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Kozaily E, Akdogan ER, Dorsey NS, Tedford RJ. Management of Pulmonary Hypertension in the Context of Heart Failure with Preserved Ejection Fraction. Curr Hypertens Rep 2024; 26:291-306. [PMID: 38558124 DOI: 10.1007/s11906-024-01296-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 04/04/2024]
Abstract
PURPOSE OF REVIEW To review the current evidence and modalities for treating pulmonary hypertension (PH) in heart failure with preserved ejection fraction (HFpEF). RECENT FINDINGS In recent years, several therapies have been developed that improve morbidity in HFpEF, though these studies have not specifically studied patients with PF-HFpEF. Multiple trials of therapies specifically targeting the pulmonary vasculature such as phosphodiesterase (PDE) inhibitors, prostacyclin analogs, endothelin receptor antagonists (ERA), and soluble guanylate cyclase stimulators have also been conducted. However, these therapies demonstrated lack of consistency in improving hemodynamics or functional outcomes in PH-HFpEF. There is limited evidence to support the use of pulmonary vasculature-targeting therapies in PH-HFpEF. The mainstay of therapy remains the treatment of the underlying HFpEF condition. There is emerging evidence that newer HF therapies such as sodium-glucose transporter 2 inhibitors and angiotensin-receptor-neprilysin inhibitors are associated with improved hemodynamics and quality of life of patients with PH-HFpEF. There is also a growing realization that more robust phenotyping PH and right ventricular (RV) function may hold promise for therapeutic strategies for patients with PH-HFpEF.
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Affiliation(s)
- Elie Kozaily
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | - Ecem Raziye Akdogan
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA
| | | | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, 29425, USA.
- Advanced Heart Failure & Transplant Fellowship Training Program, Medical University of South Carolina (MUSC), 30 Courtenay Drive, BM215, MSC592, Charleston, SC, 29425, USA.
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Zhang J, Hu Z, Tan Y, Ye J. Causal relationship from heart failure to kidney function and CKD: A bidirectional two-sample mendelian randomization study. PLoS One 2023; 18:e0295532. [PMID: 38079381 PMCID: PMC10712866 DOI: 10.1371/journal.pone.0295532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/20/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Heart Failure (HF) is a widespread condition that affects millions of people, and it is caused by issues with the heart and blood vessels. Even though we know hypertension, coronary artery disease, obesity, diabetes, and genetics can increase the risk of HF and Chronic Kidney Disease (CKD), the exact cause of these conditions remains a mystery. To bridge this gap, we adopted Mendelian Randomization (MR), which relies on genetic variants as proxies. METHODS We used data from European populations for our Bidirectional Two-Sample MR Study, which included 930,014 controls and 47,309 cases of HF from the HERMES consortium, as well as 736,396 controls and 51,256 cases of CKD. We also employed several MR variations, including MR-Egger, Inverse Variance Weighted (IVW), and Weighted Median Estimator (WME), to guarantee the results were accurate and comprehensive.). RESULTS In this study, the MR analysis found that individuals with a genetic predisposition for HF have an elevated risk of CKD. Our study revealed a significant association between the genetic prediction of HF and the risk of CKD, as evidenced by the IVW method [with an odds ratio (OR) of 1.12 (95% CI, 1.03-1.21), p = 0.009] and the WME [with an OR of 1.14 (95% CI, 1.03-1.26), p = 0.008]. This causal relationship remained robust even after conducting MR analysis while adjusting for the effects of diabetes and hypertension, yielding ORs of 1.13 (IVW:95% CI, 1.03-1.23), 1.12 (MR-Egger: 95% CI, 0.85-1.48), and 1.15 (WME:95% CI, 1.04-1.27) (p = 0.008). However, in the reverse analysis aiming to explore CKD and renal function as exposures and HF as the outcome, we did not observe a statistically significant causal link between CKD and HF. CONCLUSION Our study demonstrates the significance of HF in CKD progression, thus having meaningful implications for treatment and the potential for discovering new therapies. To better understand the relationship between HF and CKD, we need to conduct research in a variety of populations.
