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White A, Dixon DD, Agrawal V, Brittain E, Lindman B, Mallugari R, Mosley JD, Perry AS, Shah RV, Wells QS, Kuipers AL, Gupta DK. Left Ventricular Wall Stress and Incident Heart Failure in Elderly Community-Dwelling Individuals. JACC. ADVANCES 2024; 3:101262. [PMID: 39309659 PMCID: PMC11416663 DOI: 10.1016/j.jacadv.2024.101262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/28/2024] [Accepted: 08/02/2024] [Indexed: 09/25/2024]
Abstract
Background Greater left ventricular (LV) wall stress is associated with adverse outcomes among patients with prevalent heart failure (HF). Less is known about the association between LV wall stress and incident HF. Objectives The purpose of the study was to identify clinical factors associated with wall stress and test the association between wall stress and incident HF. Methods We studied 4,601 ARIC (Atherosclerosis Risk In Communities) study participants without prevalent HF who underwent echocardiography between 2011 and 2013. LV end systolic and diastolic wall stress (LVESWS, LVEDWS) were calculated from chamber and wall thickness, systemic blood pressure, and transmitral Doppler E/e' as a surrogate for LV end diastolic pressure. Incident HF was ascertained by International Classification of Diseases (ICD)-9/10 claims for hospitalized HF through December 31, 2016. We used Cox regression to test the association between wall stress and incident HF, adjusted for demographics, traditional cardiovascular risk factors, prevalent coronary artery disease and atrial fibrillation, creatinine, N-terminal pro-B-type natriuretic peptide, troponin, triglycerides, C-reactive protein, LV ejection fraction, and LV mass. Results The cohort had a median age of 75 years and 58% women, with 18% identifying as Black. Median LVESWS and LVEDWS were 48.8 (25th-75th percentile: 39.3-60.1) and 18.9 (25th-75th percentile: 15.8-22.5) kdynes/cm2, respectively. LVESWS and LVEDWS were modestly related (rho = 0.30, P < 0.001). Over 4.6 years of median follow-up (156 HF events), each 1 kdyne/cm2 greater LVEDWS was significantly associated with higher risk of incident HF (HR: 1.03; 95% CI: 1.01-1.06), while LVESWS was not (HR: 1.00; 95% CI: 0.99-1.01). Conclusions Among community-dwelling elderly individuals, greater LVEDWS is associated with a higher risk for incident HF.
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Affiliation(s)
- Audrey White
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Debra D. Dixon
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Vineet Agrawal
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Veterans Affairs, Nashville, Tennessee, USA
| | - Evan Brittain
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Brian Lindman
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ravinder Mallugari
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jonathan D. Mosley
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Division of Clinical Pharmacology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew S. Perry
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ravi V. Shah
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quinn S. Wells
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Allison L. Kuipers
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Deepak K. Gupta
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Qi B, Wang HY, Ma X, Chi YF, Gui C. Identification of the Key Genes of Immune Infiltration in Dilated Cardiomyopathy. Int Heart J 2023; 64:1054-1064. [PMID: 37967988 DOI: 10.1536/ihj.23-182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
Dilated cardiomyopathy (DCM) is a common cause of heart failure. In this study, we screened the immune infiltration-related genes associated with DCM to explore the potential molecular mechanisms and provide a basis for the early diagnosis and development of new immunotherapeutic targets. A dataset related to DCM was downloaded from the Gene Expression Omnibus (GEO) database. R software was applied to the genetic differential analysis of patients with DCM and healthy individuals, and the obtained differential expressed genes (DEGs) were screened for differentially expressed immune-related genes (DEIRGs) after comparison with the immune microsatellite database. Gene functional analysis established a protein interaction network (PPI). The immune infiltration in patients with DCM versus normal controls was assessed using the CIBERSORT algorithm, the hub genes were screened using the MOCDE app, and the hubs were validated in multiple datasets. A total of 246 DEGs were screened (adj. P < 0.05 and |logFC| > 0.3), and a total of 170 DEIRGs were compared. Gene Ontology analysis showed significant (adj. P < 0.05) Biological Process entries of 591, Cellular Component of 10, and Molecular Function of 39; Kyoto Encyclopedia of Genes and Genomes showed 20 significant entries, mainly focused on cytokines involved in immune-related response, etc. A protein interaction network comprising 28 hub DEGs was constructed in combination with the PPI network interactions. DEIRG was mainly distributed in the T-cell receptor pathway by immune infiltration detection analysis, and significant changes in central memory T-cells were found by analyzing T-cell-related subpathways, where INSR, HLA-B, IFITM1, and HBEGF were significantly differentially expressed. We selected 632 hospitalized patients for validation and found that INSR and HLA-B expression were associated with DCM development by Nomogram. The expression of HLA-B in peripheral blood T-cells was higher in DCM patients than in the normal group, as verified by qRT-PCR. However, the detailed mechanism needs to be further explored.
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Affiliation(s)
- Bin Qi
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University
| | - Hai-Yan Wang
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University
| | - Xiao Ma
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University
| | - Yu-Feng Chi
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University
| | - Chun Gui
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University
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Saha S, Singh P, Dutta A, Vaidya H, Negi PC, Sengupta S, Seth S, Basak T. A Comprehensive Insight and Mechanistic Understanding of the Lipidomic Alterations Associated With DCM. JACC. ASIA 2023; 3:539-555. [PMID: 37614533 PMCID: PMC10442885 DOI: 10.1016/j.jacasi.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/17/2023] [Accepted: 06/03/2023] [Indexed: 08/25/2023]
Abstract
Dilated cardiomyopathy (DCM) is one of the major causes of heart failure characterized by the enlargement of the left ventricular cavity and contractile dysfunction of the myocardium. Lipids are the major sources of energy for the myocardium. Impairment of lipid homeostasis has a potential role in the pathogenesis of DCM. In this review, we have summarized the role of different lipids in the progression of DCM that can be considered as potential biomarkers. Further, we have also explained the mechanistic pathways followed by the lipid molecules in disease progression along with the cardioprotective role of certain lipids. As the global epidemiological status of DCM is alarming, it is high time to define some disease-specific biomarkers with greater prognostic value. We are proposing an adaptation of a system lipidomics-based approach to profile DCM patients in order to achieve a better diagnosis and prognosis of the disease.
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Affiliation(s)
- Shubham Saha
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
| | - Praveen Singh
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Abhi Dutta
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
| | - Hiteshi Vaidya
- Department of Cardiology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - Prakash Chand Negi
- Department of Cardiology, Indira Gandhi Medical College & Hospital, Shimla, India
| | - Shantanu Sengupta
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
| | - Sandeep Seth
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Trayambak Basak
- School of Biosciences and Bioengineering. IIT-Mandi, Mandi, India
- BioX Center, Indian Institute of Technology-Mandi, Mandi, India
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Kim N, Pronto JD, Nickerson DP, Taberner AJ, Hunter PJ. A novel modular modeling approach for understanding different electromechanics between left and right heart in rat. Front Physiol 2022; 13:965054. [PMID: 36176770 PMCID: PMC9513479 DOI: 10.3389/fphys.2022.965054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/22/2022] [Indexed: 12/01/2022] Open
Abstract
While ion channels and transporters involved in excitation-contraction coupling have been linked and constructed as comprehensive computational models, validation of whether each individual component of a model can be reused has not been previously attempted. Here we address this issue while using a novel modular modeling approach to investigate the underlying mechanism for the differences between left ventricle (LV) and right ventricle (RV). Our model was developed from modules constructed using the module assembly principles of the CellML model markup language. The components of three existing separate models of cardiac function were disassembled as to create smaller modules, validated individually, and then the component parts were combined into a new integrative model of a rat ventricular myocyte. The model was implemented in OpenCOR using the CellML standard in order to ensure reproducibility. Simulated action potential (AP), Ca2+ transient, and tension were in close agreement with our experimental measurements: LV AP showed a prolonged duration and a more prominent plateau compared with RV AP; Ca2+ transient showed prolonged duration and slow decay in LV compared to RV; the peak value and relaxation of tension were larger and slower, respectively, in LV compared to RV. Our novel approach of module-based mathematical modeling has established that the ionic mechanisms underlying the APs and Ca2+ handling play a role in the variation in force production between ventricles. This simulation process also provides a useful way to reuse and elaborate upon existing models in order to develop a new model.
