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Osmancevic A, Allison M, Miljkovic I, Vella CA, Ouyang P, Trimpou P, Daka B. Levels of Sex Hormones and Abdominal Muscle Composition in Men from The Multi-Ethnic Study of Atherosclerosis. Sci Rep 2024; 14:16114. [PMID: 38997435 PMCID: PMC11245501 DOI: 10.1038/s41598-024-66948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 07/05/2024] [Indexed: 07/14/2024] Open
Abstract
Information on the associations of testosterone levels with abdominal muscle volume and density in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. Therefore, this study aimed to investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Conducted as a cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis, our analyses focused on a community-based sample of 907 men aged 45-84 years, with 878 men having complete data. CT scans of the abdomen were interrogated for muscle characteristics, and multivariable linear regressions were used to test the associations. After adjustment for relevant factors, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.74, 0.1-3.4, and 1.84, 0.4-3.3, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0-0.6, and - 0.33, - 0.6 to - 0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.Clinical Trial: NCT00005487.
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Grants
- 75N92020D00005 NHLBI NIH HHS
- N01HC95160 NHLBI NIH HHS
- N01HC95163 NHLBI NIH HHS
- UL1-TR-000040, UL1-TR-001079, and UL1-TR-001420 NCATS NIH HHS
- N01HC95168 NHLBI NIH HHS
- N01HC95165 NHLBI NIH HHS
- N01HC95159 NHLBI NIH HHS
- 75N92020D00007 NHLBI NIH HHS
- HHSN268201500003I NHLBI NIH HHS
- N01HC95167 NHLBI NIH HHS
- UL1 TR000040 NCATS NIH HHS
- 75N92020D00002 NHLBI NIH HHS
- HHSN268201500003C NHLBI NIH HHS
- UL1 TR001079 NCATS NIH HHS
- ALFGBG-966255 VGR Regional Research and Development Council Grants
- 75N92020D00001 NHLBI NIH HHS
- N01HC95169 NHLBI NIH HHS
- 75N92020D00001, HHSN268201500003I, N01-HC-95159, 75N92020D00005, N01-HC-95160, 75N92020D00002, N01-HC-95161, 75N92020D00003, N01-HC-95162, 75N92020D00006, N01-HC-95163, 75N92020D00004, N01-HC-95164, 75N92020D00007, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168 and N01-HC-95169 NHLBI NIH HHS
- N01HC95164 NHLBI NIH HHS
- N01HC95162 NHLBI NIH HHS
- 75N92020D00003 NHLBI NIH HHS
- N01HC95161 NHLBI NIH HHS
- UL1 TR001420 NCATS NIH HHS
- 75N92020D00004 NHLBI NIH HHS
- 75N92020D00006 NHLBI NIH HHS
- N01HC95166 NHLBI NIH HHS
- The Local Research and Development Council Göteborg och Södra Bohuslän
- National Heart, Lung, and Blood Institute
- National Center for Advancing Translational Sciences
- University of Gothenburg
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Affiliation(s)
- Amar Osmancevic
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Matthew Allison
- Division of Preventive Medicine, School of Medicine, UC San Diego, San Diego, CA, USA
| | - Iva Miljkovic
- Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chantal A Vella
- Department of Movement Sciences, University of Idaho, Moscow, ID, USA
| | - Pamela Ouyang
- Institute for Clinical and Translational Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Penelope Trimpou
- Department of Endocrinology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Bledar Daka
- General Practice / Family Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Osmancevic A, Allison M, Miljkovic I, Vella CA, Ouyang P, Trimpou P, Daka B. Sex Hormones and Abdominal Muscle Area and Radiodensity in Men: The Multi-Ethnic Study of Atherosclerosis. RESEARCH SQUARE 2024:rs.3.rs-3909259. [PMID: 38410430 PMCID: PMC10896404 DOI: 10.21203/rs.3.rs-3909259/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Information on the associations of testosterone levels with abdominal muscle volume and quality in men is limited, while the role of estradiol and SHBG on these muscle characteristics are unclear. To investigate the association between fasting serum sex hormones and CT-derived abdominal muscle area and radiodensity in adult men. Cross sectional observational study using data from the Multi-Ethnic Study of Atherosclerosis. A community-based sample of 907 men aged 45-84 years; 878 men with complete data were included in the analysis. CT scans of the abdomen were interrogated for muscle characteristics. Multivariable linear regressions were used to test the associations. After adjustment, higher levels of both total testosterone and estradiol were associated with higher abdominal muscle area (1.79, 0.1-3.4, & 1.79, 0.4-3.2, respectively). In the final analyses, levels of total testosterone showed a positive association, while an inverse relationship was observed for SHBG with abdominal muscle radiodensity (0.3, 0.0-0.6, & -0.34, -0.6 - -0.1, respectively). Our results indicate a complex association between sex hormones and abdominal muscle characteristics in men. Specifically, total testosterone and estradiol were associated with abdominal muscle area, while only total testosterone was associated with muscle radiodensity and SHBG was inversely associated with muscle radiodensity.
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Husain-Syed F, DiFrancesco MF, Deo R, Barr RG, Scialla JJ, Bluemke DA, Kronmal RA, Lima JAC, Praestgaard A, Tracy RP, Shlipak M, Kawut SM, Kim JS. Associations between eGFR and albuminuria with right ventricular measures: the MESA-Right Ventricle study. Clin Kidney J 2023; 16:1508-1520. [PMID: 37664568 PMCID: PMC10469092 DOI: 10.1093/ckj/sfad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Indexed: 09/05/2023] Open
Abstract
Background Chronic kidney disease (CKD) is associated with an increased risk of pulmonary hypertension, which may lead to right ventricular (RV) pressure overload and RV dysfunction. However, the presence of subclinical changes in RV structure or function in early CKD and the influence of these changes on mortality are not well studied. We hypothesized that early CKD, as indicated by elevated albuminuria or mild reductions in estimated glomerular filtration rate (eGFR), is associated with greater RV dilation and RV mass. Methods We included 4063 participants (age 45-84 years) without baseline clinical cardiovascular disease from the Multi-Ethnic Study of Atherosclerosis. The associations of baseline creatinine-cystatin C-based eGFR and albuminuria with cardiac magnetic resonance-derived RV measures (2000-02) were examined cross-sectionally with linear regression models. Cox regression models were used to examine whether RV parameters modified the associations of eGFR and albuminuria with all-cause mortality. Results Participants with reductions in eGFR primarily within the 60-89 mL/min/1.73 m2 category had smaller RV end-diastolic and end-systolic volumes and stroke volume (all adjusted P-trends <.001) than those with eGFR ≥90 mL/min/1.73 m2, an association that was predominantly seen in participants with albuminuria below 30 mg/g creatinine. Albuminuria was more strongly associated with death among those with lower RV volumes (P-values for interaction <.03). Conclusions Among community-dwelling adults, reductions in eGFR primarily within the normal range were associated with smaller RV volumes and the association of albuminuria with worse survival was stronger among those with smaller RV volumes. Further studies are needed to elucidate the underlying mechanistic pathways that link kidney measures and RV morphology.
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Affiliation(s)
- Faeq Husain-Syed
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Giessen, Germany
| | - Matthew F DiFrancesco
- Department of Medicine, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
| | - Rajat Deo
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - R Graham Barr
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
| | - Julia J Scialla
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard A Kronmal
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA
| | - Joao A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Russell P Tracy
- Department of Pathology and Laboratory Medicine and Department of Biochemistry, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Michael Shlipak
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - John S Kim
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA, USA
- Department of Medicine and Department of Epidemiology, Columbia University Medical Center, New York, NY, USA
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Balci K, Erbay İ, Demirkan B, Balci MM, Temizhan A. The association of hemodynamic markers of right ventricular dysfunction with SII index and clinical outcomes in reduced ejection fraction heart failure. Medicine (Baltimore) 2023; 102:e34809. [PMID: 37653803 PMCID: PMC10470776 DOI: 10.1097/md.0000000000034809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/02/2023] Open
Abstract
Heart failure (HF) is a clinical syndrome with various etiologies and presentations. The role of the inflammatory pathway in HF prognosis is not fully understood. We investigated the association between the systemic immune-inflammation index (SII) and HF complicated by right ventricular dysfunction (RVD) and whether the SII is related to compromised hemodynamic volume status. A total of 235 patients with HF with reduced ejection fraction (HFrEF) were enrolled and divided into 2 groups according to the presence of RVD. The relationship between the SII score, hemodynamic parameters, and clinical endpoints was evaluated. Higher SII scores and neutrophil counts (P < .001 and P = .017, respectively) were observed in the RVD group (n = 120). In the high SII score group (≥590.4), hospitalization and the need for positive inotrope treatment were significantly higher (P = .026 and P = .009, respectively), and left ventricular ejection fraction (LVEF) was significantly lower (P = .015). In addition, in the high SII score group, right heart catheterization values, including cardiac output and index, were significantly impaired compared with those in the lower SII score group. There was a significant negative correlation between the SII score and the LVEF, cardiac output, and cardiac index in the correlation analyses. A significant relationship was observed between indirect inflammation and RVD in patients with HFrEF. The hemodynamic volume status and functional capacity were impaired in patients with high SII scores. These results indicated that advanced HF with worse outcomes may be related to the inflammatory process.
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Tadic M, Cuspidi C. Right Ventricle in Arterial Hypertension: Did We Forget Something? J Clin Med 2022; 11:6257. [PMID: 36362485 PMCID: PMC9655282 DOI: 10.3390/jcm11216257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 08/30/2023] Open
Abstract
Right ventricular remodeling has been neglected in patients with arterial hypertension as all studies have concentrated on the left ventricle and left atrial-ventricular and ventricular-arterial coupling. The development of novel imaging techniques has revealed significant impairment in the RV structure, systolic and diastolic function, and, afterwards, RV longitudinal mechanics. However, these changes are subclinical and can be detected only after comprehensive imaging analysis. The latest findings confirm the importance of RV hypertrophy, systolic, and diastolic dysfunction in the prediction of cardiovascular adverse events in the hypertensive population, representing an important clinical implication of these parameters. In clinical practice, 2D echocardiography is widely used for the evaluation of RV remodeling. However, existing techniques are largely underused and limited to a few basic parameters (RV thickness and TAPSE), which are not nearly enough for a detailed assessment of RV remodeling. In addition, 3D echocardiography provides the possibility of accurate evaluation of RV volumes and ejection fraction, which are comparable with results obtained by cardiac magnetic resonance (CMR)-a gold standard for the evaluation of the RV. The use of 3D echocardiography is limited due to its low availability, the lack of adequate software necessary for the calculation of results, and the necessity for a higher level of expertise. CMR provides all information required for a detailed assessment of RV structural, functional, and mechanical remodeling, and it is considered the reference method for this type of evaluation. Furthermore, it is the only technique that may provide tissue characterization and evaluation of the interstitial space, which is essential for hypertensive heart disease. The aim of this review is to provide the current level of evidence regarding RV remodeling in patients with arterial hypertension evaluated with different imaging techniques and various parameters from each method.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy
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Tie H, Shi R, Welp H, Martens S, Li Z, Sindermann J, Martens S. C-reactive protein predicts early clinical outcomes and long-term mortality after left ventricular assisted device. Int J Artif Organs 2022; 45:497-505. [PMID: 35388731 DOI: 10.1177/03913988221088614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Left ventricular assist device (LVAD) implantation has become a reliable therapeutic strategy in patients with advanced heart failure. C-reactive protein (CRP) is a well-established biomarker of inflammation. This study aims to determine the prognostic effect of CRP level on clinical outcomes of patients who undergo LVAD implantation. METHODS This is a single-center, observational, retrospective study. One hundred fifty-three patients who received continuous-flow LVAD implantation were included and were divided into two groups of high (>3.9 mg/dL) versus low CRP (⩽3.9 mg/dL). RESULTS Patients with high pre-implant CRP levels were prone to severe preoperative clinical conditions and complicated intraoperative procedures. Compared with patients in the low CRP group, elevated pre-implant CRP was associated with increased hospital mortality (31.4% vs 8.4%, p < 0.001), postoperative right ventricular failure (47.1% vs 30.1%, p = 0.031), right ventricular assist device use (34.3% vs 16.9%, p = 0.013), AKI (70% vs 51.8%, p = 0.022) and significantly prolonged duration of postoperative mechanical ventilation and intensive care unit length of stay. Univariate Cox regression showed that high pre-implant CRP was significantly associated with increased risk of long-term mortality (Hazard ratio (HR) 2.632 95%; CI: 1.657-4.183, p < 0.001), and multivariable Cox regression also revealed the higher risk of long-term mortality in patients with elevated pre-implant CRP (HR, 2.848 95%CI: 1.659-4.888, p < 0.001). These results remained stable when treating pre-implant CRP as a continuous variable. Besides, the prognostic effect of post-implant CRP was also observed. CONCLUSIONS CRP is a reliable risk-stratification biomarker in patients receiving continuous-flow -LVAD and can be used as a predictor for short- and long-term outcomes.
