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Efremov S, Zagatina A, Filippov A, Ryadinskiy M, Novikov M, Shmatov D. Left Ventricular Diastolic Dysfunction in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00435-X. [PMID: 39069379 DOI: 10.1053/j.jvca.2024.06.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/19/2024] [Accepted: 06/27/2024] [Indexed: 07/30/2024]
Abstract
Cardiac relaxation is a complex process that involves various interconnected characteristics and, along with contractile properties, determines stroke volume. Perioperative ischemia-reperfusion injury and left ventricular diastolic dysfunction (DD) are characterized by the left ventricle's inability to receive a sufficient blood volume under adequate preload. Baseline DD and perioperative DD have an impact on postoperative complications, length of hospital stay, and major clinical outcomes in a variety of cardiac pathologies. Several baseline and perioperative factors, such as age, female sex, hypertension, left ventricle hypertrophy, diabetes, and perioperative ischemia-reperfusion injury, contribute to the risk of DD. The recommended diagnostic criteria available in guidelines have not been validated in the perioperative settings and still need clarification. Timely diagnosis of DD might be crucial for effectively treating postoperative low cardiac output syndrome. This implies the need for an individualized approach to fluid infusion strategy, cardiac rate and rhythm control, identification of extrinsic causes, and administration of drugs with lusitropic effects. The purpose of this review is to consolidate scattered information on various aspects of diastolic dysfunction in cardiac surgery and provide readers with well-organized and clinically applicable information.
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Affiliation(s)
- Sergey Efremov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation.
| | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Alexey Filippov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Mikhail Ryadinskiy
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Maxim Novikov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
| | - Dmitry Shmatov
- Saint-Petersburg State University Hospital, Saint-Petersburg, Russian Federation
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Ishiwata M, Hata U, Hashimoto Y, Okamoto T. Effects of pre-exercise intake of plant- and animal-based foods on arterial function and aerobic exercise capacity in healthy young men: a randomized cross-over trial. Appl Physiol Nutr Metab 2024; 49:880-889. [PMID: 38394648 DOI: 10.1139/apnm-2023-0314] [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: 02/25/2024]
Abstract
The purpose of this study was to examine the effects of plant- versus animal-based food intake before exercise on arterial function and subsequent aerobic exercise capacity. Eleven healthy adult males (mean age, 22.6 ± 1.8 years) participated in this study. A plant- or animal-based randomized meal type crossover comparison was conducted on separate days with a uniform protein, fat, and carbohydrate balance. Both carotid-femoral pulse wave velocity (cfPWV), femoral-ankle pulse wave velocity (faPWV), and brachial artery flow-mediated dilatation (FMD) were measured as indexes of aortic and peripheral arterial stiffness and vascular endothelial function, respectively, before and at 120 min after the meal. After these measurements, maximal oxygen uptake was assessed using a graded power test on an electronically braked cycle ergometer. The results revealed that cfPWV was significantly lower, whereas FMD was significantly higher, at 120 min after compared with before the plant-based meal (p = 0.01 and 0.02, respectively). By contrast, cfPWV and FMD did not change at 120 min after compared with before the animal-based meal. In addition, faPWV did not change at 120 min after compared with before the meal for either meal type. Maximal oxygen uptake was higher in the plant- than in the animal-based meal type (p = 0.02). These results suggest that pre-exercise plant-based food intake may improve central arterial stiffness and vascular endothelial function, which may have favorable implications for aerobic exercise capacity.
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Affiliation(s)
- Maho Ishiwata
- Faculty of Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Urara Hata
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Yuto Hashimoto
- Research Institute for Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Faculty of Sport Science, Nippon Sport Science University, Tokyo, Japan
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
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Kim HL, Jo SH. Arterial Stiffness and Heart Failure With Preserved Ejection Fraction. J Korean Med Sci 2024; 39:e195. [PMID: 38887204 PMCID: PMC11182699 DOI: 10.3346/jkms.2024.39.e195] [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: 03/25/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is prevalent and associated with a poor prognosis, imposing a significant burden on society. Arterial stiffness is increasingly recognized as a crucial factor in the pathophysiology of HFpEF, affecting diagnosis, management, and prognosis. As a hallmark of vascular aging, arterial stiffness contributes to increased afterload on the left ventricle (LV), leading to diastolic dysfunction, a key feature of HFpEF. Elevated arterial stiffness is linked with common cardiovascular risk factors in HFpEF, such as hypertension, diabetes and obesity, exacerbating the progression of disease. Studies have demonstrated that patients with HFpEF exhibit significantly higher levels of arterial stiffness compared to those without HFpEF, highlighting the value of arterial stiffness measurements as both diagnostic and prognostic tools. Moreover, interventions aimed at reducing arterial stiffness, whether through pharmacological therapies or lifestyle modifications, have shown potential in improving LV diastolic function and patient outcomes. Despite these advancements, the precise mechanisms by which arterial stiffness contributes to HFpEF are still not fully understood, necessitating the need for further research.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Di Fiore V, Cappelli F, Del Punta L, De Biase N, Armenia S, Maremmani D, Lomonaco T, Biagini D, Lenzi A, Mazzola M, Tricò D, Masi S, Mengozzi A, Pugliese NR. Novel Techniques, Biomarkers and Molecular Targets to Address Cardiometabolic Diseases. J Clin Med 2024; 13:2883. [PMID: 38792427 PMCID: PMC11122330 DOI: 10.3390/jcm13102883] [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: 04/06/2024] [Revised: 05/01/2024] [Accepted: 05/11/2024] [Indexed: 05/26/2024] Open
Abstract
Cardiometabolic diseases (CMDs) are interrelated and multifactorial conditions, including arterial hypertension, type 2 diabetes, heart failure, coronary artery disease, and stroke. Due to the burden of cardiovascular morbidity and mortality associated with CMDs' increasing prevalence, there is a critical need for novel diagnostic and therapeutic strategies in their management. In clinical practice, innovative methods such as epicardial adipose tissue evaluation, ventricular-arterial coupling, and exercise tolerance studies could help to elucidate the multifaceted mechanisms associated with CMDs. Similarly, epigenetic changes involving noncoding RNAs, chromatin modulation, and cellular senescence could represent both novel biomarkers and targets for CMDs. Despite the promising data available, significant challenges remain in translating basic research findings into clinical practice, highlighting the need for further investigation into the complex pathophysiology underlying CMDs.
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Affiliation(s)
- Valerio Di Fiore
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Federica Cappelli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Lavinia Del Punta
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Nicolò De Biase
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Silvia Armenia
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Davide Maremmani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Tommaso Lomonaco
- Department of Chemistry and Industrial Chemistry, University of Pisa, Via Giuseppe Moruzzi 13, 56124 Pisa, Italy; (T.L.)
| | - Denise Biagini
- Department of Chemistry and Industrial Chemistry, University of Pisa, Via Giuseppe Moruzzi 13, 56124 Pisa, Italy; (T.L.)
| | - Alessio Lenzi
- Department of Chemistry and Industrial Chemistry, University of Pisa, Via Giuseppe Moruzzi 13, 56124 Pisa, Italy; (T.L.)
| | - Matteo Mazzola
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Domenico Tricò
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Stefano Masi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Alessandro Mengozzi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
| | - Nicola Riccardo Pugliese
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 67, 56124 Pisa, Italy (F.C.)
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Janssens JV, Raaijmakers AJA, Koutsifeli P, Weeks KL, Bell JR, Van Eyk JE, Curl CL, Mellor KM, Delbridge LMD. Mechanical loading reveals an intrinsic cardiomyocyte stiffness contribution to diastolic dysfunction in murine cardiometabolic disease. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.21.581448. [PMID: 38659933 PMCID: PMC11042179 DOI: 10.1101/2024.02.21.581448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Cardiometabolic syndromes including diabetes and obesity are associated with occurrence of heart failure with diastolic dysfunction. There are no specific treatments for diastolic dysfunction and therapies to manage symptoms have limited efficacy. Understanding of the cardiomyocyte origins of diastolic dysfunction is an important priority to identify new therapeutics. The investigative goal was to experimentally define in vitro stiffness (stress/strain) properties of isolated cardiomyocytes derived from rodent hearts exhibiting diastolic dysfunction in vivo in response to dietary induction of cardiometabolic disease. Mice fed a High Fat/Sugar Diet (HFSD vs control) for at least 25 weeks exhibited glucose intolerance, obesity and diastolic dysfunction (echo E/e'). Intact paced cardiomyocytes were functionally investigated in three conditions: non-loaded, loaded and stretched. Mean stiffness of HFSD cardiomyocytes was 70% higher than control. The E/e' doppler ratio for the origin hearts was elevated by 35%. A significant relationship was identified between in vitro cardiomyocyte stiffness and in vivo dysfunction severity. With conversion from non-loaded to loaded condition, the decrement in maximal sarcomere lengthening rate was more accentuated in HFSD cardiomyocytes (vs control). With stretch, the Ca 2+ transient decay time course was prolonged. With transition from 2-4Hz pacing, HFSD cardiomyocyte stiffness was further increased, yet diastolic Ca 2+ rise was 50% less than control. Collectively, these findings demonstrate that a component of cardiac diastolic dysfunction in cardiometabolic disease is derived from intrinsic cardiomyocyte mechanical abnormality. Differential responses to load, stretch and pacing suggest that a previously undescribed alteration in myofilament-Ca 2+ interaction contributes to cardiomyocyte stiffness in cardiometabolic disease. KEY POINTS Understanding cardiomyocyte stiffness components is an important priority for identifying new therapeutics for diastolic dysfunction, a key feature of cardiometabolic disease. In this study cardiac function was measured in vivo (echocardiography) for mice fed a high-fat/sugar diet (HFSD, ≥25weeks) and performance of intact isolated cardiomyocytes derived from the same hearts was measured during pacing under non-loaded, loaded and stretched conditions in vitro . Using a calibrated cardiomyocyte stretch protocol, stiffness (stress/strain) was elevated in HFSD cardiomyocytes in vitro and correlated with diastolic dysfunction (E/e') in vivo . The HFSD cardiomyocyte Ca 2+ transient decay was prolonged in response to stretch, and stiffness was accentuated in response to pacing increase while the rise in diastolic Ca 2+ was attenuated. These findings suggest that stretch-dependent augmentation of the myofilament-Ca 2+ response during diastole partially underlies elevated cardiomyocyte stiffness and diastolic dysfunction of hearts of animals with cardiometabolic disease.
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Tamborini A, Gharib M. Validation of a Suprasystolic Cuff System for Static and Dynamic Representation of the Central Pressure Waveform. J Am Heart Assoc 2024; 13:e033290. [PMID: 38591330 PMCID: PMC11262511 DOI: 10.1161/jaha.123.033290] [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: 11/03/2023] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Noninvasive pulse waveform analysis is valuable for central cardiovascular assessment, yet controversies persist over its validity in peripheral measurements. Our objective was to compare waveform features from a cuff system with suprasystolic blood pressure hold with an invasive aortic measurement. METHODS AND RESULTS This study analyzed data from 88 subjects undergoing concurrent aortic catheterization and brachial pulse waveform acquisition using a suprasystolic blood pressure cuff system. Oscillometric blood pressure (BP) was compared with invasive aortic systolic BP and diastolic BP. Association between cuff and catheter waveform features was performed on a set of 15 parameters inclusive of magnitudes, time intervals, pressure-time integrals, and slopes of the pulsations. The evaluation covered both static (subject-averaged values) and dynamic (breathing-induced fluctuations) behaviors. Peripheral BP values from the cuff device were higher than catheter values (systolic BP-residual, 6.5 mm Hg; diastolic BP-residual, 12.4 mm Hg). Physiological correction for pressure amplification in the arterial system improved systolic BP prediction (r2=0.83). Dynamic calibration generated noninvasive BP fluctuations that reflect those invasively measured (systolic BP Pearson R=0.73, P<0.001; diastolic BP Pearson R=0.53, P<0.001). Static and dynamic analyses revealed a set of parameters with strong associations between catheter and cuff (Pearson R>0.5, P<0.001), encompassing magnitudes, timings, and pressure-time integrals but not slope-based parameters. CONCLUSIONS This study demonstrated that the device and methods for peripheral waveform measurements presented here can be used for noninvasive estimation of central BP and a subset of aortic waveform features. These results serve as a benchmark for central cardiovascular assessment using suprasystolic BP cuff-based devices and contribute to preserving system dynamics in noninvasive measurements.
