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Okuyama T, Nagoshi T, Hiraki N, Tanaka TD, Oi Y, Kimura H, Kashiwagi Y, Ogawa K, Minai K, Ogawa T, Kawai M, Yoshimura M. Blunted increase in plasma BNP during acute coronary syndrome attacks in obese patients. IJC HEART & VASCULATURE 2024; 54:101508. [PMID: 39314921 PMCID: PMC11417597 DOI: 10.1016/j.ijcha.2024.101508] [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: 06/24/2024] [Revised: 08/14/2024] [Accepted: 09/03/2024] [Indexed: 09/25/2024]
Abstract
Background Unexpectedly low natriuretic peptide (NP) levels in proportion to heart failure severity are often observed in obese individuals. However, the magnitude of NP elevation in response to acute cardiac stress in obesity has not yet been extensively studied. This study aimed to determine the impact of obesity on the increase in plasma NP in response to cardiac hemodynamic stress during acute coronary syndrome (ACS) attacks. Methods and Results The study population included 557 consecutive patients with ACS for whom data were collected during emergency cardiac catheterization. To determine the possible impact of body mass index (BMI) on the relationship between left ventricular ejection fraction (LVEF) and plasma B-type NP (BNP) levels, the study population was divided into two groups (Group 1: BMI <25, Group 2: BMI ≥25 [kg/m2]). Both BMI and LVEF were significantly and negatively correlated with BNP. Although a significant negative correlation between LVEF and BNP was observed in both groups, the regression line of Group 2 was significantly less steep than that of Group 1. Accordingly, BNP/LVEF ratio in Group 2, which indicates the extent of BNP increase in response to LVEF change, was significantly lower than that in Group 1. Conclusions Blunted increase in plasma BNP in response to cardiac hemodynamic stress during ACS attacks was observed in obese individuals. In addition to the relatively low plasma BNP levels at baseline in obese individuals, the blunted response of BNP elevation to ACS attacks may have important pathophysiological implications for hemodynamic regulation and myocardial energy metabolism.
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Affiliation(s)
| | | | - Nana Hiraki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Toshikazu D. Tanaka
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Yuhei Oi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Haruka Kimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Yusuke Kashiwagi
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Kazuo Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Kosuke Minai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Takayuki Ogawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
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Hemat Jouy S, Mohan S, Scichilone G, Mostafa A, Mahmoud AM. Adipokines in the Crosstalk between Adipose Tissues and Other Organs: Implications in Cardiometabolic Diseases. Biomedicines 2024; 12:2129. [PMID: 39335642 PMCID: PMC11428859 DOI: 10.3390/biomedicines12092129] [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: 08/25/2024] [Revised: 09/14/2024] [Accepted: 09/16/2024] [Indexed: 09/30/2024] Open
Abstract
Adipose tissue was previously regarded as a dormant organ for lipid storage until the identification of adiponectin and leptin in the early 1990s. This revelation unveiled the dynamic endocrine function of adipose tissue, which has expanded further. Adipose tissue has emerged in recent decades as a multifunctional organ that plays a significant role in energy metabolism and homeostasis. Currently, it is evident that adipose tissue primarily performs its function by secreting a diverse array of signaling molecules known as adipokines. Apart from their pivotal function in energy expenditure and metabolism regulation, these adipokines exert significant influence over a multitude of biological processes, including but not limited to inflammation, thermoregulation, immune response, vascular function, and insulin sensitivity. Adipokines are pivotal in regulating numerous biological processes within adipose tissue and facilitating communication between adipose tissue and various organs, including the brain, gut, pancreas, endothelial cells, liver, muscle, and more. Dysregulated adipokines have been implicated in several metabolic diseases, like obesity and diabetes, as well as cardiovascular diseases. In this article, we attempted to describe the significance of adipokines in developing metabolic and cardiovascular diseases and highlight their role in the crosstalk between adipose tissues and other tissues and organs.
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Affiliation(s)
- Shaghayegh Hemat Jouy
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, Central Tehran Branch, Islamic Azad University, Tehran 14778-93855, Iran
| | - Sukrutha Mohan
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Giorgia Scichilone
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Amro Mostafa
- Department of Pharmacology, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
| | - Abeer M Mahmoud
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, College of Medicine, University of Illinois Chicago, Chicago, IL 60612, USA
- Department of Kinesiology and Nutrition, College of Applied Health Sciences, University of Illinois Chicago, Chicago, IL 60612, USA
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3
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Domondon IAA, Jeyakumar D, Raake M, Halaharvi SP, Zafar F, Contreras Vazquez SA, Abarca YA, Goli SR, Rohra D, Shah F, Sikander M, Al-Tawil M. Outcomes of Surgical Versus Transcatheter Aortic Valve Replacement in Obese Patients: A Systematic Review and Meta-Analysis. Cardiol Rev 2024:00045415-990000000-00321. [PMID: 39254505 DOI: 10.1097/crd.0000000000000767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) has been increasingly preferred over surgical aortic valve replacement (SAVR) for treating patients with severe aortic stenosis and intermediate to high surgical risk. Recent studies have indicated that obesity may confer protective benefits in cardiac surgery, known as the obesity paradox. We conducted a systematic review and meta-analysis to explore how obesity influences outcomes of TAVI versus SAVR. We searched and reviewed relevant studies comparing TAVI and SAVR in obese patients with aortic stenosis indexed in PubMed, Embase, and Scopus databases. Data from 5 studies with 16,161 patients (TAVI, n = 2951; SAVR, n = 13,210) were included. There was a lower incidence of postprocedural in-hospital mortality [risk ratio (RR), 0.64; 95% confidence interval (CI), 0.41-0.98; P = 0.04], acute kidney injury (RR, 0.53; 95% CI, 0.38-0.73; P = 0.0001), and shorter duration of in-hospital stay (mean difference: -3.35; 95% CI, -4.93 to -1.76; P = 0.0001) in TAVI versus SAVR. There was no significant difference in the risk of postoperative stroke (RR, 0.93; 95% CI, 0.29-3.02; P = 0.91), major bleeding (RR, 0.71; 95% CI, 0.47-1.07; P = 0.10), and myocardial infarction (RR, 0.64; 95% CI, 0.39-1.06; P = 0.08) between TAVI and SAVR. Higher incidences of PPM implantation (RR, 2.0; 95% CI, 1.38-2.90; P = 0.0003) and major vascular complications (RR, 1.51; 95% CI, 1.01-2.27; P = 0.05) were observed with TAVI. In obese patients, TAVI offers similar results as in the general population when compared with SAVR, except for increased vascular complications. An individualized approach can lead to optimal outcomes in this subpopulation.
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Affiliation(s)
- Ileana Anika A Domondon
- From the Emergency Medicine Department, Portsmouth Hospitals University NHS Trust, Portsmouth, United Kingdom
| | - Deepapriya Jeyakumar
- Internal Medicine Department, Government Sivagangai Medical College, Tamil Nadu Dr. M.G.R Medical University, Sivagangai, India
| | - Mohammed Raake
- Faculty of Medicine, Annamalai University, Chidambaram, Cuddalore, India
| | - Savitri Poornima Halaharvi
- Department of Cardiology, JSS Medical College, Rajiv Gandhi University of Health Sciences, Mysore, India
| | - Fabeha Zafar
- Department of Cardiology, Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Yozahandy A Abarca
- Department of Cardiology, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Snehitha Reddy Goli
- Department of Cardiology, College of Medicine, Zhengzhou University, Henan Province, Henan, China
| | - Divya Rohra
- Department of Cardiology, Lokmanya Tilak Municipal Medical College & General Hospital, Mumbai, India
| | - Farah Shah
- Internal Medicine Department, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
| | - Mohammed Sikander
- Department of Cardiology, School of Medicine, University of Texas Rio Grande Valley, TX; and
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Harrington J. Anti-obesity medications in the management of heart failure with preserved ejection fraction: available evidence and next STEPS. Heart Fail Rev 2024; 29:939-944. [PMID: 38965119 DOI: 10.1007/s10741-024-10410-0] [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] [Accepted: 06/17/2024] [Indexed: 07/06/2024]
Abstract
Obesity is associated with an increased risk of incident heart failure with preserved ejection fraction (HFpEF) and, among patients with existing heart failure, is associated with worse quality of life, higher symptom burden, and more HF hospitalizations. Anti-obesity medication (AOM) semaglutide has been shown to be efficacious at both causing intentional weight loss and improving HF symptom burden, with some evidence to suggest that HF clinical events may also be reduced. Additional ongoing trials of AOM in patients with cardiovascular disease, including HFpEF, will further improve insight into the potential role of managing obesity to improve HF status among patients with HFpEF and obesity.
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Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA.
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Harrington J, Gale SE, Vest AR. Anti-Obesity Medications in Patients With Heart Failure: Current Evidence and Practical Guidance. Circ Heart Fail 2024; 17:e011518. [PMID: 39087359 DOI: 10.1161/circheartfailure.124.011518] [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: 03/03/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024]
Abstract
Obesity is a significant risk factor for heart failure (HF) development, particularly HF with preserved ejection fraction and as a result, many patients with HF also have obesity. There is growing clinical interest in optimizing strategies for the management of obesity in patients with HF across the spectrums of both ejection fraction and disease severity. The emergence of anti-obesity medications with cardiovascular outcomes benefits, principally glucagon-like peptide-1 receptor agonists, has made it possible to study the impact of anti-obesity medications for patients with baseline cardiovascular conditions, including HF. However, clinical trials data supporting the safety and efficacy of treating obesity in patients with HF is currently limited to patients with HF with preserved ejection fraction, but do confirm safety and weight loss efficacy in this patient population as well as improvements in HF functional status, biomarkers of inflammation and HF stability. Here, we review the current data available surrounding the management of obesity for patients with HF, including the limitations of this evidence and ongoing areas for investigation, summarize the next phase of emerging anti-obesity medications and provide practical clinical advice for the multidisciplinary management of patients with both HF and obesity.
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Affiliation(s)
- Josephine Harrington
- Department of Medicine, Division of Cardiology Duke University, Durham, NC (J.H.)
- Duke Clinical Research Institute, Durham, NC (J.H.)
| | - Stormi E Gale
- Department of Pharmacy Sciences, Atrium Health Carolinas Medical Center, Charlotte, NC (S.E.G.)
| | - Amanda R Vest
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Kaufman Center for Heart Failure Treatment and Recovery, Cleveland Clinic, OH (A.R.V.)
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Buttar C, Alai H, Matanes FN, Cassidy MM, Stencel J, Le Jemtel TH. Full decongestion in acute heart failure therapy. Am J Med Sci 2024; 368:182-189. [PMID: 38880301 DOI: 10.1016/j.amjms.2024.06.002] [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] [Received: 03/24/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 06/18/2024]
Abstract
Incomplete decongestion is the main cause of readmission in the early post-discharge period of a hospitalization for acute heart failure. Recent heart failure guidelines have highlighted initiation and rapid up-titration of quadruple therapy with angiotensin receptor neprilysin inhibitor, beta adrenergic receptor blocker, mineralocorticoid receptor antagonist, and sodium glucose cotransporter 2 inhibitor to prevent hospitalizations for heart failure with reduced ejection fraction. However, full decongestion remains the foremost therapeutic goal of hospitalization for heart failure. While early addition of sodium glucose cotransporter 2 inhibitors and mineralocorticoid receptor antagonists may be helpful, the value of the other therapeutics comes after decongestion is complete.
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Affiliation(s)
- Chandan Buttar
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Hamid Alai
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Faris N Matanes
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Mark M Cassidy
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Jason Stencel
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA
| | - Thierry H Le Jemtel
- Department of Cardiology, Tulane University Medical Center, 1415 Tulane Ave, New Orleans, LA 70112, USA; Southeast Louisiana Veterans Healthcare System, 2400 Canal Street, New Orleans, LA 70119, USA.