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Affiliation(s)
- Hongtao Tie
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Shi
- Service de médecine intensive - réanimation, Hôpitaux universitaires Paris-Saclay, Hôpital de Bicêtre, APHP, Le Kremlin-Bicêtre, France
- Inserm UMR S_999, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Henryk Welp
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sven Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Zhenhan Li
- Department of Anaesthesiology, Intensive Care Medicine and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Jürgen Sindermann
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
| | - Sabrina Martens
- Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany
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7
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Korotaeva AA, Samoilova EV, Mindzaev DR, Nasonova SN, Zhirov IV, Tereschenko SN. Pro-inflammatory cytokines in chronic cardiac failure: state of problem. TERAPEVT ARKH 2021; 93:1389-1394. [DOI: 10.26442/00403660.2021.11.201170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/28/2022] [Indexed: 01/09/2023]
Abstract
Systemic inflammation is characterized by the induction of pro-inflammatory cytokines, the increased level of which in the blood of patients with chronic heart failure (CHF) correlates with unfavorable clinical outcomes. However, it is unclear whether pro-inflammatory cytokines are the cause or the consequence of the disease progression. CHF with preserved ejection fraction and CHF with reduced ejection fraction demonstrate different inflammatory features, which suggests different degrees of pro-inflammatory pathway activation. The review deals with participation of pro-inflammatory cytokines in pathophysiological processes of CHF development, emphasizing the role of interleukin-6 activation and the effects of accompanying diseases on the course of systemic inflammation. The search for new approaches to prevention and therapy of CHF remains actual. The review presents the results of clinical trials of targeted anti-cytokine therapy which have revealed difficulties in controlling inflammation under the conditions of CHF. Identification of specific pro-inflammatory pathways in CHF pathogenesis will allow one to control inflammatory cascades, thus providing a prospective therapeutic strategy.
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Erdoğan M, Kaya Kalem A, Öztürk S, Erdöl MA, Kayaaslan B, Özbebek YE, Güner R. Interleukin-6 level is an independent predictor of right ventricular systolic dysfunction in patients hospitalized with COVID-19. Anatol J Cardiol 2021; 25:555-564. [PMID: 34369883 PMCID: PMC8357443 DOI: 10.5152/anatoljcardiol.2021.24946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Cytokine storm with elevated levels of multiple proinflammatory cytokines and inflammatory system activation underlie the pathogenesis of coronavirus disease 2019 (COVID-19). In this study, we aimed to investigate whether increased interleukin (IL)-6 levels can predict right ventricular (RV) systolic impairment in patients hospitalized with COVID-19. METHODS This prospective, observational study included 100 consecutive patients hospitalized with mild and moderate COVID-19. All the patients underwent chest computerized tomography, detailed laboratory tests including IL-6, and two dimensional (2D) transthoracic echocardiography (TTE) with assessment of 2D conventional and Doppler echocardiography parameters and RV systolic functions. RESULTS After the elimination of six patients with exclusion criteria, the remaining patients were classified into two groups, namely normal RV systolic functions (n=60) and impaired RV systolic functions (n=34). IL-6 levels were significantly higher in patients with impaired RV systolic functions than in those with normal RV systolic functions (20.3, 4.6, p<0.001, respectively). Tricuspid annular plane systolic excursion and RV derived tissue Doppler imaging (TDI) S' measurements were similar between the two groups. RV fractional area change was significantly lower, and RV TDI derived index of myocardial performance was significantly higher in patients with impaired RV systolic functions. In multivariate analysis, IL-6 levels independently predicted deterioration in RV systolic function at a significant level (odds ratio: 1.12, 95% confidence interval: 1.04-1.20, p=0.003). CONCLUSION IL-6 is an independent predictor of RV systolic impairment in patients hospitalized with mild and moderate COVID-19 suggesting a possible pathogenetic mechanism. IL-6 levels can be used to predict RV systolic impairment in patients suffering from this infection.
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Affiliation(s)
- Mehmet Erdoğan
- Department of Cardiology, Ankara Yıldırım Beyazıt University; Ankara-Turkey
- Department of Cardiology, Ministry of Health, Ankara City Hospital; Ankara-Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Selçuk Öztürk
- Department of Cardiology, Faculty of Medicine, Yozgat Bozok University; Yozgat-Turkey
| | - Mehmet Akif Erdöl
- Department of Cardiology, Ministry of Health, Ankara City Hospital; Ankara-Turkey
| | - Bircan Kayaaslan
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Yunus Emre Özbebek
- Department of Cardiology, Ankara Yıldırım Beyazıt University; Ankara-Turkey
| | - Rahmet Güner
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University; Ankara-Turkey
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Shabani M, Bakhshi H, Ostovaneh MR, Ma X, Wu CO, Ambale-Venkatesh B, Blaha MJ, Allison MA, Budoff MJ, Cushman M, Tracy RP, Herrington DM, Szklo M, Cox C, Bluemke DA, Lima JAC. Temporal change in inflammatory biomarkers and risk of cardiovascular events: the Multi-ethnic Study of Atherosclerosis. ESC Heart Fail 2021; 8:3769-3782. [PMID: 34240828 PMCID: PMC8497383 DOI: 10.1002/ehf2.13445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/30/2022] Open
Abstract
Aims Little is known about the association of temporal changes in inflammatory biomarkers and the risk of death and cardiovascular diseases. We aimed to evaluate the association between temporal changes in C‐reactive protein (CRP), fibrinogen, and interleukin‐6 (IL‐6) and risk of heart failure (HF), cardiovascular disease (CVD), and all‐cause mortality in individuals without a history of prior CVD. Methods and results Participants from the Multi‐Ethnic Study of Atherosclerosis (MESA) cohort with repeated measures of inflammatory biomarkers and no CVD event prior to the second measure were included. Quantitative measures, annual change, and biomarker change categories were used as main predictors in Cox proportional hazard models stratified based on sex and statin use. A total of 2258 subjects (50.6% female, mean age of 62 years) were studied over an average of 8.1 years of follow‐up. The median annual decrease in CRP levels was 0.08 mg/L. Fibrinogen and IL‐6 levels increased by a median of 30 mg/dL and 0.24 pg/mL annually. Temporal changes in CRP were positively associated with HF risk among females (HR: 1.18 per each standard deviation increase, P < 0.001) and other CVD in both female (HR: 1.12, P = 0.004) and male participants (HR: 1.24, P = 0.003). The association of CRP change with HF and other CVD was consistently observed in statin users (HR: 1.23 per SD increase, P = 0.001 for HF and HR: 1.19 per SD increase, P < 0.001 for other CVD). There were no significant associations between temporal changes of fibrinogen or IL‐6 with HF or other CVD. Men with sustained high values of IL‐6 had a 2.3‐fold higher risk of all‐cause mortality (P < 0.001) compared with those with sustained low values. Conclusions Temporal change in CRP is associated with HF only in women and statin users, and other CVD in both women and men, and statin users. Annual changes in fibrinogen and IL‐6 were not predictive of cardiovascular outcomes in either sex.
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Affiliation(s)
- Mahsima Shabani
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Hooman Bakhshi
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Inova Heart and Vascular Institute, Falls Church, VA, USA
| | - Mohammad R Ostovaneh
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA.,Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Xiaoyang Ma
- Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
| | - Colin O Wu
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Michael J Blaha
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA
| | - Matthew A Allison
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Mary Cushman
- Departments of Medicine and Pathology, University of Vermont, Burlington, VT, USA
| | - Russell P Tracy
- Departments of Pathology & Laboratory Medicine and Biochemistry, Larner College of Medicine at the University of Vermont, Colchester, VT, USA
| | - David M Herrington
- Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Moyses Szklo
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher Cox
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287-0409, USA
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10
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The prognostic importance of right ventricular remodeling and the circadian blood pressure pattern on the long-term cardiovascular outcome. J Hypertens 2021; 38:1525-1530. [PMID: 32371765 DOI: 10.1097/hjh.0000000000002432] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients. METHODS The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death). RESULTS During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events. CONCLUSION The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.
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11
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Mercurio V, Cuomo A, Naranjo M, Hassoun PM. Inflammatory Mechanisms in the Pathogenesis of Pulmonary Arterial Hypertension: Recent Advances. Compr Physiol 2021; 11:1805-1829. [PMID: 33792903 DOI: 10.1002/cphy.c200025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Inflammatory processes are increasingly recognized in the pathogenesis of the vascular remodeling that characterizes pulmonary arterial hypertension (PAH). Chronic inflammation may contribute to disease progression or serve as a biomarker of PAH severity. Furthermore, inflammatory pathways may represent possible therapeutic targets for novel PAH-specific drugs beyond the currently approved therapies targeting the endothelin, nitric oxide/cyclic GMP, and prostacyclin biological pathways. The main focus of this article is to provide recent advances in the understanding of the role of inflammatory pathways in the pathogenesis of PAH from preclinical studies and current clinical data supporting chronic inflammation in PAH patients and to discuss emerging therapeutic implications. © 2021 American Physiological Society. Compr Physiol 11:1805-1829, 2021.
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Affiliation(s)
- Valentina Mercurio
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Alessandra Cuomo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Mario Naranjo
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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12
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Nakanishi K, Daimon M, Yoshida Y, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Relation of Body Mass Index to Adverse Right Ventricular Mechanics. Am J Cardiol 2021; 144:137-142. [PMID: 33385349 DOI: 10.1016/j.amjcard.2020.12.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/13/2022]
Abstract
Although higher body mass index (BMI) is associated with adverse left ventricular morphology and functional remodeling, its possible association with right ventricular (RV) dysfunction has not been extensively evaluated. RV free wall longitudinal strain (RVLS) is emerging as an important tool to detect early RV dysfunction. This study aimed to investigate the independent effect of increased BMI on RVLS in a large sample of the general population without overt cardiac disease. We examined 1,085 participants (603 men, mean age 62 years) who voluntarily underwent an extensive cardiovascular health check-up. This included laboratory tests and speckle-tracking echocardiography to assess RVLS. The association between BMI and RVLS was determined by logistic regression analyses. The prevalence of abnormal RVLS (>-19.2%) was greatest in obese individuals (29.7%), followed by overweight (16.3%), and normal weight (10.6%, p <0.001). In multivariable analyses, BMI was significantly associated with abnormal RVLS (adjusted odds ratio [OR] = 1.07 per 1 kg/m2, p = 0.033) independent of traditional cardiovascular risk factors, pertinent laboratory and echocardiographic parameters including RV size and pulmonary artery systolic pressure. In subgroup analyses, BMI was significantly associated with abnormal RVLS in men (adjusted OR 1.10 per 1 kg/m2, p = 0.032) and younger (<65 years) participants (adjusted OR 1.13 per 1 kg/m2, p = 0.011), but not in women and the elderly. In a sample of the general population, higher BMI was independently associated with subclinical RV dysfunction. Furthermore, an increased BMI may carry different risk for impaired RVLS depending on the age and sex.
