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Jahn L, Kramann R, Marx N, Floege J, Becker M, Schlieper G. Speckle Tracking Echocardiography and All-Cause and Cardiovascular Mortality Risk in Chronic Kidney Disease Patients. Kidney Blood Press Res 2019; 44:690-703. [DOI: 10.1159/000501225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 05/28/2019] [Indexed: 11/19/2022] Open
Abstract
Background and Objectives: Patients with chronic kidney disease (CKD) exhibit a highly increased risk of cardiovascular (CV) morbidity and mortality. Subtle changes in left ventricular function can be detected by two-dimensional (2D) speckle tracking echocardiography (STE). This study investigated whether myocardial dysfunction detected by 2D STE may aid in CV and all-cause mortality risk assessment in patients with CKD stages 3 and 4. Method: A study group of 285 patients (CKD 3: 193 patients; CKD 4: 92 patients) and a healthy control group (34 participants) were included in the retrospective study. 2D STE values as well as early and late diastolic strain rates were measured in ventricular longitudinal, circumferential and radial directions. Patients’ CV and all-cause outcome was determined. Results: In the CKD group all measured longitudinal STE values and radial strain were significantly reduced compared to the control group. Cox proportional hazards regression revealed global longitudinal strain to predict CV and all-cause mortality (hazard ratio [HR] 1.15, 95% CI 1.06–1.25; p = 0.0008 and HR 1.09, 95% CI 1.04–1.14; p = 0.0003). After adjustment for sex, age, diabetes, estimated glomerular filtration rate, and preexisting CV disease, this association was maintained for CV mortality and all-cause mortality (HR 1.16, 95% CI 1.06–1.27; p = 0.0019 and HR 1.08, 95% CI 1.03–1.14; p = 0.0026, respectively). Conclusions: The present study shows that 2D STE detects reduced left ventricular myocardial function and allows the prediction of CV and all-cause mortality in patients at CKD stages 3 and 4.
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Rossing K, Bosselmann HS, Gustafsson F, Zhang ZY, Gu YM, Kuznetsova T, Nkuipou-Kenfack E, Mischak H, Staessen JA, Koeck T, Schou M. Urinary Proteomics Pilot Study for Biomarker Discovery and Diagnosis in Heart Failure with Reduced Ejection Fraction. PLoS One 2016; 11:e0157167. [PMID: 27308822 PMCID: PMC4911082 DOI: 10.1371/journal.pone.0157167] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 05/25/2016] [Indexed: 01/06/2023] Open
Abstract
Background Biomarker discovery and new insights into the pathophysiology of heart failure with reduced ejection fraction (HFrEF) may emerge from recent advances in high-throughput urinary proteomics. This could lead to improved diagnosis, risk stratification and management of HFrEF. Methods and Results Urine samples were analyzed by on-line capillary electrophoresis coupled to electrospray ionization micro time-of-flight mass spectrometry (CE-MS) to generate individual urinary proteome profiles. In an initial biomarker discovery cohort, analysis of urinary proteome profiles from 33 HFrEF patients and 29 age- and sex-matched individuals without HFrEF resulted in identification of 103 peptides that were significantly differentially excreted in HFrEF. These 103 peptides were used to establish the support vector machine-based HFrEF classifier HFrEF103. In a subsequent validation cohort, HFrEF103 very accurately (area under the curve, AUC = 0.972) discriminated between HFrEF patients (N = 94, sensitivity = 93.6%) and control individuals with and without impaired renal function and hypertension (N = 552, specificity = 92.9%). Interestingly, HFrEF103 showed low sensitivity (12.6%) in individuals with diastolic left ventricular dysfunction (N = 176). The HFrEF-related peptide biomarkers mainly included fragments of fibrillar type I and III collagen but also, e.g., of fibrinogen beta and alpha-1-antitrypsin. Conclusion CE-MS based urine proteome analysis served as a sensitive tool to determine a vast array of HFrEF-related urinary peptide biomarkers which might help improving our understanding and diagnosis of heart failure.