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Feng M, Zhang L, Yin A, Zhang H, Wu X, Qian L. Peptide PDRPS6 attenuates myocardial ischemia injury by improving mitochondrial function. Eur J Pharmacol 2024; 974:176570. [PMID: 38688398 DOI: 10.1016/j.ejphar.2024.176570] [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] [Received: 12/09/2023] [Revised: 04/07/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024]
Abstract
Mitochondrial dynamics play a crucial role in myocardial ischemia-reperfusion (I/R) injury, where an imbalance between fusion and fission processes occurs. However, effective measures to regulate mitochondrial dynamics in this context are currently lacking. Peptide derived from the 40 S ribosomal protein S6 (PDRPS6), a peptide identified via peptidomics, is associated with hypoxic stress. This study aimed to investigate the function and mechanism of action of PDRPS6 in I/R injury. In vivo, PDRPS6 ameliorated myocardial tissue injury and cardiomyocyte apoptosis and decreased cardiac function induced by I/R injury in rats. PDRPS6 supplementation significantly reduced apoptosis in vitro. Mechanistically, PDRPS6 improved mitochondrial function by decreasing reactive oxygen species (ROS) levels, maintaining mitochondrial membrane potential (MMP), and inhibiting mitochondrial fission. Pull-down assay analyses revealed that phosphoglycerate mutase 5 (PGAM5) may be the target of PDRPS6, which can lead to the dephosphorylation of dynamin-related protein1 (Drp1) at ser616 site. Overexpression of PGAM5 partially eliminated the effect of PDRPS6 on improving mitochondrial function. These findings suggest that PDRPS6 supplementation is a novel method for treating myocardial injuries caused by I/R.
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Affiliation(s)
- Mengwen Feng
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China; Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, 221004, China
| | - Li Zhang
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
| | - Anwen Yin
- Department of Cardiology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Han Zhang
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China
| | - Xueping Wu
- Department of Anatomy, Histology and Embryology, Shanghai University of Medicine & Health Sciences, 279 Zhouzhu Road, Pudding New District, Shanghai, 201318, China.
| | - Lingmei Qian
- Hongqiao International Institute of Medicine, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200336, China.
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Petrie MC, Borlaug BA, Butler J, Davies MJ, Kitzman DW, Shah SJ, Verma S, Jensen TJ, Einfeldt MN, Liisberg K, Perna E, Sharma K, Ezekowitz JA, Fu M, Melenovský V, Ito H, Lelonek M, Kosiborod MN. Semaglutide and NT-proBNP in Obesity-Related HFpEF: Insights From the STEP-HFpEF Program. J Am Coll Cardiol 2024; 84:27-40. [PMID: 38819334 DOI: 10.1016/j.jacc.2024.04.022] [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: 03/22/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The glucagon-like peptide-1 receptor agonist, semaglutide, improved health status and reduced body weight in patients with obesity-related heart failure (HF) with preserved ejection fraction (HFpEF) in the STEP-HFpEF (Semaglutide Treatment Effect in People with Obesity and HFpEF) program. Whether benefits were due to mechanical unloading or effects on HF pathobiology is uncertain. OBJECTIVES This study sought to determine if semaglutide 2.4 mg reduced N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with obesity-related HFpEF and compare treatment responses by baseline NT-proBNP. METHODS This was a prespecified secondary analysis of pooled data from 2 double-blind, placebo-controlled, randomized trials (STEP-HFpEF [Research Study to Investigate How Well Semaglutide Works in People Living With Heart Failure and Obesity] and STEP-HFpEF DM [Research Study to Look at How Well Semaglutide Works in People Living With Heart Failure, Obesity and Type 2 Diabetes]) testing effects of semaglutide in patients with obesity-related HFpEF. The main outcomes were change in NT-proBNP at 52 weeks and change in the dual primary endpoints of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score and body weight by baseline NT-proBNP. RESULTS In total, 1,145 patients were randomized. Semaglutide compared with placebo reduced NT-proBNP at 52 weeks (estimated treatment ratio: 0.82; 95% CI: 0.74-0.91; P = 0.0002). Improvements in health status were more pronounced in those with higher vs lower baseline NT-proBNP (estimated difference: tertile 1: 4.5 points, 95% CI: 0.8-8.2; tertile 2: 6.2 points, 95% CI: 2.4-10.0; tertile 3: 11.9 points, 95% CI: 8.1-15.7; P interaction = 0.02; baseline NT-proBNP as a continuous variable: P interaction = 0.004). Reductions in body weight were consistent across baseline NT-proBNP levels (P interaction = 0.21). CONCLUSIONS In patients with obesity-related HFpEF, semaglutide reduced NT-proBNP. Participants with higher baseline NT-proBNP had a similar degree of weight loss but experienced larger reductions in HF-related symptoms and physical limitations with semaglutide than those with lower NT-proBNP.
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Affiliation(s)
- Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, United Kingdom
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, Texas, USA; Department of Medicine, University of Mississippi, Jackson, Mississippi, USA
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, Leicester, United Kingdom
| | - Dalane W Kitzman
- Department of Cardiovascular Medicine and Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Eduardo Perna
- Instituto de Cardiología de Corrientes J. F. Cabral, Corrientes, Argentina
| | - Kavita Sharma
- Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital-Ostra, Gothenburg, Sweden
| | - Vojtěch Melenovský
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hiroshi Ito
- Department of General Internal Medicine 3, Kawasaki Medical School, Okayama, Japan
| | - Małgorzata Lelonek
- Department of Noninvasive Cardiology, Medical University of Lodz, Lodz, Poland
| | - Mikhail N Kosiborod
- Department of Cardiovascular Disease, Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA.
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Izhakian S, Frajman A, Hayat AD, Gorenshtein A, Shtraichman O, Freidkin L, Rosengarten D, Kramer MR. Pretransplant NT-proBNP levels are associated with mortality among lung transplant recipients. Pulm Circ 2024; 14:e12427. [PMID: 39157053 PMCID: PMC11327270 DOI: 10.1002/pul2.12427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 07/25/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024] Open
Abstract
The prognostic significance of pretransplant N-terminal pro-brain (B)-type natriuretic peptide (NT-proBNP) level has not been investigated in lung transplant recipients. The electronic files of 173 patients with chronic lung disease who underwent lung transplantation in 2018-2022 at a tertiary medical center were retrospectively reviewed. Right heart catheterization (RHC) and NT-proBNP determination were performed preoperatively in all cases. Pretransplant demographic, clinical, and laboratory data were compared between posttransplant survivors and nonsurvivors. Correlations of NT-proBNP values with lung function and RHC parameters and all-cause mortality were analyzed. NT-proBNP level correlated positively with mean pulmonary artery pressure (R = 0.51, p < 0.001) and pulmonary vascular resistance (PVR) (R = 0.45, p = 0.0013), and negatively with diffusing lung capacity for carbon monoxide (R = -0.25, p = 0.0017), cardiac index (R = -0.26, p = 0.001), and cardiac output (R = -0.23, p = 0.004). Over a median follow-up time of 23.22 months, 74 patients died. On univariate analysis, mortality was significantly associated with higher log-NT-proBNP (hazard ratio [HR] = 0.54, 95% confidence interval [CI] 1.15-2.05, p = 0.016), older age at transplant registration (HR = 1.033, 95% CI 1.009-1.058, p = 0.0068), higher PVR (HR 1.15, 95% CI 1.07-1.23, p = 0.015), and lower cardiac output (HR = 0.62, 95% CI 0.42-0.92, p = 0.045). On multivariate analysis adjusted for age, sex, and body mass index, mortality significance was maintained only for higher log-NT-proBNP (HR = 1.54, 95% CI 1.12-2.11, p = 0.007). Among lung transplant recipients, pretransplant NT-proBNP levels correlated well with RHC parameters and were strongly associated with posttransplantation mortality. Assessment of NT-proBNP may improve risk stratification of lung transplant candidates.
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Affiliation(s)
- Shimon Izhakian
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Assaf Frajman
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Ariel D. Hayat
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- The Adelson School of MedicineAriel UniversityArielIsrael
| | - Alon Gorenshtein
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Azrieli Faculty of MedicineBar‐Ilan UniversitySafedIsrael
| | - Osnat Shtraichman
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Lev Freidkin
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Dror Rosengarten
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
| | - Mordechai R. Kramer
- Rabin Medical Center—Beilinson Hospital, Pulmonary InstitutePetach TikvaIsrael
- Faculty of MedicineTel Aviv UniversityTel AvivIsrael
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Sato R, von Haehling S. Targeting obesity for therapeutic intervention in heart failure patients. Expert Rev Cardiovasc Ther 2024; 22:217-230. [PMID: 38864827 DOI: 10.1080/14779072.2024.2363395] [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: 02/28/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Heart failure with preserved ejection fraction (HFpEF) is a highly heterogeneous syndrome, making it challenging to improve prognosis with pharmacotherapy. Obesity is one of the leading phenotypes of HFpEF, and its prevalence continues to grow worldwide. Consequently, obesity-targeted interventions have attracted attention as a novel treatment strategy for HFpEF. AREAS COVERED The authors review the association between the pathogenesis of obesity and HFpEF and the potential for obesity-targeted pharmacotherapeutic strategies in HFpEF, together with the latest evidence. The literature search was conducted in PubMed up to April 2024. EXPERT OPINION The STEP HFpEF (Semaglutide Treatment Effect in People with obesity and HFpEF) and SELECT (Semaglutide Effects on Cardiovascular Outcomes in People with Overweight or Obesity) trials recently demonstrated that the glucagon-like peptide 1 analogue, semaglutide, improves various aspects of clinical outcomes in obese HFpEF patients and significantly reduces cardiovascular and heart failure events in non-diabetic obese patients, along with a substantial weight loss. Future clinical trials with other incretin mimetics with more potent weight loss and sub-analyses of the SELECT trial may further emphasize the importance of the obesity phenotype-based approach in the treatment of HFpEF.
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Affiliation(s)
- Ryosuke Sato
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Lower Saxony, Göttingen, Germany
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Rosół N, Procyk G, Kacperczyk-Bartnik J, Grabowski M, Gąsecka A. N-terminal prohormone of brain natriuretic peptide in gestational hypertension and preeclampsia - State of the art. Eur J Obstet Gynecol Reprod Biol 2024; 297:96-105. [PMID: 38603986 DOI: 10.1016/j.ejogrb.2024.04.007] [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] [Received: 12/04/2023] [Revised: 03/04/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
N-terminal prohormone of brain natriuretic peptide (NT-proBNP) is a non-active prohormone secreted by ventricular cardiomyocytes into the circulation in response to ventricle overload, mainly due to increased blood volume. The changes in NT-proBNP levels during pregnancy have been investigated in multiple studies. In the case of hypertensive disorders of pregnancy, increased vasoconstriction leads to increased blood pressure and afterload. Together with the volume overload of pregnancy, it leads to higher NT-proBNP secretion. As hypertensive disorders of pregnancy are among the leading causes of prematurity and perinatal mortality, early prediction and diagnosis of gestational hypertension, and preeclampsia are essential for improving maternal and infant prognosis. NT-proBNP has been regarded as a potential biomarker of hypertensive disorders of pregnancy. In this review, we have thoroughly summarized the current data on the prognostic and diagnostic utility of NT-proBNP in patients with gestational hypertension and preeclampsia. NT-proBNP values may help distinguish between non-preeclamptic and preeclamptic patients, even if there are no significant differences in blood pressure. Moreover, in pregnancies complicated by preeclampsia, the value of increased NT-proBNP level is related to the stage and the severity of the disease. Further improvement of our knowledge about NT-proBNP as a diagnostic biomarker and a putative predictor of adverse cardiac events in women with hypertensive disorders of pregnancy should lead to better management of these patients.
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Affiliation(s)
- Natalia Rosół
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland.
| | - Grzegorz Procyk
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
| | - Joanna Kacperczyk-Bartnik
- 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, Karowa 2, 00-315 Warsaw, Poland.
