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Pätz T, Stiermaier T, Meusel M, Reinhard I, Jensch PJ, Rawish E, Wang J, Feistritzer HJ, Schuster A, Koschalka A, Lange T, Kowallick JT, Desch S, Thiele H, Eitel I. Myocardial injury and clinical outcome in octogenarians after non-ST-elevation myocardial infarction. Front Cardiovasc Med 2024; 11:1422878. [PMID: 39105073 PMCID: PMC11299492 DOI: 10.3389/fcvm.2024.1422878] [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: 04/24/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction The aim of this study was to analyze age-associated myocardial injury and clinical outcome after non-ST-elevation myocardial infarction (NSTEMI). Methods This prospective, multicenter study consists of 440 patients with NSTEMI enrolled at 7 centers. All patients were treated with primary percutaneous coronary intervention and underwent cardiac magnetic resonance (CMR) imaging 1-10 days after study inclusion. CMR parameters of myocardial injury and clinical outcome were evaluated by creating 2 subgroups: <80 years vs. ≥80 years. The clinical endpoint was the 1-year incidence of major adverse cardiac events (MACE) consisting of death, re-infarction and new congestive heart failure. Results Elderly patients ≥80 years accounted for 13.9% of the study population and showed a divergent cardiovascular risk profile compared to the subgroup of patients <80 years. CMR imaging did not reveal significant differences regarding infarct size, microvascular obstruction, left ventricular ejection fraction or multidimensional strain analysis between the study groups. At 1-year follow-up, MACE rate was significantly increased in patients ≥80 years compared to patients aged <80 years (19.7% vs. 9.6%; p = 0.019). In a multiple stepwise logistic regression model, the number of diseased vessels, aldosterone antagonist use and left ventricular global longitudinal strain were identified as independent predictors for MACE in all patients, while there was no independent predictive value of age regarding 1-year clinical outcome. Conclusion This prospective, multicenter analysis shows that structural and functional myocardial damage is similar in younger and older patients with NSTEMI. Furthermore, in this heterogeneous but also clinically representative cohort with reduced sample size, age was not independently associated with 1-year clinical outcome, despite an increased event rate in patients ≥80 years.
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Affiliation(s)
- Toni Pätz
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Moritz Meusel
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Iris Reinhard
- Department of Biostatistics, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Philipp-Johannes Jensch
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Elias Rawish
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
| | - Juan Wang
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
- The Second People’s Hospital of Yibin, Yibin, Sichuan, China
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Lower Saxony, Göttingen, Germany
| | - Johannes T. Kowallick
- Institute for Diagnostic and Interventional Radiology, German Center for Cardiovascular Research (DZHK), University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, German Center for Cardiovascular Research (DZHK), University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany
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Röning T, Magga J, Laitakari A, Halmetoja R, Tapio J, Dimova EY, Szabo Z, Rahtu-Korpela L, Kemppi A, Walkinshaw G, Myllyharju J, Kerkelä R, Koivunen P, Serpi R. Activation of the hypoxia response pathway protects against age-induced cardiac hypertrophy. J Mol Cell Cardiol 2021; 164:148-155. [PMID: 34919895 DOI: 10.1016/j.yjmcc.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 11/15/2021] [Accepted: 12/09/2021] [Indexed: 12/17/2022]
Abstract
AIMS We have previously demonstrated protection against obesity, metabolic dysfunction, atherosclerosis and cardiac ischemia in a hypoxia-inducible factor (HIF) prolyl 4-hydroxylase-2 (Hif-p4h-2) deficient mouse line, attributing these protective effects to activation of the hypoxia response pathway in a normoxic environment. We intended here to find out whether the Hif-p4h-2 deficiency affects the cardiac health of these mice upon aging. METHODS AND RESULTS When the Hif-p4h-2 deficient mice and their wild-type littermates were monitored during normal aging, the Hif-p4h-2 deficient mice had better preserved diastolic function than the wild type at one year of age and less cardiomyocyte hypertrophy at two years. On the mRNA level, downregulation of hypertrophy-associated genes was detected and shown to be associated with upregulation of Notch signaling, and especially of the Notch target gene and transcriptional repressor Hairy and enhancer-of-split-related basic helix-loop-helix (Hey2). Blocking of Notch signaling in cardiomyocytes isolated from Hif-p4h-2 deficient mice with a gamma-secretase inhibitor led to upregulation of the hypertrophy-associated genes. Also, targeting Hey2 in isolated wild-type rat neonatal cardiomyocytes with siRNA led to upregulation of hypertrophic genes and increased leucine incorporation indicative of increased protein synthesis and hypertrophy. Finally, oral treatment of wild-type mice with a small molecule inhibitor of HIF-P4Hs phenocopied the effects of Hif-p4h-2 deficiency with less cardiomyocyte hypertrophy, upregulation of Hey2 and downregulation of the hypertrophy-associated genes. CONCLUSIONS These results indicate that activation of the hypoxia response pathway upregulates Notch signaling and its target Hey2 resulting in transcriptional repression of hypertrophy-associated genes and less cardiomyocyte hypertrophy. This is eventually associated with better preserved cardiac function upon aging. Activation of the hypoxia response pathway thus has therapeutic potential for combating age-induced cardiac hypertrophy.
