, USA
| | - Jenny Zhang
- Department of Surgery, The Feinberg School of Medicine, Northwestern University, 251 East Huron St, Chicago, IL, 60611, USA
| | - Joseph Forbess
- Ann and Robert H. Lurie Children's Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL, 60611, USA
| | - Xunrong Luo
- Feinberg Cardiovascular and Renal Research Institute, The Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611, USA.,Department of Surgery, The Feinberg School of Medicine, Northwestern University, 251 East Huron St, Chicago, IL, 60611, USA.,Department of Medicine, The Feinberg School of Medicine, Northwestern University, 251 East Huron St, Chicago, IL, 60611, USA
| | - Edward B Thorp
- Department of Pathology, The Feinberg School of Medicine, Northwestern University, 300 East Superior St, Chicago, IL, 60611, USA. .,Feinberg Cardiovascular and Renal Research Institute, The Feinberg School of Medicine, Northwestern University, 303 East Chicago Avenue, Chicago, IL, 60611, USA.
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15
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Yuan Y, Cai J, Cui Y, Wang J, Alwalid O, Shen X, Cao Y, Zou Y, Liang B. CMR-derived extracellular volume fraction (ECV) in asymptomatic heart transplant recipients: correlations with clinical features and myocardial edema. Int J Cardiovasc Imaging 2018; 34:1959-1967. [DOI: 10.1007/s10554-018-1421-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/25/2018] [Indexed: 11/29/2022]
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16
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Sanz-de la Garza M, Iannino N, Finnerty V, Mansour A, Blondeau L, Gayda M, Chaar D, Sirois MG, Racine N, de Denus S, Harel F, White M. Cardiopulmonary, biomarkers, and vascular responses to acute hypoxia following cardiac transplantation. Clin Transplant 2018; 32:e13352. [PMID: 30047602 DOI: 10.1111/ctr.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/05/2018] [Accepted: 07/15/2018] [Indexed: 11/27/2022]
Abstract
Previous studies have suggested good adaptation of cardiac transplant (CTx) recipients to exposure to a high altitude. No studies have investigated the cardiopulmonary and biomarker responses to acute hypoxic challenges following CTx. Thirty-six CTx recipients and 17 age-matched healthy controls (HC) were recruited. Sixteen (16) patients (42%) had cardiac allograft vasculopathy (CAV). Cardiopulmonary responses to maximal and submaximal exercise at 21% O2 , 20-minutes hypoxia (11.5% O2 ), and following a 10-minute exposure to 11.5% O2 using 30% of peak power output were completed. Vascular endothelial growth factor (VEGF), interleukin-6 (IL-6), suppression of tumorigenicity 2 (ST2) were measured at baseline and at peak stress. Endothelial peripheral function was assessed using near-infrared spectroscopy. Compared with HC, CTx presented a lesser O2 desaturation both at rest (-19.4 ± 6.8 [CTx] vs -24.2 ± 6.0% O2 [HC], P < 0.05) and following exercise (-23.2 ± 4.9 [CTx] vs -26.2 ± 4.7% O2 [HC], P < 0.05). CTx patients exhibited a significant decrease in peak oxygen uptake. IL-6 and VEGF levels were significantly higher in CTx recipients in basal conditions but did not change in response to acute stress. CTx patients exhibit a favorable ventilatory and overall response to hypoxic stress. These data provide further insights on the good adaptability of CTx to exposure to high altitude.