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
| | - Aleksandra Gąsecka
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
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12
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Hsiao CH, Yang CF, Wang JH, Hsu BG. Serum N-Terminal Pro-B-Type Natriuretic Peptide Level is Negatively Associated with Vascular Reactivity Index by Digital Thermal Monitoring in Patients with Hypertension. Rev Cardiovasc Med 2024; 25:214. [PMID: 39076346 PMCID: PMC11270078 DOI: 10.31083/j.rcm2506214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 07/31/2024] Open
Abstract
Background B-type natriuretic peptide (BNP) coordinates endothelial homeostasis and remodeling, with endothelial dysfunction associated with cardiovascular mortality in the general population without heart failure. The objective of this study was to investigate the correlation between serum N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) levels and endothelial dysfunction among patients diagnosed with hypertension. Methods This cross-sectional, single-center study included 90 patients with hypertension. An electrochemiluminescence immunoassay measured NT-pro-BNP levels, and a digital thermal monitoring device calculated a vascular reactivity index (VRI) as a measurement for endothelial function. In this study, VRI < 1.0 denoted poor vascular reactivity, 1.0 ≤ VRI < 2.0 indicated intermediate vascular reactivity, and a VRI ≥ 2.0 suggested good vascular reactivity. Results Out of all the hypertensive patients, eight (8.9%) displayed poor vascular reactivity (VRI < 1.0), while 39 (43.3%) exhibited intermediate vascular reactivity (1.0 ≤ VRI < 2.0), leaving the remaining 43 patients demonstrating good vascular reactivity. Older age (p = 0.012) and elevated serum NT-pro-BNP levels (p < 0.001) were found to be associated with poorer vascular reactivity. Older age (r = -0.221, p = 0.036) and log-transformed serum levels of NT-pro-BNP (log-NT-pro-BNP, r = -0.505, p < 0.001) exhibited a negative correlation with VRI values in patients with hypertension. Following a multivariate linear regression test, serum log-NT-pro-BNP level ( β = -0.505, adjusted R 2 change = 0.246, p < 0.001) emerged as being significantly and independently associated with VRI values among hypertensive patients. Conclusions In patients with hypertension, there was a negative association observed between serum log-NT-pro-BNP levels and endothelial dysfunction determined by VRI values.
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Affiliation(s)
- Chien-Hao Hsiao
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 97004 Hualien, Taiwan
| | - Chiu-Fen Yang
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 97004 Hualien, Taiwan
- School of Medicine, Tzu Chi University, 97004 Hualien, Taiwan
| | - Ji-Hung Wang
- Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 97004 Hualien, Taiwan
- School of Medicine, Tzu Chi University, 97004 Hualien, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, 97004 Hualien, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 97004 Hualien, Taiwan
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13
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Adedinsewo D, Morales-Lara AC, Hardway H, Johnson P, Young KA, Garzon-Siatoya WT, Butler Tobah YS, Rose CH, Burnette D, Seccombe K, Fussell M, Phillips S, Lopez-Jimenez F, Attia ZI, Friedman PA, Carter RE, Noseworthy PA. Artificial intelligence-based screening for cardiomyopathy in an obstetric population: A pilot study. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2024; 5:132-140. [PMID: 38989045 PMCID: PMC11232425 DOI: 10.1016/j.cvdhj.2024.03.005] [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] [Indexed: 07/12/2024] Open
Abstract
Background Cardiomyopathy is a leading cause of pregnancy-related mortality and the number one cause of death in the late postpartum period. Delay in diagnosis is associated with severe adverse outcomes. Objective To evaluate the performance of an artificial intelligence-enhanced electrocardiogram (AI-ECG) and AI-enabled digital stethoscope to detect left ventricular systolic dysfunction in an obstetric population. Methods We conducted a single-arm prospective study of pregnant and postpartum women enrolled at 3 sites between October 28, 2021, and October 27, 2022. Study participants completed a standard 12-lead ECG, digital stethoscope ECG and phonocardiogram recordings, and a transthoracic echocardiogram within 24 hours. Diagnostic performance was evaluated using the area under the curve (AUC). Results One hundred women were included in the final analysis. The median age was 31 years (Q1: 27, Q3: 34). Thirty-eight percent identified as non-Hispanic White, 32% as non-Hispanic Black, and 21% as Hispanic. Five percent and 6% had left ventricular ejection fraction (LVEF) <45% and <50%, respectively. The AI-ECG model had near-perfect classification performance (AUC: 1.0, 100% sensitivity; 99%-100% specificity) for detection of cardiomyopathy at both LVEF categories. The AI-enabled digital stethoscope had an AUC of 0.98 (95% CI: 0.95, 1.00) and 0.97 (95% CI: 0.93, 1.00), for detection of LVEF <45% and <50%, respectively, with 100% sensitivity and 90% specificity. Conclusion We demonstrate an AI-ECG and AI-enabled digital stethoscope were effective for detecting cardiac dysfunction in an obstetric population. Larger studies, including an evaluation of the impact of screening on clinical outcomes, are essential next steps.
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Affiliation(s)
| | | | - Heather Hardway
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Patrick Johnson
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | | | - Carl H Rose
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | - David Burnette
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota
| | | | - Mia Fussell
- Agape Community Health Center, Jacksonville, Florida
| | - Sabrina Phillips
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | | | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rickey E Carter
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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14
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Harrington J, Sattar N, Felker GM, Januzzi JL, Lam CSP, Pagidipati NJ, Pandey A, Van Spall HGC, McGuire DK. Putting More Weight on Obesity Trials in Heart Failure. Curr Heart Fail Rep 2024; 21:194-202. [PMID: 38619690 DOI: 10.1007/s11897-024-00655-z] [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] [Accepted: 03/04/2024] [Indexed: 04/16/2024]
Abstract
PURPOSE OF REVIEW To review ongoing and planned clinical trials of weight loss among individuals with or at high risk of heart failure. RECENT FINDINGS Intentional weight loss via semaglutide among persons with heart failure and preserved ejection fraction and obesity significantly improves weight loss and health status as assessed by the KCCQ-CSS score and is associated with improvements in 6-min walk test. Ongoing and planned trials will explore the role of intentional weight loss with treatments such as semaglutide or tirzepatide for individuals with heart failure across the entire ejection fraction spectrum.
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Affiliation(s)
- Josephine Harrington
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA.
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - G Michael Felker
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA
| | - James L Januzzi
- Baim Institute for Clinical Research, Boston, MA, USA
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Carolyn S P Lam
- Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- National Heart Centre Singapore and Duke-National University of Singapore, Bukit Merah, Singapore
| | - Neha J Pagidipati
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Duke Clinical Research Institute, 300 W. Morris St, Durham, NC, 27701, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Harriette G C Van Spall
- Baim Institute for Clinical Research, Boston, MA, USA
- Research Institute of St. Joe's, Hamilton, Canada
- McMaster University, Hamilton, Canada
| | - Darren K McGuire
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Parkland Health and Hospital System, Dallas, TX, USA
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15
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Chen C, Hsu YC, Chou KW, Chang KS, Hsu YH, Chiu WH, Lee CW, Yang PS, Chang WH, Huang YK, Chen PY, Chen CW, Su YJ. NT-proBNP point-of-care testing for predicting mortality in end-stage renal disease: A survival analysis. Heliyon 2024; 10:e30581. [PMID: 38742053 PMCID: PMC11089362 DOI: 10.1016/j.heliyon.2024.e30581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
This study examines the predictive value of elevated N-terminal-pro brain natriuretic peptide (NT-pro BNP) levels for mortality among patients with end-stage renal disease (ESRD). Data from 768 ESRD patients, excluding those with cancer or lost follow-up, were analyzed using Kaplan-Meier curves and Cox proportional hazards models over three years. Results indicated that patients with very high NT-pro BNP levels had shorter average survival times and a significantly higher risk of mortality (hazard ratio 1.43). Advanced age, ICU admission, and comorbidities like cerebrovascular diseases and chronic obstructive pulmonary disease also contributed to increased mortality risks. Thus, elevated NT-pro BNP is an independent risk factor for mortality in ESRD patients.
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Affiliation(s)
- Chun Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Yin-Chen Hsu
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Kuang-Wei Chou
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Kuo-Song Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Mackay Junior College of Medicine Nursing and Management, Taipei, Taiwan
| | - Ya-Hui Hsu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
| | - Wei-Huai Chiu
- Graduate Institute of Automation and Control, National Taiwan University of Science and Technology, Taipei, Taiwan
| | - Chun-Wei Lee
- Mackay Junior College of Medicine Nursing and Management, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Po-Sheng Yang
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Department of general surgery, MacKay Memorial Hospital, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yao-Kuang Huang
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Division of Thoracic and Cardiovascular Surgery, Chia Yi Hospital, Ministry of Health and Welfare, Chiayi, Taiwan
| | - Pang-Yen Chen
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Mackay Junior College of Medicine Nursing and Management, Taipei, Taiwan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital Chiayi Branch, Chiayi, Taiwan
- Chang Gung University, College of Medicine, Taoyuan, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan
- Mackay Junior College of Medicine Nursing and Management, Taipei, Taiwan
- Department of Medicine, MacKay Medical College, New Taipei, Taiwan
- Division of Toxicology, Mackay Memorial Hospital, Taipei, 10449, Taiwan
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16
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Eltayeb M, Squire I, Sze S. Biomarkers in heart failure: a focus on natriuretic peptides. Heart 2024; 110:809-818. [PMID: 37673654 DOI: 10.1136/heartjnl-2020-318553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
While progress has been made in the management of most aspects of cardiovascular disease, the incidence and prevalence of heart failure (HF) remains high. HF affects around a million people in the UK and has a worse prognosis than most cancers. Patients with HF are often elderly with complex comorbidities, making accurate assessment of HF challenging. A timely diagnosis and initiation of evidence-based treatments are key to prevent hospitalisation and improve outcomes in this population. Biomarkers have dramatically impacted the way patients with HF are evaluated and managed. The most studied biomarkers in HF are natriuretic peptides (NPs). Since their discovery in the 1980s, there has been an explosion of work in the field of NPs and they have become an important clinical tool used in everyday practice to guide diagnosis and prognostic assessment of patients with HF. In this article, we will review the physiology of NPs and study their biological effects. Then, we will discuss the role of NPs in the diagnosis, management and prognostication of patients with HF. We will also explore the role of NPs as a potential therapeutic agent.
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Affiliation(s)
- Mohamed Eltayeb
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Iain Squire
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
| | - Shirley Sze
- Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Leicester, UK
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17
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Doehner W, Akyea RK, Ntaios G. The obesity paradigm on outcome in heart failure with reduced ejection fraction. Eur Heart J 2024; 45:1484-1485. [PMID: 38240033 DOI: 10.1093/eurheartj/ehad761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2024] Open
Affiliation(s)
- Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Heart Center of the Charite, (Virchow Klinikum), Charité-Universitätsmedizin Berlin, and German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Germany
| | - Ralph Kwame Akyea
- Centre for Academic Primary Care, Lifespan and Population Health Unit, School of Medicine, University of Nottingham, UK
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
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18
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Dai Q, Zhao S, Li W, Liu K, Tao X, Liu C, Yao H, Mu F, Chen S, Li J, Wei P, Gao F, Xi M. Pharmacodynamics and Mechanism of Astragali Radix and Anemarrhenae Rhizoma in Treating Chronic Heart Failure by Inhibiting Complement Activation. Rejuvenation Res 2024; 27:61-74. [PMID: 38386515 DOI: 10.1089/rej.2023.0068] [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: 02/24/2024] Open
Abstract
Astragali radix (AR) and anemarrhenae rhizoma (AAR) are used clinically in Chinese medicine for the treatment of chronic heart failure (CHF), but the exact therapeutic mechanism is unclear. In this study, a total of 60 male C57BL/6 mice were divided into 5 groups, namely sham, model, AR, AAR, and AR-AAR. In the sham group, the chest was opened without ligation. In the other groups, the chest was opened and the transverse aorta was ligated to construct the transverse aortic constriction model. After 8 weeks of feeding, mice were given medicines by gavage for 4 weeks. Left ventricular ejection fraction (LVEF) and left ventricular fractional shortening (LVFS) were detected by echocardiography. Heart weight index (HWI) and wheat germ agglutinin staining were used to evaluate cardiac hypertrophy. Hematoxylin-eosin staining was used to observe the pathological morphology of myocardial tissue. Masson staining was used to evaluate myocardial fibrosis. The content of serum brain natriuretic peptide (BNP) was detected by enzyme-linked immunosorbent assay kit. The content of serum immunoglobulin G (IgG) was detected by immunoturbidimetry. The mechanism of AR-AAR in the treatment of CHF was explored by proteomics. Western blot was used to detect the protein expressions of complement component 1s (C1s), complement component 9 (C9), and terminal complement complex 5b-9 (C5b-9). The results show that AR-AAR inhibits the expression of complement proteins C1s, C9, and C5b-9 by inhibiting the production of IgG antibodies from B cell activation, which further inhibits the complement activation, attenuates myocardial fibrosis, reduces HWI and cardiomyocyte cross-sectional area, improves cardiomyocyte injury, reduces serum BNP release, elevates LVEF and LVFS, improves cardiac function, and exerts myocardial protection.