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Affiliation(s)
- Nari Kim
- NLRL for Innovative Cardiovascular Engineering, Department of Physiology, College of Medicine, Inje University, Busan, South Korea
- Cardiovascular and Metabolic Disease Center, Inje University, Busan, South Korea
- *Correspondence: Nari Kim,
| | - Julius D. Pronto
- NLRL for Innovative Cardiovascular Engineering, Department of Physiology, College of Medicine, Inje University, Busan, South Korea
- Cardiovascular and Metabolic Disease Center, Inje University, Busan, South Korea
| | - David P. Nickerson
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Andrew J. Taberner
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
| | - Peter J. Hunter
- Auckland Bioengineering Institute, The University of Auckland, Auckland, New Zealand
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Ozturk C, Rosalia L, Roche ET. A Multi-Domain Simulation Study of a Pulsatile-Flow Pump Device for Heart Failure With Preserved Ejection Fraction. Front Physiol 2022; 13:815787. [PMID: 35145432 PMCID: PMC8822361 DOI: 10.3389/fphys.2022.815787] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/05/2022] [Indexed: 12/02/2022] Open
Abstract
Mechanical circulatory support (MCS) devices are currently under development to improve the physiology and hemodynamics of patients with heart failure with preserved ejection fraction (HFpEF). Most of these devices, however, are designed to provide continuous-flow support. While it has been shown that pulsatile support may overcome some of the complications hindering the clinical translation of these devices for other heart failure phenotypes, the effects that it may have on the HFpEF physiology are still unknown. Here, we present a multi-domain simulation study of a pulsatile pump device with left atrial cannulation for HFpEF that aims to alleviate left atrial pressure, commonly elevated in HFpEF. We leverage lumped-parameter modeling to optimize the design of the pulsatile pump, computational fluid dynamic simulations to characterize hydraulic and hemolytic performance, and finite element modeling on the Living Heart Model to evaluate effects on arterial, left atrial, and left ventricular hemodynamics and biomechanics. The findings reported in this study suggest that pulsatile-flow support can successfully reduce pressures and associated wall stresses in the left heart, while yielding more physiologic arterial hemodynamics compared to continuous-flow support. This work therefore supports further development and evaluation of pulsatile support MCS devices for HFpEF.
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Affiliation(s)
- Caglar Ozturk
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Luca Rosalia
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Health Sciences and Technology Program, Harvard – Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Ellen T. Roche
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States
- Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA, United States
- *Correspondence: Ellen T. Roche,
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6
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Zhang C, Li X, Mou A, Huang R, Song Q, Liu A, Li Z. Assessment of late gadolinium enhancement-negative chronic total occlusion by longitudinal strain analysis using cardiac magnetic resonance imaging. Acta Radiol 2021; 63:1634-1642. [PMID: 34860127 DOI: 10.1177/02841851211055395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Strain analysis has become commonly used in clinical practice in various heart diseases. PURPOSE To explore whether late gadolinium enhancement (LGE)-negative areas with coronary artery chronic total occlusion (CTO) appear normal when analyzed for longitudinal strain using cardiac magnetic resonance (CMR) imaging. MATERIAL AND METHODS A total of 16 patients and 31 healthy controls who underwent 1.5-T MR at our hospital between January 2015 and July 2017 were included in the study. The LGE-CMR of patients with CTO was negative. Left ventricular functional parameters, segmental longitudinal strain/strain rate, and perfusion parameters were measured using CVI42 software. RESULTS For myocardial segments supplied by CTO vessels, systolic longitudinal strain rate (SLSR)was significantly lower than that of healthy controls, and diastolic longitudinal strain rate (DLSR) was significantly higher (1.19 1/s vs. 1.02 1/s; P = 0.018). Moreover, longitudinal strain (LS), SLSR, and DLSR did not differ between good and poor collateral circulation. Perfusion index of CTO territory segments was lower than non-CTO territory segments (0.20 vs. 0.22; P = 0.027). No correlation was found between longitudinal strain parameters and perfusion parameters. CONCLUSION Although LGE-CMR was negative in patients with CTO, the myocardial SLSR of CTO territory segments was significantly lower than that of healthy controls.
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Affiliation(s)
- Chen Zhang
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - Xin Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - Anna Mou
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - RongChong Huang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - Qingwei Song
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - Ailian Liu
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
| | - Zhiyong Li
- Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Dalian City, PR China
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Tsuda T. Clinical Assessment of Ventricular Wall Stress in Understanding Compensatory Hypertrophic Response and Maladaptive Ventricular Remodeling. J Cardiovasc Dev Dis 2021; 8:122. [PMID: 34677191 PMCID: PMC8538325 DOI: 10.3390/jcdd8100122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/12/2023] Open
Abstract
Ventricular wall stress (WS) is an important hemodynamic parameter to represent myocardial oxygen demand and ventricular workload. The normalization of WS is regarded as a physiological feedback signal that regulates the rate and extent of ventricular hypertrophy to maintain myocardial homeostasis. Although hypertrophy is an adaptive response to increased biomechanical stress, persistent hypertrophic stimulation forces the stressed myocardium into a progressive maladaptive process called ventricular remodeling, consisting of ventricular dilatation and dysfunction in conjunction with the development of myocyte hypertrophy, apoptosis, and fibrosis. The critical determinant of this pathological transition is not fully understood, but an energetic mismatch due to uncontrolled WS is thought to be a central mechanism. Despite extensive basic investigations conducted to understand the complex signaling pathways involved in this maladaptive process, clinical diagnostic studies that translate these molecular and cellular changes are relatively limited. Echocardiographic assessment with or without direct measurement of left ventricular pressure used to be a mainstay in estimating ventricular WS in clinical medicine, but in recent years more and more noninvasive applications with magnetic resonance imaging have been studied. In this review article, basic clinical applications of WS assessment are discussed to help understand the progression of ventricular remodeling.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours Children’s Hospital Delaware, 1600 Rockland Rd, Wilmington, DE 19803, USA; ; Tel.: +1-(302)-651-6677; Fax: +1-(302)-651-6601
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, 11th and Walnut Street, Philadelphia, PA 19107, USA
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8
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Kattel S, Bhatt H, Gurung S, Karthikeyan B, Sharma UC. Elevated myocardial wall stress after percutaneous coronary intervention in acute ST elevation myocardial infraction is associated with increased mortality. Echocardiography 2021; 38:1263-1271. [PMID: 34184304 DOI: 10.1111/echo.15131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/12/2021] [Accepted: 06/11/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite early attempts to salvage myocardium-at-risk with percutaneous coronary intervention (PCI), changes in myocardial wall stress (MWS) leads to ventricular dilatation and dysfunction after acute ST-elevation myocardial infraction (STEMI). Whether this is transient or leads to long-term adverse outcomes major adverse cardiovascular events (MACE) is not known. We studied the association between MWS and MACE in patients after a successful PCI for acute STEMI. OBJECTIVES To study the MWS in percutaneously revascularized STEMI patients in relation to all-cause mortality and MACE. METHODS We prospectively enrolled 142 patients who presented to our tertiary care hospital with acute STEMI requiring emergent PCI. In addition to the standard clinical biomarkers, both end-systolic and end-diastolic MWS was calculated using our recently validated Echocardiographic indices. Patients were then prospectively followed up to an average of 16.5 (± 12.0) months to assess all-cause mortality and MACE. RESULTS During the follow-up period, 9% of the patients died and 17% developed MACE. Patients who died had significantly elevated end-systolic WS compared to those who survived (mean ESWS, 80.01 ± 36.86 vs 59.28 ± 27.68). There was no significant difference in end-diastolic WS, left ventricular systolic function and peak troponin levels among survivors versus non-survivors. Elevated ESWS (>62.5 Kpa) and age remained the significant predictors of mortality on multivariate logistic analysis (OR 7.75, CI 1.33-73.86, P = .03; OR 1.16, CI 1.06-1.31, P = .002). CONCLUSION Elevated ESWS measured by echocardiogram is associated with increased odds of long-term mortality in STEMI patients who have undergone emergent PCI. This finding can help clinicians to risk stratify high-risk patients.