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Affiliation(s)
- Alessio Tamborini
- Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCAUSA
| | - Morteza Gharib
- Department of Medical EngineeringCalifornia Institute of TechnologyPasadenaCAUSA
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Yoon HM, Joo SJ, Boo KY, Lee JG, Choi JH, Kim SY, Lee SY. Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction. PLoS One 2024; 19:e0300578. [PMID: 38574078 PMCID: PMC10994279 DOI: 10.1371/journal.pone.0300578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation (CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the CR program and were subsequently classified as the non-CR group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P = 0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467; P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), and LV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the CR group. Changes in E' velocity were significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program effectively decreased aortic afterload and improved LV diastolic and systolic dysfunction in patients with AMI and preserved or mildly reduced EF.
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Affiliation(s)
- Ho-Min Yoon
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Ki Young Boo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Joon-Hyouk Choi
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Rehabilitation Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
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Frary CE, Blicher MK, Olesen TB, Pareek M, Vishram-Nielsen JKK, Rasmussen S, Olsen MH. N-Terminal Pro-Brain Type Natriuretic Peptide Predicts Cardiovascular Events Independently of Arterial Stiffness, Assessed By Carotid-to-Femoral Pulse Wave Velocity, in Apparently Healthy Subjects. Heart Lung Circ 2024; 33:392-400. [PMID: 38290952 DOI: 10.1016/j.hlc.2023.11.015] [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: 05/13/2023] [Revised: 11/07/2023] [Accepted: 11/19/2023] [Indexed: 02/01/2024]
Abstract
AIM This study aimed to evaluate whether N-terminal pro-brain natriuretic peptide (NT-proBNP) and carotid-to-femoral pulse wave velocity (PWV) carried independent prognostic value in predicting cardiovascular events in apparently healthy individuals beyond traditional risk factors. METHODS A total of 1,872 participants aged 41, 51, 61, or 71 years from the MONItoring of trends and determinants in CArdiovascular disease (MONICA) study were included. Traditional risk factors were assessed, including: smoking status; mean systolic and diastolic blood pressure; body mass index; fasting plasma glucose; serum triglycerides; total, high-density, and low-density lipoprotein cholesterol; NT-proBNP; and PWV. The principal endpoint that was assessed during 16 years of follow-up was a composite of major adverse cardiovascular events (MACE). The secondary endpoints were cardiovascular mortality (CVM), hospitalisation for coronary artery disease (CAD), and a composite of hospitalisation for heart failure (HF) or atrial fibrillation (AF). RESULTS At baseline, NT-proBNP was associated with PWV (β=0.14; p<0.001), but not after adjustment for traditional risk factors (β=-0.01; p=0.67). In models including traditional risk factors and PWV, NT-proBNP was associated with all four outcomes (HRMACE=1.33, 95% CI 1.16-1.52; HRCVM=2.02, 95% CI 1.65-2.48; HRCAD=1.29, 95% CI 1.07-1.55; and HRHF or AF=1.79, 95% CI 1.40-2.28). In the same model, PWV was only associated with CVM (HRCVM=1.20, 95% CI 1.01-1.41). No interactions between NT-proBNP and PWV were found. N-terminal pro-brain natriuretic peptide significantly improved net reclassification (NRI) for MACE (NRI=0.12; p=0.03), CVM (NRI=0.33; p<0.001), and HF or AF (NRI=0.33; p<0.001) beyond traditional risk factors, while PWV did not aid in net reclassification improvement for any endpoint. CONCLUSIONS In apparently healthy individuals, NT-proBNP and PWV predicted cardiovascular events independently. N-terminal pro-brain natriuretic peptide improved reclassification for the prediction of MACE, CVM, and hospitalisation for HF or AF beyond traditional risk factors, while PWV did not.
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Affiliation(s)
- Charles Edward Frary
- Cardiology Section, Department of Internal Medicine 1, Holbaek Hospital, Holbaek, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Manan Pareek
- Center for Translational Cardiology and Pragmatic Randomized Trials, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Julie K K Vishram-Nielsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Copenhagen, Denmark
| | - Susanne Rasmussen
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Michael Hecht Olsen
- Cardiology Section, Department of Internal Medicine 1, Holbaek Hospital, Holbaek, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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Hoshida S. Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction. J Clin Med 2023; 12:6692. [PMID: 37892830 PMCID: PMC10607873 DOI: 10.3390/jcm12206692] [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: 09/15/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
Of the existing non-invasive diastolic indices, none consider arterial load. This article reveals points of caution for determining the diastolic prognostic index using a novel index of vascular resistance-integrated diastolic function in old, real-world patients with heart failure with preserved ejection fraction (HFpEF) in Japan. This index represents the ratio of left ventricular diastolic elastance (Ed) to arterial elastance (Ea), where Ed/Ea = (E/e')/(0.9 × systolic blood pressure), showing a relative ratio of left atrial filling pressure to left ventricular end-systolic pressure. The role of hemodynamic prognostic factors related to diastolic function, such as Ed/Ea, may differ according to the clinical endpoint, follow-up duration, and sex. In HFpEF patients with heterogenous cardiac structure and function, an assessment using a serial echocardiographic diastolic index in clinical care can provide an accurate prognosis.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, 1-3-1 Ryuge-cho, Osaka 581-0069, Japan
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10
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Sági B, Késői I, Vas T, Csiky B, Nagy J, Kovács TJ. Relationship between arterial stiffness, left ventricular diastolic function, and renal function in chronic kidney disease. BMC Nephrol 2023; 24:261. [PMID: 37661275 PMCID: PMC10476356 DOI: 10.1186/s12882-023-03308-w] [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: 06/12/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023] Open
Abstract
AIM In chronic kidney disease, IgA nephropathy, and left ventricular diastolic dysfunction have prognostic significance as well. However, the relationship between diastolic dysfunction, arterial stiffness, and renal function has not been fully elucidated. METHODS 79 IgA nephropathy patients (aged 46 ± 11 years) and 50 controls were investigated. Tissue Doppler imaging was used to measure early (Ea) and late (Aa) diastolic velocities. Arterial stiffness was measured by a photoplethysmographic (stiffness index (SI)) and an oscillometric method (aortic pulse wave velocity (PWVao)). RESULTS We compared the IgAN patients to a similar cardiovascular risk group with a preserved eGFR. A strong correlation was found between Ea/Aa and SI (p < 0.001), also with PWVao (p < 0.001), just in IgAN, and with eGFR (p < 0.001) in both groups. IgAN patients were divided into groups CKD1-2 vs. CKD3-5. In the CKD 3-5 group, the incidence of diastolic dysfunction increased significantly: 39% vs. 72% (p = 0.003). Left ventricle rigidity (LVR) was calculated, which showed a close correlation with SI (p = 0.009) and eGFR (p = 0.038). By linear regression analysis, the independent predictors of SI were age, E/A, and E/Ea; SI was the predictor of LVR; and E/A and hypertension were the predictors of eGFR. CONCLUSION In chronic kidney disease, increased cardiac rigidity and vascular stiffness coexist with decreased renal function, which is directly connected to diastolic dysfunction and vascular stiffness. On the basis of comparing the CKD group to the control group, vascular alterations in very early CKD can be identified.
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Affiliation(s)
- Balázs Sági
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - István Késői
- Mohács Hospital, Department of Internal Medicine Cardiology, Szepessy square 7, Mohács, 7700, Hungary
| | - Tibor Vas
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Botond Csiky
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Judit Nagy
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary
| | - Tibor József Kovács
- 2nd Dept. of Internal Medicine and Nephrology, Diabetes Centre, Medical School, Clinical Center, University of Pécs, Pacsirta Street 1, Pécs, 7624, Hungary.
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Ito S, Takahama H, Asakura M, Abe Y, Ajioka M, Anzai T, Arikawa T, Hayashi T, Higashino Y, Hiramitsu S, Iwahashi N, Izumi C, Kimura K, Kinugawa K, Kioka H, Lim YJ, Matsuoka K, Matsuoka S, Motoki H, Nakamura S, Nakayama T, Nomura A, Sasaoka T, Takiuchi S, Toyoda S, Ueda T, Watanabe T, Yamada A, Yamamoto M, Sozu T, Kitakaze M. Efficacy of azilsartan on left ventricular diastolic dysfunction compared with candesartan: J-TASTE randomized controlled trial. Sci Rep 2023; 13:12517. [PMID: 37532820 PMCID: PMC10397297 DOI: 10.1038/s41598-023-39779-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
Characterized by ventricular and vascular stiffness, heart failure with preserved ejection fraction (HFpEF) has led to high morbidity and mortality. As azilsartan is an angiotensin receptor blocker with the highest myocardial and vascular affinities, azilsartan may improve the left ventricular (LV) diastolic function in patients with hypertension and either HFpEF or HF with mildly reduced ejection fraction (HFmrEF) more than candesartan. In this randomized, open-label trial, we randomly assigned 193 hypertensive patients with HF and LV ejection fraction ≥ 45% to 20 mg of azilsartan (n = 95) or 8 mg of candesartan (n = 98), once daily for 48 weeks. After the initiation of treatment, changes in the doses of the study drugs were permitted based on the patient's conditions, including blood pressure (median dose at 48 weeks: azilsartan 20.0 mg/day, candesartan 8.0 mg/day). The primary endpoint was the baseline-adjusted change in the ratio of peak early diastolic transmitral flow velocity (E) to early diastolic mitral annular velocity (e') (E/e'). Adjusted least-squares mean (LSM) change in E/e' was - 0.8 (95% confidence interval [CI] - 1.49 to - 0.04) in the azilsartan group and 0.2 (95% CI - 0.49 to 0.94) in the candesartan group, providing the LSM differences of - 1.0 (95% CI - 2.01 to 0.03, P = 0.057). The median change in left atrial volume index was - 2.7 mL/m2 with azilsartan vs 1.4 mL/m2 with candesartan (P = 0.091). The frequency of adverse events related to hypotension and hyperkalemia did not differ between the groups. The current study did not provide strong evidence that azilsartan improves LV diastolic dysfunction, and further confirmatory study is required.