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Affiliation(s)
- Qi Dai
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
| | - Shi Zhao
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
| | - Weihong Li
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
- College of Life Sciences, Northwestern University, Xi'an, China
| | - Kedi Liu
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
| | - Xingru Tao
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Chengzhao Liu
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
| | - Hong Yao
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
| | - Fei Mu
- Department of Pharmacy, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Sha Chen
- YouYi Clinical Laboratories of Shaanxi, Xi'an, China
| | - Jing Li
- YouYi Clinical Laboratories of Shaanxi, Xi'an, China
| | - Peifeng Wei
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
- National Drug Clinical Trial Institute, The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xi'an, China
| | - Feng Gao
- College of Pharmacy, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Miaomiao Xi
- TANK Medicinal Biology Institute of Xi'an, Xi'an, China
- National Drug Clinical Trial Institute, The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xi'an, China
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19
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Campbell P, Rutten FH, Lee MM, Hawkins NM, Petrie MC. Heart failure with preserved ejection fraction: everything the clinician needs to know. Lancet 2024; 403:1083-1092. [PMID: 38367642 DOI: 10.1016/s0140-6736(23)02756-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/22/2023] [Accepted: 12/06/2023] [Indexed: 02/19/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is increasingly recognised and diagnosed in clinical practice, a trend driven by an ageing population and a rise in contributing comorbidities, such as obesity and diabetes. Representing at least half of all heart failure cases, HFpEF is recognised as a complex clinical syndrome. Its diagnosis and management are challenging due to its diverse pathophysiology, varied epidemiological patterns, and evolving diagnostic and treatment approaches. This Seminar synthesises the latest insights on HFpEF, integrating findings from recent clinical trials, epidemiological research, and the latest guideline recommendations. We delve into the definition, pathogenesis, epidemiology, diagnostic criteria, and management strategies (non-pharmacological and pharmacological) for HFpEF. We highlight ongoing clinical trials and future developments in the field. Specifically, this Seminar offers practical guidance tailored for primary care practitioners, generalists, and cardiologists who do not specialise in heart failure, simplifying the complexities in the diagnosis and management of HFpEF. We provide practical, evidence-based recommendations, emphasising the importance of addressing comorbidities and integrating the latest pharmacological treatments, such as SGLT2 inhibitors.
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Affiliation(s)
- Patricia Campbell
- Department of Cardiology, Southern Trust, Craigavon Area Hospital, Portadown, UK.
| | - Frans H Rutten
- Department of General Practice and Nursing Science, Julius Centre, University Medical Centre, Utrecht University, Utrecht, Netherlands
| | - Matthew My Lee
- School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Nathaniel M Hawkins
- Division of Cardiology, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada
| | - Mark C Petrie
- School of Cardiovascular and Metabolic Health, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
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20
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Doherty DJ, Docherty KF, Gardner RS. Review of the National Institute for Health and Care Excellence guidelines on chronic heart failure. Heart 2024; 110:466-475. [PMID: 38191272 DOI: 10.1136/heartjnl-2022-322164] [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: 09/05/2023] [Accepted: 11/10/2023] [Indexed: 01/10/2024] Open
Abstract
Guidelines are more accessible than ever and represent an important tool in clinical practice. The National Institute for Health and Care Excellence (NICE) has developed recommendations for heart failure diagnosis and management based not only on morbidity and mortality trial outcome data but also in-depth economic analysis, with a focus on generalisability to UK National Health Service clinical practice. There is broad consistency in structure and content between NICE guidelines and those produced by major cardiovascular organisations such as the American College of Cardiology/American Heart Association and the European Society of Cardiology. However, important differences do exist-largely attributable to publication timing-a factor that is enhanced by the rapid pace of heart failure research. This article reviews the most recent iteration of NICE chronic heart failure guidelines and compares them with major guidelines on an international scale. Variations in recommendations will be explored including implications for NICE guideline updates in the future.
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Affiliation(s)
- Daniel J Doherty
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Kieran F Docherty
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
| | - Roy S Gardner
- Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
- School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
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21
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Mu SZ, McEvoy JW, Selvin E. Precise Exclusion Criteria Are Necessary to Define Normative Values of NT-proBNP. JACC. HEART FAILURE 2024; 12:601-602. [PMID: 38448156 DOI: 10.1016/j.jchf.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/05/2023] [Indexed: 03/08/2024]
Affiliation(s)
- Scott Z Mu
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | | | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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22
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Attanasio U, Di Sarro E, Tricarico L, Di Lisi D, Armentaro G, Miceli S, Fioretti F, Deidda M, Correale M, Novo G, Sciacqua A, Nodari S, Cadeddu C, Tocchetti CG, Palazzuoli A, Mercurio V. Cardiovascular Biomarkers in Cardio-Oncology: Antineoplastic Drug Cardiotoxicity and Beyond. Biomolecules 2024; 14:199. [PMID: 38397436 PMCID: PMC10887095 DOI: 10.3390/biom14020199] [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] [Received: 12/30/2023] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Serum biomarkers represent a reproducible, sensitive, minimally invasive and inexpensive method to explore possible adverse cardiovascular effects of antineoplastic treatments. They are useful tools in risk stratification, the early detection of cardiotoxicity and the follow-up and prognostic assessment of cancer patients. In this literature review, we aim at describing the current state of knowledge on the meaning and the usefulness of cardiovascular biomarkers in patients with cancer; analyzing the intricate relationship between cancer and cardiovascular disease (especially HF) and how this affects cardiovascular and tumor biomarkers; exploring the role of cardiovascular biomarkers in the risk stratification and in the identification of chemotherapy-induced cardiotoxicity; and providing a summary of the novel potential biomarkers in this clinical setting.
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Affiliation(s)
- Umberto Attanasio
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
| | - Elena Di Sarro
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
| | - Lucia Tricarico
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (L.T.); (M.C.)
| | - Daniela Di Lisi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (D.D.L.); (G.N.)
- Division of Cardiology, University Hospital Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Francesco Fioretti
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (F.F.); (S.N.)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy (C.C.)
| | - Michele Correale
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto 1, 71122 Foggia, Italy; (L.T.); (M.C.)
| | - Giuseppina Novo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Piazza delle Cliniche 2, 90127 Palermo, Italy; (D.D.L.); (G.N.)
- Division of Cardiology, University Hospital Paolo Giaccone, Via del Vespro 129, 90127 Palermo, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100 Catanzaro, Italy; (G.A.); (S.M.); (A.S.)
| | - Savina Nodari
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy; (F.F.); (S.N.)
| | - Christian Cadeddu
- Department of Medical Sciences and Public Health, University of Cagliari, 09042 Monserrato, Italy (C.C.)
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Center for Basic and Clinical Immunology Research (CISI), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
| | - Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio-thoracic and Vascular Department Le Scotte Hospital, University of Siena, Strada delle Scotte 14, 53100 Siena, Italy;
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy (E.D.S.); (C.G.T.)
- Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
- Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Via Sergio Pansini 5, 80131 Naples, Italy
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Zhu Y, Chen B, Zu Y. Identifying OGN as a Biomarker Covering Multiple Pathogenic Pathways for Diagnosing Heart Failure: From Machine Learning to Mechanism Interpretation. Biomolecules 2024; 14:179. [PMID: 38397416 PMCID: PMC10886937 DOI: 10.3390/biom14020179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/14/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The pathophysiologic heterogeneity of heart failure (HF) necessitates a more detailed identification of diagnostic biomarkers that can reflect its diverse pathogenic pathways. METHODS We conducted weighted gene and multiscale embedded gene co-expression network analysis on differentially expressed genes obtained from HF and non-HF specimens. We employed a machine learning integration framework and protein-protein interaction network to identify diagnostic biomarkers. Additionally, we integrated gene set variation analysis, gene set enrichment analysis (GSEA), and transcription factor (TF)-target analysis to unravel the biomarker-dominant pathways. Leveraging single-sample GSEA and molecular docking, we predicted immune cells and therapeutic drugs related to biomarkers. Quantitative polymerase chain reaction validated the expressions of biomarkers in the plasma of HF patients. A two-sample Mendelian randomization analysis was implemented to investigate the causal impact of biomarkers on HF. RESULTS We first identified COL14A1, OGN, MFAP4, and SFRP4 as candidate biomarkers with robust diagnostic performance. We revealed that regulating biomarkers in HF pathogenesis involves TFs (BNC2, MEOX2) and pathways (cell adhesion molecules, chemokine signaling pathway, cytokine-cytokine receptor interaction, oxidative phosphorylation). Moreover, we observed the elevated infiltration of effector memory CD4+ T cells in HF, which was highly related to biomarkers and could impact immune pathways. Captopril, aldosterone antagonist, cyclopenthiazide, estradiol, tolazoline, and genistein were predicted as therapeutic drugs alleviating HF via interactions with biomarkers. In vitro study confirmed the up-regulation of OGN as a plasma biomarker of HF. Mendelian randomization analysis suggested that genetic predisposition toward higher plasma OGN promoted the risk of HF. CONCLUSIONS We propose OGN as a diagnostic biomarker for HF, which may advance our understanding of the diagnosis and pathogenesis of HF.
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Affiliation(s)
- Yihao Zhu
- International Research Center for Marine Biosciences, Ministry of Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Key Laboratory of Exploration and Utilization of Aquatic Genetic Resources, Ministry of Education, Shanghai Ocean University, Shanghai 201306, China
| | - Bin Chen
- Department of Cardiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine (Lin-gang), Shanghai 201306, China
| | - Yao Zu
- International Research Center for Marine Biosciences, Ministry of Science and Technology, Shanghai Ocean University, Shanghai 201306, China
- Key Laboratory of Exploration and Utilization of Aquatic Genetic Resources, Ministry of Education, Shanghai Ocean University, Shanghai 201306, China
- Marine Biomedical Science and Technology Innovation Platform of Lin-gang Special Area, Shanghai 201306, China
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24
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Guo W, Xu Y, Liu X, Dou J, Guo Z. Therapeutic effect of adipose-derived stem cells injected into pericardial cavity in rat heart failure. ESC Heart Fail 2024; 11:492-502. [PMID: 38062920 PMCID: PMC10804146 DOI: 10.1002/ehf2.14606] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 10/26/2023] [Accepted: 11/06/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS There are few studies on the treatment of heart failure by injecting stem cells into the pericardial cavity. Can the cells injected into the pericardial cavity migrate through the epicardium to the myocardial tissue? Whether there is therapeutic effect and the mechanism of therapeutic effect are still unclear. This study investigated the therapeutic efficacy and evidence of cell migration of adipose-derived stem cells (ADSCs) injected into the pericardial cavity in rat heart failure. The aim of this study is to demonstrate the effectiveness and mechanism of treating heart failure by injecting stem cells into the pericardial cavity, laying an experimental foundation for a new approach to stem cell therapy for heart disease in clinical practice. METHODS AND RESULTS The inguinal adipose tissue of male SD rats aged 4-6 weeks was taken, ADSCs were isolated and cultured, and their stem cell surface markers were identified. Forty rats aged 6-8 weeks were divided into sham operation group, heart failure group, and treatment group; there were 15 rats in the heart failure group and 15 rats in the treatment group. The heart failure model was established by intraperitoneal injection of adriamycin hydrochloride. The heart function of the three groups was detected by small animal ultrasound. The model was successful if the left ventricular ejection fraction < 50%. The identified ADSCs were injected into the pericardial cavity of rats in the treatment group. The retention of transplanted cells in pericardial cavity was detected by small animal in vivo imaging instrument, and the migration of transplanted cells into myocardial tissue was observed by tissue section and immunofluorescence. Western blotting and immunohistochemical staining were used to detect brain natriuretic peptide (BNP), α-smooth muscle actin (α-SMA), and C-reactive protein (CRP). ADSCs express CD29, CD44, and CD73. On the fourth day after injection of ADSCs into pericardial cavity, they migrated to myocardial tissue through epicardium and gradually diffused to deep myocardium. The cell density in the pericardial cavity remains at a high level for 10 days after injection and gradually decreases after 10 days. Compared with the heart failure group, the expression of BNP and α-SMA decreased (P < 0.05 and P < 0.001, respectively), and the expression of CRP in the treatment group was higher than that in the heart failure group (P < 0.0001). A small amount of BNP, α-SMA, and CRP was expressed in the myocardium of the sham operation group. After injection of ADSCs, interleukin-6 in myocardial tissue was significantly lower than that in heart failure myocardium (P < 0.01). After treatment, vascular endothelial growth factor A was significantly higher than that of heart failure (P < 0.01). CONCLUSIONS Pericardial cavity injected ADSCs can penetrate the epicardium, migrate into the myocardium, and have a therapeutic effect on heart failure. Their mechanism of action is to exert therapeutic effects through anti-inflammatory, anti-fibrosis, and increased angiogenesis.