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Affiliation(s)
- Sharma Kattel
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA.,Department of Medicine, Division of Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Hardik Bhatt
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Sharda Gurung
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Badri Karthikeyan
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Umesh C Sharma
- Department of Medicine, Division of Cardiology, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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9
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Reichart D, Magnussen C, Zeller T, Blankenberg S. Dilated cardiomyopathy: from epidemiologic to genetic phenotypes: A translational review of current literature. J Intern Med 2019; 286:362-372. [PMID: 31132311 DOI: 10.1111/joim.12944] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Dilated cardiomyopathy (DCM) is characterized by left ventricular dilatation and, consecutively, contractile dysfunction. The causes of DCM are heterogeneous. DCM often results from myocarditis, exposure to alcohol, drugs or other toxins and metabolic or endocrine disturbances. In about 35% of patients, genetic mutations can be identified that usually involve genes responsible for cytoskeletal, sarcomere and nuclear envelope proteins. Due to its heterogeneity, a detailed diagnostic work-up is necessary to identify the specific underlying cause and exclude other conditions with phenotype overlap. Patients with DCM show typical systolic heart failure symptoms, but, with progress of the disease, diastolic dysfunction is present as well. Depending on the underlying pathology, DCM patients also become apparent through arrhythmias, thromboembolic events or cardiogenic shock. Disease progression and prognosis are mostly driven by disease severity and reverse remodelling within the heart. The worst prognosis is seen in patients with lowest ejection fractions or severe diastolic dysfunction, leading to terminal heart failure with subsequent need for left ventricular assist device implantation or heart transplantation. Guideline-based heart failure medication and device therapy reduces the frequency of heart failure hospitalizations and improves survival.
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Affiliation(s)
- D Reichart
- From the, University Heart Center Hamburg, Hamburg, Germany
| | - C Magnussen
- From the, University Heart Center Hamburg, Hamburg, Germany
| | - T Zeller
- From the, University Heart Center Hamburg, Hamburg, Germany
| | - S Blankenberg
- From the, University Heart Center Hamburg, Hamburg, Germany
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Garg V, Verma S, Connelly K. Mechanistic insights regarding the role of SGLT2 inhibitors and GLP1 agonist drugs on cardiovascular disease in diabetes. Prog Cardiovasc Dis 2019; 62:349-357. [PMID: 31381891 DOI: 10.1016/j.pcad.2019.07.005] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 12/22/2022]
Abstract
The treatment landscape for patients with established or at high risk for cardiovascular disease and type 2 diabetes mellitus has entirely changed over the past decade, with the introduction of several anti-hyperglycemic agents. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 (GLP-1) agonists are two anti-hyperglycemic classes which have been of special interest after multiple large cardiovascular disease (CVD) outcomes studies have demonstrated superiority of these agents compared to placebo for major adverse CVD events and in some cases, hospitalization for heart failure. Despite the dramatic results of these trials, only recently have we began to understand the mechanisms underlying these CVD benefits. Here we review the underlying mechanisms which have the greatest plausibility for both of these agents including the impact of ventricular loading conditions, direct effects on cardiac structure and function, myocardial energetics and sodium/hydrogen exchange for SGLT2 inhibitors, and the anti-atherosclerotic, anti-inflammatory, and modulation of endothelial function for GLP-1 agonists.
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Affiliation(s)
- Vinay Garg
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada
| | - Kim Connelly
- Division of Cardiology, St. Michael's Hospital, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Keenan Research Centre at the Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada.
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11
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Reichek N. Afterload and Fibrosis: Aortic Stenosis Co-Conspirators. JACC Cardiovasc Imaging 2019; 13:601-603. [PMID: 31326482 DOI: 10.1016/j.jcmg.2019.05.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Nathaniel Reichek
- Research Department and Cardiac Imaging Program, St. Francis Hospital-The Heart Center, Roslyn, New York; Cardiology Division, Department of Medicine, School of Medicine, Stony Brook University (SUNY), Stony Brook, New York; Biomedical Engineering Department, School of Engineering and Applied Sciences, Stony Brook University (SUNY), Stony Brook, New York.
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12
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Jordan JH, Castellino SM, Meléndez GC, Klepin HD, Ellis LR, Lamar Z, Vasu S, Kitzman DW, Ntim WO, Brubaker PH, Reichek N, D'Agostino RB, Hundley WG. Left Ventricular Mass Change After Anthracycline Chemotherapy. Circ Heart Fail 2019; 11:e004560. [PMID: 29991488 DOI: 10.1161/circheartfailure.117.004560] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment. METHODS AND RESULTS We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non-Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ2 tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF (P<0.0001) and LV mass (P=0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups (P=0.11-0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines (r=-0.27; P<0.01) but not with LVEF declines (r=0.11; P=0.45). Moreover, this finding was independent of LVEF changes and body weight. CONCLUSIONS Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.
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Affiliation(s)
- Jennifer H Jordan
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | | | - Giselle C Meléndez
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.).,Department of Internal Medicine, Section on Comparative Medicine, Department of Pathology (G.C.M.)
| | | | | | | | - Sujethra Vasu
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - William O Ntim
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Peter H Brubaker
- Wake Forest School of Medicine, and Department of Health and Exercise Sciences (P.H.B)
| | - Nathaniel Reichek
- Wake Forest University, Winston-Salem, NC. Research and Education, The Heart Center, St Francis Hospital, Roslyn, NY (N.R.)
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Division of Public Health Sciences (R.B.D'A.)
| | - W Gregory Hundley
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.) .,Department of Radiological Sciences (W.G.H.)
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13
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Affiliation(s)
- Nathaniel Reichek
- From the Cardiac Imaging Program and Research Department, St. Francis Hospital-The Heart Center, Roslyn, NY; and Division of Cardiology, Department of Medicine and Department of Biomedical Engineering, School of Engineering and Applied Mathematics, Stony Brook University, SUNY, NY.
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Kunišek J, Kunišek L. IMPACT OF BLOOD PRESSURE COMPONENTS ON LEFT VENTRICULAR HYPERTROPHY REMODELING. Acta Clin Croat 2018; 57:638-645. [PMID: 31168200 PMCID: PMC6544109 DOI: 10.20471/acc.2018.57.04.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
SUMMARY – According to present findings, the impact of particular arterial pressure components on the occurrence of left ventricular hypertrophy (LVH) differs. We sought to determine which individual component of arterial pressure has the greatest impact on the LVH geometric pattern/degree. The study included 192 patients (87 men), aged 43-80 (median 68) years with hypertension and LVH. Patients were classified into three groups according to type of hypertrophy (concentric, eccentric and asymmetric) and into three subgroups according to the degree of hypertrophy (mild, moderate and severe). All patients had their blood pressure measured, and they underwent electrocardiography and echocardiography. Antihypertensive drugs and the duration of previous treatments were taken into consideration. Pulse pressure was significantly higher in patients with concentric LVH than in those with eccentric and asymmetric LVH (p=0.029), the values of which did not differ statistically. It rose with LVH degree (not significantly, p=0.217). There were no significant differences in systolic pressure among study groups (p=0.177). We concluded that pulse pressure had the greatest impact on the left ventricular geometry, particularly of the concentric type.
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Affiliation(s)
| | - Leon Kunišek
- 1Department of Internal Medicine, Crikvenica Thalassotherapia, Special Hospital for Medical Rehabilitation, Crikvenica, Croatia; 2Rijeka University Hospital Centre, Department of Cardiac Surgery, Rijeka, Croatia
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15
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Alter P, Jörres RA, Watz H, Welte T, Gläser S, Schulz H, Bals R, Karch A, Wouters EFM, Vestbo J, Young D, Vogelmeier CF. Left ventricular volume and wall stress are linked to lung function impairment in COPD. Int J Cardiol 2018; 261:172-178. [PMID: 29657040 DOI: 10.1016/j.ijcard.2018.02.074] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/13/2018] [Accepted: 02/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cardiovascular comorbidities are common in chronic obstructive pulmonary disease (COPD). We examined the association between airflow limitation, hyperinflation and the left ventricle (LV). METHODS Patients from the COPD cohort COSYCONET underwent evaluations including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), effective airway resistance (Reff), intrathoracic gas volume (ITGV), and echocardiographic LV end-diastolic volume (LVEDV), stroke volume (LVSV), end-systolic volume (LVESV), and end-diastolic and end-systolic LV wall stress. Data from Visit 1 (baseline) and Visit 3 (18 months later) were used. In addition to comparisons of both visits, multivariate regression analysis was conducted, followed by structural equation modelling (SEM) with latent variables "Lung" and "Left heart". RESULTS A total of 641 participants were included in this analysis. From Visit 1 to Visit 3, there were significant declines in FEV1 and FEV1/FVC, and increases in Reff, ITGV and LV end-diastolic wall stress, and a borderline significant decrease in LV mass. There were significant correlations of: FEV1% predicted with LVEDV and LVSV; Reff with LVSV; and ITGV with LV mass and LV end-diastolic wall stress. The SEM fitted the data of both visits well (comparative fit index: 0.978, 0.962), with strong correlation between "Lung" and "Left heart". CONCLUSIONS We demonstrated a relationship between lung function impairment and LV wall stress in patients with COPD. This supports the hypothesis that LV impairment in COPD could be initiated or promoted, at least partly, by mechanical factors exerted by the lung disorder.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany.