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Affiliation(s)
- Kasper Rossing
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Helle Skovmand Bosselmann
- Department of Cardio-, Nephro-, and Endocrinology, North Zealand Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Zhen-Yu Zhang
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yu-Mei Gu
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Tatiana Kuznetsova
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Harald Mischak
- Mosaiques Diagnostics and Therapeutics AG, Hanover, Germany
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jan A. Staessen
- Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Thomas Koeck
- Mosaiques Diagnostics and Therapeutics AG, Hanover, Germany
| | - Morten Schou
- Institute for Clinical Medicine, Herlev Hospital, Herlev, Denmark
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Stoltze Gaborit F, Bosselmann H, Kistorp C, Iversen K, Kumler T, Gustafsson F, Goetze JP, Sölétormos G, Tønder N, Schou M. Galectin 3: association to neurohumoral activity, echocardiographic parameters and renal function in outpatients with heart failure. BMC Cardiovasc Disord 2016; 16:117. [PMID: 27246703 PMCID: PMC4886419 DOI: 10.1186/s12872-016-0290-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 05/14/2016] [Indexed: 02/07/2023] Open
Abstract
Background Galectin 3 (Gal-3) reflects cardiac fibrosis in heart failure HF, but has also been associated to renal fibrosis and impaired renal function. Previous research has suggested that Gal-3 could be a cardio-renal biomarker, but it has never been tested simultaneous in a single study whether Gal-3 reflects echocardiographic measures, neurohumoral activity and renal function. The aim of this study was to evaluate the relationship between plasma concentrations of Gal-3 and neurohumoral activity, myocardial and renal function in patients with HF, including advanced echocardiographic measures and 24-h urinary albumin excretion (albuminuria). Methods We prospectively enrolled 132 patients with reduced left ventricular ejection fraction (LVEF) referred to an outpatient HF clinic. The patients had a median age of 70 years (interquartile rage: 64–75), 26.5 % were female, median LVEF was 33 % (27–39 %) and 30 % were in NYHA class III-IV. Results Patients with plasma concentrations of Gal-3 above the median had significantly lower estimated glomerular filtration rate (eGFR) and this association remained significant in multivariate regression analysis (β: −0.010; 95 % CI −0.012–-0.008; P < 0.001), adjusted for age, gender, medical treatment. Plasma concentrations of Gal-3 were not associated with albuminuria (Beta: 0.008; 95 % CI:-0.028–0.045; P = 0.652). There were no association between plasma concentrations of Gal-3 and myocardial function or structure estimated by LVEF, LVmassIndex, LVIDd, E/é or LV global longitudinal strain (P > 0.05 for all). In multivariate analyses plasma concentrations of Gal-3 were significantly associated with the cardiac biomarkers: NT-proBNP (β: 0.047; 95 % CI: 0.008–0.086; P = 0.020), proANP (β: 0.137; 95 % CI: 0.067–0.207; P < 0.001), chromogranin A (β: 0.123; 95 % CI: 0.052–0.194; P < 0.001) and Copeptin (β: 0.080; 95 % CI: 0.000–0.160; P = 0.049). Multivariate analysis was adjusted for eGFR, age, gender and medical treatment. Conclusions Increased plasma concentrations of Gal-3 are associated with reduced eGFR and increased plasma concentrations of NT-proBNP, proANP, chromogranin A and Copeptin, but not with echocardiographic parameters reflecting myocardial function. These results suggest that Gal-3 reflects both increased neurohumoral activity and reduced eGFR, but not myocardial function in patients with systolic HF. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0290-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Freja Stoltze Gaborit
- Department of Cardiology, Herlev University Hospital, Herlev, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Helle Bosselmann
- Department of Internal Medicine KNEA, North Zealand University Hospital, Hillerod, Denmark.,Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Caroline Kistorp
- Department of Internal Medicine, Endocrinology Unit, Herlev University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Kumler
- Department of Cardiology, Herlev University Hospital, Herlev, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - György Sölétormos
- Department of Clinical Biochemistry, North Zealand University Hospital, Hillerod, Denmark
| | - Niels Tønder
- Department of Internal Medicine KNEA, North Zealand University Hospital, Hillerod, Denmark
| | - Morten Schou
- Department of Cardiology, Herlev University Hospital, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abstract
Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high despite therapeutic options. Medical management consists of a neurohormonal blockade of an overly activated neurohormonal axis. No single marker has been able to predict or monitor HF with respect to disease progression, hospitalization, or mortality. New methods for diagnosis, monitoring therapy, and prognosis are warranted. Copeptin, a precursor of pre-provasopressin, is a new biomarker in HF with promising potential. Copeptin has been found to be elevated in both acute and chronic HF and is associated with prognosis. Copeptin, in combination with other biomarkers, could be a useful marker in the monitoring of disease severity and as a predictor of prognosis and survival in HF.
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Affiliation(s)
- Louise Balling
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Finn Gustafsson
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Gaborit F, Bosselmann H, Tønder N, Iversen K, Kümler T, Kistorp C, Sölétormos G, Goetze JP, Schou M. Association between left ventricular global longitudinal strain and natriuretic peptides in outpatients with chronic systolic heart failure. BMC Cardiovasc Disord 2015; 15:92. [PMID: 26289429 PMCID: PMC4546045 DOI: 10.1186/s12872-015-0063-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background Both impaired left ventricular (LV) global longitudinal strain (GLS) and increased plasma concentrations of natriuretic peptides(NP) are associated with a poor outcome in heart failure (HF). Increased levels of NP reflect increased wall stress of the LV. However, little is known about the relationship between LV GLS and NP. This aim of this study was to evaluate the relationship between the echocardiographic measure LV GLS and plasma levels of NP. Methods We prospectively included 149 patients with verified systolic HF at the baseline visit in an outpatient HF clinic. LV GLS was assessed by two dimension speckle tracking and plasma concentrations of N-terminal-pro-brain-natriuretic-peptide (NT-proBNP) and pro-atrial-natriuretic-peptide (proANP) were analysed. Results The patients had a median age of 70 years, 28.2 % were females, 26.5 % were in functional class III-IV, median left ventricular ejection fraction (LVEF) was 33 % and median LV GLS was −11 %. LV GLS was associated with increased plasma concentrations of NT-proBNP and proANP in multivariate logistic regression (NT-proBNP: Odds RatioGLS: 7.25, 95 %-CI: 2.48-21.1, P < 0.001 and proANP: Odds RatioGLS: 3.26, 95-%-CI: 1.28-8.30, P = 0.013) and linear regression (NT-proBNP: βGLS: 1.19, 95 %-CI: 0.62-1.76, P < 0.001 and proANP: βGLS: 0.42, 95-%-CI: 0.11-0.72, P = 0.007) models after adjustment for traditional confounders (age, gender, body-mass-index, atrial fibrillation, renal function) and left atrial volume index. Conclusion Impaired LV GLS is associated with increased plasma concentrations of NP and our data suggest that left ventricular myocardial mechanics estimated by LV GLS reflects myocardial wall stress in chronic systolic HF.