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Affiliation(s)
- Tapio Röning
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Johanna Magga
- Biocenter Oulu and Research Unit of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Finland
| | - Anna Laitakari
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Riikka Halmetoja
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Joona Tapio
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Elitsa Y Dimova
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Zoltan Szabo
- Biocenter Oulu and Research Unit of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Finland
| | - Lea Rahtu-Korpela
- Biocenter Oulu and Research Unit of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Finland
| | - Anna Kemppi
- Biocenter Oulu and Research Unit of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Finland
| | | | - Johanna Myllyharju
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland
| | - Risto Kerkelä
- Biocenter Oulu and Research Unit of Biomedicine, Department of Pharmacology and Toxicology, University of Oulu, Finland
| | - Peppi Koivunen
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland.
| | - Raisa Serpi
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, Oulu Center for Cell-Matrix Research, University of Oulu, Oulu, Finland; Faculty of Medicine, University of Oulu, Oulu, Finland; Biobank Borealis of Northern Finland, Oulu University Hospital, Finland
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O'Brien JD, Ferguson JH, Howlett SE. Effects of ischemia and reperfusion on isolated ventricular myocytes from young adult and aged Fischer 344 rat hearts. Am J Physiol Heart Circ Physiol 2008; 294:H2174-83. [DOI: 10.1152/ajpheart.00058.2008] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the impact of age on contractile function, Ca2+homeostasis, and cell viability in isolated myocytes exposed to simulated ischemia and reperfusion. Ventricular myocytes were isolated from anesthetized young adult (3 mo) and aged (24 mo) male Fischer 344 rats. Cells were field-stimulated at 4 Hz (37°C), exposed to simulated ischemia, and reperfused with Tyrode solution. Cell shortening and intracellular Ca2+were measured simultaneously with an edge detector and fura-2. Cell viability was assessed by Trypan blue exclusion. Ischemia (20–45 min) depressed amplitudes of contraction equally in isolated myocytes from young adult and aged animals. The degree of postischemic contractile depression (stunning) was comparable in both groups. Ca2+transient amplitudes were depressed in early reperfusion in young adult and aged cells and then recovered to preischemic levels in both groups. Cell viability also declined equally in reperfusion in both groups. In short, some cellular responses to simulated ischemia and reperfusion were similar in both groups. Even so, aged myocytes exhibited a much greater and more prolonged accumulation of diastolic Ca2+in ischemia and in early reperfusion compared with myocytes from younger animals. In addition, the degree of mechanical alternans in ischemia increased significantly with age. The observation that there is an age-related increase in accumulation of diastolic Ca2+in ischemia and early reperfusion may account for the increased sensitivity to ischemia and reperfusion injury in the aging heart. The occurrence of mechanical alternans in ischemia may contribute to contractile dysfunction in ischemia in the aging heart.
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Abstract
Advanced age is a strong independent predictor for death, disability, and morbidity in patients with structural heart disease. With the projected increase in the elderly population and the prevalence of age-related cardiovascular disabilities worldwide, the need to understand the biology of the aging heart, the mechanisms for age-mediated cardiac vulnerability, and the development of strategies to limit myocardial dysfunction in the elderly have never been more urgent. Experimental evidence in animal models indicate attenuation in cardioprotective pathways with aging, yet limited information is available regarding age-related changes in the human heart. Human cardiac aging generates a complex phenotype, only partially replicated in animal models. Here, we summarize current understanding of the aging heart stemming from clinical and experimental studies, and we highlight targets for protection of the vulnerable senescent myocardium. Further progress mandates assessment of human tissue to dissect specific aging-associated genomic and proteomic dynamics, and their functional consequences leading to increased susceptibility of the heart to injury, a critical step toward designing novel therapeutic interventions to limit age-related myocardial dysfunction and promote healthy aging.
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Affiliation(s)
- Arshad Jahangir
- Marriott Heart Disease Research Program, Division of Cardiovascular Diseases, and Department of Medicine, Mayo Clinic College of Medicine, Rochester, MN 55905, USA.
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