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Affiliation(s)
- Maria Sanz-de la Garza
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Cardiology Department, Hospital Clinic, IDIBAPS, Barcelona, Spain
| | - Nadia Iannino
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Vincent Finnerty
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Asmaa Mansour
- Division of the Montreal Heart Institute, Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Lucie Blondeau
- Division of the Montreal Heart Institute, Montreal Health Innovations Coordinating Center (MHICC), Montreal, Quebec, Canada
| | - Mathieu Gayda
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada.,Cardiovascular Prevention and Rehabilitation Center (ÉPIC), Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Diana Chaar
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Martin G Sirois
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Normand Racine
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- Research Center, Montreal Heart Institute, Université de Montréal Beaulieu-Saucier Pharmacogenomics Center and Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - François Harel
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
| | - Michel White
- Cardiology Department, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada
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17
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Wang D, Zhang L, Zeng Q, Xie M. Assessment of left ventricular performance in heart transplant recipients by three-dimensional speckle tracking imaging. Medicine (Baltimore) 2017; 96:e8129. [PMID: 29019881 PMCID: PMC5662304 DOI: 10.1097/md.0000000000008129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To calculate left ventricular (LV) global performance values in heart transplant (HT) recipients by three-dimensional speckle tracking imaging (3D-STI) and to observe the changes in LV global performance over time after HT and investigate the correlated factors.The 30 HT patients were divided into 2 groups according to postoperative time: 1 month postoperatively (HT-1) group and 6 months postoperatively (HT-2) group. Thirty healthy subjects were enrolled as control group. 3D-STI was performed to assess LV torsion, LV systolic dyssynchrony index (SDI), and LV global strain (GS). Global performance index (GPI) was calculated, and correlations factors with GPI were studied.Heart rate (HR), left atrium (LA), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), and left ventricular mass (LVM) in both HT groups were higher than those in the control group. Compared with the control group, SDI was significantly higher in both HT groups, and SDI of the HT-1 group was much higher than that of HT-2 group. Compared with the control group, apical rotation (RoA), twist and torsion in the both HT groups decreased significantly. There were no significant differences in these values between the 2 HT groups; Basal rotation (RoB) showed no significantly difference among the 3 groups. GS in the both HT groups decreased significantly compared with the control group, and there were no significant differences in these values between the 2 HT groups. GPI of the both HT groups was significantly lower than that of the control group; however, GPI of HT-2 group was higher than that of HT-1 group. Multivariate stepwise regression analysis identified global left ventricular longitudinal peak systolic strain (GLS), the time length since surgery, left ventricular mass (LVM), and RoA as predictors of LV GPI. GLS was the most influential to GPI.The values of LV rotation, twist and SDI can be used to assess the LV systolic function and dyssynchrony. The GPI value based on 3D-STI may accurately reflect LV performance changes over time after HT. The GPI value has potential applications in clinical practice. GLS, the time length since surgery, LVM and RoA values can be the predictors of LV global performance, and as long as the left ventricular ejection fraction (LVEF) is preserved, the left ventricular global performance of HT recipients remains stable, and tends to improve over time after HT.
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Affiliation(s)
- Dan Wang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Li Zhang
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Qingyu Zeng
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology
- Hubei Province Key Lab of Molecular Imaging, Wuhan, China
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18
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Left ventricular global longitudinal strain predicts major adverse cardiac events and all-cause mortality in heart transplant patients. J Heart Lung Transplant 2017; 36:567-576. [DOI: 10.1016/j.healun.2016.12.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 12/06/2016] [Accepted: 12/09/2016] [Indexed: 02/06/2023] Open
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19
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Talha S, Charloux A, Piquard F, Geny B. Brain natriuretic peptide and right heart dysfunction after heart transplantation. Clin Transplant 2017; 31. [PMID: 28314080 DOI: 10.1111/ctr.12969] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 02/04/2023]
Abstract
Heart transplantation (HT) should normalize cardiac endocrine function, but brain natriuretic peptide (BNP) levels remain elevated after HT, even in the absence of left ventricular hemodynamic disturbance or allograft rejection. Right ventricle (RV) abnormalities are common in HT recipients (HTx), as a result of engraftment process, tricuspid insufficiency, and/or repeated inflammation due to iterative endomyocardial biopsies. RV function follow-up is vital for patient management as RV dysfunction is a recognized cause of in-hospital death and is responsible for a worse prognosis. Interestingly, few and controversial data are available concerning the relationship between plasma BNP levels and RV functional impairment in HTx. This suggests that infra-clinical modifications, such as subtle immune system disorders or hypoxic conditions, might influence BNP expression. Nevertheless, due to other altered circulating molecular forms of BNP, a lack of specificity of BNP assays is described in heart failure patients. This phenomenon could exist in HT population and could explain elevated BNP plasmatic levels despite a normal RV function. In clinical practice, intra-individual change in BNP over time, rather than absolute BNP values, might be more helpful in detecting right cardiac dysfunction in HTx.