| | - Rudolf A Jörres
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig Maximilians University, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany.
| | - Henrik Watz
- Pulmonary Research Institute at Lungen Clinic Grosshansdorf, Airway Research Centre North (ARCN), Member of the German Centre for Lung Research (DZL), Grosshansdorf, Germany
| | - Tobias Welte
- Clinic for Pneumology, Hannover Medical School, Member of the German Centre for Lung Research (DZL), Hannover, Germany
| | - Sven Gläser
- Department for Pneumology, University of Greifswald, Greifswald, Germany
| | - Holger Schulz
- Helmholtz Centre Munich, Institute of Epidemiology, German Research Centre for Environmental Health, Comprehensive Pneumology Centre Munich (CPC-M), Member of the German Centre for Lung Research (DZL), Munich, Germany
| | - Robert Bals
- Department of Internal Medicine V - Pulmonology, Allergology, Intensive Care Medicine, Saarland University Hospital, Germany
| | - Annika Karch
- Institute for Biostatistics, Centre for Biometry, Medical Informatics and Medical Technology, Hannover Medical School, Hannover, Germany
| | - Emiel F M Wouters
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK
| | - David Young
- Young Medical Communications and Consulting Limited, Horsham, UK
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Member of the German Centre for Lung Research (DZL), Marburg, Germany
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Mosleh W, Elango K, Shah T, Chaudhari M, Gandhi S, Kattel S, Karki R, Khalil C, Frodey K, Dahal S, Okeeffe C, Aljebaje Z, Nagahama M, Punnanithinont N, Sharma UC. Elevated end-diastolic wall stress after acute myocardial infarction predicts adverse cardiovascular outcomes and longer hospital length of stay. Echocardiography 2018; 35:1721-1728. [DOI: 10.1111/echo.14136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 10/28/2022] Open
Affiliation(s)
- Wassim Mosleh
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Kalaimani Elango
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Tanvi Shah
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Milind Chaudhari
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Sumeet Gandhi
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Sharma Kattel
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Roshan Karki
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Charl Khalil
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Kevin Frodey
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Suraj Dahal
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Cale Okeeffe
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Zaid Aljebaje
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | - Makoto Nagahama
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
| | | | - Umesh C. Sharma
- Department of Medicine; Division of Cardiology; University at Buffalo; Buffalo New York
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17
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Andreas S, Bothner U, Trampisch M, Haensel M, Buhl R, Alter P. Effect of long-acting β 2-agonists olodaterol and formoterol on heart rate and blood pressure in chronic obstructive pulmonary disease patients. Pulm Pharmacol Ther 2018; 52:1-6. [PMID: 30077810 DOI: 10.1016/j.pupt.2018.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiovascular comorbidities are common in chronic obstructive pulmonary disease (COPD), and elevated heart rate reflects increased cardiovascular risk over time, which is associated with unfavourable neurohumoral activation. Long-acting β2-agonists (LABAs) are established treatments in COPD, but potentially increase heart rate. We report a post hoc pooled analysis of the effect of olodaterol (5 or 10 μg) or formoterol (12 μg) on heart rate and blood pressure (BP) in Global Initiative for Chronic Obstructive Lung Disease Stage 2-4 COPD patients. METHODS Four randomised, double-blind, placebo-controlled, Phase III studies were analysed. Changes in heart rate and systolic/diastolic BP were measured before and after dosing with the study medication at each visit. RESULTS At each study visit, the increase in pre-dose heart rate was numerically lower with both LABAs compared with placebo. Systolic and diastolic BP were decreased with all treatments. Short-term (pre-dose to 40 min post-dose) effects of drug administration on heart rate were small and similar for all treatment arms (between -3 and +1 beats per minute). CONCLUSION Heart rate and BP were not adversely influenced in this study involving long-term administration of olodaterol or formoterol in patients with moderate-to-severe COPD. This supports the cardiovascular safety of LABAs in COPD maintenance treatment.
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Affiliation(s)
- Stefan Andreas
- Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, and Lung Clinic Immenhausen, Immenhausen, Germany.
| | - Ulrich Bothner
- Pharmacovigilance, Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Matthias Trampisch
- Biostatistics and Data Sciences Europe, Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Michaela Haensel
- TA Respiratory/Biosimilars, Boehringer Ingelheim International GmbH, Ingelheim Am Rhein, Germany
| | - Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University of Marburg, Marburg, Germany
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18
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Treibel TA, Kozor R, Fontana M, Torlasco C, Reant P, Badiani S, Espinoza M, Yap J, Diez J, Hughes AD, Lloyd G, Moon JC. Sex Dimorphism in the Myocardial Response to Aortic Stenosis. JACC Cardiovasc Imaging 2018; 11:962-973. [PMID: 29153564 PMCID: PMC6278887 DOI: 10.1016/j.jcmg.2017.08.025] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/16/2017] [Accepted: 08/15/2017] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The goal of this study was to explore sex differences in myocardial remodeling in aortic stenosis (AS) by using echocardiography, cardiac magnetic resonance (CMR), and biomarkers. BACKGROUND AS is a disease of both valve and left ventricle (LV). Sex differences in LV remodeling are reported in AS and may play a role in disease phenotyping. METHODS This study was a prospective assessment of patients awaiting surgical valve replacement for severe AS using echocardiography, the 6-min walking test, biomarkers (high-sensitivity troponin T and N-terminal pro-brain natriuretic peptide), and CMR with late gadolinium enhancement and extracellular volume fraction, which dichotomizes the myocardium into matrix and cell volumes. LV remodeling was categorized into normal geometry, concentric remodeling, concentric hypertrophy, and eccentric hypertrophy. RESULTS In 168 patients (age 70 ± 10 years, 55% male, indexed aortic valve area 0.40 ± 0.13 cm2/m2, mean gradient 47 ± 4 mm Hg), no sex or age differences in AS severity or functional capacity (6-min walking test) were found. CMR captured sex dimorphism in LV remodeling not apparent by using 2-dimensional echocardiography. Normal geometry (82% female) and concentric remodeling (60% female) dominated in women; concentric hypertrophy (71% male) and eccentric hypertrophy (76% male) dominated in men. Men also had more evidence of LV decompensation (pleural effusions), lower left ventricular ejection fraction (67 ± 16% vs. 74 ± 13%; p < 0.001), and higher levels of N-terminal pro-brain natriuretic peptide (p = 0.04) and high-sensitivity troponin T (p = 0.01). Myocardial fibrosis was higher in men, with higher focal fibrosis (late gadolinium enhancement 16.5 ± 11.2 g vs. 10.5 ± 8.9 g; p < 0.001) and extracellular expansion (matrix volume 28.5 ± 8.8 ml/m2 vs. 21.4 ± 6.3 ml/m2; p < 0.001). CONCLUSIONS CMR revealed sex differences in associations between AS and myocardial remodeling not evident from echocardiography. Given equal valve severity, the myocardial response to AS seems more maladaptive in men than previously reported. (Regression of Myocardial Fibrosis After Aortic Valve Replacement [RELIEF-AS]; NCT02174471).