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13
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Murphy SP, Kakkar R, McCarthy CP, Januzzi JL. Inflammation in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:1324-1340. [PMID: 32192660 DOI: 10.1016/j.jacc.2020.01.014] [Citation(s) in RCA: 256] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/08/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
It has long been observed that heart failure (HF) is associated with measures of systemic inflammation. In recent years, there have been significant advancements in our understanding of how inflammation contributes to the pathogenesis and progression of HF. However, although numerous studies have validated the association between measures of inflammation and HF severity and prognosis, clinical trials of anti-inflammatory therapies have proven mostly unsuccessful. On this backdrop emerges the yet unmet goal of targeting precise phenotypes within the syndrome of HF; if such precise definitions can be realized, and with better understanding of the roles played by specific inflammatory mediators, the expectation is that targeted anti-inflammatory therapies may improve prognosis in patients whose HF is driven by inflammatory pathobiology. Here, the authors describe mechanistic links between inflammation and HF, discuss traditional and novel inflammatory biomarkers, and summarize the latest evidence from clinical trials of anti-inflammatory therapies.
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Affiliation(s)
- Sean P Murphy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Rahul Kakkar
- Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Cian P McCarthy
- Division of Cardiology, Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
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14
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Hołda MK, Stachowicz A, Suski M, Wojtysiak D, Sowińska N, Arent Z, Palka N, Podolec P, Kopeć G. Myocardial proteomic profile in pulmonary arterial hypertension. Sci Rep 2020; 10:14351. [PMID: 32873862 PMCID: PMC7462861 DOI: 10.1038/s41598-020-71264-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 07/31/2020] [Indexed: 01/04/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a rare, fatal, and incurable disorder. Although advances in the understanding of the PAH pathobiology have been seen in recent years, molecular processes underlying heart remodelling over the course of PAH are still insufficiently understood. Therefore, the aim of this study was to investigate myocardial proteomic profile of rats at different stages of monocrotaline-induced PAH. Samples of left and right ventricle (LV and RV) free wall collected from 32 Wistar rats were subjected to proteomic analysis using an isobaric tag for relative quantitation method. Hemodynamic parameters indicated development of mild elevation of pulmonary artery pressure in the early PAH group (27.00 ± 4.93 mmHg) and severe elevation in the end-stage PAH group (50.50 ± 11.56 mmHg). In early PAH LV myocardium proteins that may be linked to an increase in inflammatory response, apoptosis, glycolytic process and decrease in myocardial structural proteins were differentially expressed compared to controls. During end-stage PAH an increase in proteins associated with apoptosis, fibrosis and cardiomyocyte Ca2+ currents as well as decrease in myocardial structural proteins were observed in LV. In RV during early PAH, especially proteins associated with myocardial structural components and fatty acid beta-oxidation pathway were upregulated. During end-stage PAH significant changes in RV proteins abundance related to the increased myocardial structural components, intensified fibrosis and glycolytic processes as well as decreased proteins related to cardiomyocyte Ca2+ currents were observed. At both PAH stages changes in RV proteins linked to apoptosis inhibition were observed. In conclusion, we identified changes of the levels of several proteins and thus of the metabolic pathways linked to the early and late remodelling of the left and right ventricle over the course of monocrotaline-induced PAH to delineate potential therapeutic targets for the treatment of this severe disease.
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Affiliation(s)
- Mateusz K Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Kopernika 12, 31-034, Kraków, Poland. .,Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland. .,Division of Cardiovascular Sciences, The University of Manchester, Manchester, UK.
| | - Aneta Stachowicz
- Department of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Maciej Suski
- Department of Pharmacology, Jagiellonian University Medical College, Kraków, Poland
| | - Dorota Wojtysiak
- Department of Animal Genetics, Breeding and Ethology, University of Agriculture in Cracow, Kraków, Poland
| | - Natalia Sowińska
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Zbigniew Arent
- Center of Experimental and Innovative Medicine, University Center of Veterinary Medicine JU-AU, University of Agriculture in Cracow, Kraków, Poland
| | - Natalia Palka
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
| | - Grzegorz Kopeć
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, Kraków, Poland
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Abstract
Heart failure (HF) is the leading cause of morbidity and mortality in developed countries, and it is the primary cause of mortality in the elderly worldwide. The processes of inflammatory response activation, production and release of pro-inflammatory cytokines, activation of the complement system, synthesis of autoantibodies, and overexpression of Class II major histocompatibility complex molecules contribute to the HF development and progression. High levels of circulating cytokines correlate with the severity of HF, measured with the use of New York Heart Association's classification, and prognosis of the disease. In HF, there is an imbalance between pro-inflammatory and anti-inflammatory cytokines. Concentrations of several interleukins are increased in HF, including IL-1β, IL-6, IL-8, IL-9, IL-10, IL-13, IL-17, and IL-18, whereas the levels of IL-5, IL-7, or IL-33 are down-regulated. Concentrations of inflammatory mediators are associated with cardiac function and can be HF markers and predictors of adverse outcomes or mortality. This review presents the role of interleukins, which contribute to the HF initiation and progression, the importance of their pathways in transition from myocardial injury to HF, and the role of interleukins as markers of disease severity and outcome predictors.
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16
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Clonally selected primitive endothelial cells promote occlusive pulmonary arteriopathy and severe pulmonary hypertension in rats exposed to chronic hypoxia. Sci Rep 2020; 10:1136. [PMID: 31980720 PMCID: PMC6981224 DOI: 10.1038/s41598-020-58083-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 01/10/2020] [Indexed: 12/15/2022] Open
Abstract
One current concept suggests that unchecked proliferation of clonally selected precursors of endothelial cells (ECs) contribute to severe pulmonary arterial hypertension (PAH). We hypothesized that clonally selected ECs expressing the progenitor marker CD117 promote severe occlusive pulmonary hypertension (PH). The remodelled pulmonary arteries of PAH patients harboured CD117+ ECs. Rat lung CD117+ ECs underwent four generations of clonal expansion to enrich hyperproliferative ECs. The resulting clonally enriched ECs behaved like ECs, as measured by in vitro and in vivo angiogenesis assays. The same primitive ECs showed a limited ability for mesenchymal lineage differentiation. Endothelial differentiation and function were enhanced by blocking TGF-β signalling, promoting bone morphogenic protein (BMP) signalling. The transplantation of the EC clones caused arterio-occlusive PH in rats exposed to chronic hypoxia. These EC clones engrafted in the pulmonary arteries. Yet cessation of chronic hypoxia promoted lung cell apoptosis and resolution of vascular lesions. In conclusion, this is to the best of our knowledge, the first report that clonally enriched primitive ECs promote occlusive pulmonary arteriopathy and severe PH. These primitive EC clones further give rise to cells of endothelial and mesenchymal lineage as directed by BMP and TGF-β signaling.
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17
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Pauli N, Puchałowicz K, Kuligowska A, Krzystolik A, Dziedziejko V, Safranow K, Rać M, Chlubek D, Ewa Rać M. Associations between IL-6 and Echo-Parameters in Patients with Early Onset Coronary Artery Disease. Diagnostics (Basel) 2019; 9:E189. [PMID: 31739518 PMCID: PMC6963263 DOI: 10.3390/diagnostics9040189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the last two decades, many studies have investigated the association between interleukin 6 (IL-6) and pathogenesis and progression of coronary artery disease (CAD). Patients with CAD manifested at a young age are a particularly interesting group. They differ from older patients, not only in terms of the severity of coronary artery atherosclerosis, but also risk factor profiles, short- and long-term prognosis after myocardial infarction (MI). The role of IL-6 in younger patients with CAD is less well-known. Therefore, our study aimed to analyze the relationship between IL-6 level and other inflammations, atherosclerosis, and cardiac function parameters in early onset CAD patients. METHODS The study covered 100 patients with early onset CAD and a group of 50 healthy participants. Plasma levels of IL-6 and basic biochemical parameters, anthropometric, echocardiographic, and arteries Doppler ultrasound measurements were performed. RESULTS We did not observe a significant difference in IL-6 concentration in plasma between patients with early onset CAD and a control group, but IL-6 level was negatively correlated with echocardiographic measurements of ascending aorta diameter, left ventricular shortening fraction, and right ventricular end-diastolic diameter in our patients. CONCLUSIONS In patients with early onset CAD, plasma IL-6 level is associated with other inflammation parameters and with cardiac function, potentially contributing to right ventricular remodeling and left ventricular systolic dysfunction. This suggests possible prognostic benefits of long-time observation of IL-6 level after the acute coronary syndrome.
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Affiliation(s)
- Natalia Pauli
- Department of Cardiology, Regional Hospital, 66-400 Gorzow Wielkopolski, Poland;
| | - Kamila Puchałowicz
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
| | - Agnieszka Kuligowska
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
| | | | - Violetta Dziedziejko
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
| | - Michał Rać
- Department of Diagnostic Imaging and Interventional Radiology, Pomeranian Medical University, 71-252 Szczecin, Poland;
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
| | - Monika Ewa Rać
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, 70-111 Szczecin, Poland; (K.P.); (A.K.); (V.D.); (K.S.); (D.C.)
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18
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Interleukin-6 in pulmonary artery hypertension. J LAB MED 2019. [DOI: 10.1515/labmed-2018-0196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Interleukin (IL)-6 is a pleiotropic cytokine, playing an important role in various pathological conditions, such as inflammatory, infectious, and neoplastic disorders. The casual relationship between IL-6 levels and development of pulmonary artery hypertension (PAH) has been elusive. Based on comprehensive retrieval of pertinent literature of recent two decades, this article aims to give an overview of the impact of IL-6 on PAH development in view of both clinical and experimental aspects. Results showed that IL-6 was overexpressed in all types of PAH in both human and animal models. The elevated IL-6 levels were closely related to right ventricular (RV) dysfunction and predicted poor prognosis and mortality of PAH patients. Several IL-6-regulated signaling pathways including transforming growth factor (TGF)-β/bone morphogenetic protein signaling pathway are involved in PAH development. IL-6 antagonizing agents are effective in ameliorating the symptoms and improving the RV function of PAH patients.