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Affiliation(s)
- Samy Talha
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - Anne Charloux
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - François Piquard
- Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
| | - Bernard Geny
- Department of Physiology and Functional Explorations, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Equipe d'Accueil 3072, Université de Strasbourg, Strasbourg, France
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20
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Ide S, Riesenkampff E, Chiasson DA, Dipchand AI, Kantor PF, Chaturvedi RR, Yoo SJ, Grosse-Wortmann L. Histological validation of cardiovascular magnetic resonance T1 mapping markers of myocardial fibrosis in paediatric heart transplant recipients. J Cardiovasc Magn Reson 2017; 19:10. [PMID: 28143545 PMCID: PMC5286863 DOI: 10.1186/s12968-017-0326-x] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Accepted: 01/13/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Adverse fibrotic remodeling is detrimental to myocardial health and a reliable method for monitoring the development of fibrotic remodeling may be desirable during the follow-up of patients after heart transplantation (HTx). Quantification of diffuse myocardial fibrosis with cardiovascular magnetic resonance (CMR) has been increasingly applied and validated histologically in adult patients with heart disease. However, comparisons of CMR findings with histological fibrosis burden in children are lacking. This study aimed to compare native T1 times and extracellular volume fraction (ECV) derived from CMR with the degree of collagen on endomyocardial biopsy (EmBx), and to investigate the association between myocardial fibrosis and clinical as well as functional markers in children after HTx. METHODS EmBx and CMR were performed on the same day. All specimens were stained with picrosirius red. The collagen volume fraction (CVF) was calculated as ratio of stained collagen area to total myocardial area on EmBx. Native T1 values and ECV were measured by CMR on a mid-ventricular short axis slice, using a modified look-locker inversion recovery approach. RESULTS Twenty patients (9.9 ± 6.2 years of age; 9 girls) after HTx were prospectively enrolled, at a median of 1.3 years (0.02-12.6 years) post HTx, and compared to 24 controls (13.9 ± 2.6 years of age; 12 girls). The mean histological CVF was 10.0 ± 3.4%. Septal native T1 times and ECV were higher in HTx patients compared to controls (1008 ± 32 ms vs 979 ± 24 ms, p < 0.005 and 0.30 ± 0.03 vs 0.22 ± 0.03, p < 0.0001, respectively). CVF showed a moderate correlation with native T1 (r = 0.53, p < 0.05) as well as ECV (r = 0.46, p < 0.05). Native T1 time, but not ECV and CVF, correlated with ischemia time (r = 0.46, p < 0.05). CONCLUSIONS CMR-derived fibrosis markers correlate with histological degree of fibrosis on EmBx in children after HTx. Further, native T1 times are associated with longer ischemia times.