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Affiliation(s)
- Wenjing Guo
- Henan Key Laboratory of Medical Tissue RegenerationXinxiang Medical University601 Jinsui RoadXinxiangHenanChina
- Henan Provincial Key Laboratory of Heart Reconstruction and TransplantationZhengzhou Cardiovascular HospitalZhengzhouHenanChina
| | - Yaping Xu
- Henan Provincial Key Laboratory of Heart Reconstruction and TransplantationZhengzhou Cardiovascular HospitalZhengzhouHenanChina
| | - Xinyi Liu
- Henan Key Laboratory of Medical Tissue RegenerationXinxiang Medical University601 Jinsui RoadXinxiangHenanChina
- Henan Provincial Key Laboratory of Heart Reconstruction and TransplantationZhengzhou Cardiovascular HospitalZhengzhouHenanChina
| | - Jintao Dou
- Henan Key Laboratory of Medical Tissue RegenerationXinxiang Medical University601 Jinsui RoadXinxiangHenanChina
- Henan Provincial Key Laboratory of Heart Reconstruction and TransplantationZhengzhou Cardiovascular HospitalZhengzhouHenanChina
| | - Zhikun Guo
- Henan Key Laboratory of Medical Tissue RegenerationXinxiang Medical University601 Jinsui RoadXinxiangHenanChina
- Henan Provincial Key Laboratory of Heart Reconstruction and TransplantationZhengzhou Cardiovascular HospitalZhengzhouHenanChina
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25
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Yadav R, Swetanshu, Singh P. The molecular mechanism of obesity: The science behind natural exercise yoga and healthy diets in the treatment of obesity. Curr Probl Cardiol 2024; 49:102345. [PMID: 38103823 DOI: 10.1016/j.cpcardiol.2023.102345] [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] [Received: 12/06/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
The review centers on the scientific evidence underlying obesity, providing a detailed examination of the role of perilipin in this condition. It explores potential causes of obesity and delves into therapeutic approaches involving exercise, yoga, and herbal treatments. The paper discusses natural sources that can contribute to combating obesity and underscores the importance of exercise in a scientific context for overcoming obesity. Additionally, it includes information on herbal ingredients that aid in reducing obesity. The review also examines the impact of exercise type and intensity at various time intervals on muscle development. It elucidates triglyceride hydrolysis through different enzymes and the deposition of fatty acids in adipose tissue. The mechanisms by which alpha/beta hydrolase domain-containing protein 5 (ABHD5) and hormone-sensitive lipase (HSL) target and activate their functions are detailed. The inflammatory response in obesity is explored, encompassing inflammatory markers, lipid storage diseases, and their classification with molecular mechanisms. Furthermore, the hormonal regulation of lipolysis is elaborated upon in the review.
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Affiliation(s)
- Rajesh Yadav
- Sharda School of Allied Health Sciences, Sharda University, Greater Noida-201310, Uttar Pradesh, India; Department of Physiology, All India Institute of Medical Science, New Delhi, India
| | - Swetanshu
- Department of Zoology, Banaras Hindu University, U.P, India
| | - Pratichi Singh
- School of Biological and Life Sciences, Galgotias University, Greater Noida-203201, Uttar Pradesh, India.
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26
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Sugiura T, Takase H, Dohi Y, Yamashita S, Seo Y. Impact of medical checkup parameters on major adverse cardiovascular events in the general Japanese population. Prev Med Rep 2024; 38:102600. [PMID: 38283961 PMCID: PMC10821589 DOI: 10.1016/j.pmedr.2024.102600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 01/30/2024] Open
Abstract
Medical checkups play a role in the identification of individuals at increased cardiovascular risk. However, the impact of each medical examination parameter on the incidence of major adverse cardiovascular events (MACE) has not been intensively studied. Here we assessed the predictors of MACE among parameters examined during medical checkups in the general Japanese population. A total of 13,522 individuals (mean age, 52.8 ± 12.3 years) who participated in our medical checkup program from 2008 to 2015 were followed up for a median of 1,827 days with the endpoint of MACE. MACE included cardiovascular death, non-fatal myocardial infarction, angina, decompensated heart failure, stroke, and other cardiovascular events requiring hospitalization. Possible associations between MACE and baseline clinical test parameters were investigated. During follow-up, MACE occurred in 196 participants. Participants with hypertension, diabetes mellitus, dyslipidemia, or metabolic syndrome were at increased risk of MACE on the univariate analysis. Multivariate Cox hazard analysis demonstrated that male sex, age, systolic blood pressure, and baseline B-type natriuretic peptide level were independently correlated with future MACE after the adjustment for confounders; the impact of B-type natriuretic peptide was most prominent among the investigated variables. These results suggest that B-type natriuretic peptide level obtained during a medical checkup examination is an independent and strong predictor of MACE. The inclusion of BNP as part of medical checkup parameters may improve the ability to identify individuals at increased cardiovascular risk and prevent cardiovascular disease among them.
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Affiliation(s)
- Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
| | - Hiroyuki Takase
- Department of Internal Medicine, Enshu Hospital, 1-1-1 Chuo, Chuo-ku, Hamamatsu 430-0929, Japan
| | - Yasuaki Dohi
- Department of Internal Medicine, Faculty of Rehabilitation Sciences, Nagoya Gakuin University, 1-25 Atsuta Nishi-machi, Atsuta-ku, Nagoya 456-8612, Japan
| | - Sumiyo Yamashita
- Department of Cardiology, Nagoya City University Mirai Kousei Hospital, 2-1501 Sekobo, Meito-ku, Nagoya 465-8650, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan
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27
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Oyetoro RO, Conners KM, Joo J, Turecamo S, Sampson M, Wolska A, Remaley AT, Otvos JD, Connelly MA, Larson NB, Bielinski SJ, Hashemian M, Shearer JJ, Roger VL. Circulating ketone bodies and mortality in heart failure: a community cohort study. Front Cardiovasc Med 2024; 11:1293901. [PMID: 38327494 PMCID: PMC10847221 DOI: 10.3389/fcvm.2024.1293901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 01/11/2024] [Indexed: 02/09/2024] Open
Abstract
Background The relationship between ketone bodies (KB) and mortality in patients with heart failure (HF) syndrome has not been well established. Objectives The aim of this study is to assess the distribution of KB in HF, identify clinical correlates, and examine the associations between plasma KB and all-cause mortality in a population-based HF cohort. Methods The plasma KB levels were measured by nuclear magnetic resonance spectroscopy. Multivariable linear regression was used to examine associations between clinical correlates and KB levels. Proportional hazard regression was employed to examine associations between KB (represented as both continuous and categorical variables) and mortality, with adjustment for several clinical covariates. Results Among the 1,382 HF patients with KB measurements, the median (IQR) age was 78 (68, 84) and 52% were men. The median (IQR) KB was found to be 180 (134, 308) μM. Higher KB levels were associated with advanced HF (NYHA class III-IV) and higher NT-proBNP levels (both P < 0.001). The median follow-up was 13.9 years, and the 5-year mortality rate was 51.8% [95% confidence interval (CI): 49.1%-54.4%]. The risk of death increased when KB levels were higher (HRhigh vs. low group 1.23; 95% CI: 1.05-1.44), independently of a validated clinical risk score. The association between higher KB and mortality differed by ejection fraction (EF) and was noticeably stronger among patients with preserved EF. Conclusions Most patients with HF exhibited KB levels that were consistent with those found in healthy adults. Elevated levels of KB were observed in patients with advanced HF. Higher KB levels were found to be associated with an increased risk of death, particularly in patients with preserved EF.
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Affiliation(s)
- Rebecca O. Oyetoro
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Katherine M. Conners
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Jungnam Joo
- Office of Biostatistics Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Sarah Turecamo
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Maureen Sampson
- Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Anna Wolska
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Alan T. Remaley
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - James D. Otvos
- Lipoprotein Metabolism Laboratory, Translational Vascular Medicine Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | | | - Nicholas B. Larson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Suzette J. Bielinski
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Maryam Hashemian
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Joseph J. Shearer
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
| | - Véronique L. Roger
- Heart Disease Phenomics Laboratory, Epidemiology and Community Health Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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Willinger L, Brudy L, Häcker AL, Meyer M, Hager A, Oberhoffer-Fritz R, Ewert P, Müller J. High-sensitive troponin T and N-terminal pro-B-type natriuretic peptide independently predict survival and cardiac-related events in adults with congenital heart disease. Eur J Cardiovasc Nurs 2024; 23:55-61. [PMID: 36883916 DOI: 10.1093/eurjcn/zvad032] [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: 11/01/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
AIMS High-sensitive troponin T (hs-TnT), N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) are established prognostic biomarkers for cardiovascular (CV) morbidity and mortality and frequently used in symptomatic and/or hospitalized adults with congenital heart disease (ACHD). Their prognostic value in clinically stable ACHD has not yet been well established. This study investigates the predictive value of hs-TnT, NT-proBNP, and CRP for survival and CV events in stable ACHD. METHODS AND RESULTS In this prospective cohort study, 495 outpatient ACHD (43.9 ± 10.0 years, 49.1% female) underwent venous blood sampling including hs-TnT, NT-proBNP, and CRP. Patients were followed up for survival status and the occurrence of CV events. Survival analyses were performed with Cox proportional hazards regression analysis and Kaplan-Meier curves. During a mean follow-up of 2.8 ± 1.0 years, 53 patients (10.7%) died or reached a cardiac-related endpoint including sustained ventricular tachycardia, hospitalization with cardiac decompensation, ablation, interventional catheterization, pacer implantation, or cardiac surgery. Multivariable Cox regression revealed hs-TnT (P = 0.005) and NT-proBNP (P = 0.018) as independent predictors of death or cardiac-related events in stable ACHD, whilst the prognostic value of CRP vanished after multivariable adjustment (P = 0.057). Receiver-operator characteristic curve analysis identified cut-off values for event-free survival of hs-TnT ≤9 ng/L and NT-proBNP ≤200 ng/L. Patients with both increased biomarkers had a 7.7-fold (confidence interval 3.57-16.40, P < 0.001) higher risk for death and cardiac-related events compared with patients without elevated blood values. CONCLUSION Subclinical values of hs-TnT and NT-proBNP are a useful, simple, and independent prognostic tool for adverse cardiac events and survival in stable outpatient ACHD. REGISTRATION German Clinical Trial Registry DRKS00015248.
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Affiliation(s)
- Laura Willinger
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
| | - Leon Brudy
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Anna-Luisa Häcker
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Michael Meyer
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Alfred Hager
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
| | - Renate Oberhoffer-Fritz
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jan Müller
- Department of Congenital Heart Disease and Pediatric Cardiology, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636 Munich, Germany
- Institute of Preventive Pediatrics, Technische Universität München, Georg-Brauchle-Ring 60/62, 80992 München, Germany
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29
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Hughes D, Aminian A, Tu C, Okushi Y, Saijo Y, Wilson R, Chan N, Kumar A, Grimm RA, Griffin BP, Tang WHW, Nissen SE, Xu B. Impact of Bariatric Surgery on Left Ventricular Structure and Function. J Am Heart Assoc 2024; 13:e031505. [PMID: 38156532 PMCID: PMC10863834 DOI: 10.1161/jaha.123.031505] [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: 06/23/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Obesity leads to an increased risk of cardiovascular disease morbidity and death, including heart failure. Bariatric surgery has been proven to be the most effective long-term weight management treatment. This study investigated the changes in cardiac structure and function after bariatric surgery, including left ventricular global longitudinal strain. METHODS AND RESULTS There were 398 consecutive patients who underwent bariatric surgery with pre- and postoperative transthoracic echocardiographic imaging at a US health system between 2004 and 2019. We compared cardiovascular risk factors and echocardiographic parameters between baseline and follow-up at least 6 months postoperatively. Along with decreases in weight postoperatively, there were significant improvements in cardiovascular risk factors, including reduction in systolic blood pressure levels from 132 mm Hg (25th-75th percentile: 120-148 mm Hg) to 127 mm Hg (115-140 mm Hg; P=0.003), glycated hemoglobin levels from 6.5% (5.9%-7.6%) to 5.7% (5.4%-6.3%; P<0.001), and low-density lipoprotein levels from 97 mg/dL (74-121 mg/dL) to 86 mg/dL (63-106 mg/dL; P<0.001). Left ventricular mass decreased from 205 g (165-261 g) to 190 g (151-236 g; P<0.001), left ventricular ejection fraction increased from 58% (55%-61%) to 60% (55%-64%; P<0.001), and left ventricular global longitudinal strain improved from -15.7% (-14.3% to -17.5%) to -18.6% (-16.0% to -20.3%; P<0.001) postoperatively. CONCLUSIONS This study has shown the long-term impact of bariatric surgery on cardiac structure and function, with reductions in left ventricular mass and improvement in left ventricular global longitudinal strain. These findings support the cardiovascular benefits of bariatric surgery.