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19
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Jabagi H, Mielniczuk LM, Liu PP, Ruel M, Sun LY. Biomarkers in the Diagnosis, Management, and Prognostication of Perioperative Right Ventricular Failure in Cardiac Surgery-Are We There Yet? J Clin Med 2019; 8:jcm8040559. [PMID: 31027170 PMCID: PMC6517903 DOI: 10.3390/jcm8040559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/27/2019] [Accepted: 04/22/2019] [Indexed: 12/19/2022] Open
Abstract
Right ventricular failure (RVF) is a major risk factor for end organ morbidity and mortality following cardiac surgery. Perioperative RVF is difficult to predict and detect, and to date, no convenient, accurate, or reproducible measure of right ventricular (RV) function is available. Few studies have examined the use of biomarkers in RVF, and even fewer have examined their utility in the perioperative setting of patients undergoing cardiac surgery. Of the available classes of biomarkers, this review focuses on biomarkers of (1) inflammation and (2) myocyte injury/stress, due to their superior potential in perioperative RV assessment, including Galectin 3, ST2/sST2, CRP, cTN/hs-cTn, and BNP/NT-proBNP. This review was performed to help highlight the importance of perioperative RV function in patients undergoing cardiac surgery, to review the current modalities of RV assessment, and to provide a review of RV specific biomarkers and their potential utilization in the clinical and perioperative setting in cardiac surgery. Based on current evidence, we suggest the potential utility of ST2, sST2, Gal-3, CRP, hs-cTn, and NT-proBNP in predicting and detecting RVF in cardiac surgery patients, as they encompass the multifaceted nature of perioperative RVF and warrant further investigation to establish their clinical utility.
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Affiliation(s)
- Habib Jabagi
- Divisions of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
| | - Lisa M Mielniczuk
- Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
| | - Peter P Liu
- Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
| | - Marc Ruel
- Divisions of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
| | - Louise Y Sun
- Cardiac Anesthesiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.
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20
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Kowal J, Ahmad MI, Li Y, Soliman EZ. Prognostic significance of electrocardiographic right ventricular hypertrophy in the general population. J Electrocardiol 2019; 54:49-53. [PMID: 30901607 DOI: 10.1016/j.jelectrocard.2019.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/22/2019] [Accepted: 03/13/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Echocardiographically detected right ventricular hypertrophy (RVH) is associated with cardiovascular disease (CVD) and mortality. However, the prognostic significance of electrocardiographic (ECG)RVH criteria as predictors of poor outcomes in the general population is unclear. METHODS This study included 7857 participants (59.8 ± 13.4 years, 52.6% women) from the Third National Health and Nutrition Examination Survey. Sixteen different ECG-RVH criteria were created from digitally recorded and centrally processed electrocardiograms. All-cause mortality was ascertained using the National Death Index. Cox proportional hazards analysis was used to examine the association between baseline ECG-RVH criteria and all-cause mortality. RESULTS The prevalence of RVH varied widely among the criteria. The lowest ECG-RVH prevalence was 0.09% (using S > R in I, II, III) while the highest prevalence was 20.7% (using (R I + S III) - (S I + R III) < 15 mm). During a median follow-up of 14 years, 2812 deaths occurred. The mortality rate was highest among participants with ECG-RVH defined as R:S ratio V5 < 0.75. In multivariable adjusted models, 9 out of the 16 ECG-RVH criteria were significantly associated with all-cause mortality. When ECG-RVH was defined as the presence of any ECG-RVH criteria, each additional ECG-RVH criteria was associated with 6% increased risk of all-cause mortality (HR (95% CI):1.06(1.03,1.10)). CONCLUSIONS There is a wide variation in the prevalence of ECG-RVH when different criteria are applied in the general population. However, the presence of ECG-RVH by most criteria regardless of prevalence was associated with poor prognosis suggesting that appropriate choice of criteria may enhance the utilization of these ECG markers in risk stratification.
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Affiliation(s)
- Jamie Kowal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Muhammad Imtiaz Ahmad
- Department of Internal Medicine, Section on Hospital Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Yabing Li
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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21
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The relationship between endothelial function and aortic valve calcification: Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2018; 280:155-165. [PMID: 30529828 DOI: 10.1016/j.atherosclerosis.2018.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 10/19/2018] [Accepted: 11/16/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS Aortic valve calcification (AVC) may be associated with atherogenic processes arising from endothelial dysfunction (ED). Limited data is available about the relationship between ED, defined by flow mediated dilation (FMD%) and biomarkers, and the prevalence and progression of AVC in a multiethnic population. METHODS A sample of 3475 individuals from the Multi-Ethnic Study of Atherosclerosis (MESA), with both initial and repeat CT scans at a mean of 2.65 ± 0.84 years and FMD% and serologic markers of ED [ C-reactive protein (CRP), Von Willebrand factor (vWF), Plasminogen Activator Inhibitor (PAI), fibrinogen, Interleukin 6 (IL6), E-selectin and ICAM-1 (Intercellular Adhesion Molecule 1)], were analyzed. Multivariate modeling evaluated the association between ED and the prevalent AVC and AVC progression. RESULTS The median levels of FMD% was lower and vWF%, fibrinogen, IL6 and ICAM-1 were significantly higher in the AVC prevalence group versus no AVC prevalence (all p < 0.001). In the fully adjusted model for established risk factors, decreasing FMD% or increasing biomarkers was not independently associated with AVC prevalence [OR FMD% 1.028 (0.786, 1.346), CRP 0.981 (0.825, 1.168), vWF 1.132 (0.559, 2.292), PAI 1.124 (0.960, 1.316), fibrinogen 1.116 (0.424, 2.940), IL6 1.065 (0.779, 1.456), E-selectin 0.876 (0.479, 1.602) and ICAM-1 1.766 (0.834, 3.743)]. In the AVC progression group, FMD%, vWF%, fibrinogen and IL6 were significantly different (p < 0.05). After adjusting for cardiac risk factors, AVC progression was not independently associated with decreasing FMD% or increasing biomarkers [OR FMD% 1.105 (0.835, 1.463), CRP 1.014 (0.849, 1.210), vWF% 1.132 (0.559, 2.292), PAI 1.124 (0.960, 1.316), fibrinogen 0.909 (0.338, 2.443), IL6 1.061 (0.772, 1.459), E-selectin 0.794 (0.426, 1.480) and ICAM-1 0.998 (0.476, 2.092)]. CONCLUSIONS Endothelial dysfunction by FMD% and biomarkers is not significantly associated with the prevalence or progression of aortic valve calcification after adjustment for cardiac risk factors.
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22
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Manichaikul A, Wang XQ, Li L, Erdmann J, Lettre G, Bis JC, Waterworth D, Cushman M, Jenny NS, Post WS, Palmas W, Tsai MY, Wallentin L, White H, Schunkert H, O’Donnell CJ, Herrington DM, Rich SS, O’Donoghue ML, Rodriguez A. Lp-PLA2, scavenger receptor class B type I gene (SCARB1) rs10846744 variant, and cardiovascular disease. PLoS One 2018; 13:e0204352. [PMID: 30289950 PMCID: PMC6173398 DOI: 10.1371/journal.pone.0204352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 09/06/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We previously reported association of SCARB1 SNP rs10846744 with common carotid IMT (cIMT) and cardiovascular disease (CVD) events. Since rs10846744 has been reported in association with Lp-PLA2 mass and activity, we hypothesized that inflammatory pathways might mediate the association of rs10846744 with atherosclerosis. METHODS We first examined association of rs10846744 in CVD in multiple large-scale consortium-based genome-wide association studies. We further examined 27 parameters of interest, including Lp-PLA2 mass and activity, inflammatory markers, and plasma phospholipid fatty acids, and fatty acid ratios in participants from the Multi-Ethnic Study of Atherosclerosis (MESA), as potential mediators in the pathway linking rs10846744 with cIMT and incident CVD. Finally, we examined the association of rs10846744 with Lp-PLA2 activity, cardiovascular outcomes, and interaction with the Lp-PLA2 inhibitor, darapladib, in the Stabilization of Atherosclerotic Plaque by Initiation of Darapladib Therapy (STABILITY) and Stabilization of Plaque using Darapladib-Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) studies. RESULTS SCARB1 rs10846744 was associated with coronary artery disease events in CARDIoGRAMplusC4D (odds ratio 1.05; 95% CI [1.02, 1.07]; P = 1.4x10-4). In combined analysis across race/ethnic groups in MESA, rs10846744 was associated with Lp-PLA2 mass (P = 0.04) and activity (P = 0.001), homocysteine (P = 0.03), LDL particle number (P = 0.01), docosahexaenoic acid [DHA] (P = 0.01), docosapentaenoic acid [DPA] (P = 0.04), DPA/ eicosapentaenoic acid [EPA] ratio (P = 0.002), and DHA/EPA ratio (P = 0.008). Lp-PLA2 activity was identified as a mediator of rs10846744 with cIMT in a basic model (P = 8x10-5), but not after adjustment for CVD risk factors. There was no interaction or modifier effect of the Lp-PLA2 inhibitor darapladib assignment on the relationship between rs10846744 and major CVD events in either STABILITY or SOLID-TIMI 52. SUMMARY SCARB1 rs10846744 is significantly associated with Lp-PLA2 activity, atherosclerosis, and CVD events, but Lp-PLA2 activity is not a mediator in the association of rs10846744 with cIMT in MESA.
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Affiliation(s)
- Ani Manichaikul
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, United States of America
- Department of Public Health Sciences, Biostatistics Section, University of Virginia, Charlottesville, VA, United States of America
| | - Xin-Qun Wang
- Department of Public Health Sciences, Biostatistics Section, University of Virginia, Charlottesville, VA, United States of America
| | - Li Li
- Genomic Medicine, PAREXEL International, Durham, NC, United States of America
| | - Jeanette Erdmann
- Institut für Integrative und Experimentelle Genomik, University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg, Kiel, Lübeck, Germany
| | - Guillaume Lettre
- Montreal Heart Institute, Montreal, Quebec, Canada
- Université de Montréal, Montreal, Quebec, Canada
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, United States of America
- Department of Medicine, University of Washington, Seattle, WA, United States of America
| | - Dawn Waterworth
- Genetics, GlaxoSmithKline, King of Prussia, PA, United States of America
| | - Mary Cushman
- Department of Medicine, University of Vermont, Burlington, VT, United States of America
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, United States of America
| | - Nancy S. Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, VT, United States of America
| | - Wendy S. Post
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Walter Palmas
- Division of General Medicine, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY, United States of America
| | - Michael Y. Tsai
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States of America
| | - Lars Wallentin
- Uppsala Clinical Research Center and Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Harvey White
- Auckland City Hospital Green Lane Cardiovascular Sciences, Auckland, New Zealand
| | - Heribert Schunkert
- DZHK (German Research Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Christopher J. O’Donnell
- Cardiology Section, Boston Veteran’s Administration Healthcare, Boston, MA, United States of America
- NHLBI and Boston University Framingham Heart Study, Framingham, MA, United States of America
| | - David M. Herrington
- Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, United States of America
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville, VA, United States of America
- Department of Public Health Sciences, Biostatistics Section, University of Virginia, Charlottesville, VA, United States of America
| | - Michelle L. O’Donoghue
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston MA, United States of America
| | - Annabelle Rodriguez
- Department of Cell Biology, Center for Vascular Biology, University of Connecticut Health, Farmington, CT, United States of America
- * E-mail:
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Transcriptomic Signature of Right Ventricular Failure in Experimental Pulmonary Arterial Hypertension: Deep Sequencing Demonstrates Mitochondrial, Fibrotic, Inflammatory and Angiogenic Abnormalities. Int J Mol Sci 2018; 19:ijms19092730. [PMID: 30213070 PMCID: PMC6164263 DOI: 10.3390/ijms19092730] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/01/2018] [Accepted: 09/02/2018] [Indexed: 12/19/2022] Open
Abstract
Right ventricular failure (RVF) remains the leading cause of death in pulmonary arterial hypertension (PAH). We investigated the transcriptomic signature of RVF in hemodynamically well-phenotyped monocrotaline (MCT)-treated, male, Sprague-Dawley rats with severe PAH and decompensated RVF (increased right ventricular (RV) end diastolic volume (EDV), decreased cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE) and ventricular-arterial decoupling). RNA sequencing revealed 2547 differentially regulated transcripts in MCT-RVF RVs. Multiple enriched gene ontology (GO) terms converged on mitochondria/metabolism, fibrosis, inflammation, and angiogenesis. The mitochondrial transcriptomic pathway is the most affected in RVF, with 413 dysregulated genes. Downregulated genes included TFAM (−0.45-fold), suggesting impaired mitochondrial biogenesis, CYP2E1 (−3.8-fold), a monooxygenase which when downregulated increases oxidative stress, dehydrogenase/reductase 7C (DHRS7C) (−2.8-fold), consistent with excessive autonomic activation, and polypeptide N-acetyl-galactose-aminyl-transferase 13 (GALNT13), a known pulmonary hypertension (PH) biomarker (−2.7-fold). The most up-regulated gene encodes Periostin (POSTN; 4.5-fold), a matricellular protein relevant to fibrosis. Other dysregulated genes relevant to fibrosis include latent-transforming growth factor beta-binding protein 2 (LTBP2), thrombospondin4 (THBS4). We also identified one dysregulated gene relevant to all disordered transcriptomic pathways, ANNEXIN A1. This anti-inflammatory, phospholipid-binding mediator, is a putative target for therapy in RVF-PAH. Comparison of expression profiles in the MCT-RV with published microarray data from the RV of pulmonary artery-banded mice and humans with bone morphogenetic protein receptor type 2 (BMPR2)-mutations PAH reveals substantial conservation of gene dysregulation, which may facilitate clinical translation of preclinical therapeutic and biomarkers studies. Transcriptomics reveals the molecular fingerprint of RVF to be heavily characterized by mitochondrial dysfunction, fibrosis and inflammation.