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Affiliation(s)
- Seiko Ide
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Eugenie Riesenkampff
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - David A. Chiasson
- Division of Pathology, Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Anne I. Dipchand
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Paul F. Kantor
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Division of Cardiology, Department of Paediatrics, Stollery Children’s Hospital, Edmonton, AB Canada
| | - Rajiv R. Chaturvedi
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Shi-Joon Yoo
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - Lars Grosse-Wortmann
- Division of Cardiology, Department of Paediatrics, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, ON M5G 1X8 Canada
- Department of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
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21
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Zarndt R, Piloto S, Powell FL, Haddad GG, Bodmer R, Ocorr K. Cardiac responses to hypoxia and reoxygenation in Drosophila. Am J Physiol Regul Integr Comp Physiol 2015; 309:R1347-57. [PMID: 26377557 PMCID: PMC4698404 DOI: 10.1152/ajpregu.00164.2015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 09/09/2015] [Indexed: 11/22/2022]
Abstract
An adequate supply of oxygen is important for the survival of all tissues, but it is especially critical for tissues with high-energy demands, such as the heart. Insufficient tissue oxygenation occurs under a variety of conditions, including high altitude, embryonic and fetal development, inflammation, and thrombotic diseases, often affecting multiple organ systems. Responses and adaptations of the heart to hypoxia are of particular relevance in human cardiovascular and pulmonary diseases, in which the effects of hypoxic exposure can range in severity from transient to long-lasting. This study uses the genetic model system Drosophila to investigate cardiac responses to acute (30 min), sustained (18 h), and chronic (3 wk) hypoxia with reoxygenation. Whereas hearts from wild-type flies recovered quickly after acute hypoxia, exposure to sustained or chronic hypoxia significantly compromised heart function upon reoxygenation. Hearts from flies with mutations in sima, the Drosophila homolog of the hypoxia-inducible factor alpha subunit (HIF-α), exhibited exaggerated reductions in cardiac output in response to hypoxia. Heart function in hypoxia-selected flies, selected over many generations for survival in a low-oxygen environment, revealed reduced cardiac output in terms of decreased heart rate and fractional shortening compared with their normoxia controls. Hypoxia-selected flies also had smaller hearts, myofibrillar disorganization, and increased extracellular collagen deposition, consistent with the observed reductions in contractility. This study indicates that longer-duration hypoxic insults exert deleterious effects on heart function that are mediated, in part, by sima and advances Drosophila models for the genetic analysis of cardiac-specific responses to hypoxia and reoxygenation.
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Affiliation(s)
- Rachel Zarndt
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California; School of Medicine, University of California-San Diego, La Jolla, California; and
| | - Sarah Piloto
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Frank L Powell
- School of Medicine, University of California-San Diego, La Jolla, California; and
| | - Gabriel G Haddad
- Department of Pediatrics, University of California-San Diego, La Jolla, California
| | - Rolf Bodmer
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California
| | - Karen Ocorr
- Development, Aging and Regeneration Program, Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California;
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22
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Clemmensen TS, Eiskjaer H, Løgstrup BB, Mellemkjaer S, Andersen MJ, Tolbod LP, Harms HJ, Poulsen SH. Clinical features, exercise hemodynamics, and determinants of left ventricular elevated filling pressure in heart-transplanted patients. Transpl Int 2015; 29:196-206. [DOI: 10.1111/tri.12690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 08/10/2015] [Accepted: 09/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Hans Eiskjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Denmark
| | | | - Søren Mellemkjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Denmark