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Affiliation(s)
- Thomas A Treibel
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Rebecca Kozor
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Sydney Medical School, University of Sydney, Sydney, Australia
| | - Marianna Fontana
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Camilla Torlasco
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Patricia Reant
- University Hospital Center of Bordeaux, and University of Bordeaux, Bordeaux, France
| | - Sveeta Badiani
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Maria Espinoza
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - John Yap
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - Javier Diez
- Program of Cardiovascular Diseases, Center for Applied Medical Research, University of Navarra, Pamplona, Spain; CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Alun D Hughes
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - James C Moon
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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Ghelani SJ, Colan SD, Azcue N, Keenan EM, Harrild DM, Powell AJ, Geva T, Rathod RH. Impact of Ventricular Morphology on Fiber Stress and Strain in Fontan Patients. Circ Cardiovasc Imaging 2018; 11:e006738. [DOI: 10.1161/circimaging.117.006738] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 05/10/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Sunil J. Ghelani
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Nina Azcue
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Ellen M. Keenan
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - David M. Harrild
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Andrew J. Powell
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Tal Geva
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Rahul H. Rathod
- Department of Cardiology, Boston Children’s Hospital, MA. Department of Pediatrics, Harvard Medical School, Boston, MA
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21
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Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet 2017; 390:400-414. [PMID: 28190577 DOI: 10.1016/s0140-6736(16)31713-5] [Citation(s) in RCA: 385] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 09/09/2016] [Accepted: 09/14/2016] [Indexed: 12/18/2022]
Abstract
Dilated cardiomyopathy is defined by the presence of left ventricular dilatation and contractile dysfunction. Genetic mutations involving genes that encode cytoskeletal, sarcomere, and nuclear envelope proteins, among others, account for up to 35% of cases. Acquired causes include myocarditis and exposure to alcohol, drugs and toxins, and metabolic and endocrine disturbances. The most common presenting symptoms relate to congestive heart failure, but can also include circulatory collapse, arrhythmias, and thromboembolic events. Secondary neurohormonal changes contribute to reverse remodelling and ongoing myocyte damage. The prognosis is worst for individuals with the lowest ejection fractions or severe diastolic dysfunction. Treatment of chronic heart failure comprises medications that improve survival and reduce hospital admission-namely, angiotensin converting enzyme inhibitors and β blockers. Other interventions include enrolment in a multidisciplinary heart failure service, and device therapy for arrhythmia management and sudden death prevention. Patients who are refractory to medical therapy might benefit from mechanical circulatory support and heart transplantation. Treatment of preclinical disease and the potential role of stem-cell therapy are being investigated.
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Affiliation(s)
- Robert G Weintraub
- Department of Cardiology, Royal Children's Hospital, Melbourne, VIC, Australia; Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Peter Macdonald
- St Vincent's Hospital, Sydney, NSW, Australia; Victor Chang Cardiac Research Institute, Sydney, NSW, Australia
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Kitahara M, Miyagawa S, Fukushima S, Saito A, Shintani A, Akita T, Sawa Y. Biodegradable vs Nonbiodegradable Cardiac Support Device for Treating Ischemic Cardiomyopathy in a Canine Heart. Semin Thorac Cardiovasc Surg 2017; 29:51-61. [PMID: 28683998 DOI: 10.1053/j.semtcvs.2017.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2017] [Indexed: 11/11/2022]
Abstract
Clinical studies of the efficacy of the nonbiodegradable CorCap device have shown inconsistent findings, at least in part, because of device-related impairment of diastolic cardiac function. We hypothesized that use of biodegradable material for the cardiac support device could contribute to an improvement in the diastolic function of the failing heart. Polyglycolic acid and polyethylene terephthalate were used to prepare biodegradable and nonbiodegradable cardiac support devices, respectively. Twelve-month-old beagles underwent anterior coronary artery ligation. One week after, the beagles were randomly assigned for implantation of a biodegradable cardiac support device (n = 7), nonbiodegradable cardiac support device (n = 8), or sham operation (n = 8). Twelve weeks after coronary artery ligation, the biodegradable group showed a significantly greater recovery of echocardiographical ejection fraction than the nonbiodegradable and the sham groups (40% ± 3.3%, 32% ± 2.5%, and 29 ± 2.6%, respectively). Of note, diastolic function, as assessed by Tau, -dp/dt min, and end-diastolic pressure-volume relationship in the cardiac catheter, was significantly better in both left and right ventricles in the biodegradable group than in the nonbiodegradable group. Moreover, global end-systolic wall stress was significantly lower in the 2 device groups than in the sham group (P < 0.03). Furthermore, global end-diastolic wall stress was significantly less in the biodegradable device group than in the nonbiodegradable group (P < 0.02). The cardiac support devices made of biodegradable material were more effective in improving systolic function, with preservation of diastolic function in the canine infarct heart, than devices made of nonbiodegradable material.
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Affiliation(s)
- Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satsuki Fukushima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsuhiro Saito
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ayumi Shintani
- Department of Clinical Epidemiology and Biostatistics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Toshiaki Akita
- Department of Cardiovascular Surgery, Kanazawa Medical University, Ishikawa, Japan
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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Vallabhajosyula S, Sundaragiri PR, Kanmanthareddy A, Ahmed AA, Mahfood Haddad T, Rayes HAA, Khan AN, Buaisha HM, Pershwitz GE, McCann DA, Holmberg MJ, Morrow LE. Influence of Left Ventricular Hypertrophy on In-Hospital Outcomes in Acute Exacerbation of Chronic Obstructive Pulmonary Disease. COPD 2016; 13:712-717. [PMID: 27379826 DOI: 10.1080/15412555.2016.1195349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Left ventricular hypertrophy (LVH) is associated with worse outcomes in chronic obstructive pulmonary disease (COPD); however, its role in an acute exacerbation of COPD (AECOPD) has not been reported. This was a retrospective cohort study during 2008-2012 at an academic medical center. AECOPD patients >18 years with available echocardiographic data were included. LVH was defined as LV mass index (LVMI) >95 g/m2 (women) and >115g/m2 (men). Relative wall thickness was used to classify LVH as concentric (>0.42) or eccentric (<0.42). Outcomes included need for and duration of non-invasive ventilation (NIV) and mechanical ventilation (MV), NIV failure, intensive care unit (ICU) and total length of stay (LOS), and in-hospital mortality. Two-tailed p < 0.05 was considered statistically significant. Of 802 patients with AECOPD, 615 patients with 264 (42.9%) having LVH were included. The LVH cohort had higher LVMI (141.1 ± 39.4 g/m2 vs. 79.7 ± 19.1 g/m2; p < 0.001) and lower LV ejection fraction (44.5±21.9% vs. 50.0±21.6%; p ≤ 0.001). The LVH cohort had statistically non-significant longer ICU LOS, and higher NIV and MV use and duration. Of the 264 LVH patients, concentric LVH (198; 75.0%) was predictive of greater NIV use [82 (41.4%) vs. 16 (24.2%), p = 0.01] and duration (1.0 ± 1.9 vs. 0.6 ± 1.4 days, p = 0.01) compared to eccentric LVH. Concentric LVH remained independently associated with NIV use and duration. In-hospital outcomes in patients with AECOPD were comparable in patients with and without LVH. Patients with concentric LVH had higher NIV need and duration in comparison to eccentric LVH.