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Affiliation(s)
- Shin Ito
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroyuki Takahama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masanori Asakura
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Masayoshi Ajioka
- Department of Cardiovascular Internal Medicine, Tosei General Hospital, Seto, Aichi, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | | | - Yorihiko Higashino
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | | | - Noriaki Iwahashi
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Koichiro Kinugawa
- The Second Department of Internal Medicine, University of Toyama, Toyama, Japan
| | - Hidetaka Kioka
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Young-Jae Lim
- Cardiovascular Center, Kawachi General Hospital, Osaka, Japan
| | - Ken Matsuoka
- Department of Internal Medicine, Yoshikawa Hospital, Osaka, Japan
| | | | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan
| | - Sunao Nakamura
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Akihiro Nomura
- Innovative Clinical Research Center/Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | | | - Shin Takiuchi
- Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Hyogo, Japan
| | - Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Tomoya Ueda
- Department of Cardiovascular Medicine, Nara Medical University, Nara, Japan
| | - Tetsuya Watanabe
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan.
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, 3-5-8 Minamisumiyoshi, Sumiyoshi-ku, Osaka, 558-0041, Japan.
- The Osaka Medical Research Foundation for Intractable Diseases, Osaka, Japan.
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12
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Weismann CG, Hlebowicz J. Editorial: Aortopathy in congenital heart disease. Front Cardiovasc Med 2023; 10:1231646. [PMID: 37502190 PMCID: PMC10370265 DOI: 10.3389/fcvm.2023.1231646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Affiliation(s)
- Constance G. Weismann
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilian University, Munich, Germany
| | - Joanna Hlebowicz
- Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Pediatric Cardiology, Skåne University Hospital, Lund, Sweden
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13
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Yoshida Y, Nakanishi K, Jin Z, Daimon M, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Association Between Progression of Arterial Stiffness and Left Ventricular Remodeling in a Community-Based Cohort. JACC. ADVANCES 2023; 2:100409. [PMID: 38938996 PMCID: PMC11198086 DOI: 10.1016/j.jacadv.2023.100409] [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: 10/03/2022] [Revised: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 06/29/2024]
Abstract
Background Cross sectionally measured, elevated arterial stiffness is associated with unfavorable left ventricular (LV) remodeling, suggesting its important role in the pathophysiology of heart failure. However, data linking the degree of arterial stiffness progression with LV remodeling are scarce. Objectives The purpose of this study was to investigate the association between longitudinal change in arterial stiffness and changes in LV remodeling. Methods Serial measurements of arterial stiffness by cardio-ankle vascular index (CAVI) were performed in 317 participants without cardiovascular disease and with normal arterial stiffness. LV size, mass, and function were assessed by transthoracic echocardiography and including LV global longitudinal strain (LVGLS) by speckle-tracking and tissue Doppler velocity (e') of the mitral annulus (diastolic function). Results During a median follow-up of 26.8 mo, there was a significant increase in CAVI (P < 0.001). Generalized estimating equation analyses showed that longitudinal increase in CAVI was associated with impaired LVGLS (estimate 0.46, 95% CI: 0.11-0.82; P = 0.010) after adjustment for demographics and baseline cardiovascular factors, but not with changes of LV mass index and e' velocity. When controlling for longitudinal change of covariates, CAVI progression remained associated with change in LVGLS (estimate 0.50, 95% CI: 0.16-0.85; P = 0.004). In sex stratified analysis, progression of CAVI was significantly associated with LVGLS deterioration only in women (estimate 0.92, 95% CI: 0.27-1.58; P = 0.006). Conclusions Longitudinal increase in arterial stiffness is associated with deterioration in LVGLS. Vascular-ventricular coupling plays an important role in the progressive decline in ventricular function even at an early, subclinical stage.
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Affiliation(s)
- Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Medicine, Columbia University, New York, New York, USA
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Zhezhen Jin
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo, Tokyo, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Shunichi Homma
- Department of Medicine, Columbia University, New York, New York, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
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14
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Agbaje AO. Does arterial stiffness mediate or suppress the associations of blood pressure with cardiac structure and function in adolescents? Am J Physiol Heart Circ Physiol 2023; 324:H776-H781. [PMID: 36930657 DOI: 10.1152/ajpheart.00094.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/07/2023] [Accepted: 03/14/2023] [Indexed: 03/18/2023]
Abstract
There is limited understanding of the role of arterial stiffness in cardiovascular disease risk in the pediatric population, lagging behind strong evidence in the adult population. Arterial stiffness progression among adolescents with hypertension has been considered hypertension-mediated vascular damage. However, emerging pediatric reports suggest that arterial stiffness may precede increased blood pressure and hypertension, whereas increased blood pressure from childhood has been associated with signs of cardiac damage in mid-adulthood. Thus, this study used a third variable analytical approach to examine whether arterial stiffness mediates or suppresses the effects of increasing blood pressure on cardiac structure and function in the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort of 1,778 adolescents. After an adjustment for cardiometabolic and lifestyle factors, arterial stiffness measured as carotid-femoral pulse wave velocity partly suppressed the association of higher systolic blood pressure with higher left ventricular mass (standardized regression coefficient, β = -0.012; P = 0.017; suppression effect = 4%), partly mediated the associations of higher systolic and diastolic blood pressure with higher relative ventricular wall thickness, and partly suppressed the association of higher diastolic blood pressure with lower left ventricular diastolic function (β = -0.021; P = 0.003; suppression effect = 14.5%). In conclusion, increasing arterial stiffness could attenuate some of the adverse effects of increased blood pressure on cardiac structure and function in adolescents possibly by modifying the Windkessel effects.NEW & NOTEWORTHY The present study demonstrates that the associations of blood pressure with cardiac function and structure in adolescents may be mediated or suppressed by arterial stiffness depending on the blood pressure phenotype: systolic or diastolic. Arterial stiffness may be considered as an intermediate pathway to attenuate the effect of increased blood pressure on altered cardiac structure and function in youth.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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15
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Khalid Khan S, Rawat A, Khan Z, Reyaz I, Kumar V, Batool S, Yadav R, Hirani S. Safety and Efficacy of Istaroxime in Patients With Acute Heart Failure: A Meta-Analysis of Randomized Controlled Trials. Cureus 2023; 15:e41084. [PMID: 37519574 PMCID: PMC10377750 DOI: 10.7759/cureus.41084] [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] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
The aim of this study was to assess the efficacy and safety of istaroxime in patients with heart failure. Following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, a search was conducted on the EMBASE and Medline databases to identify articles related to the safety and efficacy of istaroxime in patients with heart failure. The search covered the period from inception to May 31st, 2023, without any restrictions on the year of publication. The search strategy utilized relevant terms such as "istaroxime," "heart failure", "efficacy," and other related terms, along with their corresponding Medical Subject Headings (MeSH) terms. The outcomes assessed in this meta-analysis included the change in left ventricular ejection fraction (LVEF), E to A ratio (a marker of left ventricle function), cardiac index in L/min/m2, systolic blood pressure (SBP) in mmHg, left ventricular end-systolic volume (LVESV) in ml, and left ventricular end-diastolic volume (LVDSV) in ml. For safety analysis, gastrointestinal events and cardiovascular events were assessed. A total of three randomized controlled trials (RCTs) were included in this meta-analysis encompassing 211 patients with heart failure. Pooled analysis showed that istaroxime was effective in increasing LVEF (MD: 1.26, 95% CI: 0.91 to 1.62, p-value: 0.001), reducing E to A ratio (MD: -0.39, 95% CI: -0.60 to -0.19, p-value: 0.001), increasing cardiac index (MD: 0.22, 95% CI: 0.18 to 0.25, p-value: 0.001), reducing LVESV (MD: -11.84, 95% CI: -13.91 to -9.78, p-value: 0.001), reducing LVEDV (MD: -12.25, 95% CI: -14.63 to -9.87, p-value: 0.001) and increasing SBP (MD: 8.41, 95% CI: 5.23 to 11.60, p-value: 0.001) compared to the placebo group. However, risk of gastrointestinal events was significantly higher in patients receiving istaroxime compared to the placebo group (RR: 2.64, 95% CI: 1.53 to 4.57, p-value: 0.0005). These findings support the enhancement of heart function with istaroxime administration, aligning with previous clinical and experimental evidence.
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Affiliation(s)
| | - Anurag Rawat
- Interventional Cardiology, Himalayan Institute of Medical Sciences, Dehradun, IND
| | - Zarghuna Khan
- Internal Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Ibrahim Reyaz
- Internal Medicine, Christian Medical College and Hospital Ludhiana, Punjab, Ludhiana, IND
| | - Vikash Kumar
- Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Saima Batool
- Internal Medicine, Hameed Latif Hospital, Lahore, PAK
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16
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Desbiens LC, Fortier C, Nadeau-Fredette AC, Madore F, Hametner B, Wassertheurer S, Agharazii M, Goupil R. Prediction of Cardiovascular Events by Pulse Waveform Parameters: Analysis of CARTaGENE. J Am Heart Assoc 2022; 11:e026603. [PMID: 36056725 PMCID: PMC9496446 DOI: 10.1161/jaha.122.026603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Waveform parameters provide approximate data about aortic wave reflection. However, their association with cardiovascular events remains controversial and their role in cardiovascular prediction is unknown. Methods and Results We analyzed participants aged between 40 and 69 from the population-based CARTaGENE cohort. Baseline pulse wave analysis (central pulse pressure, augmentation index) and wave separation analysis (forward pressure, backward pressure, reflection magnitude) parameters were derived from radial artery tonometry. Associations between each parameter and major adverse atherosclerotic events (MACE; cardiovascular death, stroke, myocardial infarction) were obtained using adjusted Cox models. The incremental predictive value of each parameter compared with the 10-year atherosclerotic cardiovascular disease score alone was assessed using hazard ratios, c-index differences, continuous net reclassification indexes, and integrated discrimination indexes. From 17 561 eligible patients, 2315 patients had a MACE during a median follow-up of 10.1 years. Central pulse pressure, forward pressure, and backward pressure, but not augmentation index and reflection magnitude, were significantly associated with MACE after full adjustment. All parameters except forward pressure statistically improved MACE prediction compared with the atherosclerotic cardiovascular disease score alone. The greatest prediction improvement was seen with augmentation index and reflection magnitude but remained small in magnitude. These 2 parameters enhanced predictive performance more strongly in patients with low baseline atherosclerotic cardiovascular disease scores. Up to 5.7% of individuals were reclassified into a different risk stratum by adding waveform parameters to atherosclerotic cardiovascular disease scores. Conclusions Some waveform parameters are independently associated with MACEs in a population-based cohort. Augmentation index and reflection magnitude slightly improve risk prediction, especially in patients at low cardiovascular risk.