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Affiliation(s)
- Diarmaid Hughes
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Ali Aminian
- Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandOH
| | - Chao Tu
- Department of Quantitative Health SciencesCleveland ClinicClevelandOH
| | - Yuichiro Okushi
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Yoshihito Saijo
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Rickesha Wilson
- Bariatric and Metabolic Institute, Department of General SurgeryCleveland ClinicClevelandOH
| | - Nicholas Chan
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Ashwin Kumar
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Richard A. Grimm
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Brian P. Griffin
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - W. H. Wilson Tang
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Steven E. Nissen
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
| | - Bo Xu
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic InstituteCleveland ClinicClevelandOH
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Gupta A, Mathew R, Anand A, Bhardwaj T, Singh A, Singh K, Kumar A, Mishra PR, Sharma TK. A DNA aptamer-based assay for the detection of soluble ST2, a prognostic biomarker for monitoring heart failure. Int J Biol Macromol 2024; 256:128295. [PMID: 37992929 DOI: 10.1016/j.ijbiomac.2023.128295] [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] [Received: 06/30/2023] [Revised: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 11/24/2023]
Abstract
Heart failure (HF) is emerging as a leading cause of death worldwide. Estimation of BNP levels is a routine diagnosis in these patients. However, in patients having high body-mass index (BMI), renal disease or in geriatric patients, BNP level is reported to be noisy and leads to incongruous conclusion. Thus, for better risk stratification among heart failure patients, it is imperative to look for a superior biomarker. In recent times, sST2 has shown promise as a biomarker. Identifying such biomarkers in peripheral blood of HF patients, need an affine and selective molecular recognition element. Thus, in the current study an aptamer (sS9_P) against sST2 was identified from an aptamer library. Systematic Evolution of Ligands through Exponential enrichment (SELEX) derived aptamer evinced role of its primer binding domains in maintaining its selectivity. This aptamer candidate demonstrated dissociation constant (Kd) in low nanomolar range, and the Limit of Detection (LOD) was ~4 ng. Circular dichroism confirms the formation of complex stem-loop like structure. The well characterized sS9_P aptamer was used in an Aptamer Linked Immobilized Sorbent Assay (ALISA) to detect sST2 level in patients' serum (n = 99). Aptamer sS9_P has shown significant discrimination to differentiate HF patients and healthy volunteers with a reasonable specificity (~83 %) with a modest sensitivity of ~64 %. While sST-2 antibody has shown poor specificity of ~44% but good sensitivity (~87%). The insight obtained from this study indicates that a combination of aptamer and antibody-based assay can be used to design a point-of-care assay for the rapid detection of HF patients in emergency settings.
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Affiliation(s)
- Ankit Gupta
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India
| | - Roshan Mathew
- All India Institute of Medical Sciences (AIIMS), New Delhi, Delhi 110029, India
| | - Anjali Anand
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India
| | - Tanu Bhardwaj
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India; Department of Medical Biotechnology, Gujarat Biotechnology University, GIFT-City, Gandhinagar, Gujarat 382355, India
| | - Aakriti Singh
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Madhya Pradesh 453552, India
| | - Krishna Singh
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Madhya Pradesh 453552, India
| | - Amit Kumar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Simrol, Madhya Pradesh 453552, India
| | | | - Tarun Kumar Sharma
- Aptamer Technology and Diagnostics Laboratory, Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad, Haryana 121001, India; Department of Medical Biotechnology, Gujarat Biotechnology University, GIFT-City, Gandhinagar, Gujarat 382355, India.
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31
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Chen S, Pan X, Mo J, Wang B. Establishment and validation of a prediction nomogram for heart failure risk in patients with acute myocardial infarction during hospitalization. BMC Cardiovasc Disord 2023; 23:619. [PMID: 38110880 PMCID: PMC10726532 DOI: 10.1186/s12872-023-03665-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/08/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) with consequent heart failure is one of the leading causes of death in humans. The aim of this study was to develop a prediction model to identify heart failure risk in patients with AMI during hospitalization. METHODS The data on hospitalized patients with AMI were retrospectively collected and divided randomly into modeling and validation groups at a ratio of 7:3. In the modeling group, the independent risk factors for heart failure during hospitalization were obtained to establish a logistic prediction model, and a nomogram was constructed. The receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were used to evaluate the predictive performance and clinical value. Machine learning models with stacking method were also constructed and compared to logistic model. RESULTS A total of 1875 patients with AMI were enrolled in this study, with a heart failure rate of 5.1% during hospitalization. The independent risk factors for heart failure were age, heart rate, systolic blood pressure, troponin T, left ventricular ejection fraction and pro-brain natriuretic peptide levels. The area under the curve (AUC) of the model in modeling group and validation group were 0.829 and 0.846, respectively. The calibration curve showed high prediction accuracy and the DCA curve showed good clinical value. The AUC value of the ensemble model by the stacking method in the validation group were 0.821, comparable to logistic prediction model. CONCLUSIONS This model, combining laboratory and clinical factors, has good efficacy in predicting heart failure during hospitalization in AMI patients.
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Affiliation(s)
- Shengyue Chen
- Author affiliations Dalian Medical University, Dalian, Liaoning, China
| | - Xinling Pan
- Author affiliations Department of Biomedical Sciences Laboratory, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, Zhejiang, China
| | - Jiahang Mo
- Author affiliations Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Bin Wang
- Author affiliations Department of Hepatobiliary Surgery, Wenzhou Medical University Affiliated Dongyang Hospital, Dongyang, Zhejiang, China.
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Patel RN, Sharma A, Prasad A, Bansal S. Heart Failure With Preserved Ejection Fraction With CKD: A Narrative Review of a Multispecialty Disorder. Kidney Med 2023; 5:100705. [PMID: 38046909 PMCID: PMC10692714 DOI: 10.1016/j.xkme.2023.100705] [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] [Indexed: 12/05/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a heterogenous syndrome with varying phenotypic expression. The phenotype chronic kidney disease (CKD) associated HFpEF is increasing in prevalence globally and is associated with increased morbidity and mortality compared to other HFpEF variants. These 2 conditions share common risk factors, including obesity, diabetes, and metabolic syndrome, as well as similar pathophysiology, including systemic inflammation, oxidative stress, elevated neurohormones, mineralocorticoid-receptor activation, and venous congestion. Given the coexistence of CKD and HFpEF, the diagnosis of HFpEF can be difficult. Moreover, treatment options for HFpEF have remained limited despite the success seen in its counterpart, heart failure with reduced ejection fraction. HFpEF encompasses complex multisystem pathophysiological perturbations beyond neurohormones, it is unlikely that a single agent can have significant benefit in this population. Recent data on sodium-glucose cotransporter 2 (SGLT2) inhibitors in HFpEF and CKD, and on glucagon-like peptide-1 (GLP-1) agonists and mineralocorticoid-receptor antagonists in metabolic syndrome, which target multiple pathways simultaneously, have led to promising therapeutics for HFpEF and CKD. In this perspective, our goal is to increase awareness of HFpEF as a multisystem disorder that shares the same disease processes seen in CKD and to emphasize that its management in individuals with CKD warrants a collective and multidisciplinary approach.
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Affiliation(s)
- Rahul N. Patel
- Transplant Renal Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Akash Sharma
- The University of Texas Health Science Center at San Antonio Joe R and Teresa Lozano Long School of Medicine, San Antonio, TX, USA
| | - Anand Prasad
- Division of Cardiology, The University of Texas Health at San Antonio, San Antonio, Texas, USA
| | - Shweta Bansal
- Division of Nephrology, The University of Texas Health at San Antonio, San Antonio, Texas, USA
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Nogi K, Yamamoto R, Ueda T, Nogi M, Ishihara S, Nakada Y, Hashimoto Y, Nakagawa H, Nishida T, Seno A, Onoue K, Watanabe M, Takaya N, Masuda I, Saito Y. Derivation and validation of a clinical predictive model of NT-proBNP ≥125 pg/mL to detect pre-heart failure. J Cardiol 2023; 82:481-489. [PMID: 37247659 DOI: 10.1016/j.jjcc.2023.05.011] [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: 02/12/2023] [Revised: 05/13/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Several guidelines recommend the measurement of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to diagnose heart failure (HF); however, no screening criteria for measuring NT-proBNP in asymptomatic patients exist. We develop/validate a clinical prediction model for elevated NT-proBNP to support clinical outpatient decision-making. METHODS In this multicenter cohort study, we used a derivation cohort (24 facilities) from 2017 to 2021 and a validation cohort at one facility from 2020 to 2021. Patients were aged ≥65 years with at least one risk factor of HF. The primary endpoint was NT-proBNP ≥125 pg/mL. The final model was selected using backward stepwise logistic regression analysis. Diagnostic performance was evaluated for sensitivity and specificity, the area under the curve (AUC), and calibration. In total, 1645 patients (derivation cohort, n = 837; validation cohort, n = 808) were included, of whom 378 (23.0 %) had NT-proBNP ≥125 pg/mL. Body mass index, age, systolic blood pressure, estimated glomerular filtration rate, cardiothoracic ratio, and heart disease were used as predictors and aggregated into a BASE-CH score of 0-11 points. RESULTS Internal validation resulted in an AUC of 0.74 and an external validation AUC of 0.70. CONCLUSIONS Based on available clinical and laboratory variables, we developed and validated a new risk score to predict NT-proBNP ≥125 pg/mL in patients at risk for HF or with pre-HF.
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Affiliation(s)
- Kazutaka Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
| | - Ryohei Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Maki Nogi
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Satomi Ishihara
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yasuki Nakada
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Yukihiro Hashimoto
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Hitoshi Nakagawa
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Taku Nishida
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Ayako Seno
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Kenji Onoue
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Makoto Watanabe
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | | | - Izuru Masuda
- Medical Examination Center, Takeda Hospital, Kyoto, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan; Nara Prefectural Hospital Organization, Nara Prefecture Seiwa Medical Center, Sango, Japan
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Bhatia MS, Attri R, Sharda SC, Swarup P, Garg A. Natriuretic Peptides and Need for Reliable Tool to Assess Pulmonary Congestion for Treatment Monitoring in Heart Failure. J Community Hosp Intern Med Perspect 2023; 13:120-125. [PMID: 38596554 PMCID: PMC11000840 DOI: 10.55729/2000-9666.1260] [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: 06/13/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 04/11/2024] Open
Abstract
Natriuretic peptides (NPs) play a significant role in the pathophysiology of heart failure (HF) and are considered reliable diagnostic and prognostic indicators of congestive HF. Pulmonary congestion in HF patients leads to clinical deterioration and hospitalizations. It remains an important aspect to address the management and treatment tailoring in HF patients. However, the role of NP-guided therapy remains debatable due to contrasting reports in the literature. Current guidelines do not recommend the use of NP-guided therapy in the treatment monitoring of HF. Therefore, there is an urgent need to identify reliable markers for treatment monitoring in congestive HF. For early detection of congestion, a technology-based approach to monitor pulmonary hemodynamics and absolute lung fluid measurement is found to be effective in guiding treatment. Remote dielectric sensing technology is one such non-invasive approach that measures pulmonary fluid levels in the lungs which results in reduced hospitalization and re-admission rate in HF patients. In this review, we summarized the role of natriuretic peptides and the need for a reliable tool to assess pulmonary congestion for treatment monitoring in HF.