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Affiliation(s)
- Saraschandra Vallabhajosyula
- a Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic , Rochester , MN , USA.,b Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) Laboratory, Mayo Clinic , Rochester , MN , USA
| | - Pranathi R Sundaragiri
- c Division of Hospital Internal Medicine, Department of Internal Medicine, Mayo Clinic , Rochester , MN , USA
| | - Arun Kanmanthareddy
- d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA
| | - Anas A Ahmed
- e Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Tufts University School of Medicine , Boston , MA , USA
| | - Toufik Mahfood Haddad
- d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA
| | - Hamza A A Rayes
- f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA
| | - Anila N Khan
- g Department of Internal Medicine , Rush Medical College of Rush University , Chicago , IL , USA
| | - Haitam M Buaisha
- f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA
| | - Gene E Pershwitz
- f Department of Internal Medicine , Creighton University School of Medicine , Omaha , NE , USA
| | - Dustin A McCann
- h Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA
| | - Mark J Holmberg
- d Division of Cardiovascular Diseases, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA
| | - Lee E Morrow
- h Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Creighton University School of Medicine , Omaha , NE , USA.,i Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Veterans Affairs Nebraska-Western Iowa Health Care System , Omaha , NE , USA
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Beta-Adrenoceptor Stimulation Reveals Ca2+ Waves and Sarcoplasmic Reticulum Ca2+ Depletion in Left Ventricular Cardiomyocytes from Post-Infarction Rats with and without Heart Failure. PLoS One 2016; 11:e0153887. [PMID: 27096943 PMCID: PMC4838269 DOI: 10.1371/journal.pone.0153887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/05/2016] [Indexed: 11/25/2022] Open
Abstract
Abnormal cellular Ca2+ handling contributes to both contractile dysfunction and arrhythmias in heart failure. Reduced Ca2+ transient amplitude due to decreased sarcoplasmic reticulum Ca2+ content is a common finding in heart failure models. However, heart failure models also show increased propensity for diastolic Ca2+ release events which occur when sarcoplasmic reticulum Ca2+ content exceeds a certain threshold level. Such Ca2+ release events can initiate arrhythmias. In this study we aimed to investigate if both of these aspects of altered Ca2+ homeostasis could be found in left ventricular cardiomyocytes from rats with different states of cardiac function six weeks after myocardial infarction when compared to sham-operated controls. Video edge-detection, whole-cell Ca2+ imaging and confocal line-scan imaging were used to investigate cardiomyocyte contractile properties, Ca2+ transients and Ca2+ waves. In baseline conditions, i.e. without beta-adrenoceptor stimulation, cardiomyocytes from rats with large myocardial infarction, but without heart failure, did not differ from sham-operated animals in any of these aspects of cellular function. However, when exposed to beta-adrenoceptor stimulation, cardiomyocytes from both non-failing and failing rat hearts showed decreased sarcoplasmic reticulum Ca2+ content, decreased Ca2+ transient amplitude, and increased frequency of Ca2+ waves. These results are in line with a decreased threshold for diastolic Ca2+ release established by other studies. In the present study, factors that might contribute to a lower threshold for diastolic Ca2+ release were increased THR286 phosphorylation of Ca2+/calmodulin-dependent protein kinase II and increased protein phosphatase 1 abundance. In conclusion, this study demonstrates both decreased sarcoplasmic reticulum Ca2+ content and increased propensity for diastolic Ca2+ release events in ventricular cardiomyocytes from rats with heart failure after myocardial infarction, and that these phenomena are also found in rats with large myocardial infarctions without heart failure development. Importantly, beta-adrenoceptor stimulation is necessary to reveal these perturbations in Ca2+ handling after a myocardial infarction.
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Glück T, Alter P. Marine omega-3 highly unsaturated fatty acids: From mechanisms to clinical implications in heart failure and arrhythmias. Vascul Pharmacol 2016; 82:11-9. [PMID: 27080538 DOI: 10.1016/j.vph.2016.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 03/12/2016] [Accepted: 03/29/2016] [Indexed: 12/17/2022]
Abstract
Therapeutic implications of marine omega-3 highly unsaturated fatty acids (HUFA) in cardiovascular disease are still discussed controversially. Several clinical trials report divergent findings and thus leave ambiguity on the meaning of oral omega-3 therapy. Potential prognostic indications of HUFA treatment have been predominantly studied in coronary artery disease, sudden cardiac death, ventricular arrhythmias, atrial fibrillation and heart failure of various origin. It is suspected that increased ventricular wall stress is crucially involved in the prognosis of heart failure. Increased wall stress and an unfavorable myocardial remodeling is associated with an increased risk of arrhythmias by stretch-activated membrane ion channels. Integration of HUFA into the microenvironment of cardiomyocyte ion channels lead to allosteric changes and increase the electrical stability. Increased ventricular wall stress appears to be involved in the local myocardial as well as in the hepatic fatty acid metabolism, i.e. a cardio-hepatic syndrome. Influences of an altered endogenous HUFA metabolism and an inverse shift of the fatty acid profile was underrated in the past. A better understanding of these interacting endogenous mechanisms appears to be required for interpreting the findings of recent experimental and clinical studies. The present article critically reviews major studies on basic pathophysiological mechanisms and treatment effects in clinical trials.
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Affiliation(s)
- Tobias Glück
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University, Marburg, Germany; Department of Medicine, Cardiology and Angiology, AGAPLESION Evangelisches Krankenhaus Mittelhessen, Gießen, Germany.
| | - Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, Philipps University, Marburg, Germany.
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Pressure-independent relationship of aortic characteristic impedance with left ventricular mass and geometry in untreated hypertension. J Hypertens 2016; 33:153-60. [PMID: 25269017 DOI: 10.1097/hjh.0000000000000354] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
METHOD We investigated whether aortic characteristic impedance (Zc), that is, the ratio between the pulsatile change in pressure and flow in the proximal aorta, is related to left ventricular hypertrophy and geometry independently of blood pressure (BP). A total of 438 never-treated hypertensive individuals (men 62%, age 48 ± 11 years, BP 147/90 ± 16/10 mm Hg) underwent echocardiography and 24 h BP monitoring. Aortic pressure waveform was obtained from radial tonometry with a generalized transfer function (SphygmoCor). Using a validated aortic blood flow model based on higher order Windkessel theory (ARCSolver), aortic Zc, forward (Pf) and backward (Pb) wave amplitudes and their ratio (Pb/Pf = reflection magnitude) were calculated from central waveform. RESULTS After adjusting for age, BMI, and 24-h SBP, aortic Zc was higher in individuals with left ventricular hypertrophy (0.230 ± 0.09 vs. 0.205 ± 0.07 arbitrary units, P = 0.04 in women; 0.232 ± 0.07 vs. 0.214 ± 0.06 arbitrary units, P < 0.05 in men). Women with left ventricular concentric remodeling had higher adjusted Zc (0.225 ± 0.08 vs. 0.203 ± 0.07 arbitrary units, P = 0.04), whereas men did not differ (0.218 ± 0.07 vs. 0.218 ± 0.07 arbitrary units, P = 0.64). After controlling for age, BMI, 24 h SBP, and other relevant variables, aortic Zc independently predicted left ventricular mass (β = 0.14, P < 0.05) and relative wall thickness (β = 0.21, P < 0.01) in women, and left ventricular mass in men (β = 0.11, P < 0.05), whereas other arterial function parameters had no independent relation with left ventricular mass or geometry. CONCLUSION Aortic Zc has a significant association with left ventricular mass and a sex-specific one with left ventricular concentric geometry in hypertension. These effects are independent from, and additional to, those of 24 h SBP.
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Alter P. RE: Relation of Late Gadolinium Enhancement to Increased Ventricular Wall Stress in Dilated Cardiomyopathy. Korean J Radiol 2016; 17:171-2. [PMID: 26798231 PMCID: PMC4720806 DOI: 10.3348/kjr.2016.17.1.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 10/01/2015] [Indexed: 12/04/2022] Open
Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg 35033, Germany
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Wall stress determines systolic and diastolic function — Characteristics of heart failure. Int J Cardiol 2016; 202:685-93. [PMID: 26454537 DOI: 10.1016/j.ijcard.2015.09.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 09/19/2015] [Indexed: 11/23/2022]
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Scardulla F, Rinaudo A, Pasta S, Scardulla C. Evaluation of ventricular wall stress and cardiac function in patients with dilated cardiomyopathy. Proc Inst Mech Eng H 2015; 230:71-4. [DOI: 10.1177/0954411915617984] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
Dilated cardiomyopathy is a heart disease characterized by both left ventricular dilatation and left ventricular systolic dysfunction, leading to cardiac remodeling and ultimately heart failure. We aimed to investigate the effect of dilated cardiomyopathy on the pump performance and myocardial wall mechanics using patient-specific finite element analysis. Results evinced pronounced end-systolic wall stress on left ventricular wall of patients with dilated cardiomyopathy as compared to that of normal hearts. In dilated cardiomyopathy, both end-diastolic and end-systolic pressure–volume relationships of left ventricle and right ventricle were shifted to the right compared to controls, suggesting reduced myocardial contractility. We hereby propose that finite element analysis represents a useful tool to assess the myocardial wall stress and cardiac work, which are responsible for progressive left ventricular deterioration and poor clinical course.