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Affiliation(s)
- Junyu Zhang
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Zhixi Hu
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Yuquan Tan
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
| | - Jiahao Ye
- Institute of Traditional Chinese Medicine Diagnostics, Hunan University of Chinese Medicine, Changsha, Hunan, China
- Hunan Provincial Key Laboratory of Diagnostic Research in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan, China
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Ltaief Z, Yerly P, Liaudet L. Pulmonary Hypertension in Left Heart Diseases: Pathophysiology, Hemodynamic Assessment and Therapeutic Management. Int J Mol Sci 2023; 24:9971. [PMID: 37373119 PMCID: PMC10298585 DOI: 10.3390/ijms24129971] [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: 05/08/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
Pulmonary hypertension (PH) associated with left heart diseases (PH-LHD), also termed group 2 PH, represents the most common form of PH. It develops through the passive backward transmission of elevated left heart pressures in the setting of heart failure, either with preserved (HFpEF) or reduced (HFrEF) ejection fraction, which increases the pulsatile afterload of the right ventricle (RV) by reducing pulmonary artery (PA) compliance. In a subset of patients, progressive remodeling of the pulmonary circulation resulted in a pre-capillary phenotype of PH, with elevated pulmonary vascular resistance (PVR) further increasing the RV afterload, eventually leading to RV-PA uncoupling and RV failure. The primary therapeutic objective in PH-LHD is to reduce left-sided pressures through the appropriate use of diuretics and guideline-directed medical therapies for heart failure. When pulmonary vascular remodeling is established, targeted therapies aiming to reduce PVR are theoretically appealing. So far, such targeted therapies have mostly failed to show significant positive effects in patients with PH-LHD, in contrast to their proven efficacy in other forms of pre-capillary PH. Whether such therapies may benefit some specific subgroups of patients (HFrEF, HFpEF) with specific hemodynamic phenotypes (post- or pre-capillary PH) and various degrees of RV dysfunction still needs to be addressed.
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Affiliation(s)
- Zied Ltaief
- Service of Adult Intensive Care Medicine, University Hospital, 1011 Lausanne, Switzerland;
| | - Patrick Yerly
- Service of Cardiology, University Hospital, 1011 Lausanne, Switzerland;
| | - Lucas Liaudet
- Service of Adult Intensive Care Medicine, University Hospital, 1011 Lausanne, Switzerland;
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Feng J, Liang L, Chen Y, Tian P, Zhao X, Huang B, Wu Y, Wang J, Guan J, Huang L, Li X, Zhang Y, Zhang J. Big Endothelin-1 as a Predictor of Reverse Remodeling and Prognosis in Dilated Cardiomyopathy. J Clin Med 2023; 12:jcm12041363. [PMID: 36835899 PMCID: PMC9967115 DOI: 10.3390/jcm12041363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
This study aimed to investigate the predictive value of Big endothelin-1(ET-1) for left ventricular reverse remodeling (LVRR) and prognosis in patients with dilated cardiomyopathy (DCM). Patients with DCM and a left ventricular ejection fraction (LVEF) ≤ 50% from 2008 to 2017 were included. LVRR was defined as the LVEF increased by at least 10% or follow-up LVEF increased to at least 50% with a minimum improvement of 5%; meanwhile, the index of left ventricular end-diastolic diameter (LVEDDi) decreased by at least 10% or LVEDDi decreased to ≤33 mm/m2. The composite outcome for prognostic analysis consisted of death and heart transplantations. Of the 375 patients included (median age 47 years, 21.1% female), 135 patients (36%) had LVRR after a median of 14 months of treatment. An independent association was found between Big ET-1 at baseline and LVRR in the multivariate model (OR 0.70, 95% CI 0.55-0.89, p = 0.003, per log increase). Big ET-1, body mass index, systolic blood pressure, diagnosis of type 2 diabetes mellitus (T2DM) and treatment with ACEI/ARB were significant predictors for LVRR after stepwise selection. Adding Big ET-1 to the model improved the discrimination (∆AUC = 0.037, p = 0.042 and reclassification (IDI, 3.29%; p = 0.002; NRI, 35%; p = 0.002) for identifying patients with LVRR. During a median follow-up of 39 (27-68) months, Big ET-1 was also independently associated with the composite outcome of death and heart transplantations (HR 1.45, 95% CI 1.13-1.85, p = 0.003, per log increase). In conclusion, Big ET-1 was an independent predictor for LVRR and had prognostic implications, which might help to improve the risk stratification of patients with DCM.