| | | | - Lars Poulsen Tolbod
- Department of Nuclear Medicine & PET Center; Aarhus University Hospital; Skejby Denmark
| | - Hendrik J. Harms
- Department of Nuclear Medicine & PET Center; Aarhus University Hospital; Skejby Denmark
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23
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Inhomogeneous myocardial stress perfusion in SPECT studies predicts future allograft dysfunction in heart transplant recipients. EJNMMI Res 2015; 5:51. [PMID: 26438347 PMCID: PMC4593982 DOI: 10.1186/s13550-015-0129-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Myocardial perfusion gated single photon emission computed tomography (SPECT) can be used for non-invasive detection of coronary artery stenosis and cardiac allograft vasculopathy (CAV), which is a crucial factor for the long-term survival of heart transplant (HTx) recipients. A frequently observed finding in myocardial perfusion imaging of patients after HTx is inhomogeneous myocardial perfusion. This finding is not associated with epicardial CAV, but its prognostic relevance is unclear so far. We therefore evaluated the prognosis of patients with homogeneous versus inhomogeneous myocardial stress perfusion. METHODS One hundred four HTx patients (mean 3.6 ± 2.9 years after HTx) without significant stress-induced ischemia (summed stress score ≤3) in gated SPECT and without CAV were included. Myocardial stress perfusion was visually assessed as homogeneous, moderately, or severely inhomogeneous. The mean follow-up period after SPECT was 9.4 ± 3.1 years. End points were the diagnosis of CAV, major cardiac events (MACE) or death, and the development of allograft dysfunction (left ventricular ejection fraction, LVEF <45 %). RESULTS Of all HTx patients, 24 % enrolled in this study (n = 25) presented with inhomogeneous myocardial perfusion. Compared to the patients with homogeneous perfusion, these patients were at higher risk for developing allograft dysfunction (multivariate hazard ratio, HR = 5.59). As to the development of CAV, the occurrence of MACE, or death, no statistical differences were observed between patients with homogenous and inhomogeneous perfusion. There was no correlation between myocardial perfusion pattern and prior cardiac allograft rejections. CONCLUSIONS Inhomogeneous myocardial stress perfusion in SPECT studies predicts a higher risk for future development of allograft dysfunction in HTx patients (LVEF <45 %) but is not associated with future CAV, MACE, or overall survival.
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24
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Clemmensen TS, Løgstrup BB, Eiskjær H, Poulsen SH. Serial changes in longitudinal graft function and implications of acute cellular graft rejections during the first year after heart transplantation. Eur Heart J Cardiovasc Imaging 2015; 17:184-93. [PMID: 26034093 DOI: 10.1093/ehjci/jev133] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 04/25/2015] [Indexed: 01/09/2023] Open
Abstract
AIMS The aim of this prospective study was to use left ventricular global longitudinal strain (LV-GLS) as a non-invasive tool for the monitoring of graft function in relation to acute cellular rejection (ACR) during the first year after heart transplantation (HTX). METHODS AND RESULTS The study population consisted of 36 patients undergoing HTX from November 2010 until October 2013. Patients were followed by comprehensive echocardiography and biopsies at 2 weeks and 1, 3, 6, and 12 months after HTX. ACRs were classified based on the ISHLT classification (0R-3R). Patients were divided into two groups according to the presence of one or more episodes of biopsy proven ≥grade 2R ACR during follow-up. We found that LV-GLS and tricuspid annular plane systolic excursion (TAPSE) were significantly related to ACR burden in a linear regression model. The absolute difference in LV-GLS between patients in the ACR group (-14.4%) and patients in the ACR-free group (-16.8%) was -2.4% (P < 0.01) 12 months after HTX. In the ACR group, patients' LV-GLS did not improve between 1 and 12 months, whereas an improvement of -2.9% was seen in the ACR-free group in this period (P < 0.01). The two groups appeared not to differ in terms of diastolic Doppler parameters or LV ejection fraction, but TAPSE was 15.3 ± 2.8 mm in the ACR-free group vs. 13.2 ± 2.1 mm ACR group, P < 0.05, 12 months after HTX. CONCLUSION Gradual improvement of longitudinal LV and RV function was seen within the first year after HTX, but the degree of recovery was strongly influenced by ACR episodes.