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Affiliation(s)
| | - Catherine Fortier
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | - Annie-Claire Nadeau-Fredette
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital Maisonneuve-Rosemont Université de Montréal Montréal Canada
| | - François Madore
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
| | | | | | - Mohsen Agharazii
- Department of Medicine Université Laval Quebec City Canada.,CHU de Quebec Université Laval Quebec City Canada
| | - Rémi Goupil
- Department of Medicine Université de Montréal Montreal Canada.,Hôpital du Sacré-Coeur de Montréal Research Center Montreal Canada
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17
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Hoshida S, Hikoso S, Shinoda Y, Tachibana K, Minamisaka T, Shunsuke T, Yano M, Hayashi T, Nakagawa A, Nakagawa Y, Yamada T, Yasumura Y, Nakatani D, Sakata Y. Time-sensitive prognostic performance of an afterload-integrated diastolic index in heart failure with preserved ejection fraction: a prospective multicentre observational study. BMJ Open 2022; 12:e059614. [PMID: 35948381 PMCID: PMC9379494 DOI: 10.1136/bmjopen-2021-059614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The prognostic significance of an afterload-integrated diastolic index, the ratio of diastolic elastance (Ed) to arterial elastance (Ea) (Ed/Ea=[E/e']/[0.9×systolic blood pressure]), is valid for 1 year after discharge in older patients with heart failure with preserved ejection fraction (HFpEF). We aimed to clarify the association with changes in Ed/Ea from enrolment to 1 year and prognosis thereafter in patients with HFpEF. SETTING A prospective, multicentre observational registry of collaborating hospitals in Osaka, Japan. PARTICIPANTS We enrolled 659 patients with HFpEF hospitalised for acute decompensated heart failure (men/women: 296/363). Blood tests and transthoracic echocardiography were performed before discharge and at 1 year after. PRIMARY OUTCOME MEASURES All-cause mortality and/or re-admission for heart failure were evaluated after discharge. RESULTS High Ed/Ea assessed before discharge was a significant prognostic factor during the first, but not the second, year after discharge in all-cause mortality or all-cause mortality and/or re-admission for heart failure. When re-analysis was performed using the value of Ed/Ea at 1 year after discharge, high Ed/Ea was significant for the prognosis during the second year for both end points (p=0.012 and p=0.033, respectively). The poorest mortality during 1‒2 years after enrolment was observed in those who showed a worsening Ed/Ea during the first year associated with larger left ventricular mass index and reduced left ventricular ejection fraction. In all-cause mortality and/or re-admission for heart failure, the event rate during 1‒2 years was highest in those with persistently high Ed/Ea even after 1 year. CONCLUSIONS Time-sensitive prognostic performance of Ed/Ea, an afterload-integrated diastolic index, was observed in older patients with HFpEF. TRIAL REGISTRATION NUMBER UMIN000021831.
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Affiliation(s)
- Shiro Hoshida
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Shinoda
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Koichi Tachibana
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Tomoko Minamisaka
- Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Japan
| | - Tamaki Shunsuke
- Department of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, Sakai, Japan
| | | | - Akito Nakagawa
- Division of Cardiovascular Medicine, Amagasaki Chuo Hospital, Amagasaki, Japan
- Department of Medical Informatics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yusuke Nakagawa
- Division of Cardiology, Kawanishi City Hospital, Kawanishi, Japan
| | - Takahisa Yamada
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Yoshio Yasumura
- Division of Cardiovascular Medicine, Amagasaki-Chuo Hospital, Amagasaki, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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18
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Abstract
The aorta contributes to cardiovascular physiology and function. Understanding biomechanics in health, disease, and after aortic interventions will facilitate optimization of perioperative patient care.
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19
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Popevska S, Rademakers F. Prolonged Asynchronous Left Ventricular Isovolumic Relaxation Constant in Ascending Compared to Descending Thoracic Aortic Stenosis for Chronic Early Left Ventricular Afterload and Late Left Ventricular Afterload Increase. Pril (Makedon Akad Nauk Umet Odd Med Nauki) 2022; 43:89-99. [PMID: 35843925 DOI: 10.2478/prilozi-2022-0022] [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: 06/15/2023]
Abstract
Background: In arterial hypertension, left ventricular relaxation is affected early on in relation to a chronic difference in peak left ventricular afterload with early development of HF. Objective: in ascending compares to descending thoracic aortic stenosis, resulting in chronic late and early LV afterload increase, to assess the left ventricular isovolumic relaxation pressure decay constant through regression analysis, a parameter of left ventricular relaxation on the 4th and 8th week period from invasive left ventricular pressure measurements. Methods: fourteen pigs underwent posterolateral thoracotomy for ascending aortic stenosis, resulting in chronic early left ventricular afterload increase (EL = 6], or descending thoracic aortic stenosis creating chronic late systolic left ventricular load (LL = 8]. Exponential regression with nonzero asymptote for τ assessment, with linear and nonlinear regression were performed on isovolumic relaxation pressure decay from the left ventricular invasive pressure measurements on 4th and 8th week. Two-way repeated measurement ANOVA, post-hoc Tukey test and linear regression were performed for statistical analysis. Results presented are mean ± SEM or median (quartiles], with significance is at p < 0.05. Results: The ascending aortic stenosis associated with prolonged biexponential asynchronous τ, compared to the descending thoracic aorta stenosis, resulted in data that were different at the 8th week in presence of respirations (interaction p < 0.05]. Monoexponential and linear τ were not different in either respiration being preserved or suspended transitionally and in preload reduction. Preload sensitive response of τ was found in ascending compared to descending thoracic aortic banding that reduced in EL and in LL it increased with load reduction (p < 0.05]. These results indicated that τ is not different in and between LV afterloading conditions in a chronic setting, although it indicates that myocardial ischemia is present and that it is greater in ascending aortic banding, compared to descending thoracic aorta banding at the 8th week. Conclusion: In different sequence of the left ventricular afterload, ventricular relaxation is affected early on, having in EL compared to LL prolonged biexponential asynchronous left ventricular relaxation constant, thus indicating the development left ventricular myocardial ischemia and different elastic recoil in an invasive left ventricular hemodynamic assessment.
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Affiliation(s)
- Sofija Popevska
- Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universitet Leuven, Medical Faculty Leuven, Belgium
| | - Frank Rademakers
- Imaging and Dynamics, Department of Cardiovascular Sciences, Katholieke Universitet Leuven, Medical Faculty Leuven, Belgium
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20
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Karamichalakis N, Xanthopoulos A, Triposkiadis F, Paraskevaidis I, Tsougos E. Reshaping Treatment of Heart Failure with Preserved Ejection Fraction. J Clin Med 2022; 11:3706. [PMID: 35806994 PMCID: PMC9267897 DOI: 10.3390/jcm11133706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/24/2022] [Indexed: 02/05/2023] Open
Abstract
Current data indicate that in the community, approximately 50% of patients with heart failure (HF) have preserved left ventricular (LV) ejection fraction (LVEF)—the so-called HFpEF. Treatment of HFpEF has been considered an unmet need for decades. We believe that the main underlying reasons have been (a) the ever-changing LVEF cut-offs used for HF classification; (b) controversies regarding the definition of the LVEF normal range; (c) the fact that HFpEF does not represent a phenotype, but a category of diseases with entirely different characteristics (hypertensive heart disease, valvular heart disease (VHD), hypertrophic cardiomyopathy (HCM) etc.); (d) the lack of recognition that hypertensive HFpEF is the most common and important HFpEF phenotype; (e) the assumption that neurohormonal overactivity is absent in HF patients with a LVEF > 45−50% which has been proven to be wrong. Current HFpEF trials, in which the vast majority of the participants suffered from hypertension (HTN), whereas VHD and HCM were absent, demonstrated that neurohormonal and sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective in HF patients over a wide LVEF range. Thus, restricting these lifesaving treatments to HF patients with reduced LVEF is not justified anymore and it should be additionally considered for HFpEF patients suffering from HTN.
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Affiliation(s)
| | - Andrew Xanthopoulos
- Department of Cardiology, University Hospital of Larissa, 41110 Larissa, Greece;
| | | | - Ioannis Paraskevaidis
- 6th Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece; (N.K.); (I.P.); (E.T.)
| | - Elias Tsougos
- 6th Department of Cardiology, Hygeia Hospital, 15123 Athens, Greece; (N.K.); (I.P.); (E.T.)
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21
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Abstract
Obesity has reached epidemic proportions and is a major contributor to insulin resistance (IR) and type 2 diabetes (T2D). Importantly, IR and T2D substantially increase the risk of cardiovascular (CV) disease. Although there are successful approaches to maintain glycemic control, there continue to be increased CV morbidity and mortality associated with metabolic disease. Therefore, there is an urgent need to understand the cellular and molecular processes that underlie cardiometabolic changes that occur during obesity so that optimal medical therapies can be designed to attenuate or prevent the sequelae of this disease. The vascular endothelium is in constant contact with the circulating milieu; thus, it is not surprising that obesity-driven elevations in lipids, glucose, and proinflammatory mediators induce endothelial dysfunction, vascular inflammation, and vascular remodeling in all segments of the vasculature. As cardiometabolic disease progresses, so do pathological changes in the entire vascular network, which can feed forward to exacerbate disease progression. Recent cellular and molecular data have implicated the vasculature as an initiating and instigating factor in the development of several cardiometabolic diseases. This Review discusses these findings in the context of atherosclerosis, IR and T2D, and heart failure with preserved ejection fraction. In addition, novel strategies to therapeutically target the vasculature to lessen cardiometabolic disease burden are introduced.
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22
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Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test. High Blood Press Cardiovasc Prev 2022; 29:145-154. [PMID: 35107808 PMCID: PMC8942964 DOI: 10.1007/s40292-021-00494-2] [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: 09/23/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear. The combined cardiopulmonary-echocardiography stress test (CPET-ESE) represents a precious non-invasive aid to detect alterations in patients at the earliest stages of HF. The opportunity to study the response of the cardiovascular system to exercise, and to differentiate central from peripheral cardiovascular maladaptations, makes the CPET-ESE an ideal technique to gain insights into the mechanisms involved in the transition from AH to HF, by recognizing alterations that might be silent at rest but influence the response to exercise. Identifications of these subclinical alterations might allow for a better risk stratification in hypertensive patients, facilitating the recognition of those at higher risk of evolution towards established HF. This may also lead to the development of novel preventive strategies and help tailor medical treatment. The purpose of this review is to summarise the potential advantages of using CPET-ESE in the characterisation of hypertensive patients in the cardiovascular continuum.
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23
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Augustine JA, Lefferts WK, DeBlois JP, Barreira TV, Taylor BA, Liu K, Heffernan KS. Sex differences in cardiovascular adaptations in recreational marathon runners. Eur J Appl Physiol 2021; 121:3459-3472. [PMID: 34515867 DOI: 10.1007/s00421-021-04806-1] [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: 03/22/2021] [Accepted: 09/02/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There are well-established sex differences in central hemodynamic and cardiac adaptations to endurance exercise; however, controversial evidence suggests that excessive endurance exercise may be related to detrimental cardiovascular adaptations in marathoners. PURPOSE To examine left ventricle (LV) structure, LV function, 24-h central hemodynamics and ventricular-vascular coupling in male and female marathoners and recreationally active adults. METHODS 52 marathoners (41 ± 5 years, n = 28 female, completed 6 ± 1 marathons/3 years) and 49 recreationally active controls (42 ± 5 years, n = 25 female) participated in the study. Three-Dimensional Echocardiography (3DE) was used to measure LV mass index and LV longitudinal (LS) circumferential (CS), area (AS), and radial strain (RS). An ambulatory blood pressure (BP) cuff was used to measure 24-h central hemodynamics (BP, pulse wave velocity, PWV, wave reflection index, RIx). Hemodynamic and 3DE measures were combined to derive the ratio of arterial elastance (Ea) to ventricular elastance (Elv) as a global measure of ventricular-vascular coupling. RESULTS There were no sex or group differences in LS, CS, AS, and RS (p > 0.05). Females marathoners had similar aortic BP (116 ± 9 vs. 113 ± 1 mmHg), and PWV (5.9 ± 0.5 vs. 5.9 ± 1.1 m/s) compared to female controls but lower aSBP (116 ± 9 vs. 131 ± 10 mmHg) and PWV (5.9 ± 0.5 vs. 6.2 ± 0.5 m/s) compared to male marathoners (p < 0.05). Female marathoners had lower Ea/Elv than female controls (0.67 ± 0.20 vs. 0.93 ± 0.36) and male marathoners (0.67 ± 0.20 vs. 0.85 ± 0.42, p < 0.05). CONCLUSIONS Women that have completed multiple marathons do not have reduced LV function or increased aortic stiffness and may have better ventricular-vascular coupling compared to male marathoners and their female untrained counterparts.