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Affiliation(s)
| | | | - Salvatore Pasta
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, ISMETT, Palermo, Italy
- Fondazione Ri.MED, Palermo, Italy
| | - Cesare Scardulla
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, ISMETT, Palermo, Italy
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Alter P, van de Sand K, Nell C, Figiel JH, Greulich T, Vogelmeier CF, Koczulla AR. Airflow limitation in COPD is associated with increased left ventricular wall stress in coincident heart failure. Respir Med 2015; 109:1131-7. [DOI: 10.1016/j.rmed.2015.07.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 01/08/2023]
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Kozakova M, Palombo C, Morizzo C, Højlund K, Hatunic M, Balkau B, Nilsson PM, Ferrannini E. Obesity and carotid artery remodeling. Nutr Diabetes 2015; 5:e177. [PMID: 26302064 PMCID: PMC4558557 DOI: 10.1038/nutd.2015.26] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 06/18/2015] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/OBJECTIVE The present study tested the hypothesis that obesity-related changes in carotid intima-media thickness (IMT) might represent not only preclinical atherosclerosis but an adaptive remodeling meant to preserve circumferential wall stress (CWS) in altered hemodynamic conditions characterized by body size-dependent increase in stroke volume (SV) and blood pressure (BP). SUBJECTS/METHODS Common carotid artery (CCA) luminal diameter (LD), IMT and CWS were measured in three different populations in order to study: (A) cross-sectional associations between SV, BP, anthropometric parameters and CCA LD (266 healthy subjects with wide range of body weight (24-159 kg)); (B) longitudinal associations between CCA LD and 3-year IMT progression rate (ΔIMT; 571 healthy non-obese subjects without increased cardiovascular (CV) risk); (C) the impact of obesity on CCA geometry and CWS (88 obese subjects without CV complications and 88 non-obese subjects matched for gender and age). RESULTS CCA LD was independently associated with SV that was determined by body size. In the longitudinal study, baseline LD was an independent determinant of ΔIMT, and ΔIMT of subjects in the highest LD quartile was significantly higher (28±3 μm) as compared with those in the lower quartiles (8±3, 16±4 and 16±3 μm, P=0.001, P<0.05 and P=0.01, respectively). In addition, CCA CWS decreased during the observational period in the highest LD quartile (from 54.2±8.6 to 51.6±7.4 kPa, P<0.0001). As compared with gender- and age-matched lean individuals, obese subjects had highly increased CCA LD and BP (P<0.0001 for both), but only slightly higher CWS (P=0.05) due to a significant increase in IMT (P=0.005 after adjustment for confounders). CONCLUSIONS Our findings suggest that in obese subjects, the CCA wall thickens to compensate the luminal enlargement caused by body size-induced increase in SV, and therefore, to normalize the wall stress. CCA diameter in obesity could represent an additional biomarker, depicting the impact of altered hemodynamics on arterial wall.
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Affiliation(s)
- M Kozakova
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - C Palombo
- Department of Surgical, Medical, Molecular Pathology and Critical Care, University of Pisa, Pisa, Italy
| | - C Morizzo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - K Højlund
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - M Hatunic
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B Balkau
- INSERM, CESP, Center for Research in Epidemiology and Population Health, U1018, University Paris Sud, Villejuif, France
| | - P M Nilsson
- Department of Clinical Science, Lund University, Skåne University Hospital, Malmö, Sweden
| | - E Ferrannini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Yoon JH, Son JW, Chung H, Park CH, Kim YJ, Chang HJ, Hong GR, Kim TH, Ha JW, Choi BW, Rim SJ, Chung N, Choi EY. Relationship between Myocardial Extracellular Space Expansion Estimated with Post-Contrast T1 Mapping MRI and Left Ventricular Remodeling and Neurohormonal Activation in Patients with Dilated Cardiomyopathy. Korean J Radiol 2015; 16:1153-62. [PMID: 26355278 PMCID: PMC4559787 DOI: 10.3348/kjr.2015.16.5.1153] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 06/30/2015] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Post-contrast T1 values are closely related to the degree of myocardial extracellular space expansion. We determined the relationship between post-contrast T1 values and left ventricular (LV) diastolic function, LV remodeling, and neurohormonal activation in patients with dilated cardiomyopathy (DCM). MATERIALS AND METHODS Fifty-nine patients with DCM (mean age, 55 ± 15 years; 41 males and 18 females) who underwent both 1.5T magnetic resonance imaging and echocardiography were enrolled. The post-contrast 10-minute T1 value was generated from inversion time scout images obtained using the Look-Locker inversion recovery sequence and a curve-fitting algorithm. The T1 sample volume was obtained from three interventricular septal points, and the mean T1 value was used for analysis. The N-Terminal pro-B-type natriuretic peptide (NT-proBNP) level was measured in 40 patients. RESULTS The mean LV ejection fraction was 24 ± 9% and the post-T1 value was 254.5 ± 46.4 ms. The post-contrast T1 value was significantly correlated with systolic longitudinal septal velocity (s'), peak late diastolic velocity of the mitral annulus (a'), the diastolic elastance index (Ed, [E/e']/stroke volume), LV mass/volume ratio, LV end-diastolic wall stress, and LV end-systolic wall stress. In a multivariate analysis without NT-proBNP, T1 values were independently correlated with Ed (β = -0.351, p = 0.016) and the LV mass/volume ratio (β = 0.495, p = 0.001). When NT-proBNP was used in the analysis, NT-proBNP was independently correlated with the T1 values (β = -0.339, p = 0.017). CONCLUSION Post-contrast T1 is closely related to LV remodeling, diastolic function, and neurohormonal activation in patients with DCM.
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Affiliation(s)
- Ji Hyun Yoon
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jung Woo Son
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hyemoon Chung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Chul Hwan Park
- Department of Radiology, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Young-Jin Kim
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Hyuk-Jae Chang
- Department of Radiology, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Geu-Ru Hong
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Tae Hoon Kim
- Department of Radiology, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Jong-Won Ha
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Byoung Wook Choi
- Department of Radiology, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Se-Joong Rim
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Namsik Chung
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
| | - Eui-Young Choi
- Cardiology Division, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 06273, Korea
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Alter P, Glück T, Figiel JH, Koczulla AR, Vogelmeier CF, Rupp H. From Heart Failure to Highly Unsaturated Fatty Acid Deficiency and Vice Versa: Bidirectional Heart and Liver Interactions. Can J Cardiol 2015; 32:217-25. [PMID: 26277086 DOI: 10.1016/j.cjca.2015.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In several trials, beneficial prognostic effects of highly unsaturated fatty acids (HUFAs) in heart failure were shown. Because other studies showed no incremental benefit in nearly preserved cardiac function, the question arises, whether the degree of cardiac dysfunction is involved. It is hypothesized that increased left ventricular (LV) wall stress affects the endogenous hepatic HUFA metabolism, which in turn exhibits adverse cardiac consequences. METHODS Cardiac magnetic resonance imaging was performed in 30 patients with suspected cardiomyopathy. The serum fatty acid profile was assessed using gas chromatography/mass spectrometry. RESULTS Docosahexaenoic acid (DHA; P = 0.002) and eicosapentaenoic acid (EPA; by trend) levels were decreased in patients with reduced LV ejection fraction (≤ 50%) or LV dilatation (≥ 90 mL/m(2)). Decreased DHA (P = 0.003) and EPA (P = 0.022) levels were associated with a reduced LV ejection fraction. Decreased DHA level was correlated with increased end-diastolic (P = 0.047) and end-systolic LV wall stress (P = 0.001). Pseudocholinesterase activity was inversely correlated with end-diastolic (P = 0.020) and end-systolic LV wall stress (P = 0.025). CONCLUSIONS DHA level was significantly reduced in heart failure. Similar, but less pronounced effects were found for EPA and arachidonic acid by trend. Increased LV wall stress was correlated with a reduced DHA level. Increased LV wall stress exhibits various adverse consequences (eg, increased oxygen consumption, favouring of arrhythmias, and an unfavourable remodelling). The increase of wall stress was paralleled by reduced HUFA level. Increased LV wall stress was correlated with reduced pseudocholinesterase, which is suggestive of hepatic congestion (ie, a cardiohepatic syndrome, involved in the altered fatty acid profile in heart failure) and has major consequences regarding the dose-efficacy of HUFA treatment.