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Dewachter L, Dewachter C. Inflammation in Right Ventricular Failure: Does It Matter? Front Physiol 2018; 9:1056. [PMID: 30177883 PMCID: PMC6109764 DOI: 10.3389/fphys.2018.01056] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/16/2018] [Indexed: 01/22/2023] Open
Abstract
Right ventricular (RV) failure is a common consequence of acute and chronic RV overload of pressure, such as after pulmonary embolism and pulmonary hypertension. It has been recently realized that symptomatology and survival of patients with pulmonary hypertension are essentially determined by RV function adaptation to increased afterload. Therefore, improvement of RV function and reversal of RV failure are treatment goals. Currently, the pathophysiology and the pathobiology underlying RV failure remain largely unknown. A better understanding of the pathophysiological processes involved in RV failure is needed, as there is no proven treatment for this disease at the moment. The present review aims to summarize the current understanding of the pathogenesis of RV failure, focusing on inflammation. We attempt to formally emphasize the importance of inflammation and associated representative inflammatory molecules and cells in the primum movens and development of RV failure in humans and in experimental models. We present inflammatory biomarkers and immune mediators involved in RV failure. We focus on inflammatory mediators and cells which seem to correlate with the deterioration of RV function and also explain how all these inflammatory mediators and cells might impact RV function adaptation to increased afterload. Finally, we also discuss the evidence on potential beneficial effects of targeted anti-inflammatory agents in the setting of acute and chronic RV failure.
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Affiliation(s)
- Laurence Dewachter
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Céline Dewachter
- Laboratory of Physiology and Pharmacology, Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium.,Department of Cardiology, Erasmus Academic Hospital, Brussels, Belgium
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25
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High-sensitivity C-reactive protein in heart failure with preserved ejection fraction. PLoS One 2018; 13:e0201836. [PMID: 30114262 PMCID: PMC6095520 DOI: 10.1371/journal.pone.0201836] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/17/2018] [Indexed: 11/19/2022] Open
Abstract
Background Microvascular inflammation may contribute to the pathogenesis of both heart failure with preserved ejection fraction (HFpEF) and pulmonary hypertension (PH). We investigated whether the inflammation biomarker C-reactive protein (CRP) was associated with clinical characteristics, disease severity or PH in HFpEF. Methods Patients in the Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart failure (RELAX) trial had baseline high-sensitivity CRP levels measured (n = 214). Clinical characteristics, exercise performance, echocardiographic variables and biomarkers of neurohumoral activation, fibrosis and myocardial necrosis were assessed. Patients with normal (≤3mg/L) versus high (>3mg/L) CRP levels were compared. Results The median CRP level was 3.69mg/L. CRP was elevated in 57% of patients. High CRP levels were associated with younger age, higher body mass index (BMI), chronic obstructive pulmonary disease (COPD), lower peak oxygen consumption and higher endothelin-1 and aldosterone levels. CRP increased progressively with the number of comorbidities (0.7mg/L per increment in comorbidity number, P = 0.02). Adjusting for age, BMI and statin use, high CRP levels were additionally associated with atrial fibrillation, right ventricular dysfunction, and higher N-terminal pro-B-type natriuretic peptide levels (P<0.05 for all). CRP was not associated with PH or left ventricular function. CRP did not identify responders to sildenafil(P-value for interaction 0.13). Conclusions In HFpEF, high CRP is associated with greater comorbidity burden and some markers of disease severity but CRP was normal in 40% of patients. These findings support the presence of comorbidity-driven systemic inflammation in HFpEF but also the need to study other biomarkers which may better reflect the presence of systemic inflammation.
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Cainzos-Achirica M, Miedema MD, McEvoy JW, Cushman M, Dardari Z, Greenland P, Nasir K, Budoff MJ, Al-Mallah MH, Yeboah J, Blumenthal RS, Comin-Colet J, Blaha MJ. The prognostic value of high sensitivity C-reactive protein in a multi-ethnic population after >10 years of follow-up: The Multi-Ethnic Study of Atherosclerosis (MESA). Int J Cardiol 2018; 264:158-164. [PMID: 29776564 PMCID: PMC5963727 DOI: 10.1016/j.ijcard.2018.02.027] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 01/15/2018] [Accepted: 02/07/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND The prognostic value of hsCRP in contemporary multi-ethnic populations is unclear, particularly in statin users. The aim of this study was to characterize the prognostic utility of hsCRP for atherosclerotic CVD (ASCVD) risk prediction in a multi-ethnic population including non-users and users of statins followed for >13 years. Associations with heart failure (HF), atrial fibrillation (AF), venous thromboembolism (VTE), cancer, and all-cause death were also examined. METHODS AND RESULTS We evaluated 6757 participants from the Multi-Ethnic Study of Atherosclerosis (MESA; 1002 using statins at baseline), median follow-up 13.2 years. Higher levels of hsCRP were associated with a higher risk of all study endpoints in the unadjusted Cox Proportional Hazards regression analyses, except AF. Among non-users of statins, hsCRP only remained associated with VTE after adjusting for ASCVD risk factors, and did not improve risk prediction. Among users of statins, hsCRP did not improve ASCVD risk prediction either, although it was strongly associated with incident HF (HR for hsCRP ≥ 2 vs <2 mg/L 3.99; 95% CI 2.02, 7.90) and all-cause death (HR 1.52; 95% CI 1.11, 2.08) in multivariable analyses, and hsCRP significantly improved prediction of HF (area under the curve [AUC] basic model 0.741, AUC basic + hsCRP 0.788). CONCLUSIONS The utility of hsCRP for ASCVD prediction was modest. On the other hand, hsCRP was associated with incident VTE in statin non-users, and all-cause mortality and HF in statin users. In the latter, hsCRP improved the prediction of incident HF events. This finding should be replicated in larger cohorts.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain; RTI Health Solutions, Pharmacoepidemiology and Risk Management, Barcelona, Spain
| | - Michael D Miedema
- Minneapolis Heart Institute, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Johns Hopkins Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mary Cushman
- Departments of Medicine and Pathology and Laboratory Medicine, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Khurram Nasir
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Center for Healthcare Advancement and Outcomes, Miami Cardiac and Vascular Institute, Baptist Heath South Florida, Miami, FL, USA
| | - Matthew J Budoff
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Cardiac Center, Ministry of National Guard, Health Affairs, Saudi Arabia
| | | | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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27
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Sydykov A, Mamazhakypov A, Petrovic A, Kosanovic D, Sarybaev AS, Weissmann N, Ghofrani HA, Schermuly RT. Inflammatory Mediators Drive Adverse Right Ventricular Remodeling and Dysfunction and Serve as Potential Biomarkers. Front Physiol 2018; 9:609. [PMID: 29875701 PMCID: PMC5974151 DOI: 10.3389/fphys.2018.00609] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Accepted: 05/04/2018] [Indexed: 01/07/2023] Open
Abstract
Adverse right ventricular (RV) remodeling leads to ventricular dysfunction and failure that represents an important determinant of outcome in patients with pulmonary hypertension (PH). Recent evidence indicates that inflammatory activation contributes to the pathogenesis of adverse RV remodeling and dysfunction. It has been shown that accumulation of inflammatory cells such as macrophages and mast cells in the right ventricle is associated with maladaptive RV remodeling. In addition, inhibition of inflammation in animal models of RV failure ameliorated RV structural and functional impairment. Furthermore, a number of circulating inflammatory mediators have been demonstrated to be associated with RV performance. This work reviews the role of inflammation in RV remodeling and dysfunction and discusses anti-inflammatory strategies that may attenuate adverse structural alterations while promoting improvement of RV function.
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Affiliation(s)
- Akylbek Sydykov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany.,Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Argen Mamazhakypov
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
| | - Aleksandar Petrovic
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
| | - Djuro Kosanovic
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
| | - Akpay S Sarybaev
- Department of Mountain and Sleep Medicine and Pulmonary Hypertension, National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Norbert Weissmann
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
| | - Hossein A Ghofrani
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
| | - Ralph T Schermuly
- Excellence Cluster Cardio-Pulmonary System, Universities of Giessen and Marburg Lung Center, German Center for Lung Research, Justus Liebig University of Giessen, Giessen, Germany
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28
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Portal congestion and intestinal edema in hospitalized patients with heart failure. Heart Vessels 2018; 33:740-751. [DOI: 10.1007/s00380-018-1117-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 01/05/2018] [Indexed: 12/17/2022]
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Jenny NS, Olson NC, Allison MA, Rifkin DE, Daniels LB, de Boer IH, Wassel CL, Tracy RP. Biomarkers of Key Biological Pathways in CVD. Glob Heart 2018; 11:327-336.e3. [PMID: 27741979 DOI: 10.1016/j.gheart.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/19/2016] [Accepted: 07/21/2016] [Indexed: 01/30/2023] Open
Abstract
This review provides background on the laboratory design for MESA (Multi-Ethnic Study of Atherosclerosis) as well as the approach used in MESA to select biomarkers for measurement. The research related to the multitude of circulating and urinary biomarkers of inflammation and other novel and emerging biological pathways in MESA is summarized by domain, or pathway, represented by the biomarker. The contributions of MESA biomarkers to our knowledge of these key pathways in the development and progression of atherosclerosis, cardiovascular disease, diabetes, kidney disease, and pulmonary disease are highlighted, as are the contributions of MESA to recommendations for clinical use of several of these biomarkers. In addition, contributions of MESA to multicohort genomics consortia and current collaborations in transomics and metabolomics are noted.