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Affiliation(s)
- Tor Skibsted Clemmensen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Brian Bridal Løgstrup
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Hans Eiskjær
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
| | - Steen Hvitfeldt Poulsen
- Department of Cardiology, Aarhus University Hospital, Brendstrupgårdsvej 100, Skejby 8200, Denmark
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Vitiello D, Chaar D, Neagoe PE, Ducharme A, Carrier M, Pelletier GB, Racine N, Liszkowski M, Sirois MG, White M. Decreased circulating and neutrophil mediated VEGF-A165 release in stable long-term cardiac transplant recipients. Vasc Cell 2015; 7:4. [PMID: 25922663 PMCID: PMC4411699 DOI: 10.1186/s13221-015-0029-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 03/17/2015] [Indexed: 01/13/2023] Open
Abstract
Background Vascular endothelial growth factor (VEGF) may play a role on the allograft remodelling following cardiac transplantation (CTx). We measured the circulating levels of VEGF-A165 concomitantly with the proinflammatory (Interleukin-8; IL-8), anti-inflammatory (IL-1 receptor antagonist; IL-1RA) and their release from neutrophils of CTx recipients. Methods Eighteen CTx recipients aged 49.6 ± 3.1 years, being transplanted for 145 ± 20 months were age-matched to 35 healthy control (HC) subjects. Concomitantly to plasma assessment, circulating neutrophils were isolated, purified and stimulated by vehicle (PBS), N-formyl-Met-Leu-Phe (fMLP, 10−7 M), bacterial lipopolysaccharide (LPS, 1 μg/mL), or tumour necrosis factor alpha (TNF-α, 10 ng/mL). Results Compared with HC, CTx recipients exhibited a decrease (−80%) in plasmatic levels of VEGF-A165 (225 ± 42 (HC) vs 44 ± 10 pg/mL (CTx); (p < 0.001). There were no differences in the levels of IL-8 and IL-1RA. Under basal or stimulated conditions, neutrophils from CTx patients exhibited a marked decrease ranging from −30 to −88% on their capacity to release VEGF-A165, IL-8 and IL-1RA upon stimulation. Conclusions Long-term CTx recipients exhibit a marked reduction in the circulating levels of VEGF-A165, as well as neutrophil-mediated release of VEGF-A165, IL-1RA and IL-8 compared to healthy volunteers. The mechanisms and physiological impacts of these findings deserve additional investigations.
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Affiliation(s)
- Damien Vitiello
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Diana Chaar
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | | | - Anique Ducharme
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Michel Carrier
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Guy B Pelletier
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Normand Racine
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Mark Liszkowski
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Martin G Sirois
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
| | - Michel White
- Research Center, Montreal Heart Institute, Montréal, Qc Canada ; Université de Montréal, 5000 Belanger Street, Montreal, QC Canada
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26
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Lim CY, Kim BY, Lim SH, Cho SI. Effects of Pogostemon cablin Blanco extract on hypoxia induced rabbit cardiomyocyte injury. Pharmacogn Mag 2015; 11:311-9. [PMID: 25829770 PMCID: PMC4378129 DOI: 10.4103/0973-1296.153084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 07/18/2014] [Accepted: 03/12/2015] [Indexed: 12/20/2022] Open
Abstract
Background: Pogostemonis Herba, the dried aerial part of Pogostemon cablin Blanco, is a well-known materia medica in Asia that is widely used for syndrome of gastrointestinal dysfunctions. Objective: This study was undertaken to examine whether Pogostemon cablin extract (PCe) might have any beneficial effect on hypoxia induced rabbit cardiomyocyte injury. Materials and Methods: Isolated cardiomyocytes were divided into three groups and the changes of cell viability in cardiomyocytes of hypoxic and hypoxia/reoxygenation group were determined. The effect of PCe on reactive oxygen species (ROS) generation, intracellular formation of ROS was also measured by monitoring the 2’,7’-dichlorofluorescein fluorescence. Results: PCe effectively protected the cells against both the hypoxia and reoxygenation induced injury, and the protective effect of PCe is not mediated by interaction with adenosine triphosphate-sensitive K+ channels. In the presence of PCe, production of ROS under chemical hypoxia was remarkably reduced which suggests that PCe might exert its effect as a ROS scavenger. Conclusion: The present study provides clear evidence for the beneficial effect of PCe on cardiomyocyte injury during hypoxia or reoxygenation following prolonged hypoxia.