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Affiliation(s)
- Jacqueline A Augustine
- Kinesiology Department, School of Professional Studies, State University of New York at Cortland, Office 1149, Cortland, NY, 13045, USA. .,Department of Exercise Science, Syracuse University, Syracuse, NY, USA.
| | - Wesley K Lefferts
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA.,Department of Kinesiology, Iowa State University, Ames, IA, USA
| | - Jacob P DeBlois
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Tiago V Barreira
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
| | - Beth A Taylor
- Department of Kinesiology, University of Connecticut, Storrs, CT, USA
| | - Kan Liu
- Division of Cardiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.,State University of New York, Upstate Medical University, Syracuse, NY, USA
| | - Kevin S Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, NY, USA
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24
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Kobayashi M, Huttin O, Magnusson M, Ferreira JP, Bozec E, Huby AC, Preud'homme G, Duarte K, Lamiral Z, Dalleau K, Bresso E, Smaïl-Tabbone M, Devignes MD, Nilsson PM, Leosdottir M, Boivin JM, Zannad F, Rossignol P, Girerd N. Machine Learning-Derived Echocardiographic Phenotypes Predict Heart Failure Incidence in Asymptomatic Individuals. JACC Cardiovasc Imaging 2021; 15:193-208. [PMID: 34538625 DOI: 10.1016/j.jcmg.2021.07.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to identify homogenous echocardiographic phenotypes in community-based cohorts and assess their association with outcomes. BACKGROUND Asymptomatic cardiac dysfunction leads to a high risk of long-term cardiovascular morbidity and mortality; however, better echocardiographic classification of asymptomatic individuals remains a challenge. METHODS Echocardiographic phenotypes were identified using K-means clustering in the first generation of the STANISLAS (Yearly non-invasive follow-up of Health status of Lorraine insured inhabitants) cohort (N = 827; mean age: 60 ± 5 years; men: 48%), and their associations with vascular function and circulating biomarkers were also assessed. These phenotypes were externally validated in the Malmö Preventive Project cohort (N = 1,394; mean age: 67 ± 6 years; men: 70%), and their associations with the composite of cardiovascular mortality (CVM) or heart failure hospitalization (HFH) were assessed as well. RESULTS Three echocardiographic phenotypes were identified as "mostly normal (MN)" (n = 334), "diastolic changes (D)" (n = 323), and "diastolic changes with structural remodeling (D/S)" (n = 170). The D and D/S phenotypes had similar ages, body mass indices, cardiovascular risk factors, vascular impairments, and diastolic function changes. The D phenotype consisted mainly of women and featured increased levels of inflammatory biomarkers, whereas the D/S phenotype, consisted predominantly of men, displayed the highest values of left ventricular mass, volume, and remodeling biomarkers. The phenotypes were predicted based on a simple algorithm including e', left ventricular mass and volume (e'VM algorithm). In the Malmö cohort, subgroups derived from e'VM algorithm were significantly associated with a higher risk of CVM and HFH (adjusted HR in the D phenotype = 1.87; 95% CI: 1.04 to 3.37; adjusted HR in the D/S phenotype = 3.02; 95% CI: 1.71 to 5.34). CONCLUSIONS Among asymptomatic, middle-aged individuals, echocardiographic data-driven classification based on the simple e'VM algorithm identified profiles with different long-term HF risk. (4th Visit at 17 Years of Cohort STANISLAS-Stanislas Ancillary Study ESCIF [STANISLASV4]; NCT01391442).
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Affiliation(s)
- Masatake Kobayashi
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Olivier Huttin
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Sweden
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Erwan Bozec
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Anne-Cecile Huby
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Gregoire Preud'homme
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Zohra Lamiral
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Kevin Dalleau
- Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Emmanuel Bresso
- Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Malika Smaïl-Tabbone
- French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France; Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Marie-Dominique Devignes
- French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France; Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Jean-Marc Boivin
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France.
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Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for more than one-half of patients with heart failure. Effective treatment of HFpEF has not been established, largely because of the complexities and heterogeneity in the phenotypes of HFpEF. Categorizing patients based on clinical and pathophysiologic phenotype may provide more targeted and efficacious therapies. Despite this clinical need, there is no consensus on how to categorize patients with HFpEF into phenogroups. Possible metrics include the presence or absence of specific comorbidities that influence pathophysiology, imaging, hemodynamics, or other biomarkers. This article describes currently recognized phenotypes of HFpEF and potential treatment strategies.
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26
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Zern EK, Ho JE, Panah LG, Lau ES, Liu E, Farrell R, Sbarbaro JA, Schoenike MW, Pappagianopoulos PP, Namasivayam M, Malhotra R, Nayor M, Lewis GD. Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Arterial Stiffness and Aabnormal Left Ventricular Hemodynamic Responses During Exercise. J Card Fail 2021; 27:625-634. [PMID: 33647476 PMCID: PMC8180488 DOI: 10.1016/j.cardfail.2021.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 02/01/2021] [Accepted: 02/03/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Arterial stiffness is thought to contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). We sought to examine arterial stiffness in HFpEF and hypertension and investigate associations of arterial and left ventricular hemodynamic responses to exercise. METHODS AND RESULTS A total of 385 symptomatic individuals with an EF of ≥50% underwent upright cardiopulmonary exercise testing with invasive hemodynamic assessment of arterial stiffness and load (aortic augmentation pressure, augmentation index, systemic vascular resistance index, total arterial compliance index, effective arterial elastance index, and pulse pressure amplification) at rest and during incremental exercise. An abnormal hemodynamic response to exercise was defined as a steep increase in pulmonary capillary wedge pressure relative to cardiac output (∆PCWP/∆CO > 2 mm Hg/L/min). We compared rest and exercise measures between HFpEF and hypertension in multivariable analyses. Among 188 participants with HFpEF (mean age 61 ± 13 years, 56% women), resting arterial stiffness parameters were worse compared with 94 hypertensive participants (mean age 55 ± 15 years, 52% women); these differences were accentuated during exercise in HFpEF (all P ≤ .0001). Among all participants, exercise measures of arterial stiffness correlated with worse ∆PCWP/∆CO. Specifically, a 1 standard deviation higher exercise augmentation pressure was associated with 2.15-fold greater odds of abnormal LV hemodynamic response (95% confidence interval 1.52-3.05; P < .001). Further, exercise measures of systemic vascular resistance index, elastance index, and pulse pressure amplification correlated with a lower peak oxygen consumption. CONCLUSIONS Exercise accentuates the increased arterial stiffness found in HFpEF, which in turn correlates with left ventricular hemodynamic responses. Unfavorable ventricular-vascular interactions during exercise in HFpEF may contribute to exertional intolerance and inform future therapeutic interventions.
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Affiliation(s)
- Emily K Zern
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer E Ho
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts.
| | - Lindsay G Panah
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily S Lau
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Liu
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Robyn Farrell
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - John A Sbarbaro
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark W Schoenike
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Paul P Pappagianopoulos
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Mayooran Namasivayam
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajeev Malhotra
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Nayor
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory D Lewis
- Corrigan Minehan Heart Center, Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
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27
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Mishra S, Kass DA. Cellular and molecular pathobiology of heart failure with preserved ejection fraction. Nat Rev Cardiol 2021; 18:400-423. [PMID: 33432192 PMCID: PMC8574228 DOI: 10.1038/s41569-020-00480-6] [Citation(s) in RCA: 183] [Impact Index Per Article: 61.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2020] [Indexed: 01/30/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) affects half of all patients with heart failure worldwide, is increasing in prevalence, confers substantial morbidity and mortality, and has very few effective treatments. HFpEF is arguably the greatest unmet medical need in cardiovascular disease. Although HFpEF was initially considered to be a haemodynamic disorder characterized by hypertension, cardiac hypertrophy and diastolic dysfunction, the pandemics of obesity and diabetes mellitus have modified the HFpEF syndrome, which is now recognized to be a multisystem disorder involving the heart, lungs, kidneys, skeletal muscle, adipose tissue, vascular system, and immune and inflammatory signalling. This multiorgan involvement makes HFpEF difficult to model in experimental animals because the condition is not simply cardiac hypertrophy and hypertension with abnormal myocardial relaxation. However, new animal models involving both haemodynamic and metabolic disease, and increasing efforts to examine human pathophysiology, are revealing new signalling pathways and potential therapeutic targets. In this Review, we discuss the cellular and molecular pathobiology of HFpEF, with the major focus being on mechanisms relevant to the heart, because most research has focused on this organ. We also highlight the involvement of other important organ systems, including the lungs, kidneys and skeletal muscle, efforts to characterize patients with the use of systemic biomarkers, and ongoing therapeutic efforts. Our objective is to provide a roadmap of the signalling pathways and mechanisms of HFpEF that are being characterized and which might lead to more patient-specific therapies and improved clinical outcomes.
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Affiliation(s)
- Sumita Mishra
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - David A. Kass
- Department of Medicine, Division of Cardiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Biomedical Engineering, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Pharmacology and Molecular Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,
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28
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Samuel TJ, Wei J, Sharif B, Tamarappoo BK, Pattisapu V, Maughan J, Cipher DJ, Suppogu N, Aldiwani H, Thomson LEJ, Shufelt C, Berman DS, Li D, Bairey Merz CN, Nelson MD. Diastolic dysfunction in women with ischemia and no obstructive coronary artery disease: Mechanistic insight from magnetic resonance imaging. Int J Cardiol 2021; 331:1-7. [PMID: 33545261 PMCID: PMC8026746 DOI: 10.1016/j.ijcard.2021.01.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 12/11/2020] [Accepted: 01/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Ischemia with no obstructive coronary artery disease (INOCA) is prevalent in women and is associated with increased risk of developing heart failure with preserved ejection fraction (HFpEF); however, the mechanism(s) contributing to this progression remains unclear. Given that diastolic dysfunction is common in women with INOCA, defining mechanisms related to diastolic dysfunction in INOCA could identify therapeutic targets to prevent HFpEF. METHODS Cardiac MRI was performed in 65 women with INOCA and 12 reference controls. Diastolic function was defined by left ventricular early diastolic circumferential strain rate (eCSRd). Contributors to diastolic dysfunction were chosen a priori as coronary vascular dysfunction (myocardial perfusion reserve index [MPRI]), diffuse myocardial fibrosis (extracellular volume [ECV]), and aortic stiffness (aortic pulse wave velocity [aPWV]). RESULTS Compared to controls, eCSRd was lower in INOCA (1.61 ± 0.33/s vs. 1.36 ± 0.31/s, P = 0.016); however, this difference was not exaggerated when the INOCA group was sub-divided by low and high MPRI (P > 0.05) nor was ECV elevated in INOCA (29.0 ± 1.9% vs. 28.0 ± 3.2%, control vs. INOCA; P = 0.38). However, aPWV was higher in INOCA vs. controls (8.1 ± 3.2 m/s vs. 6.1 ± 1.5 m/s; P = 0.045), and was associated with eCSRd (r = -0.50, P < 0.001). By multivariable linear regression analysis, aPWV was an independent predictor of decreased eCSRd (standardized β = -0.39, P = 0.003), as was having an elevated left ventricular mass index (standardized β = -0.25, P = 0.024) and lower ECV (standardized β = 0.30, P = 0.003). CONCLUSIONS These data provide mechanistic insight into diastolic dysfunction in women with INOCA, identifying aortic stiffness and ventricular remodeling as putative therapeutic targets.