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Affiliation(s)
- Nancy Swords Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA.
| | - Nels C Olson
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Matthew A Allison
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Dena E Rifkin
- Department of Family and Preventive Medicine, University of California San Diego, La Jolla, CA, USA
| | - Lori B Daniels
- Department of Medicine, Division of Cardiovascular Medicine, University of California, San Diego, CA, USA
| | - Ian H de Boer
- Kidney Research Institute, University of Washington, Seattle, WA, USA
| | - Christina L Wassel
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont College of Medicine, Burlington, VT, USA; Department of Biochemistry, University of Vermont College of Medicine, Burlington, VT, USA
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30
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Cerit L. Is There Any Link Among C-Reactive Protein, Right Ventricular Function, and Postoperative Atrial Fibrillation? J Cardiothorac Vasc Anesth 2017; 32:e52-e53. [PMID: 29229254 DOI: 10.1053/j.jvca.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Levent Cerit
- Department of Cardiology, Near East University, Nicosia, Cyprus
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31
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Ting PC, Chou AH, Wu VCC, Chen SW. Reply to "Is There Any Link Among C-Reactive Protein, Right Ventricular Function, and Postoperative Atrial Fibrillation?". J Cardiothorac Vasc Anesth 2017; 32:e53-e54. [PMID: 29229251 DOI: 10.1053/j.jvca.2017.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Pei-Chi Ting
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Hsun Chou
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Shao-Wei Chen
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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32
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Interleukin-6 is independently associated with right ventricular function in pulmonary arterial hypertension. J Heart Lung Transplant 2017; 37:376-384. [PMID: 28893516 DOI: 10.1016/j.healun.2017.08.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 07/25/2017] [Accepted: 08/24/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An elevated serum level of interleukin-6 (IL-6) in pulmonary arterial hypertension (PAH) patients results in a greater symptom burden and increased mortality; however, the mechanisms underlying these observations remain unclear. Because both pre-clinical and clinical data associate elevated IL-6 levels with impaired cardiac function, we hypothesized that the adverse effects of IL-6 in PAH result, in part, from right ventricular (RV) dysfunction. METHODS We analyzed the relationship between IL-6 and RV function in 40 patients with PAH identified in our institutional PAH registry. Serum IL-6 levels was quantified by enzyme-linked immunoassay. RESULTS PAH patients had higher IL-6 levels than age- and gender-matched controls. Circulating IL-6 levels correlated inversely with echocardiography-based measures of RV function and RV-pulmonary artery (RV-PA) coupling. When dividing PAH patients by median IL-6 level, patients with higher IL-6 had significantly worse RV function (fractional area change [FAC] 23 ± 12% vs 38 ± 11%, tricuspid annular plane systolic excursion [TAPSE] 1.3 ± 0.3 cm vs 2.1 ± 0.5 cm), impaired RV-PA coupling (0.6 ± 0.5%/mm Hg vs 0.9 ± 0.5%/mm Hg), higher right atrial pressure (13 ± 7 mm Hg vs 9 ± 5 mm Hg), reduced cardiac index (2.0 ± 0.5 liters/min/m2 vs 2.8 ± 1.0 liters/min/m2) and lower stroke volume (48 ± 20 ml vs 70 ± 28 ml). In contrast, the relationships between IL-6 and mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR) and pulmonary arterial compliance (PAC) were not significant. Finally, IL-6 was independently associated with RV function and RV-PA coupling after adjusting for static (PVR) and pulsatile (PAC) after-load on the RV. CONCLUSIONS Serum IL-6 levels are independently associated with RV function and RV-PA coupling in PAH. Patients with higher IL-6 levels have more severe RV dysfunction and diminished RV-PA coupling despite a comparable severity of pulmonary vascular disease.
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Shah RV, Anderson A, Ding J, Budoff M, Rider O, Petersen SE, Jensen MK, Koch M, Allison M, Kawel-Boehm N, Wisocky J, Jerosch-Herold M, Mukamal K, Lima JAC, Murthy VL. Pericardial, But Not Hepatic, Fat by CT Is Associated With CV Outcomes and Structure: The Multi-Ethnic Study of Atherosclerosis. JACC Cardiovasc Imaging 2017; 10:1016-1027. [PMID: 28330662 PMCID: PMC5591038 DOI: 10.1016/j.jcmg.2016.10.024] [Citation(s) in RCA: 97] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 09/23/2016] [Accepted: 10/27/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The study sought to determine the associations between local (pericardial) fat and incident cardiovascular disease (CVD) events and cardiac remodeling independent of markers of overall adiposity. BACKGROUND The impact of pericardial fat-a local fat depot encasing the heart-on myocardial function and long-term CV prognosis independent of systemic consequences of adiposity or hepatic fat is an area of active debate. METHODS We studied 4,234 participants enrolled in the MESA (Multi-Ethnic Study of Atherosclerosis) study with concomitant cardiac magnetic resonance imaging and computed tomography (CT) measurements for pericardial fat volume and hepatic attenuation (a measure of liver fat). Poisson and Cox regression were used to estimate the annualized risk of incident hard atherosclerotic CVD (ASCVD), all-cause death, heart failure, all-cause CVD, hard coronary heart disease, and stroke as a function of pericardial and hepatic fat. Generalized additive models were used to assess the association between cardiac magnetic resonance indices of left ventricular (LV) structure and function and pericardial fat. Models were adjusted for relevant clinical, demographic, and cardiometabolic covariates. RESULTS MESA study participants with higher pericardial and hepatic fat were more likely to be older, were more frequently men, and had a higher prevalence of cardiometabolic risk factors (including dysglycemia, dyslipidemia, hypertension), as well as adiposity-associated inflammation. Over a median 12.2-year follow-up (interquartile range: 11.6 to 12.8 years), pericardial fat was associated with a higher rate of incident hard ASCVD (standardized hazard ratio: 1.22; 95% confidence interval: 1.10 to 1.35; p = 0.0001). Hepatic fat by CT was not significantly associated with hard ASCVD (standardized hazard ratio: 0.96; 95% confidence interval: 0.86 to 1.08; p = 0.52). Higher pericardial fat was associated with greater indexed LV mass (37.8 g/m2.7 vs. 33.9 g/m2.7, highest quartile vs. lowest quartile; p < 0.01), LV mass-to-volume ratio (1.2 vs. 1.1, highest quartile vs. lowest quartile; p < 0.01). In adjusted models, a higher pericardial fat volume was associated with greater LV mass (p < 0.0001) and concentricity (p < 0.0001). CONCLUSIONS Pericardial fat is associated with poorer CVD prognosis and LV remodeling, independent of insulin resistance, inflammation, and CT measures of hepatic fat.
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Affiliation(s)
- Ravi V Shah
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.
| | - Amanda Anderson
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Jingzhong Ding
- Department of Medicine, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Matthew Budoff
- Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Los Angeles, California
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research, University of Oxford, Oxford, United Kingdom
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, United Kingdom
| | | | - Manja Koch
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Matthew Allison
- Department of Family and Preventative Medicine, University of California-San Diego, San Diego, California
| | - Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubünden, Chur, Switzerland; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Jessica Wisocky
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Jerosch-Herold
- Non-Invasive Cardiovascular Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Kenneth Mukamal
- Cardiology Division and Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - João A C Lima
- Cardiology Division, Johns Hopkins Medical Institute, Baltimore, Maryland
| | - Venkatesh L Murthy
- Cardiovascular Medicine Division, Department of Medicine, University of Michigan, Ann Arbor, Michigan; Nuclear Medicine Division, Department of Radiology, University of Michigan, Ann Arbor, Michigan; Cardiothoracic Imaging Division, Department of Radiology, University of Michigan, Ann Arbor, Michigan.
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Chatterjee NA, Shah RV, Murthy VL, Praestgaard A, Shah SJ, Ventetuolo CE, Barr RG, Kronmal R, Lima JAC, Bluemke DA, Jerosch-Herold M, Alonso A, Kawut SM. Right Ventricular Structure and Function Are Associated With Incident Atrial Fibrillation: MESA-RV Study (Multi-Ethnic Study of Atherosclerosis-Right Ventricle). Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004738. [PMID: 28082528 DOI: 10.1161/circep.116.004738] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 11/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular (RV) morphology has been associated with drivers of atrial fibrillation (AF) risk, including left ventricular and pulmonary pathology, systemic inflammation, and neurohormonal activation. The aim of this study was to investigate the association between RV morphology and risk of incident AF. METHODS AND RESULTS We interpreted cardiac magnetic resonance imaging in 4204 participants free of clinical cardiovascular disease in the MESA (Multi-Ethnic Study of Atherosclerosis). Incident AF was determined using hospital discharge records, study electrocardiograms, and Medicare claims data. The study sample (n=3819) was 61±10 years old and 47% male with 47.2% current/former smokers. After adjustment for demographics and clinical factors, including incident heart failure, higher RV ejection fraction (hazard ratio, 1.16 per SD; 95% confidence interval, 1.03-1.32; P=0.02) and greater RV mass (hazard ratio, 1.25 per SD; 95% confidence interval, 1.08-1.44; P=0.002) were significantly associated with incident AF. After additional adjustment for the respective left ventricular parameter, higher RV ejection fraction remained significantly associated with incident AF (hazard ratio, 1.15 per SD; 95% confidence interval, 1.01-1.32; P=0.04), whereas the association was attenuated for RV mass (hazard ratio, 1.16 per SD; 95% confidence interval, 0.99-1.35; P=0.07). In a subset of patients with available spirometry (n=2540), higher RV ejection fraction and mass remained significantly associated with incident AF after additional adjustment for lung function (P=0.02 for both). CONCLUSIONS Higher RV ejection fraction and greater RV mass were associated with an increased risk of AF in a multiethnic population free of clinical cardiovascular disease at baseline.
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Affiliation(s)
| | - Ravi V Shah
- For the author affiliations, please see the Appendix
| | | | | | - Sanjiv J Shah
- For the author affiliations, please see the Appendix
| | | | - R Graham Barr
- For the author affiliations, please see the Appendix
| | | | - Joao A C Lima
- For the author affiliations, please see the Appendix
| | | | | | - Alvaro Alonso
- For the author affiliations, please see the Appendix
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Al Rifai M, DeFilippis AP, McEvoy JW, Hall ME, Acien AN, Jones MR, Keith R, Magid HS, Rodriguez CJ, Barr GR, Benjamin EJ, Robertson RM, Bhatnagar A, Blaha MJ. The relationship between smoking intensity and subclinical cardiovascular injury: The Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2017; 258:119-130. [PMID: 28237909 PMCID: PMC5404388 DOI: 10.1016/j.atherosclerosis.2017.01.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/29/2016] [Accepted: 01/18/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND AIMS Modern tobacco regulatory science requires an understanding of which biomarkers of cardiovascular injury are most sensitive to cigarette smoking exposure. METHODS We studied self-reported current smokers from the Multi-Ethnic Study of Atherosclerosis. Smoking intensity was defined by number of cigarettes/day and urinary cotinine levels. Subclinical cardiovascular injury was assessed using markers of inflammation [high-sensitivity C-reactive protein (hsCRP), interleukin 6 & 2 (IL-2 & IL-6), tumor necrosis factor alpha (TNF-α)], thrombosis (fibrinogen, D-dimer, homocysteine), myocardial injury (troponin T; TnT), endothelial damage (albumin: creatinine ratio), and vascular function [aortic & carotid distensibility, flow-mediated dilation (FMD)]. Biomarkers were modeled as absolute and percent change using multivariable-adjusted linear regression models adjusted for cardiovascular risk factors and smoking duration. RESULTS Among 843 current smokers, mean age was 58 (9) years, 53% were men, 39% were African American, mean number of cigarettes per day was 13 (10), and median smoking duration was 39 (15) years. Cigarette count was significantly associated with higher hsCRP, IL-6 and fibrinogen (β coefficients: 0.013, 0.011, 0.60 respectively), while ln-transformed cotinine was associated with the same biomarkers (β coefficients: 0.12, 0.04, 5.3 respectively) and inversely associated with aortic distensibility (β coefficient: -0.13). There was a limited association between smoking intensity and homocysteine, D-dimer, and albumin:creatinine ratio in partially adjusted models only, while there was no association with IL-2, TNF-α, carotid distensibility, FMD, or TnT in any model. In percent change analyses, relationships were strongest with hsCRP. CONCLUSIONS Smoking intensity was associated with early biomarkers of CVD, particularly, markers of systemic inflammation. Of these, hsCRP may be the most sensitive.