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Affiliation(s)
- Chi-Yeon Lim
- Department of Medicine, College of Medicine, Dongguk University, Ilsan 305-701, Republic of Korea
| | - Bu-Yeo Kim
- Herbal Medicine Research Division, Korea Institute of Oriental Medicine, Daejeon 305-701, Republic of Korea
| | - Se-Hyun Lim
- Department of Nursing, School of Public Health, Far East University, Chungbuk 369-700, Republic of Korea
| | - Su-In Cho
- Department of Korean Medicine, School of Korean Medicine, Pusan National University, Yangsan, Gyeongnam 626-870, Republic of Korea
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27
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Clemmensen TS, Løgstrup BB, Eiskjaer H, Høyer S, Poulsen SH. The long-term influence of repetitive cellular cardiac rejections on left ventricular longitudinal myocardial deformation in heart transplant recipients. Transpl Int 2015; 28:475-84. [DOI: 10.1111/tri.12520] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 11/16/2014] [Accepted: 01/07/2015] [Indexed: 12/01/2022]
Affiliation(s)
| | | | - Hans Eiskjaer
- Department of Cardiology; Aarhus University Hospital; Skejby Denmark
| | - Søren Høyer
- Department of Pathology; Aarhus University Hospital; Skejby Denmark
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28
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Burt JR, Zimmerman SL, Kamel IR, Halushka M, Bluemke DA. Myocardial T1 mapping: techniques and potential applications. Radiographics 2015; 34:377-95. [PMID: 24617686 DOI: 10.1148/rg.342125121] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Myocardial fibrosis is a common endpoint in a variety of cardiac diseases and a major independent predictor of adverse cardiac outcomes. Short of histopathologic analysis, which is limited by sampling bias, most diagnostic modalities are limited in their depiction of myocardial fibrosis. Cardiac magnetic resonance (MR) imaging has the advantage of providing detailed soft-tissue characterization, and a variety of novel quantification methods have further improved its usefulness. Contrast material-enhanced cardiac MR imaging depends on differences in signal intensity between regions of scarring and adjacent normal myocardium. Diffuse myocardial fibrosis lacks these differences in signal intensity. Measurement of myocardial T1 times (T1 mapping) with gadolinium-enhanced inversion recovery-prepared sequences may depict diffuse myocardial fibrosis and has good correlation with ex vivo fibrosis content. T1 mapping calculates myocardial T1 relaxation times with image-based signal intensities and may be performed with standard cardiac MR imagers and radiologic workstations. Myocardium with diffuse fibrosis has greater retention of contrast material, resulting in T1 times that are shorter than those in normal myocardium. Early studies have suggested that diffuse myocardial fibrosis may be distinguished from normal myocardium with T1 mapping. Large multicenter studies are needed to define the role of T1 mapping in developing prognoses and therapeutic assessments. However, given its strengths as a noninvasive method for direct quantification of myocardial fibrosis, T1 mapping may eventually play an important role in the management of cardiac disease.
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Affiliation(s)
- Jeremy R Burt
- From the Russell H. Morgan Department of Radiology and Radiological Sciences (J.R.B., S.L.Z., I.R.K., D.A.B.) and Department of Pathology (M.H.), Johns Hopkins University School of Medicine, Baltimore, Md; and Radiology and Imaging Sciences, Clinical Center, and National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, 10 Center Dr, Room 1C355, Bethesda, MD 20892 (D.A.B.)