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Affiliation(s)
- T Jake Samuel
- The University of Texas at Arlington, Arlington, TX, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Behzad Sharif
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Balaji K Tamarappoo
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Varun Pattisapu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Jenna Maughan
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Nissi Suppogu
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Haider Aldiwani
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Louise E J Thomson
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Daniel S Berman
- Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Debiao Li
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA
| | - Michael D Nelson
- The University of Texas at Arlington, Arlington, TX, USA; Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA, USA.
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29
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Pecchiari M, Pontikis K, Alevrakis E, Vasileiadis I, Kompoti M, Koutsoukou A. Cardiovascular Responses During Sepsis. Compr Physiol 2021; 11:1605-1652. [PMID: 33792902 DOI: 10.1002/cphy.c190044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sepsis is the life-threatening organ dysfunction arising from a dysregulated host response to infection. Although the specific mechanisms leading to organ dysfunction are still debated, impaired tissue oxygenation appears to play a major role, and concomitant hemodynamic alterations are invariably present. The hemodynamic phenotype of affected individuals is highly variable for reasons that have been partially elucidated. Indeed, each patient's circulatory condition is shaped by the complex interplay between the medical history, the volemic status, the interval from disease onset, the pathogen, the site of infection, and the attempted resuscitation. Moreover, the same hemodynamic pattern can be generated by different combinations of various pathophysiological processes, so the presence of a given hemodynamic pattern cannot be directly related to a unique cluster of alterations. Research based on endotoxin administration to healthy volunteers and animal models compensate, to an extent, for the scarcity of clinical studies on the evolution of sepsis hemodynamics. Their results, however, cannot be directly extrapolated to the clinical setting, due to fundamental differences between the septic patient, the healthy volunteer, and the experimental model. Numerous microcirculatory derangements might exist in the septic host, even in the presence of a preserved macrocirculation. This dissociation between the macro- and the microcirculation might account for the limited success of therapeutic interventions targeting typical hemodynamic parameters, such as arterial and cardiac filling pressures, and cardiac output. Finally, physiological studies point to an early contribution of cardiac dysfunction to the septic phenotype, however, our defective diagnostic tools preclude its clinical recognition. © 2021 American Physiological Society. Compr Physiol 11:1605-1652, 2021.
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Affiliation(s)
- Matteo Pecchiari
- Dipartimento di Fisiopatologia Medico Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Konstantinos Pontikis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Emmanouil Alevrakis
- 4th Department of Pulmonary Medicine, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Ioannis Vasileiadis
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
| | - Maria Kompoti
- Intensive Care Unit, Thriassio General Hospital of Eleusis, Magoula, Greece
| | - Antonia Koutsoukou
- Intensive Care Unit, 1st Department of Pulmonary Medicine, National & Kapodistrian University of Athens, General Hospital for Diseases of the Chest 'I Sotiria', Athens, Greece
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Kresoja KP, Rommel KP, Fengler K, von Roeder M, Besler C, Lücke C, Gutberlet M, Desch S, Thiele H, Böhm M, Lurz P. Renal Sympathetic Denervation in Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2021; 14:e007421. [PMID: 33706547 DOI: 10.1161/circheartfailure.120.007421] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arterial hypertension is the most common comorbidity in patients with heart failure with preserved ejection fraction (HFpEF) and mediates adverse hemodynamics through related aortic stiffness and increased pulsatile load. We aimed to investigate the clinical and hemodynamic implications of renal sympathetic denervation (RDN) in patients with HFpEF and uncontrolled arterial hypertension. METHODS Patients undergoing RDN between 2011 and 2018 in a single-center were retrospectively analyzed and classified as HFpEF (n=99) or no HF (n=65). Stroke volume index and aortic distensibility were measured through cardiac magnetic resonance imaging, and left ventricular (LV) systolic and diastolic properties were assessed echocardiographically. RESULTS At baseline, patients with HFpEF had higher stroke volume index (median 40 [interquartile range, 33-48] versus 33 [26-40] mL/m2, P=0.002), pulse pressure (69 [63-77] versus 61 [55-67] mm Hg, P<0.001), but lower LV-VPES100mm Hg (18 [10-28] versus 24 [15-40] mL, P=0.007) and aortic distensibility (1.5 [1.1-2.6] versus 2.7 [1.1-3.5] 10-3 mm Hg-1, P=0.013) as compared to no-HF patients. Systolic blood pressure decreased comparable in patients with HFpEF and no-HF patients following RDN (-9 [-16 to -2], P<0.001). After RDN stroke volume index (-3 [-9 to +3] mL/m2, P=0.011) decreased and aortic distensibility (0.2 [-0.1 to +1.1] 10-3 mm Hg-1, P=0.007) and systolic stiffness (P<0.001) increased in HFpEF patients. LV diastolic stiffness and LV filling pressures as well as NT-proBNP (N-terminal pro-B-type natriuretic peptide) decreased after RDN in patients with HFpEF (P=0.032, P=0.043, and P<0.001, respectively). CONCLUSIONS Patients with HFpEF undergoing RDN showed increased stroke volume index, vascular, and LV stiffness as compared to no-HF patients. Following RDN those hemodynamic alterations and reduced systolic and diastolic LV stiffness were partly normalized, implying RDN might be a potential therapeutic strategy for arterial hypertension and HFpEF.
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Affiliation(s)
- Karl-Patrik Kresoja
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl-Philipp Rommel
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
| | - Karl Fengler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Maximilian von Roeder
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Besler
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Christian Lücke
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology (C.L., M.G.), Heart Center Leipzig, University of Leipzig, Germany
| | - Steffen Desch
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Holger Thiele
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Saarland University Hospital, Homburg/Saar, Germany (M.B.)
| | - Philipp Lurz
- Department of Cardiology (K.-P.K., K.-P.R., K.F., M.v.R., C.B., S.D., H.T., P.L.), Heart Center Leipzig, University of Leipzig, Germany.,Leipzig Heart Institute, Heart Center Leipzig, Germany (K.-P.K., K.-P.R., P.L.)
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Iida M, Ishiguro Y. Association of prediabetes with impaired left atrial contractility in patients with never-treated hypertension. J Diabetes Complications 2021; 35:107827. [PMID: 33422384 DOI: 10.1016/j.jdiacomp.2020.107827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/27/2020] [Accepted: 12/05/2020] [Indexed: 01/11/2023]
Abstract
AIM Prediabetes defined by HbA1c 5.7-6.4 has been shown to be associated with left ventricular (LV) hypertrophy and diastolic dysfunction in hypertensive patients. We hypothesized HbA1c prediabetes may be related to the alterations of LA contractility or volume in nondiabetic hypertension. METHODS Nondiabetic individuals on sinus rhythm were enrolled; 107 patients with never-treated hypertension, 134 patients with treated hypertension, and 71 normotensive subjects. Participants were classified as normal glucose tolerance (NGT, HbA1c<5.7), prediabetes (HbA1c 5.7-6.4) according to the ADA criteria. They underwent echocardiography to measure left atrial (LA) phasic volumes and functions, as well as mitral E/e' and mitral e'. RESULTS In nondiabetic patients with never-treated hypertension, prediabetes saw lower LA total emptying fraction (53.7 ± 8.2 vs. 48.3 ± 9.9*) and mitral e' (7.38 ± 2.18 vs. 6.17 ± 1.50*) than NGT, implicating that the association of prediabetes with reduced LA contractility and LV stiffness. On the other hand, in nondiabetic patients with treated hypertension, prediabetes saw higher maximum LA volume/BSA (29.7 ± 7.1 vs. 32.9 ± 6.2* ml/mm2) and mitral E/e' (10.72 ± 3.08 vs. 12.37 ± 3.35*) than NGT, suggesting the relationship of prediabetes with increased LA preload. CONCLUSION Prediabetes may be involved in the progression of LA structural and functional alterations in nondiabetic hypertensive patients.
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Affiliation(s)
- Masato Iida
- Department of Cardiology, Aichi Sannomaru Clinic, Nagoya, Japan.
| | - Yuko Ishiguro
- Department of Cardiology, Aichi Sannomaru Clinic, Nagoya, Japan
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MacNamara JP, Koshti V, Cheng IJ, Dias KA, Hearon CM, Cornwell W, Howden EJ, Levine BD, Sarma S. The role of systolic-diastolic coupling in distinguishing impaired diastolic recoil in healthy aging and heart failure with preserved ejection fraction. Echocardiography 2021; 38:261-270. [PMID: 33438312 DOI: 10.1111/echo.14975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/16/2020] [Accepted: 01/01/2021] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Age-related changes to left ventricular (LV) early diastolic recoil confound the diagnostic value of e' velocity in heart failure with preserved ejection fraction (HFpEF). Systolic-diastolic coupling quantifies passive left ventricular elastic recoil and may be superior to e' in differentiating abnormal diastolic recoil in HFpEF from healthy aging. This study aims to determine the effect of healthy aging and HFpEF on systolic-diastolic coupling. METHODS Healthy adults (n = 141, aged 20-90 years) underwent right heart catheterization (RHC) to quantify LV filling pressure and tissue Doppler echocardiography to define peak velocities and excursion (velocity time integral) of the mitral annulus. Separately, HFpEF patients (n = 12, age 67 ± 5 years) and controls (n = 12, age 68 ± 5 years) underwent RHC and echocardiography. Systolic-diastolic coupling was measured as early diastolic excursion (EDexc ) divided by systolic excursion (Sexc ). RESULTS In healthy adults, EDexc / Sexc declined by 15% per decade of life (r2 = 0.53, P < .001). EDexc /Sexc was significantly lower in HFpEF compared with controls (0.43 ± 0.11 vs 0.56 ± 0.11, P = .011), while e' was similar (6.2 ± 1.5 vs 6.8 ± 1.3 cm/s, P = .33). Using ROC analysis, EDexc /Sexc had an AUC to detect HFpEF of 0.82 (0.61-0.95, P = .007), which was superior to e' alone (AUC 0.60(0.39-0.80), P = .39; P = .026 for difference). CONCLUSIONS Systolic-diastolic coupling, quantified by the EDexc /Sexc ratio, declined linearly with healthy aging. The EDexc /Sexc ratio was further reduced in HFpEF and able to predict HFpEF more accurately than e' alone. Systolic-diastolic coupling may be a useful diagnostic tool to detect HFpEF.