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Affiliation(s)
- Mahmoud Al Rifai
- Department of Medicine, University of Kansas School of Medicine, Wichita, KS, USA; Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Andrew P DeFilippis
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA; Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, KY, USA; Division of Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA
| | - Michael E Hall
- University of Mississippi Medical Center, Division of Cardiology, Jackson, MS, USA
| | - Ana Navas Acien
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rachel Keith
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, KY, USA; Division of Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Hoda S Magid
- UC Berkeley School of Public Health, Berkley, CA, USA
| | - Carlos J Rodriguez
- Maya Angelou Center for Health Equity, Wake Forest University, Winston-Salem, NC, USA
| | - Graham R Barr
- Columbia University Medical Center, Division of Pulmonary, Allergy and Critical Care Medicine, New York, NY, USA
| | - Emelia J Benjamin
- Boston University, School of Medicine, Vascular Testing and Echocardiography, Boston, MA, USA
| | | | - Aruni Bhatnagar
- Diabetes and Obesity Center, University of Louisville School of Medicine, Louisville, KY, USA; Division of Cardiology, University of Louisville School of Medicine, Louisville, KY, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for Prevention of Heart Disease, Baltimore, MD, USA.
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Ikeda Y, Ishii S, Fujita T, Iida Y, Kaida T, Nabeta T, Maekawa E, Yanagisawa T, Koitabashi T, Takeuchi I, Inomata T, Ako J. Prognostic impact of intestinal wall thickening in hospitalized patients with heart failure. Int J Cardiol 2017; 230:120-126. [DOI: 10.1016/j.ijcard.2016.12.063] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 11/13/2016] [Accepted: 12/16/2016] [Indexed: 12/28/2022]
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Al-Naamani N, Chirinos JA, Zamani P, Ruthazer R, Paulus JK, Roberts KE, Barr RG, Lima JA, Bluemke DA, Kronmal R, Kawut SM. Association of Systemic Arterial Properties With Right Ventricular Morphology: The Multi-Ethnic Study of Atherosclerosis (MESA)-Right Ventricle Study. J Am Heart Assoc 2016; 5:e004162. [PMID: 27881423 PMCID: PMC5210393 DOI: 10.1161/jaha.116.004162] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 10/17/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systemic arterial stiffness is recognized as a major contributor to development of left ventricular dysfunction and failure; however, the relationship of systemic arterial properties and the right ventricle (RV) is unknown. METHODS AND RESULTS The associations between systemic arterial measures (total arterial compliance [TAC], systemic vascular resistance [SVR], and aortic augmentation index [AI]) and RV morphology (mass, end-systolic [RVESV] and end-diastolic volume [RVEDV], and ejection fraction [RVEF]) were examined using data from the Multi-Ethnic Study of Atherosclerosis. All analyses were adjusted for anthropometric, demographic, and clinical variables and the corresponding left ventricular parameter. A total of 3842 subjects without clinical cardiovascular disease were included with a mean age of 61 years, 48% male, 39% non-Hispanic white, 25% Chinese-American, 23% Hispanic, and 13% black. RV measures were within normal range for age and sex. A 1-mL/mm Hg decrease in TAC was associated with 3.9-mL smaller RVESV, 7.6-mL smaller RVEDV, and 2.4-g lower RV mass. A 5-Wood-unit increase in SVR was associated with 0.6-mL decrease in RVESV, 1.7-mL decrease in RVEDV, and 0.4-g decrease in RV mass. A 1% increase in AI was associated with 0.2-mL decrease in RVEDV. We found significant effect modification by age, sex, and race for some of these relationships, with males, whites, and younger individuals having greater decreases in RV volumes and mass. CONCLUSIONS Markers of increased systemic arterial load were associated with smaller RV volumes and lower RV mass in a population of adults without clinical cardiovascular disease.
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Affiliation(s)
- Nadine Al-Naamani
- Department of Medicine, Tufts Medical Center, Boston, MA
- Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA
| | - Julio A Chirinos
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Payman Zamani
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robin Ruthazer
- Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA
| | - Jessica K Paulus
- Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA
| | - Kari E Roberts
- Department of Medicine, Tufts Medical Center, Boston, MA
| | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Joao A Lima
- Department of Medicine, Johns Hopkins University, Baltimore, MD
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health/Clinical Center, Bethesda, MD
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA
| | - Steven M Kawut
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Wenger DS, Kawut SM, Ding J, Bluemke DA, Hough CL, Kronmal RA, Lima JA, Leary PJ. Pericardial Fat and Right Ventricular Morphology: The Multi-Ethnic Study of Atherosclerosis- Right Ventricle Study (MESA-RV). PLoS One 2016; 11:e0157654. [PMID: 27311062 PMCID: PMC4911142 DOI: 10.1371/journal.pone.0157654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/02/2016] [Indexed: 12/19/2022] Open
Abstract
Background Pericardial fat has been implicated in the pathogenesis of obesity-related cardiovascular disease. Proposed mechanisms may be relevant in right heart failure, but relationships between pericardial fat and right ventricular (RV) morphology have not been explored. Methods The Multi-Ethnic Study of Atherosclerosis is a prospective cohort that enrolled participants without clinical cardiovascular disease. Pericardial fat was measured using computed tomography and RV parameters using cardiac MRI. Linear regression estimated associations of pericardial fat with RV mass, RV end diastolic volume (RV-EDV), RV end systolic volume (RV-ESV), RV stroke volume (RV-SV), and RV ejection fraction (RV-EF). Limited models adjusted for age, gender, race, height, and study site with and without weight. Fully adjusted models also accounted for socioeconomic parameters and health behaviors. Adjustment for left ventricular morphology, metabolic syndrome, and systemic inflammation was also performed. Results The study sample included 3988 participants with complete assessment of RV morphology, pericardial fat and all covariates. Greater pericardial fat volume was associated with reduced RV mass (-0.3g per 40 cm3 increase in pericardial fat, p<0.001), smaller RV-EDV (-3.7ml per 40 cm3 increase in pericardial fat, p<0.001), smaller RV-ESV (-1.0ml per 40cm3 increase in pericardial fat, p<0.001), and smaller RV-SV (-2.7mL per 40 cm3 increase in pericardial fat, p<0.001) in participants after adjustment for weight. Associations were unchanged when accounting for health behaviors, markers of systemic inflammation, and the metabolic syndrome. Conclusions Greater pericardial fat was associated with reduced RV mass, smaller RV-EDV, smaller RV-ESV, and smaller RV-SV in participants after adjustment for weight. Relationships between pericardial fat and RV morphology could be relevant to diseases of right heart failure.
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Affiliation(s)
- David S. Wenger
- Department of General Internal Medicine, University of Washington, Seattle, Washington, United States of America
| | - Steven M. Kawut
- Department of Medicine and Epidemiology, Division of Pulmonary and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Jingzhong Ding
- Department of General Internal Medicine, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - David A. Bluemke
- Department of Radiology, Division of Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland, United States of America
| | - Catherine L. Hough
- Department of General Internal Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, United States of America
| | - Richard A. Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Joao A. Lima
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Peter J. Leary
- Department of General Internal Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, Washington, United States of America
- * E-mail:
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H2 receptor antagonists and right ventricular morphology: the MESA right ventricle study. Ann Am Thorac Soc 2015; 11:1379-86. [PMID: 25295642 DOI: 10.1513/annalsats.201407-344oc] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE H2 receptor antagonist (H2RA) use is common and may act directly on the heart through myocardial H2 receptors or indirectly through changes in pulmonary vascular resistance. OBJECTIVES To determine the relationship between histamine H2RA use and right ventricular (RV) morphology. METHODS We studied 4,122 participants in the Multi-Ethnic Study of Atherosclerosis without clinical cardiovascular disease who had magnetic resonance imaging assessment of RV morphology and ascertainment of medication use. Multivariable linear regression estimated cross-sectional associations between H2RA use and RV morphology after adjusting for demographics, anthropometrics, smoking status, diabetes mellitus, and hypertension. Further adjustments for co-medication use, left ventricular parameters, lung structure and function, renal function, or inflammatory markers were considered in separate models. Analyses in a subcohort restricted to H2RA or proton pump inhibitor users accounted for confounding by the indication of gastroesophageal reflux disease. MEASUREMENTS AND MAIN RESULTS H2RA use was associated with lower RV mass (-0.7 g; 95% confidence interval, -1.2 to -0.2 g; P = 0.004) and smaller RV end-diastolic volume (-4.2 ml; 95% confidence interval, -7.2 to -1.2 ml; P = 0.006). This relationship was unchanged with adjustment for co-medication use, lung structure and function, renal function, and inflammation. The relationship with RV mass was independent of left ventricular mass. Results were similar in the smaller cohort restricted to proton pump inhibitor and H2RA users. CONCLUSIONS H2RA use was associated with lower RV mass and smaller RV end-diastolic volume. Additional study of histamine and H2 receptors in cardiopulmonary diseases affecting the RV may have direct clinical relevance.
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Abstract
Both experimental and clinical evidence accumulated over the last couple of decades has linked inflammatory activation to the initiation and progression of chronic heart failure (HF). Circulating levels of inflammatory mediators are associated with cardiac function and inform risk prediction in patients, but the effect of anti-inflammatory therapy in HF remains uncertain. Interleukin (IL)-6 type cytokines are central to the inflammatory response, and convey their signals through the ubiquitously expressed glycoprotein (gp) 130 receptor subunit. IL-6-type/gp130 signaling therefore represents an inflammatory nexus, with inherent potential for disease modification. This review focuses on the current knowledge of IL-6/gp130 signaling in relation to HF, with a particular emphasis on the role of soluble gp130 (sgp130), a signaling pathway modulator. Biological aspects of sgp130 and IL-6 signaling are discussed, as are potential novel therapeutic approaches to modulate this central inflammatory signaling pathway.
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Kawut SM, Poor HD, Parikh MA, Hueper K, Smith BM, Bluemke DA, Lima JAC, Prince MR, Hoffman EA, Austin JHM, Vogel-Claussen J, Barr RG. Cor pulmonale parvus in chronic obstructive pulmonary disease and emphysema: the MESA COPD study. J Am Coll Cardiol 2014; 64:2000-9. [PMID: 25440095 DOI: 10.1016/j.jacc.2014.07.991] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2014] [Revised: 07/05/2014] [Accepted: 07/08/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND The classic cardiovascular complication of chronic obstructive pulmonary disease (COPD) is cor pulmonale or right ventricular (RV) enlargement. Most studies of cor pulmonale were conducted decades ago. OBJECTIVES This study sought to examine RV changes in contemporary COPD and emphysema using cardiac magnetic resonance (CMR) imaging. METHODS We performed a case-control study nested predominantly in 2 general population studies of 310 participants with COPD and control subjects 50 to 79 years of age with ≥10 pack-years of smoking who were free of clinical cardiovascular disease. RV volumes and mass were assessed using magnetic resonance imaging. COPD and COPD severity were defined according to standard spirometric criteria. The percentage of emphysema was defined as the percentage of lung regions <-950 Hounsfield units on full-lung computed tomography; emphysema subtypes were scored by radiologists. Results were adjusted for age, race/ethnicity, sex, height, weight, smoking status, pack-years, systemic hypertension, and sleep apnea. RESULTS Right ventricular end-diastolic volume (RVEDV) was reduced in COPD compared with control subjects (-7.8 ml; 95% confidence interval: -15.0 to -0.5 ml; p = 0.04). Increasing severity of COPD was associated with lower RVEDV (p = 0.004) and lower RV stroke volume (p < 0.001). RV mass and ejection fraction were similar between the groups. A greater percentage of emphysema also was associated with lower RVEDV (p = 0.005) and stroke volume (p < 0.001), as was the presence of centrilobular and paraseptal emphysema. CONCLUSIONS RV volumes are lower without significant alterations in RV mass and ejection fraction in contemporary COPD, and this reduction is related to the greater percentage of emphysema on computed tomography.