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Affiliation(s)
- Jiayu Feng
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lin Liang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuyi Chen
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Pengchao Tian
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xuemei Zhao
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Boping Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yihang Wu
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jing Wang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jingyuan Guan
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Liyan Huang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Xinqing Li
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuhui Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Correspondence: (Y.Z.); (J.Z.)
| | - Jian Zhang
- State Key Laboratory of Cardiovascular Disease, Heart Failure Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
- Key Laboratory of Clinical Research for Cardiovascular Medications, National Health Committee, Beijing 100037, China
- Correspondence: (Y.Z.); (J.Z.)
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Zhang H, Ren L, Shivnaraine RV. Targeting GPCRs to treat cardiac fibrosis. Front Cardiovasc Med 2022; 9:1011176. [PMID: 36277752 PMCID: PMC9582444 DOI: 10.3389/fcvm.2022.1011176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac fibrosis occurs ubiquitously in ischemic heart failure, genetic cardiomyopathies, diabetes mellitus, and aging. It triggers myocardial stiffness, which impairs cardiac function, ultimately progressing to end-stage heart failure and increased mortality. Although several targets for anti-fibrotic therapies have been identified, including TGF-β and receptor tyrosine kinase, there is currently no FDA-approved drug specifically targeting cardiac fibrosis. G protein-coupled receptors (GPCRs) are integral, multipass membrane-bound receptors that exhibit diverse and cell-specific expression, offering novel and unrealized therapeutic targets for cardiac fibrosis. This review highlights the emerging roles of several GPCRs and briefly explores their downstream pathways that are crucial in cardiac fibrosis. We will not only provide an overview of the GPCRs expressed on cardiac fibroblasts that are directly involved in myofibroblast activation but also describe those GPCRs which contribute to cardiac fibrosis via indirect crosstalk mechanisms. We also discuss the challenges of identifying novel effective therapies for cardiac fibrosis and offer strategies to circumvent these challenges.
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Affiliation(s)
- Hao Zhang
- Department of Medicine, Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States,*Correspondence: Hao Zhang
| | - Lu Ren
- Department of Medicine, Division of Cardiovascular Medicine, Stanford Cardiovascular Institute, Stanford University, Stanford, CA, United States
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Mohebi R, Murphy S, Jackson L, McCarthy C, Abboud A, Murtagh G, Gawel S, Miksenas H, Gaggin H, Januzzi JL. Biomarker prognostication across Universal Definition of Heart Failure stages. ESC Heart Fail 2022; 9:3876-3887. [PMID: 35942508 PMCID: PMC9773759 DOI: 10.1002/ehf2.14071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIM The Universal Definition of Heart Failure (UDHF) provides a framework for staging risk for HF events. It is not clear whether prognostic biomarkers have different meaning across UDHF stages. We sought to evaluate performance of biomarkers to predict HF events among high-risk patients undergoing coronary and/or peripheral angiography categorized into UDHF stages. METHODS One thousand two hundred thirty-five individuals underwent coronary and/or peripheral angiography were enrolled. Study participants were categorized into UDHF Stage A (at risk), Stage B (pre-HF), and Stage C or D (HF, including end stage) and grouped into Stage A/B and C/D. Biomarkers and clinical variables were used to develop prognostic models. Other measures examined included total HF hospitalizations. RESULTS Over a median of 3.67 years of follow-up, 155 cardiovascular (CV) deaths occurred, and 299 patients were hospitalized with acute HF. In patients with Stage A/B, galectin-3 (HR = 1.52, P = 0.03), endothelin-1 (HR = 2.16, P = 0.001), and N-terminal pro-B-type natriuretic peptide (NT-proBNP; HR = 1.43, P < 0.001) were associated with incident CV death/HF hospitalization. In Stage C/D, NT-proBNP (HR = 1.26, P = 0.006), soluble urokinase-type plasminogen activator receptor (suPAR; HR = 1.57, P = 0.007) and high-sensitivity C-reactive protein (hs-CRP; HR = 1.15, P = 0.01) were associated with these outcomes. Higher biomarker concentrations were associated with greater total burden of HF events in Stages A/B and C/D. CONCLUSIONS Among higher risk individuals undergoing angiographic procedures, different biomarkers improve risk stratification in different UDHF stages of HF. More precise prognostication may offer a window of opportunity to initiate targeted preventive measures.