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Affiliation(s)
- James P MacNamara
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Vivek Koshti
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - I-Jou Cheng
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,Tri-Service General Hospital, National Defense Medical Center, Taiwan, China
| | - Katrin A Dias
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christopher M Hearon
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - William Cornwell
- University of Colorado Anschutz Medical Campus Aurora, Aurora, CO, USA
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, Vic., Australia
| | - Benjamin D Levine
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Satyam Sarma
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital, Dallas, TX, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
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Madsen NL, Haley JE, Moore RA, Khoury PR, Urbina EM. Increased Arterial Stiffness Is Associated With Reduced Diastolic Function in Youth With Obesity and Type 2 Diabetes. Front Pediatr 2021; 9:781496. [PMID: 34912763 PMCID: PMC8666894 DOI: 10.3389/fped.2021.781496] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Increased arterial stiffness is associated with diastolic dysfunction in adults. Data in youth are lacking, so we examined the impact of arterial stiffness on diastolic function in youth. Methods: We obtained diastolic function and augmentation index, pulse wave velocity, brachial artery distensibility, and carotid stiffness on 612 youth [10-24 years, 65% female, 38% normal weight, 36% obese, and 26% with type 2 diabetes mellitus (T2DM)]. Participants were classified as compliant (C) vs. stiff (S) arteries based on seven arterial stiffness parameters [Global Stiffness Index (GSI), S = GSI > 4). Mean differences in covariates were evaluated by Student's t-tests. A stepwise regression analysis was performed to determine if GSI was an independent predictor of diastolic function. Results: Lower diastolic function and more adverse cardiovascular disease (CVD) risk factors were present in the S group (n = 67) than the C group (n = 545) (p < 0.001). Covariates that were associated with diastolic dysfunction were higher GSI, male sex, higher body mass index (BMI), and systolic blood pressure (SBP) z-score (R 2 = 0.18 to 0.25; p ≤ 0.05). Conclusion: Adverse diastolic function is seen in youth with increased arterial stiffness independent of CVD risk factors. Interventions to improve arterial stiffness prior to clinical onset of diastolic dysfunction are needed to prevent development of heart failure.
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Affiliation(s)
- Nicolas L Madsen
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Jessica E Haley
- Department of Pediatrics, Rady Children's Hospital, San Diego, CA, United States
| | - Ryan A Moore
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Philip R Khoury
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, United States
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Abstract
PURPOSE OF THE REVIEW This review summarizes sex-related changes in the heart and vasculature that occur with aging, both in the presence and absence of cardiovascular disease (CVD). RECENT FINDINGS In the presence of CVD risk factors and/or overt CVD, sex-specific changes in the number of cardiomyocytes, extent of the myocardial extracellular matrix, and myocellular hypertrophy promote unique patterns of LV remodeling in men and women. In addition, age- and sex-specific vascular stiffening is also well established, driven by changes in endothelial dysfunction, elastin-collagen content, microvascular dysfunction, and neurohormonal signaling. Together, these changes in LV chamber geometry and morphology, coupled with heightened vascular stiffness, appear to drive both age-related increases in systolic function and declines in diastolic function, particularly in postmenopausal women. Accordingly, estrogen has been implicated as a key mediator, given its direct vasodilating properties, association with nitric oxide excretion, and involvement in myocellular Ca2+ handling, mitochondrial energy production, and oxidative stress. The culmination of the abovementioned sex-specific cardiac and vascular changes across the lifespan provides important insight into heart failure development, particularly of the preserved ejection fraction variety, while offering promise for future preventive strategies and therapeutic approaches.
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Affiliation(s)
- Andrew Oneglia
- Applied Physiology and Advanced Imaging Lab, University of Texas at Arlington, 655 West Mitchell St, Arlington, TX, 76010, USA
| | - Michael D Nelson
- Applied Physiology and Advanced Imaging Lab, University of Texas at Arlington, 655 West Mitchell St, Arlington, TX, 76010, USA
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP Suite A3206, Los Angeles, CA, 90048, USA
| | - C Noel Bairey Merz
- Barbra Streisand Women's Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, AHSP Suite A3206, Los Angeles, CA, 90048, USA.
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35
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Hashimoto Y, Okamoto T. Arterial Stiffness and Left Ventricular Diastolic Function in Endurance Athletes. Int J Sports Med 2020; 42:497-505. [PMID: 33176384 DOI: 10.1055/a-1293-8430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The present study investigated the relationship between arterial stiffness and left ventricular diastolic function in endurance-trained athletes. Sixteen young male endurance-trained athletes and nine sedentary of similar age men participated in this study. Resting measures in carotid-femoral pulse wave velocity were obtained to assess arterial stiffness. Left ventricular diastolic function was assessed using 2-dimensional echocardiography. The athletes tended to have lower arterial stiffness than the controls (P=0.071). Transmitral A-waves in the athletes were significantly lower (P=0.018) than the controls, and left ventricular mass (P=0.034), transmitral E-wave/A-wave (P=0.005) and peak early diastolic mitral annular velocity at the septal site (P=0.005) in the athletes were significantly greater than the controls. A significant correlation was found between arterial stiffness and left ventricular diastolic function (E-wave: r=- 0.682, P=0.003, E-wave/A-wave: r=- 0.712, P=0.002, peak early diastolic mitral annular velocity at the septal site: r=- 0.557, P=0.025) in the athletes, whereas no correlation was found in controls. These results suggest that lower arterial stiffness is associated with higher left ventricular diastolic function in endurance-trained athletes.
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Affiliation(s)
- Yuto Hashimoto
- Graduate School of Health and Sport Science, Nippon Sport Science University, Tokyo, Japan
| | - Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University, Tokyo, Japan
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36
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Wen HJ, Wang XY. Left ventricular diastolic dysfunction is associated with cerebral infarction in young hypertensive patients: A retrospective case-control study. Exp Ther Med 2020; 20:61. [PMID: 32952651 PMCID: PMC7485303 DOI: 10.3892/etm.2020.9189] [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: 08/24/2019] [Accepted: 01/23/2020] [Indexed: 11/06/2022] Open
Abstract
Studies have indicated that hypertension is associated with the occurrence of acute cerebral infarction (CI) in young patients (18-45 years). However, the association between CI and left ventricular diastolic (LVD) dysfunction in young patients with hypertension has rarely been reported. The purpose of the present study was to investigate the association between LVD dysfunction and acute CI in young patients with hypertension. A total of 92 patients with acute CI who had hypertension were selected as the study group (CI group) and 98 young patients with only hypertension were selected as the control group (non-CI group). Blood pressure measurements, LVD functional assessment and cerebral MRI were performed. The χ² test was used to compare the left ventricular diastolic function between the CI and non-CI groups. The results indicated that LVD function of young patients was associated with hypertension and there was a correlation between the decrease in LVD function and the occurrence of acute CI in young patients with hypertension. The incidence of acute CI was higher in patients with decreased LVD function than in those with normal LVD function. In conclusion, hypertension in the young is associated with decreased LVD function and is a risk factor for diastolic dysfunction of the left ventricle. LVD function may be an independent predictor of acute CI in young patients with hypertension and should be considered by clinicians. By predicting the risk of acute CI in young patients with hypertension, LVD testing may aid in the primary prevention of CI or guide early treatment.
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Affiliation(s)
- Hui-Jun Wen
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
| | - Xiao-Yong Wang
- Department of Neurology, Baoji Municipal Central Hospital, Baoji, Shaanxi 721008, P.R. China
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Goldberg YH, Megyessi D, Flam M, Spevack DM, Sundqvist MG, Ugander M. Mechanistic validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Guidelines for the assessment of diastolic dysfunction in heart failure with reduced ejection fraction. Cardiovasc Ultrasound 2020; 18:42. [PMID: 33066772 PMCID: PMC7568361 DOI: 10.1186/s12947-020-00224-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022] Open
Abstract
Background The American Society for Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) 2016 guidelines for assessment of diastolic dysfunction (DD) are based primarily on the effects of diastolic dysfunction on left ventricular filling hemodynamics. However, these measures do not provide quantifiable mechanistic information about diastolic function. The Parameterized Diastolic Filling (PDF) formalism is a validated theoretical framework that describes DD in terms of the physical properties of left ventricular filling. Aims We hypothesized that PDF analysis can provide mechanistic insight into the mechanical properties governing higher grade DD. Methods Patients referred for echocardiography showing reduced left ventricular ejection fraction (< 45%) were prospectively classified into DD grade according to 2016 ASE/EACVI guidelines. Serial E-waves acquired during free breathing using pulsed wave Doppler of transmitral blood flow were analyzed using the PDF formalism. Results Higher DD grade (grade 2 or 3, n = 20 vs grade 1, n = 30) was associated with increased chamber stiffness (261 ± 71 vs 169 ± 61 g/s2, p < 0.001), increased filling energy (2.0 ± 0.9 vs 1.0 ± 0.5 mJ, p < 0.001) and greater peak forces resisting filling (median [interquartile range], 18 [15–24] vs 11 [8–14] mN, p < 0.001). DD grade was unrelated to chamber viscoelasticity (21 ± 4 vs 20 ± 6 g/s, p = 0.32). Stiffness was inversely correlated with ejection fraction (r = − 0.39, p = 0.005). Conclusions Higher grade DD was associated with changes in the mechanical properties that determine the physics of poorer left ventricular filling. These findings provide mechanistic insight into, and independent validation of the appropriateness of the 2016 guidelines for assessment of DD.
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Affiliation(s)
- Ythan H Goldberg
- Department of Medicine, Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, NY, USA
| | - David Megyessi
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - Mischa Flam
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | | | - Martin G Sundqvist
- Department of Cardiology, Södersjukhuset, and Karolinska Institutet, Stockholm, Sweden
| | - Martin Ugander
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden. .,Kolling Institute, Royal North Shore Hospital, and Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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38
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Hawes JZ, Cocciolone AJ, Cui AH, Griffin DB, Staiculescu MC, Mecham RP, Wagenseil JE. Elastin haploinsufficiency in mice has divergent effects on arterial remodeling with aging depending on sex. Am J Physiol Heart Circ Physiol 2020; 319:H1398-H1408. [PMID: 33035438 DOI: 10.1152/ajpheart.00517.2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Elastin is a primary structural protein in the arterial wall that contributes to vascular mechanical properties and degrades with aging. Aging is associated with arterial stiffening and an increase in blood pressure. There is evidence that arterial aging follows different timelines with sex. Our objective was to investigate how elastin content affects arterial remodeling in male and female mice with aging. We used male and female wild-type (Eln+/+) and elastin heterozygous (Eln+/-) mice at 6, 12, and 24 mo of age and measured their blood pressure and arterial morphology, wall structure, protein content, circumferential stress, stretch ratio, and stiffness. Two arteries were used with varying contents of elastin: the left common carotid and ascending aorta. We show that Eln+/- arteries start at a different homeostatic set point for circumferential wall stress, stretch, and material stiffness but show similar increases with aging to Eln+/+ mice. With aging, structural stiffness is greatly increased, while material stiffness and circumferential stress are only slightly increased, highlighting the importance of maintaining these homeostatic values. Circumferential stretch shows the smallest change with age and may be important for controlling cellular phenotype. Independent sex differences are mostly associated with males being larger than females; however, many of the measured factors show age × sex and/or genotype × sex interactions, indicating that males and females follow different cardiovascular remodeling timelines with aging and are differentially affected by reduced elastin content.NEW & NOTEWORTHY A comprehensive study on arterial mechanical behavior as a function of elastin content, aging, and sex in mice. Elastin haploinsufficient arteries start at a different homeostatic set point for mechanical parameters such as circumferential stress, stretch, and material stiffness. Structural stiffness of the arterial wall greatly increases with aging, as expected, but there are interactions between sex and aging for most of the mechanical parameters that are important to consider in future work.