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Affiliation(s)
- F Gaborit
- Department of Cardiology, Herlev University Hospital, DK-2730, Herlev, Denmark.
| | - H Bosselmann
- Department of Internal Medicine KNEA, North Zealand University Hospital, DK-3400, Hillerod, Denmark
| | - N Tønder
- Department of Internal Medicine KNEA, North Zealand University Hospital, DK-3400, Hillerod, Denmark
| | - K Iversen
- Department of Cardiology, Herlev University Hospital, DK-2730, Herlev, Denmark
| | - T Kümler
- Department of Cardiology, Herlev University Hospital, DK-2730, Herlev, Denmark
| | - C Kistorp
- Department of Internal Medicine O, Herlev University Hospital, DK-2730, Herlev, Denmark
| | - G Sölétormos
- Department of Clinical Biochemistry, North Zealand University Hospital, DK-3400, Hillerod, Denmark
| | - J P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - M Schou
- Department of Cardiology, Herlev University Hospital, DK-2730, Herlev, Denmark
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Schou M, Bosselmann H, Gaborit F, Iversen K, Goetze JP, Soletomas G, Rasmussen J, Kistorp C, Kober L, Gustafsson F, Tonder N. Iron deficiency: Prevalence and relation to cardiovascular biomarkers in heart failure outpatients. Int J Cardiol 2015; 195:143-8. [PMID: 26043148 DOI: 10.1016/j.ijcard.2015.05.096] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/07/2015] [Accepted: 05/17/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Both iron deficiency (ID) and cardiovascular biomarkers are associated with a poor outcome in heart failure (HF). The relationship between different cardiovascular biomarkers and ID is unknown, and the true prevalence of ID in an outpatient HF clinic is probably overlooked. OBJECTIVES To identify the prevalence of ID in a HF clinic and evaluate whether ID is associated with increased plasma concentrations of different cardiovascular biomarkers that carry a poor prognosis. METHODS We prospectively included 149 patients with systolic HF referred to an outpatients HF clinic. ID was defined as ferritin<100 μg/L or ferritin 100-300 μg/L and Tranferin-saturation<0.20. Five different cardiovascular biomarkers were analyzed on frozen plasma. RESULTS The patients had a median age of 70 (Interquartile range: 64-75) years, 25% were females, 29% were in functional class III-IV and LVEF was 32 (27-39) %. The prevalence of ID was 45% (95%-confidence interval (CI): 37-53%). In multivariate analyses, ID was not associated with plasma concentrations of troponin I, NT-proBNP, MR-proANP, chromogranin A or copeptin (P>0.05 for all) but with plasma concentrations of hs-CRP (odds ratio: 2.03, 95%-CI: 1.02-4.02, P=0.043). CONCLUSION ID is frequent in an outpatient HF clinic. ID is not associated with cardiovascular biomarkers after adjustment for traditional confounders. Inflammation, but not neurohormonal activation is associated with ID in systolic HF. Further studies are needed to understand iron metabolism in elderly HF patients.
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Affiliation(s)
- Morten Schou
- Department of Cardiology, Herlev University Hospital, DK-2730 Herlev, Denmark.
| | - Helle Bosselmann
- Department of Internal Medicine KNEA, North Zealand University Hospital, DK-3400 Hillerod, Denmark
| | - Freja Gaborit
- Department of Cardiology, Herlev University Hospital, DK-2730 Herlev, Denmark
| | - Kasper Iversen
- Department of Cardiology, Herlev University Hospital, DK-2730 Herlev, Denmark
| | - Jens P Goetze
- Department of Clinical Biochemistry, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Georg Soletomas
- Department of Clinical Biochemistry, North Zealand University Hospital, DK-3400 Hillerod, Denmark
| | - Jon Rasmussen
- Department of Endocrinology, Herlev University Hospital, DK-2730 Herlev, Denmark
| | - Caroline Kistorp
- Department of Endocrinology, Herlev University Hospital, DK-2730 Herlev, Denmark
| | - Lars Kober
- Department of Cardiology, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet, DK-2100 Copenhagen, Denmark
| | - Niels Tonder
- Department of Internal Medicine KNEA, North Zealand University Hospital, DK-3400 Hillerod, Denmark
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