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Affiliation(s)
- Peter Alter
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany.
| | - Tobias Glück
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany
| | - Jens H Figiel
- Department of Radiology, University of Marburg, Marburg, Germany
| | - A Rembert Koczulla
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany
| | - Claus F Vogelmeier
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany
| | - Heinz Rupp
- Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany
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Alter P, Vogelmeier CF, Koczulla AR. Late Gadolinium Enhancement in Sarcoidosis. Chest 2015; 147:e118. [DOI: 10.1378/chest.14-2740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Prognostic value of late gadolinium enhancement in cardiomyopathy: Causative risk factor or surrogate marker? Int J Cardiol 2015; 180:111-3. [DOI: 10.1016/j.ijcard.2014.11.173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/23/2014] [Indexed: 02/02/2023]
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Alter P. Increased ventricular wall stress and late gadolinium enhancement in Takotsubo cardiomyopathy. Int J Cardiol 2014; 174:804-5. [DOI: 10.1016/j.ijcard.2014.04.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/12/2014] [Indexed: 11/30/2022]
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Alter P, Luetteken L, Nell C, Haid D, Kehr K, Greulich T, Apelt S, Langenhan K, Hohmann C, Vogelmeier CF, Koczulla AR. Exercise training leads to physiological left ventricular hypertrophy in COPD. Int J Cardiol 2014; 174:156-7. [PMID: 24726167 DOI: 10.1016/j.ijcard.2014.03.160] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- P Alter
- University of Marburg, Internal Medicine, Cardiology, Germany.
| | - L Luetteken
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - C Nell
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - D Haid
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - K Kehr
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - T Greulich
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - S Apelt
- University of Marburg, Physiotherapy, Germany
| | - K Langenhan
- University of Marburg, Physiotherapy, Germany
| | - C Hohmann
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - C F Vogelmeier
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany
| | - A R Koczulla
- University of Marburg, Internal Medicine, Pulmonary and Critical Care Medicine, Member of the German Center for Lung Reserach (DZL), Germany.
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Alter P, Figiel JH, Rominger MB. Increased ventricular wall stress and late gadolinium enhancement in Takotsubo cardiomyopathy. Int J Cardiol 2014; 172:e184-6. [DOI: 10.1016/j.ijcard.2013.12.139] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 12/23/2013] [Indexed: 10/25/2022]
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Mirelis JG, Paetsch I, Jahnke C, Ibañez B, Fleck E, Alonso-Pulpon LA, Fuster V, Gebker R. Impact of diastolic wall stress on the diagnostic value of visually interpreted dobutamine stress MR imaging. Int J Cardiol 2014; 172:e39-42. [PMID: 24433613 DOI: 10.1016/j.ijcard.2013.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 12/21/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Jesus G Mirelis
- German Heart Institute, Berlin, Germany; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Puerta de Hierro Majadahonda University Hospital, Madrid, Spain.
| | - Ingo Paetsch
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Cosima Jahnke
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Borja Ibañez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Valentín Fuster
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Alter P, Rupp H. Treatment of sleep-disordered breathing in heart failure: reduction of high ventricular wall stress should be a diagnostic and therapeutic target. Eur J Heart Fail 2014; 14:1189. [DOI: 10.1093/eurjhf/hfs131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Peter Alter
- Internal Medicine-Cardiology; University of Marburg; Baldingerstrasse D-35033 Marburg Germany
| | - Heinz Rupp
- Internal Medicine-Cardiology; University of Marburg; Germany
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Aggarwal NR, Peterson TJ, Young PM, Araoz PA, Glockner J, Mankad SV, Williamson EE. Unveiling nonischemic cardiomyopathies with cardiac magnetic resonance. Expert Rev Cardiovasc Ther 2014; 12:217-39. [PMID: 24417294 DOI: 10.1586/14779072.2014.876900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiomyopathy is defined as a heterogeneous group of myocardial disorders with mechanical or electrical dysfunction. Identification of the etiology is important for accurate diagnosis, treatment and prognosis, but continues to be challenging. The ability of cardiac MRI to non-invasively obtain 3D-images of unparalleled resolution without radiation exposure and to provide tissue characterization gives it a distinct advantage over any other diagnostic tool used for evaluation of cardiomyopathies. Cardiac MRI can accurately visualize cardiac morphology and function and also help identify myocardial edema, infiltration and fibrosis. It has emerged as an important diagnostic and prognostic tool in tertiary care centers for work up of patients with non-ischemic cardiomyopathies. This review covers the role of cardiac MRI in evaluation of nonischemic cardiomyopathies, particularly in the context of other diagnostic and prognostic imaging modalities.
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Affiliation(s)
- Niti R Aggarwal
- Department of Internal, Division of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
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Alter P. Letter by Alter regarding article, "Myocardial fibrosis as a key determinant of left ventricular remodeling in idiopathic dilated cardiomyopathy: a contrast-enhanced cardiovascular magnetic study". Circ Cardiovasc Imaging 2013; 6:e77. [PMID: 24254487 DOI: 10.1161/circimaging.113.001204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Alter
- Department of Internal Medicine-Cardiology, University of Marburg, Marburg, Germany
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Abstract
Although echocardiography remains the standard diagnostic tool for identifying pericardial diseases, procedures with better delineation of morphology and heart function are often required. The pericardium consists of an inner visceral (epicardium) and outer parietal layer (pericardium), which constitute for the pericardial cavity. Pericardial effusion can occur as transudate, exudate, pyopneumopericardium, or hemopericardium. Potential causes are inflammatory processes, that is, pericarditis due to autoimmune or infective reasons, neoplasms, irradiation, or systemic disorders, chronic renal failure, endocrine, or metabolic diseases. Pericardial fat can mimic pericardial effusion. Using various image-acquisition sequences, MRI allows identifying and separating fluid and solid structures. Fast spin-echo T1-weighted sequences with black-blood preparation are favourably used for morphological evaluation. Fast spin-echo T2-weighted sequences, particularly with fat saturation, and short-tau inversion-recovery sequences are useful to visualize oedema and inflammation. For further tissue characterization, delayed inversion-recovery imaging is used. Therefore, image acquisition is performed at 5-20 min subsequent to contrast agent administration, the so-called technique of late gadolinium enhancement. Ventricular volumes and myocardial mass can be assessed accurately by steady-state free-precession sequences, which is required to measure cardiac function and ventricular wall stress. Constrictive pericarditis usually results from chronic inflammatory processes leading to increased stiffness, which impedes the slippage of both pericardial layers and thereby the normal cardiac filling. CT imaging can favourably assess pericardial calcification. Thus, MR and CT imaging allow a comprehensive delineation of the pericardium. Superior to echocardiography, both methods provide a larger field of view and depiction of the complete chest including abnormalities of the surrounding mediastinum and lungs. PET provides unique information on the in vivo metabolism of 18-fluorodeoxyglucose that can be superimposed on CT findings and is useful for identifying inflammatory processes or masses, for example neoplasms. These imaging techniques provide advanced information of anatomy and cardiac function to optimize the pericardial access, for example by the AttachLifter system, for diagnosis and treatment.
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Takaoka H, Funabashi N, Takahashi M, Uchimura Y, Sairaku A, Kobayashi Y. Left-atrial wall thickening may be an important-response in systemic hypertension as well as left-ventricular hypertrophy and more remarkable than left-ventricular diastolic dysfunction and left-atrial enlargement. Int J Cardiol 2013; 168:598-600. [PMID: 23452886 DOI: 10.1016/j.ijcard.2013.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 01/18/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, Chiba 260-8670, Japan
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Current World Literature. Curr Opin Cardiol 2013; 28:369-79. [DOI: 10.1097/hco.0b013e328360f5be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rupp TP, Rupp KG, Alter P, Rupp H. Replacement of Reduced Highly Unsaturated Fatty Acids (HUFA Deficiency) in Dilative Heart Failure: Dosage of EPA/DHA and Variability of Adverse Peroxides and Aldehydes in Dietary Supplement Fish Oils. Cardiology 2013; 125:223-31. [DOI: 10.1159/000350656] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Accepted: 03/13/2013] [Indexed: 11/19/2022]
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Alter P, Heitmann J, Rupp H. From Sleep-Disordered Breathing to Increased Left Ventricular Wall Stress in Heart Failure. Chest 2012; 142:813. [DOI: 10.1378/chest.12-1057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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The missing link between heart failure and sleep disordered breathing: Increased left ventricular wall stress. Int J Cardiol 2012; 157:294-7. [DOI: 10.1016/j.ijcard.2012.03.123] [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: 03/06/2012] [Accepted: 03/10/2012] [Indexed: 12/23/2022]
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