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Affiliation(s)
- Mandip S. Bhatia
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh,
India
| | - Ritu Attri
- Department of General Medicine, Dr.BR. Ambedkar State Institute of Medical Sciences, Mohali, Punjab,
India
| | - Saurabh C. Sharda
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh,
India
| | - Pulkit Swarup
- Medical & Clinical Affairs, Terumo India Pvt. Ltd.,
India
| | - Amit Garg
- Medical & Clinical Affairs, Terumo India Pvt. Ltd.,
India
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Harskamp RE, De Clercq L, Veelers L, Schut MC, van Weert HCPM, Handoko ML, Moll van Charante EP, Himmelreich JCL. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. Diagnosis (Berl) 2023; 10:432-439. [PMID: 37667563 DOI: 10.1515/dx-2023-0089] [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] [Received: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds. METHODS A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding. RESULTS A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold. CONCLUSIONS NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.
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Affiliation(s)
- Ralf E Harskamp
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lukas De Clercq
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Laboratory Medicine, Translational AI. Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC Location VU University, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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Espinoza-Derout J, Arambulo JML, Ramirez-Trillo W, Rivera JC, Hasan KM, Lao CJ, Jordan MC, Shao XM, Roos KP, Sinha-Hikim AP, Friedman TC. The lipolysis inhibitor acipimox reverses the cardiac phenotype induced by electronic cigarettes. Sci Rep 2023; 13:18239. [PMID: 37880325 PMCID: PMC10600141 DOI: 10.1038/s41598-023-44082-x] [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: 04/19/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023] Open
Abstract
Electronic cigarettes (e-cigarettes) are a prevalent alternative to conventional nicotine cigarettes among smokers and people who have never smoked. Increased concentrations of serum free fatty acids (FFAs) are crucial in generating lipotoxicity. We studied the effects of acipimox, an antilipolytic drug, on e-cigarette-induced cardiac dysfunction. C57BL/6J wild-type mice on high fat diet were treated with saline, e-cigarette with 2.4% nicotine [e-cigarette (2.4%)], and e-cigarette (2.4%) plus acipimox for 12 weeks. Fractional shortening and ejection fraction were diminished in mice exposed to e-cigarettes (2.4%) compared with saline and acipimox-treated mice. Mice exposed to e-cigarette (2.4%) had increased circulating levels of inflammatory cytokines and FFAs, which were diminished by acipimox. Gene Set Enrichment Analysis revealed that e-cigarette (2.4%)-treated mice had gene expression changes in the G2/M DNA damage checkpoint pathway that was normalized by acipimox. Accordingly, we showed that acipimox suppressed the nuclear localization of phospho-p53 induced by e-cigarette (2.4%). Additionally, e-cigarette (2.4%) increased the apurinic/apyrimidinic sites, a marker of oxidative DNA damage which was normalized by acipimox. Mice exposed to e-cigarette (2.4%) had increased cardiac Heme oxygenase 1 protein levels and 4-hydroxynonenal (4-HNE). These markers of oxidative stress were decreased by acipimox. Therefore, inhibiting lipolysis with acipimox normalizes the physiological changes induced by e-cigarettes and the associated increase in inflammatory cytokines, oxidative stress, and DNA damage.
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Affiliation(s)
- Jorge Espinoza-Derout
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA.
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA.
| | - Jose Mari Luis Arambulo
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
| | - William Ramirez-Trillo
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
| | - Juan Carlos Rivera
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
| | - Kamrul M Hasan
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Candice J Lao
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Maria C Jordan
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Xuesi M Shao
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Kenneth P Roos
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Amiya P Sinha-Hikim
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - Theodore C Friedman
- Division of Endocrinology, Metabolism and Molecular Medicine, Department of Internal Medicine, Charles R. Drew University of Medicine and Science, 1731 E. 120th Street, Los Angeles, CA, 90059, USA
- Departments of Physiology, Medicine, and Neurobiology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, 90095, USA
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Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, Christodorescu RM, Crawford C, Di Angelantonio E, Eliasson B, Espinola-Klein C, Fauchier L, Halle M, Herrington WG, Kautzky-Willer A, Lambrinou E, Lesiak M, Lettino M, McGuire DK, Mullens W, Rocca B, Sattar N. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J 2023; 44:4043-4140. [PMID: 37622663 DOI: 10.1093/eurheartj/ehad192] [Citation(s) in RCA: 250] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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Haynes ZA, Chandel A, King CS. Pulmonary Hypertension in Interstitial Lung Disease: Updates in Disease, Diagnosis, and Therapeutics. Cells 2023; 12:2394. [PMID: 37830608 PMCID: PMC10572438 DOI: 10.3390/cells12192394] [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] [Received: 07/02/2023] [Revised: 08/15/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
Pulmonary hypertension is a debilitating condition that frequently develops in the setting of interstitial lung disease, likely related to chronic alveolar hypoxemia and pulmonary vascular remodeling. This disease process is likely to be identified more frequently by providers given recent advancements in definitions and diagnostic modalities, and provides practitioners with emerging opportunities to improve patient outcomes and quality of life. Despite years of data suggesting against the efficacy of pulmonary vasodilator therapy in patients with pulmonary hypertension due to interstitial lung disease, new data have emerged identifying promising advancements in therapeutics. The authors present to you a comprehensive review of pulmonary hypertension in interstitial lung disease, reviewing our current understanding of pathophysiology, updates in diagnostic approaches, and highlights of recent clinical trials which provide an effective approach for medical management.
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Affiliation(s)
- Zachary A. Haynes
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Abhimanyu Chandel
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Christopher S. King
- Advanced Lung Disease and Transplant Program, Inova Heart and Vascular Institute, Inova Fairfax Hospital, Fairfax, VA 22031, USA;
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Großmann S, Geisreiter F, Schroll S. [Natriuretic peptides in intensive care medicine]. Med Klin Intensivmed Notfmed 2023; 118:527-533. [PMID: 37099150 DOI: 10.1007/s00063-023-01002-1] [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] [Received: 09/29/2022] [Revised: 01/18/2023] [Accepted: 03/06/2023] [Indexed: 04/27/2023]
Abstract
Natriuretic peptides must be interpreted in their clinical context, especially in intensive care medicine. This overview presents the diagnostic, prognostic, and therapeutic significance of B‑type natriuretic peptide (BNP) and N‑terminal pro B‑type natriuretic peptide (NT-proBNP) in patients with cardiac dysfunction, kidney failure, sepsis, pulmonary embolism, acute respiratory distress syndrome (ARDS), acute exacerbations of chronic obstructive pulmonary disease (AECOPD), and weaning from a respirator.
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Affiliation(s)
- Stefan Großmann
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland.
| | - Florian Geisreiter
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
| | - Stephan Schroll
- Klinik für Pneumologie und konservative Intensivmedizin, Krankenhaus Barmherzige Brüder Regensburg, Prüfeninger Str. 86, 93049, Regensburg, Deutschland
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Saleem D, Madhavan MV, Nigoghossian CD, Driggin E, Nouri SN, Burton J, Zilinyi R, Snyder DJ, Lumish H, Lavelle M, Li J, Rosenzweig EB, Takeda K, Kirtane AJ, Fried J, Brodie D, Agerstrand C, Einstein AJ, Maurer M, Parikh SA, Sethi SS, Finn MT. Association of Modified Body Mass Index With In-Hospital Outcomes After Intermediate or High-Risk Pulmonary Embolism. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2023; 2:101037. [PMID: 39132386 PMCID: PMC11308384 DOI: 10.1016/j.jscai.2023.101037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/16/2023] [Accepted: 04/26/2023] [Indexed: 08/13/2024]
Abstract
Background Pulmonary embolism (PE) outcomes are determined by presentation severity and host-related factors. Limited data exist regarding the association of modified body mass index (mBMI), used as a frailty surrogate, with clinical outcomes after treatment for PE. Therefore, we sought to determine the association of mBMI with mortality and bleeding after treatment for intermediate or high-risk PE. Methods Patients treated for intermediate-risk or high-risk PE at a large academic center between 2013 and 2019 were studied. PE was characterized as intermediate risk (right ventricular compromise) or high risk (hemodynamic compromise) per European Society of Cardiology guidelines. mBMI was defined as the product of serum albumin concentration and body mass index. Patients were stratified according to mBMI quartiles, with low mBMI defined as ≤79, and evaluated for primary end points of in-hospital mortality and bleeding after treatment. A multivariable logistic regression analysis was performed for primary end points. Results A total of 843 patients were treated for PE. Low mBMI was associated with increased burden of comorbidities and lower rates of interventional or surgical treatment. mBMI was independently associated with mortality (Q1, 22.8%; Q2, 12.4%; Q3, 10.9%; Q4, 6.6%; P = .005) and bleeding (Q1, 20.1%; Q2, 10.1%; Q3, 13.3%; Q4, 11.0%; P = .006). Compared with the lowest mBMI quartile, the highest mBMI quartile was independently associated with lower rates of mortality (OR, 0.28; 95% CI, 0.13-0.58; P < .001) and bleeding (OR, 0.42; 95% CI, 0.23-0.76; P = .004). Conclusions Low mBMI is prevalent in patients with intermediate-risk and high-risk PE and is independently associated with in-hospital mortality and bleeding after treatment.
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Affiliation(s)
- Danial Saleem
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Mahesh V. Madhavan
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | | | - Elissa Driggin
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Shayan N. Nouri
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - John Burton
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Robert Zilinyi
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel J. Snyder
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Heidi Lumish
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Michael Lavelle
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Jianhua Li
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Erika B. Rosenzweig
- Division of Pediatric Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Koji Takeda
- Division of Cardiothoracic Surgery, Columbia University Irving Medical Center, New York, New York
| | - Ajay J. Kirtane
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Justin Fried
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Daniel Brodie
- Division of Pulmonology, Columbia University Irving Medical Center, New York, New York
| | - Cara Agerstrand
- Division of Pulmonology, Columbia University Irving Medical Center, New York, New York
| | - Andrew J. Einstein
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Mathew Maurer
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sahil A. Parikh
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Sanjum S. Sethi
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
| | - Matthew T. Finn
- NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Tah S, Valderrama M, Afzal M, Iqbal J, Farooq A, Lak MA, Gostomczyk K, Jami E, Kumar M, Sundaram A, Sharifa M, Arain M. Heart Failure With Preserved Ejection Fraction: An Evolving Understanding. Cureus 2023; 15:e46152. [PMID: 37900404 PMCID: PMC10613100 DOI: 10.7759/cureus.46152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a clinical syndrome in which patients have signs and symptoms of HF due to high left ventricular (LV) filling pressure despite normal or near normal LV ejection fraction. It is more common than HF with reduced ejection fraction (HFrEF), and its diagnosis and treatment are more challenging than HFrEF. Although hypertension is the primary risk factor, coronary artery disease and other comorbidities, such as atrial fibrillation (AF), diabetes, chronic kidney disease (CKD), and obesity, also play an essential role in its formation. This review summarizes current knowledge about HFpEF, its pathophysiology, clinical presentation, diagnostic challenges, current treatments, and promising novel treatments. It is essential to continue to be updated on the latest treatments for HFpEF so that patients always receive the most therapeutic treatments. The use of GnRH agonists in the management of HFpEF, infusion of Apo a-I nanoparticle, low-level transcutaneous vagal stimulation (LLTS), and estrogen only in post-menopausal women are promising strategies to prevent diastolic dysfunction and HFpEF; however, there is still no proven curative treatment for HFpEF yet.
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Affiliation(s)
- Sunanda Tah
- Surgery, Beckley Appalachian Regional Healthcare (ARH) Hospital, Beckley, USA
- Surgery, Saint James School of Medicine, Arnos Vale, VCT
| | | | - Maham Afzal
- Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | | | - Aisha Farooq
- Internal Medicine, Dr. Ruth Pfau Hospital, Karachi, PAK
| | | | - Karol Gostomczyk
- Medicine, Collegium Medicum Nicolaus Copernicus University, Bydgoszcz, POL
| | - Elhama Jami
- Internal Medicine, Herat Regional Hospital, Herat, AFG
| | | | | | | | - Mustafa Arain
- Internal Medicine, Civil Hospital Karachi, Karachi, PAK
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Ha Manh T, Do Anh D, Le Viet T. Effect of body mass index on N-terminal pro-brain natriuretic peptide values in patients with heart failure. Egypt Heart J 2023; 75:75. [PMID: 37642755 PMCID: PMC10465415 DOI: 10.1186/s43044-023-00401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a biomarker used for the diagnosis of heart failure. There is a relationship between NT-proBNP levels and body mass index (BMI). The study aimed to explore the impact of BMI on NT-proBNP concentrations and to examine whether other factors independent of or combined with BMI affect NT-proBNP values in patients with heart failure. RESULTS A total of 293 participants were recruited. The mean age was 68.9 ± 13.2 years, males accounted for 46.4% of the total cohort, the mean BMI was 23.1 ± 4.0 kg/m2, and the median NT-proBNP level was 3776 (1672-8806) pg/ml. There was an inverse relationship between BMI and log NT-proBNP (r = - 0.29; p < 0.001, Spearman correlation). Each standard deviation increase in BMI (4 kg/m2) was associated with a 7% decrease in NT-proBNP values in the total cohort. The independent inverse determinants of NT-proBNP other than BMI were male gender and eGFR, while the variables directly correlated to NT-proBNP were LVEF ≤ 40% and NYHA class III-IV heart failure. CONCLUSIONS There is an inverse association between BMI and NT-proBNP levels. However, the correlation is weak, and there are other variables that have a significant impact on the NT-proBNP values as well. The NT-proBNP levels are still valuable in the diagnosis of heart failure regardless of BMI status.