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29
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Tsuda T, Dunn S, Radtke W. Acquired discrete subaortic stenosis in solid organ transplant recipients. Pediatr Transplant 2014; 18:E161-4. [PMID: 24814282 DOI: 10.1111/petr.12270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/30/2022]
Abstract
DSS is a rare acquired abnormality of the LV outflow tract in children and adults. DSS can be seen with or without associated congenital heart disease, but the mechanism of its emergence has been poorly understood. Here, we report two cases of DSS that developed after solid organ transplant in childhood. One patient underwent liver and kidney transplant at three yr of age for hereditary polycystic disease, and the other had liver transplant at three months of age due to uncontrollable high-output failure secondary to a large hepatic hemangioma. Both patients developed mild dynamic LV outflow tract obstruction and systemic hypertension soon after transplant, both of which resolved by the time of discharge. Transient LV hypertrophy was observed in both cases. Corticosteroids, cyclosporine A, and tacrolimus were used as initial immunosuppressants. Both patients developed DSS long after the regression of the initial dynamic LV outflow tract obstruction. Herein, we report DSS as an atypical late cardiovascular complication after solid organ transplant and postulate that transient post-transplant hyperdynamic LV outflow tract obstruction and chronic immunosuppressive treatment may lead to subendocardial remodeling resulting in a fibromuscular membranous ridge in susceptible subjects.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE, USA
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30
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Cardiac signaling molecules and plasma biomarkers after cardiac transplantation: Impact of tacrolimus versus cyclosporine. J Heart Lung Transplant 2013; 32:1222-32. [DOI: 10.1016/j.healun.2013.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/01/2013] [Accepted: 09/17/2013] [Indexed: 02/07/2023] Open
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31
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Kobashigawa JA, Itagaki BK, Razi RR, Patel JK, Chai W, Kawano MA, Goldstein Z, Kittleson MM, Fishbein MC. Correlation between myocardial fibrosis and restrictive cardiac physiology in patients undergoing retransplantation. Clin Transplant 2013; 27:E679-84. [DOI: 10.1111/ctr.12250] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Jon A. Kobashigawa
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | - Brandon K. Itagaki
- Department of Cardiology; Kaiser Permanente; Los Angeles Medical Center; Los Angeles CA USA
| | - Rabia R. Razi
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | - Jignesh K. Patel
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | - Wanxing Chai
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | - Matthew A. Kawano
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | - Zachary Goldstein
- Cedars-Sinai Heart Institute; Heart Transplant Program; Los Angeles CA USA
| | | | - Michael C. Fishbein
- Department of Pathology and Laboratory Medicine; UCLA Medical Center; Los Angeles CA USA
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32
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Left ventricular twist in clinically stable heart transplantation recipients: A speckle tracking echocardiography study. Int J Cardiol 2013; 168:357-61. [DOI: 10.1016/j.ijcard.2012.09.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 09/15/2012] [Indexed: 11/24/2022]
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33
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Common threads in cardiac fibrosis, infarct scar formation, and wound healing. FIBROGENESIS & TISSUE REPAIR 2012; 5:19. [PMID: 23114500 PMCID: PMC3534582 DOI: 10.1186/1755-1536-5-19] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 10/04/2012] [Indexed: 12/19/2022]
Abstract
Wound healing, cardiac fibrosis, and infarct scar development, while possessing distinct features, share a number of key functional similarities, including extracellular matrix synthesis and remodeling by fibroblasts and myofibroblasts. Understanding the underlying mechanisms that are common to these processes may suggest novel therapeutic approaches for pathologic situations such as fibrosis, or defective wound healing such as hypertrophic scarring or keloid formation. This manuscript will briefly review the major steps of wound healing, and will contrast this process with how cardiac infarct scar formation or interstitial fibrosis occurs. The feasibility of targeting common pro-fibrotic growth factor signaling pathways will be discussed. Finally, the potential exploitation of novel regulators of wound healing and fibrosis (ski and scleraxis), will be examined.
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35
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Eisen HJ. Late Myocardial Remodeling in Cardiac Allografts: Challenges and Opportunities. J Heart Lung Transplant 2009; 28:1127-8. [DOI: 10.1016/j.healun.2009.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2009] [Accepted: 08/22/2009] [Indexed: 11/24/2022] Open
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