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Affiliation(s)
- Reza Mohebi
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Sean Murphy
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Laurel Jackson
- Medical and Scientific AffairsAbbott DiagnosticsAbbott ParkILUSA
| | - Cian McCarthy
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Andrew Abboud
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Gillian Murtagh
- Medical and Scientific AffairsAbbott DiagnosticsAbbott ParkILUSA
| | - Susan Gawel
- Medical and Scientific AffairsAbbott DiagnosticsAbbott ParkILUSA
| | - Hannah Miksenas
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - Hanna Gaggin
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA
| | - James L. Januzzi
- Cardiology DivisionMassachusetts General HospitalBostonMAUSA,Harvard Medical SchoolBostonMAUSA,Baim Institute for Clinical ResearchBostonMAUSA
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Krishnarao K, Bruno KA, Di Florio DN, Edenfield BH, Whelan ER, Macomb LP, McGuire MM, Hill AR, Ray JC, Cornell LF, Tan W, Geiger XJ, Salomon GR, Douglass EJ, Fairweather D, Yamani MH. Upregulation of Endothelin-1 May Predict Chemotherapy-Induced Cardiotoxicity in Women with Breast Cancer. J Clin Med 2022; 11:jcm11123547. [PMID: 35743613 PMCID: PMC9224558 DOI: 10.3390/jcm11123547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 02/04/2023] Open
Abstract
As survival in breast cancer patients from newer therapies increases, concerns for chemotherapy-induced cardiotoxicity (CIC) have offset some of these benefits, manifesting as a decline in left ventricular ejection fraction (LVEF). Patients receiving anthracycline-based chemotherapy followed by trastuzumab are at risk for CIC. Previous research evaluating whether clinical biomarkers predict cardiotoxicity has been inconsistent. Recently, angiotensin II type 1 receptor (ATR1) and endothelin 1 (ET1) have been shown to play a role in breast tumor growth. We evaluated ATR1 and ET1 expression in breast cancer tissue and its association with CIC. A total of 33 paraffin-embedded breast tissue specimens from women with breast cancer treated with anthracycline-based chemotherapy and trastuzumab were analyzed by immunohistochemistry (IHC) and qRT-PCR. We found that ET1 expression was increased in patients with an LVEF ≤ 50% (p = 0.032) with a lower LVEF correlating with higher ET1 expression (r = 0.377, p = 0.031). In patients with a change in LVEF of greater than 10%, greater ET1 expression was noted compared to those without a change in LVEF (p = 0.017). Increased ET1 expression in breast tumor tissue is associated with reduced LVEF. Future studies need to examine whether ET1 may be a tissue biomarker that helps predict the risk of developing CIC in women with breast cancer.
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Affiliation(s)
- Krithika Krishnarao
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
- Department of Cardiovascular Medicine, Ochsner Health, New Orleans, LA 70121, USA
- Correspondence: ; Tel.: +1-504-842-9780
| | - Katelyn A. Bruno
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL 32224, USA
| | - Damian N. Di Florio
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL 32224, USA
| | | | - Emily R. Whelan
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Logan P. Macomb
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Molly M. McGuire
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Anneliese R. Hill
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Jordan C. Ray
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Lauren F. Cornell
- Department of Oncology, Mayo Clinic, Jacksonville, FL 32224, USA; (L.F.C.); (W.T.)
| | - Winston Tan
- Department of Oncology, Mayo Clinic, Jacksonville, FL 32224, USA; (L.F.C.); (W.T.)
| | | | - Gary R. Salomon
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - Erika J. Douglass
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
| | - DeLisa Fairweather
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
- Center for Clinical and Translational Science, Mayo Clinic, Jacksonville, FL 32224, USA
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
| | - Mohamad H. Yamani
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL 32224, USA; (K.A.B.); (D.N.D.F.); (E.R.W.); (L.P.M.); (M.M.M.); (A.R.H.); (J.C.R.); (G.R.S.); (E.J.D.); (D.F.); (M.H.Y.)