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Affiliation(s)
- Tuan Ha Manh
- University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Str., District 5, Ward 11, Ho Chi Minh City, 700000 Vietnam
| | - Duong Do Anh
- Laboratory Department, Sai Gon - Long Khanh Clinic, 57 Nguyen Thi Minh Khai Str., Quarter 5, Ward Xuan An, Long Khanh City, Dong Nai Province 76000 Vietnam
| | - Tung Le Viet
- University of Medicine and Pharmacy at Ho Chi Minh City, 215 Hong Bang Str., District 5, Ward 11, Ho Chi Minh City, 700000 Vietnam
- University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Str., District 5, Ward 12, Ho Chi Minh City, 700000 Vietnam
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Venegas‐Rodríguez A, Pello AM, López‐Castillo M, Taibo Urquía M, Balaguer‐Germán J, Munté A, González‐Martín G, Carriazo‐Julio SM, Martínez‐Milla J, Kallmeyer A, González Lorenzo Ó, Gaebelt Slocker HP, Tuñón J, González‐Parra E, Aceña Á. The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study. ESC Heart Fail 2023; 10:2418-2426. [PMID: 37226407 PMCID: PMC10375164 DOI: 10.1002/ehf2.14398] [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] [Received: 11/18/2022] [Revised: 04/09/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023] Open
Abstract
AIMS Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients.
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Affiliation(s)
- Ana Venegas‐Rodríguez
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Ana María Pello
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Marta López‐Castillo
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Mikel Taibo Urquía
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Jorge Balaguer‐Germán
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Alicia Munté
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
| | | | | | - Juan Martínez‐Milla
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC)C. de Melchor Fernández Almagro, 3Madrid28029Spain
| | - Andrea Kallmeyer
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Óscar González Lorenzo
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | | | - José Tuñón
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
| | - Emilio González‐Parra
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
- Department of NephrologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
| | - Álvaro Aceña
- Department of CardiologyIIS‐Fundación Jiménez DíazAvda. Reyes Católicos, 2Madrid28040Spain
- Universidad Autónoma de MadridCiudad Universitaria de CantoblancoMadrid28049Spain
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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45
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Esmati S, Tavoosi A, Mehrban S, Laleh Far V, Mehrakizadeh A, Shahi S, Larti F. NT-proBNP level as a substitute for myocardial perfusion scan in preoperative cardiovascular risk assessment in noncardiac surgery. BMC Anesthesiol 2023; 23:244. [PMID: 37474913 PMCID: PMC10360337 DOI: 10.1186/s12871-023-02205-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Preoperative cardiovascular risk assessment is one of the main principles before noncardiac surgeries. Cardiac stress imaging, such as myocardial perfusion scan (MPS), is a proposed cardiovascular risk evaluation method according to the latest guidelines. Yet, its efficacy, along with the cost-effectiveness of the method, has been questioned in previous studies. Our study aims to evaluate the utility of N-terminal pro-b-type natriuretic peptide (NT-proBNP) level measurement in predicting postoperative cardiovascular complications in candidates who have undergone an MPS before surgery and compare the results. METHODS A cohort of 80 patients with a revised cardiac risk index score of one or more who were scheduled for moderate to high-risk noncardiac surgeries and met the criteria to undergo an MPS for risk assessment were included in the study. All of them underwent an MPS one week before surgery. Their preoperative NT-proBNP, troponin levels, and electrocardiograms were obtained one day before surgery and again on day three postoperative. The predictive efficacy of NT-proBNP levels and MPS were compared. RESULTS Seventy-eight patients underwent surgery, three of which exhibited a rise in troponin level, six showed changes on electrocardiogram, and pulmonary edema was detected in one, three days after surgery. There was no mortality in our patients. The sensitivity and specificity of the MPS for predicting postoperative cardiovascular complications were 100% and 66%, respectively. MPS also had a positive predictive value of 20% and a negative predictive value of 100% in our study. A 332.5 pg/ml cut-off value for NT-proBNP level yielded a sensitivity of 100%, specificity of 79.2%, positive predictive value of 40%, and negative predictive value of 100%. CONCLUSIONS Our study reveals the incremental specificity and positive predictive value of NT-proBNP level measurement in preoperative cardiovascular risk evaluation compared to MPS. Given the low feasibility, high costs, and disappointing predictive value of MPS, preoperative NT-proBNP level assessment can be substituted. This method can assist anesthesiologists and surgeons with precisely detecting at-risk patients resulting in taking proper measures to reduce the morbidity and mortality of the proposed patients before and during surgeries.
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Affiliation(s)
- Saeede Esmati
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Anahita Tavoosi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Saghar Mehrban
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Vahideh Laleh Far
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Ali Mehrakizadeh
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Shayan Shahi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Keshavarz Boulevard, Tehran, 1419733141, Iran.
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Abstract
Hypertrophic cardiomyopathy is one of the most frequently diagnosed primary conditions of the heart muscle. It is considered to be inherited, caused by genetic mutations encoding for sarcomere proteins. The marked heterogeneity in clinical manifestations and natural course of the disease, even among family members sharing the same genetic mutation, has raised the question of non-genetic environmental factors contributing to the phenotype. Obesity has been associated with worse cardiovascular outcomes in the general population. Its prevalence is increased in hypertrophic cardiomyopathy, and the two conditions share some similar pathophysiological and clinical characteristics. In this review, we aim to summarise the effects of obesity in the cardiac phenotype, the symptoms and management in patients with hypertrophic cardiomyopathy.
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Affiliation(s)
| | - Konstantinos Savvatis
- Barts Health NHS Trust, London, UK; William Harvey Research Institute, Queen Mary University London, UK; Institute for Cardiovascular Science, University College London, London, UK
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47
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Wołowiec Ł, Banach J, Budzyński J, Wołowiec A, Kozakiewicz M, Bieliński M, Jaśniak A, Olejarczyk A, Grześk G. Prognostic Value of Plasma Catestatin Concentration in Patients with Heart Failure with Reduced Ejection Fraction in Two-Year Follow-Up. J Clin Med 2023; 12:4208. [PMID: 37445245 PMCID: PMC10342751 DOI: 10.3390/jcm12134208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
The primary objective of the study was to evaluate the prognostic value of measuring plasma catestatin (CST) concentration in patients with heart failure with reduced ejection fraction (HFrEF) as a predictor of unplanned hospitalization and all-cause death independently and as a composite endpoint at 2-year follow-up. The study group includes 122 hospitalized Caucasian patients in NYHA classes II to IV. Patients who died during the 24-month follow-up period (n = 44; 36%) were significantly older on the day of enrollment, were more likely to be in a higher NYHA class, had lower TAPSE, hemoglobin concentration, hematocrit, and platelet count, higher concentrations of CST, NT-proBNP, troponin T, creatinine, and glucose, and higher red cell distribution width value and leukocyte and neutrocyte count than patients who survived the follow-up period. Plasma catestatin concentration increased with NYHA class (R = 0.58; p <0.001) and correlated significantly with blood NT-proBNP concentration (R = 0.44; p <0.001). We showed that higher plasma catestatin concentration increased the risk of all-cause death by more than five times. Plasma CST concentration is a valuable prognostic parameter in predicting death from all causes and unplanned hospitalization in patients with HFrEF.
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Affiliation(s)
- Łukasz Wołowiec
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland (A.J.); (G.G.)
| | - Joanna Banach
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland (A.J.); (G.G.)
| | - Jacek Budzyński
- Department of Vascular and Internal Diseases, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.B.); (A.O.)
| | - Anna Wołowiec
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (A.W.); (M.K.)
| | - Mariusz Kozakiewicz
- Department of Geriatrics, Division of Biochemistry and Biogerontology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (A.W.); (M.K.)
| | - Maciej Bieliński
- Department of Clinical Neuropsychology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 85-094 Bydgoszcz, Poland;
| | - Albert Jaśniak
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland (A.J.); (G.G.)
| | - Agata Olejarczyk
- Department of Vascular and Internal Diseases, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland; (J.B.); (A.O.)
| | - Grzegorz Grześk
- Department of Cardiology and Clinical Pharmacology, Faculty of Health Sciences, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, 87-100 Toruń, Poland (A.J.); (G.G.)
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48
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Correale M, Fioretti F, Tricarico L, Croella F, Brunetti ND, Inciardi RM, Mattioli AV, Nodari S. The Role of Congestion Biomarkers in Heart Failure with Reduced Ejection Fraction. J Clin Med 2023; 12:jcm12113834. [PMID: 37298029 DOI: 10.3390/jcm12113834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/22/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
In heart failure with reduced ejection fraction, edema and congestion are related to reduced cardiac function. Edema and congestion are further aggravated by chronic kidney failure and pulmonary abnormalities. Furthermore, together with edema/congestion, sodium/water retention is an important sign of the progression of heart failure. Edema/congestion often anticipates clinical symptoms, such as dyspnea and hospitalization; it is associated with a reduced quality of life and a major risk of mortality. It is very important for clinicians to predict the signs of congestion with biomarkers and, mainly, to understand the pathophysiological findings that underlie edema. Not all congestions are secondary to heart failure, as in nephrotic syndrome. This review summarizes the principal evidence on the possible roles of the old and new congestion biomarkers in HFrEF patients (diagnostic, prognostic, and therapeutic roles). Furthermore, we provide a description of conditions other than congestion with increased congestion biomarkers, in order to aid in reaching a differential diagnosis. To conclude, the review focuses on how congestion biomarkers may be affected by new HF drugs (gliflozins, vericiguat, etc.) approved for HFrEF.
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Affiliation(s)
- Michele Correale
- Cardiology Unit, Policlinico Riuniti University Hospital, 71100 Foggia, Italy
| | - Francesco Fioretti
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Lucia Tricarico
- Cardiology Unit, Policlinico Riuniti University Hospital, 71100 Foggia, Italy
- Department of Medical & Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Francesca Croella
- Department of Medical & Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiology Unit, Policlinico Riuniti University Hospital, 71100 Foggia, Italy
- Department of Medical & Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Riccardo M Inciardi
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Anna Vittoria Mattioli
- Department of Surgical, Medical and Dental Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Savina Nodari
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
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Affiliation(s)
- Alicja Jasinska-Piadlo
- Cardiology Department, Southern Health and Social Care Trust, Portadown, UK
- School of Computing, Ulster University, Belfast, UK
| | - Patricia Campbell
- Cardiology Department, Southern Health and Social Care Trust, Portadown, UK
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Abstract
Patients with chronic kidney disease (CKD) are at high risk to develop cardiovascular disease with its manifestations coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. In addition, the presence of CKD has a major impact on the prognosis of patients with cardiovascular disease, leading to an increased morbidity and mortality if both comorbidities are present. Therapeutic options including medical therapy and interventional treatment are often limited in patients with advanced CKD, and in most cardiovascular outcome trials, patients with advanced CKD have been excluded. Thus, in many patients, treatment strategies for cardiovascular disease need to be extrapolated from trials conducted in patients without CKD. The current article summarizes the epidemiology, clinical presentation, and treatment options for the most prevalent manifestations of cardiovascular disease in CKD and discusses the currently available treatment options to reduce morbidity and mortality in this high-risk population.
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Affiliation(s)
- Katharina Schuett
- Department of Internal Medicine I (Cardiology), University Hospital, RWTH Aachen University, Germany
| | - Nikolaus Marx
- Department of Internal Medicine I (Cardiology), University Hospital, RWTH Aachen University, Germany
| | - Michael Lehrke
- Department of Internal Medicine I (Cardiology), University Hospital, RWTH Aachen University, Germany
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