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Affiliation(s)
- Steven M Kawut
- Departments of Medicine and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hooman D Poor
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Megha A Parikh
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Katja Hueper
- Department of Radiology, Hannover Medical School, Hannover, Germany
| | - Benjamin M Smith
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York
| | - David A Bluemke
- Radiology and Imaging Sciences, NIH Clinical Center, Bethesda, Maryland
| | - João A C Lima
- Departments of Medicine and Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Martin R Prince
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | - Eric A Hoffman
- Department of Radiology, University of Iowa, Iowa City, Iowa
| | - John H M Austin
- Department of Radiology, College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - R Graham Barr
- Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
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Xu B, Yu DM, Liu FS. Effect of siRNA‑induced inhibition of IL‑6 expression in rat cerebral gliocytes on cerebral edema following traumatic brain injury. Mol Med Rep 2014; 10:1863-8. [PMID: 25109513 DOI: 10.3892/mmr.2014.2462] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Accepted: 04/25/2014] [Indexed: 11/06/2022] Open
Abstract
The present study aimed to investigate the effect of RNA interference (RNAi) on the inhibition of interleukin (IL)‑6 expression in rat cerebral gliocytes in vitro and rat cerebral traumatic tissues in vivo, as well as the effect of RNAi on cerebral edema. pSUPER vectors containing IL‑6 small hairpin RNA (pSUPER‑IL‑6 1‑5) were designed, constructed and transfected into C6 rat glioma cells using cationic liposomes. ELISA was used to select the plasmid with the strongest interference effect. A freefall method was used to generate a rat brain injury model and rats were randomly divided into treatment, empty plasmid and control groups (n=14/group). IL‑6 levels, water content and sodium content were determined in the brain tissues at 24 and 72 h post‑injury. pSUPER‑IL‑6 was effectively transfected into C6 cells and was found to inhibit the expression of IL‑6 rather than IL‑8. The pSUPER‑IL‑6 1 vector was most effective in inducing RNAi. In vivo, IL‑6 levels were observed to be lowest in the interference group and there were statistically significant differences in water and sodium content among the experimental groups (P<0.05). RNAi was found to inhibit IL‑6 expression in vivo and in vitro in rat cerebral gliocytes, and the reduction of the IL‑6 levels was found to reduce post‑traumatic cerebral edema.
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Affiliation(s)
- Bin Xu
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Dong-Ming Yu
- Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
| | - Fu-Sheng Liu
- Brain Tumor Research Center, Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, P.R. China
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Serrano-Ferrer J, Walther G, Crendal E, Vinet A, Dutheil F, Naughton G, Lesourd B, Chapier R, Courteix D, Obert P. Right ventricle free wall mechanics in metabolic syndrome without type-2 diabetes: effects of a 3-month lifestyle intervention program. Cardiovasc Diabetol 2014; 13:116. [PMID: 25407698 PMCID: PMC4149206 DOI: 10.1186/s12933-014-0116-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/20/2014] [Indexed: 01/18/2023] Open
Abstract
Background Growing evidence demonstrates subtle left ventricular myocardial dysfunction in patients with metabolic syndrome (MetS), with central obesity, glucose intolerance and inflammation emerging as important contributors. Whether these results can be translated to the right ventricle (RV) is not yet fully elucidated. Furthermore, although lifestyle intervention favorably impacts MetS components and inflammatory biomarkers, its effect on RV myocardial function remains unknown today. Methods Thirty-nine MetS adults free of diabetes were enrolled in a three month lifestyle intervention program including diet and physical exercise, and compared with forty healthy controls. Blood biochemistry, echocardiography including tissue Doppler imaging (TDI), and vector velocity imaging of the RV free wall to assess global longitudinal strain (GLS) and strain rates (SR) were obtained at baseline and after the intervention. Results Compared with controls, MetS patients presented similar right atrial and RV morphology but reduced systolic (P = 0.04) and early diastolic (P = 0.02) velocities of the tricuspid annulus. They showed attenuated RV GLS (−21.4 ± 4.5vs-25.7 ± 4.9%, P < 0.001) as well as early diastolic (P = 0.003) and systolic (P < 0.001) SR. Multiple regression analyses revealed log PAI-1 active, (P < 0.001), log adiponectin, (P = 0.01), LV mass indexed (P = 0.004) and central fat (P = 0.03) as independent predictors of RV GLS (R2 = 0.46, P < 0.001). Biological markers of MetS and inflammation as well as RV GLS (−21.8 ± 3.8vs-24.3 ± 3.0%, P = 0.009) and systolic (P = 0.003) and early diastolic (P = 0.01) SR, but not TDI indexes, significantly improved after diet and exercise training, and vector velocity imaging data in MetS following the lifestyle intervention no longer differed from controls. Conclusions MetS is associated with subtle impairments in both RV free wall diastolic and systolic myocardial function which could be partly related to central-obesity induced changes in pro- and anti-inflammatory cytokines and left ventricular remodeling. The favorable impact of healthy dieting and physical activity on RV free wall mechanics indicates that cellular and sub-cellular alterations responsible for the RV myocardial abnormalities are probably not permanent and modifiable throughout adequate interventional strategies. Trial registration American National Institutes of Health database NCT00917917.
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Leary PJ, Jenny NS, Barr RG, Bluemke DA, Harhay MO, Heckbert SR, Kronmal RA, Lima JA, Mikacenic C, Tracy RP, Kawut SM. Pentraxin-3 and the right ventricle: the Multi-Ethnic Study of Atherosclerosis-Right Ventricle Study. Pulm Circ 2014; 4:250-9. [PMID: 25006444 DOI: 10.1086/675988] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/09/2013] [Indexed: 12/21/2022] Open
Abstract
Pentraxin-3 (PTX3) is a protein mediator of innate immunity that is elevated in the setting of left heart disease and pulmonary arterial hypertension. The relationship between PTX3 and right ventricular (RV) structure and function is not known. We included men and women with magnetic resonance imaging assessment of RV structure and function and measurement of PTX3 from the Multi-Ethnic Study of Atherosclerosis, a study of individuals free of clinical cardiovascular disease. Multivariable linear regression estimated associations between PTX3 protein levels and RV measures after adjusting for demographic characteristics, anthropometrics, smoking status, diabetes mellitus, hypertension, and corresponding left ventricular (LV) parameters. Instrumental variable analysis exploiting Mendelian randomization was attempted using two-stage least squares regression. The study sample included 1,779 participants with available PTX3 levels, RV measures, and all covariables. Mean PTX3 level was 2.1 ng/mL. Higher PTX3 was independently associated with greater RV mass and larger RV end-diastolic volume with and without adjustment for the corresponding LV parameters or C-reactive protein (all P < .05). There was no association between PTX3 and RV ejection fraction or stroke volume. Single-nucleotide polymorphisms were not associated with PTX3 protein levels or RV measures after accounting for race. Instrumental variable analysis could not be reliably performed. Higher PTX3 protein levels were associated with greater RV mass and larger RV end-diastolic volume. These associations were independent of common cardiovascular risk factors and LV morphologic changes. Inflammation is associated with differences in the pulmonary circulation-RV axis in adults without clinical cardiovascular disease.
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Affiliation(s)
- Peter J Leary
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Nancy S Jenny
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - R Graham Barr
- Departments of Medicine and Epidemiology, Columbia University, New York, New York, USA
| | - David A Bluemke
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Maryland, USA
| | - Michael O Harhay
- Department of Medicine, Center for Clinical Epidemiology and Biostatistics, and the Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susan R Heckbert
- Departments of Epidemiology and Pharmacy, University of Washington, Seattle, Washington, USA
| | - Richard A Kronmal
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - João A Lima
- Departments of Medicine and Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Carmen Mikacenic
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Russell P Tracy
- Department of Pathology and Laboratory Medicine, University of Vermont, Burlington, Vermont, USA
| | - Steven M Kawut
- Department of Medicine, Center for Clinical Epidemiology and Biostatistics, and the Penn Cardiovascular Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Tadic M, Cuspidi C, Sljivic A, Andric A, Ivanovic B, Scepanovic R, Ilic I, Jozika L, Marjanovic T, Celic V. Effects of the metabolic syndrome on right heart mechanics and function. Can J Cardiol 2013; 30:325-31. [PMID: 24484912 DOI: 10.1016/j.cjca.2013.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/08/2013] [Accepted: 12/08/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND We sought to investigate right ventricular (RV) and right atrial (RA) deformation obtained using 3-dimensional echocardiography (3DE) and 2-dimensional (2DE) strain in subjects with the metabolic syndrome (MS). METHODS This cross-sectional study included 108 untreated subjects with the MS and 75 control subjects similar according to sex and age. The MS was defined by the presence ≥ 3 American Heart Association/National Heart, Lung, and Blood Institute criteria. All the subjects underwent adequate laboratory analyses and complete 2DE and 3DE examination. RESULTS 2DE global longitudinal strain of the RV was significantly decreased in the MS group compared with the control subjects (-24 ± 5 vs -27 ± 5%; P < 0.001). Similar results were obtained for the RA longitudinal strain (40 ± 5 vs 44 ± 7%; P < 0.001). Systolic and early diastolic RV and RA strain rates were decreased, whereas late diastolic strain rates were increased among the MS participants compared with the control subjects. 3DE RV ejection fraction was significantly decreased in the MS subjects (55 ± 4 vs 58 ± 4%; P < 0.001). The multivariate analysis of MS criteria showed that systolic blood pressure, waist circumference, and fasting glucose were independently associated with RV and/or RA myocardial function and deformation. CONCLUSIONS RV mechanics and RA mechanics, assessed using 3DE and 2DE strain, were significantly deteriorated in the MS subjects. Among all MS risk factors, systolic blood pressure, abdominal circumference, and fasting glucose were the most responsible for the right heart remodelling.
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Affiliation(s)
- Marijana Tadic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca and Istituto Auxologico Italiano, Clinical Research Unit, Meda, Italy
| | - Aleksandra Sljivic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Anita Andric
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Branislava Ivanovic
- Clinical Centre of Serbia, Clinic of Cardiology, Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Radisav Scepanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Irena Ilic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Ljilja Jozika
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Tamara Marjanovic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia
| | - Vera Celic
- University Clinical Hospital Center "Dr Dragisa Misovic," Belgrade, Serbia; University of Belgrade, Faculty of Medicine, Belgrade, Serbia
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Papageorgiou N, Tousoulis D, Androulakis E, Antoniades C, Tentolouris C, Stefanadis C. Inflammation and right ventricle: the hunting of the missing link. Int J Cardiol 2013; 168:3152-4. [PMID: 23910446 DOI: 10.1016/j.ijcard.2013.07.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Nikolaos Papageorgiou
- 1st Cardiology Department, Athens University Medical School, Hippokration Hospital, Greece.
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