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Inampudi C, Silverman D, Simon MA, Leary PJ, Sharma K, Houston BA, Vachiéry JL, Haddad F, Tedford RJ. Pulmonary Hypertension in the Context of Heart Failure With Preserved Ejection Fraction. Chest 2021; 160:2232-2246. [PMID: 34391755 PMCID: PMC8727853 DOI: 10.1016/j.chest.2021.08.039] [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: 02/12/2021] [Revised: 07/23/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is the most common form of heart failure and frequently is associated with pulmonary hypertension (PH). HFpEF associated with PH may be difficult to distinguish from precapillary forms of PH, although this distinction is crucial because therapeutic pathways are divergent for the two conditions. A comprehensive and systematic approach using history, clinical examination, and noninvasive and invasive evaluation with and without provocative testing may be necessary for accurate diagnosis and phenotyping. After diagnosis, HFpEF associated with PH can be subdivided into isolated postcapillary pulmonary hypertension (IpcPH) and combined postcapillary and precapillary pulmonary hypertension (CpcPH) based on the presence or absence of elevated pulmonary vascular resistance. CpcPH portends a worse prognosis than IpcPH. Despite its association with reduced functional capacity and quality of life, heart failure hospitalizations, and higher mortality, therapeutic options focused on PH for HFpEF associated with PH remain limited. In this review, we aim to provide an updated overview on clinical definitions and hemodynamically characterized phenotypes of PH, pathophysiologic features, therapeutic strategies, and ongoing challenges in this patient population.
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Affiliation(s)
- Chakradhari Inampudi
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Daniel Silverman
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Marc A Simon
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco
| | - Peter J Leary
- Department of Medicine, University of Washington, Seattle, WA
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Brian A Houston
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC
| | - Jean-Luc Vachiéry
- Département de Cardiologie Cliniques, Universitaires de Bruxelles-Hôpital Erasme, Brussels, Belgium
| | - Francois Haddad
- Division of Cardiovascular Medicine and Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC.
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Li MN, Yu HP, Ke QF, Zhang CQ, Gao YS, Guo YP. Gelatin methacryloyl hydrogels functionalized with endothelin-1 for angiogenesis and full-thickness wound healing. J Mater Chem B 2021; 9:4700-4709. [PMID: 34076027 DOI: 10.1039/d1tb00449b] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Natural polymer hydrogels are widely used as wound dressings, but they do not have enough bioactivity to accelerate angiogenesis and re-epithelialization. Herein, a therapeutic system was firstly constructed in which endothelin-1 (ET-1), as an endogenous vasoconstrictor peptide, was embedded in a photo-crosslinking gelatin methacryloyl (GelMA) hydrogel for full-thickness wound healing. The multifunctional GelMA-ET-1 hydrogels contained the arginine-glycine-aspartate (RGD) motifs of gelatin that provided adhesive sites for cell proliferation and migration. The ET-1 was wrapped within the network of crosslinked GelMA hydrogels via intermolecular hydrogen bonding interactions, effectively avoiding oxidization by atmospheric oxygen and in vivo enzymatic biodegradation. Notably, the ET-1 in the functional hydrogels significantly promoted the proliferation, migration and angiogenesis-related gene expression of human umbilical vein endothelial cells (HUVECs) and fibroblasts. The full-thickness skin defect model of rats further revealed that the GelMA-ET-1 hydrogels significantly accelerated new blood vessel formation, collagen deposition and re-epithelialization. After 14 days, the full-thickness skin defects almost closed and were filled with the newly formed tissue. Hence, the photo-crosslinking GelMA-ET-1 hydrogels functionalized with ET-1 can be employed as a promising therapeutic system for wound healing.
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Affiliation(s)
- Meng-Na Li
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China.
| | - Hong-Ping Yu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China. and The First Affiliated Hospital of Xiamen University, Xiamen 361005, China
| | - Qin-Fei Ke
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China.
| | - Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China.
| | - Ya-Ping Guo
- The Education Ministry Key Lab of Resource Chemistry and Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China.
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In reply, endothelin-1 and the Anrep effect. J Heart Lung Transplant 2020; 39:847. [DOI: 10.1016/j.healun.2020.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 11/17/2022] Open
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Endothelin-1 and conflicting Risk Association: A new lens A Response to Leary et al, “Endothelin-1, cardiac morphology, and heart failure: the MESA angiogenesis study.”. J Heart Lung Transplant 2020; 39:846. [DOI: 10.1016/j.healun.2020.01.1341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/20/2022] Open
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