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Affiliation(s)
- Jie Z Hawes
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
| | - Austin J Cocciolone
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
| | - Amy H Cui
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
| | - Diana B Griffin
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
| | | | - Robert P Mecham
- Department of Cell Biology and Physiology, Washington University, St. Louis, Missouri
| | - Jessica E Wagenseil
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, Missouri
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Mika M, Kanzaki H, Hasegawa T, Fukuda H, Amaki M, Kim J, Asakura M, Asanuma H, Nishimura M, Kitakaze M. Arterial stiffening is a crucial factor for left ventricular diastolic dysfunction in a community-based normotensive population. Int J Cardiol Hypertens 2020; 6:100038. [PMID: 33447764 PMCID: PMC7803042 DOI: 10.1016/j.ijchy.2020.100038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/29/2020] [Accepted: 06/12/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction is an important underlying hemodynamic mechanism for heart failure. Hypertension reportedly increases aortic stiffness with histological changes in the aorta assessed using aortic pulse wave velocity (PWV) that is associated with LV diastolic dysfunction. The role of hypertension per se in the relationship between aortic stiffness and LV diastolic dysfunction has not been clarified; therefore, we investigated whether this relation works for normotensive subjects. METHODS Of the 502 subjects who underwent both echocardiography and PWV measurement in a medical check-up conducted in Arita, Japan, we enrolled 262 consecutive normotensive subjects (age 52 ± 13 years). LV diastolic dysfunction was defined as abnormal relaxation and pseudonormal or restrictive patterns determined with both transmitral flow velocity and mitral annular velocity. Aortic stiffness was assessed via non-invasive brachial-ankle PWV measurement. RESULTS LV diastolic dysfunction was detected in 67 of the 262 (26%) normotensive subjects, and PWV was higher in subjects with LV diastolic dysfunction (15.4 ± 3.6 vs. 13.0 ± 2.7 m/s, p < 0.01). Multivariate logistic regression analyses revealed that PWV was independently associated with LV diastolic dysfunction (p = 0.02) after the adjustment for age; body mass index; blood pressure; eGFR; blood levels of BNP, glucose, and HDL cholesterol; LV mass index; and LA dimension. CONCLUSIONS Both aortic stiffness and LV diastolic function are mutually related even in normotensive subjects, independent of the potential confounding factors. The increase in aortic stiffness may be a risk factor for LV diastolic dysfunction, irrespective of blood pressure.
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Affiliation(s)
- Maeda Mika
- Division of Organ Regeneration Surgery, Department of Surgery, Tottori University, Yonago, Japan
| | - Hideaki Kanzaki
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takuya Hasegawa
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroki Fukuda
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Jiyoong Kim
- Department of Cardiology, Kim Cardiovascular Clinic, Osaka, Japan
| | - Masanori Asakura
- Department of Cardiovasculcar and Renal Medicine, Hyogo Ika Daigaku, Nishinomiya, Japan
| | - Hiroshi Asanuma
- Faculty of Health Science, Meiji University of Integrative Medicine, Nantan, Japan
| | - Motonobu Nishimura
- Division of Organ Regeneration Surgery, Department of Surgery, Tottori University, Yonago, Japan
| | - Masafumi Kitakaze
- Division of Cardiology, Department of Internal Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
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40
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Egbe AC, Anderson JH, Ammash NM, Taggart NW. Left Ventricular Remodeling After Transcatheter Versus Surgical Therapy in Adults With Coarctation of Aorta. JACC Cardiovasc Imaging 2020; 13:1863-1872. [PMID: 32199847 PMCID: PMC7486991 DOI: 10.1016/j.jcmg.2020.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/08/2020] [Accepted: 01/17/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES The purpose of this retrospective cohort study was to compare remodeling of left ventricular (LV) structure and function after transcatheter stent therapy with remodeling of LV structure and function after surgical therapy for COA. BACKGROUND Transcatheter stent therapy is as effective as surgery in producing acute hemodynamic improvement in patients with coarctation of aorta (COA). However, LV remodeling after transcatheter COA intervention has not been systematically investigated. METHODS LV remodeling was assessed at 1, 3, and 5 years post-intervention by using LV mass index (LVMI), LV end-diastolic dimension, LV ejection fraction, LV global longitudinal strain (LVGLS), LV mitral annular tissue Doppler early velocity (LVe'), and ratio of mitral inflow pulsed wave Doppler early velocity and e' (E/e') ratio. RESULTS There were 44 patients in the transcatheter group and 128 patients in the surgical group. Compared to the surgical group, the transcatheter group had less regression of LVMI (-4.6; 95% confidence interval [CI]: -5.5 to -3.7 vs. -7.3; 95% CI: -8.4 to -6.6 g/m2; p < 0.001), less improvement in LVGLS (2.1; 95% CI: 1.8 to 2.4 vs. 2.9; 95% CI: 2.6 to 3.2%; p = 0.024), and in e' (1.0 ; 95% CI: 0.7 to 1.2 vs. 1.5 ; 95% CI: 1.3 to 1.7 cm/s; p = 0.009) at 5 years post-intervention. Exploratory analysis showed a correlation between change in LVMI and LVGLS, and between change in LVMI and mitral annular tissue Doppler early velocity (e'), and this correlations were independent of the type of intervention received. CONCLUSIONS Transcatheter stent therapy was associated with less remodeling of LV structure and function during mid-term follow-up. As transcatheter stent therapy becomes more widely used in the adult COA population, there is a need for ongoing clinical monitoring to determine if these observed differences in LV remodeling translate to differences in clinical outcomes.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota.
| | - Jason H Anderson
- Division of Pediatric Cardiology, Mayo Clinic Rochester, Minnesota
| | - Naser M Ammash
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
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Lund JS, Aksetøy ILA, Dalen H, Amundsen BH, Støylen A. Left ventricular diastolic function: Effects of high-intensity exercise after acute myocardial infarction. Echocardiography 2020; 37:858-866. [PMID: 32497332 DOI: 10.1111/echo.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 04/20/2020] [Accepted: 05/12/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Reduced left ventricular (LV) diastolic function indicates poor prognosis after acute myocardial infarction (AMI). Our aim was to study whether a twelve-week high-intensity interval training program could improve diastolic function in patients with a relatively recent AMI. DESIGN Twenty-eight patients (mean age 56 (SD 8) years) with a recent AMI performed high-intensity interval training twice a week for 12 weeks. Each training session consisted of four 4-minute bouts at 85%-95% of peak heart rate, separated by 4-minute active breaks. A cardiopulmonary exercise test was performed to determine peak oxygen uptake (VO2peak ). Echocardiography was performed at rest and during an upright bicycle exercise test. RESULTS There was a significant increase in mitral annulus early diastolic velocity (e') at peak exercise (75 W) from baseline to follow-up (7.9 (1.5) vs. 8.4 (1.7) cm/s, P = .012), but no change in e' at rest (7.1 (1.9) vs. 7.3 (1.7) cm/s, P = .42). There was a significant increase in VO2peak (mean (SD), 35.2 (7.3) vs. 38.9 (7.4) ml/kg/min, P < .001). e' at peak exercise correlated with VO2peak both at baseline and follow-up (r = 0.50, P = .007, and r = 0.41, P = .032). CONCLUSION The present study shows that LV diastolic function during exercise is related to VO2peak . We also found an improvement of diastolic function after exercise training, even in a population with a relatively well preserved systolic and diastolic function. The results demonstrate the importance of obtaining measurements during exercise when evaluating the effects of exercise interventions.
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Affiliation(s)
- Joakim Schistad Lund
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Inger-Lise Aamot Aksetøy
- K.G. Jebsen Centre of Exercise in Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Services, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håvard Dalen
- K.G. Jebsen Centre of Exercise in Medicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Brage Høyem Amundsen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Asbjørn Støylen
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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42
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Okamoto T, Hashimoto Y, Kobayashi R, Nakazato K, Willems MET. Effects of blackcurrant extract on arterial functions in older adults: A randomized, double-blind, placebo-controlled, crossover trial. Clin Exp Hypertens 2020; 42:640-647. [PMID: 32396017 DOI: 10.1080/10641963.2020.1764015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE Blackcurrant extract mainly contains anthocyanins. Several reports suggest that anthocyanins have beneficial effect for cardiovascular functions. The aim of this study was to examine the effect of 7-day intake of New Zealand blackcurrant (NZBC) extract on arterial functions, e.g. arterial stiffness, and serum lipids. METHODS A randomized, double-blind, placebo-controlled, crossover design study with a washout period of 28 days was conducted. Fourteen older adults participated in this study (age 73.3 ± 1.7 years). Participants took either a 7-day course of placebo or two capsules of NZBC extract (each 300 mg capsule contains 35% blackcurrant extract). Participants took one of the two trials first and then took the other after a washout period. Carotid-femoral pulse-wave velocity, an index of central arterial stiffness, and central blood pressure were measured at baseline and again at the end of the 7-day study period. RESULTS Compared to baseline, carotid-femoral pulse-wave velocity (P = .03) and central blood pressure (P = .02) decreased significantly after the 7-day study period with NZBC intake. In addition, carotid-femoral pulse-wave velocity (P = .04) and central blood pressure (P = .001) in the NZBC intake trial decreased significantly more than in the placebo intake trial. No effects were observed on serum lipids. CONCLUSION These results suggest that short-term NZBC intake reduces central arterial stiffness and central blood pressure in older adults. Therefore, anthocyanin-rich blackcurrants might be beneficial for maintaining or improving cardiovascular health as an alternative to pharmaceutical medications. ABBREVIATIONS Aix: augmentation index; BP: blood pressure; cfPWV: carotid-femoral pulse-wave velocity; CVD: cardiovascular diseases; DBP: diastolic blood pressure; faPWV: femoral-ankle pulse-wave velocity; FG: fasting glucose; HDL: high-density lipoprotein cholesterol; LDL: low-density lipoprotein cholesterol; MBP: mean blood pressure; NZBC: New Zealand blackcurrant; PP: pulse pressure; SBP: systolic blood pressure; TG: triglycerides.
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Affiliation(s)
- Takanobu Okamoto
- Department of Exercise Physiology, Nippon Sport Science University , Tokyo, Japan
| | - Yuto Hashimoto
- Department of Exercise Physiology, Nippon Sport Science University , Tokyo, Japan
| | - Ryota Kobayashi
- Center for Fundamental Education, Teikyo University of Science , Tokyo, Japan
| | - Koichi Nakazato
- Department of Exercise Physiology, Nippon Sport Science University , Tokyo, Japan
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Chioncel O, Collins SP, Butler J. Istaroxime in acute heart failure: the holy grail is at HORIZON? Eur J Heart Fail 2020; 22:1694-1697. [PMID: 32374050 DOI: 10.1002/ejhf.1843] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 04/09/2020] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases 'Prof. C.C. Iliescu', University of Medicine Carol Davila, Bucharest, Romania
| | - Sean P Collins
- Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension. Blood Press Monit 2020; 25:26-33. [DOI: 10.1097/mbp.0000000000000416] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Aldhahi MI, Guccione AA, Chin LMK, Woolstenhulme J, Keyser RE. Modulation of left ventricular diastolic filling during exercise in persons with cervical motor incomplete spinal cord injury. Eur J Appl Physiol 2019; 119:2435-2447. [PMID: 31701273 PMCID: PMC10496443 DOI: 10.1007/s00421-019-04249-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/26/2019] [Indexed: 12/01/2022]
Abstract
PURPOSE To characterize left ventricular diastolic function during an exertional challenge in adults with incomplete cervical spinal cord Injury (icSCI). METHODS In this cross-sectional study, a two-group convenience sample was used to compare left ventricular LV diastolic performance during a 5-10 W·min-1 incremental arm ergometer exercise protocol, using bioimpedance cardiography. Subjects were eight males with cervical incomplete spinal cord injury (icSCI; C5-C7: age 39 ± 14 years) versus eight able-bodied males (CON: age 38 ± 13 years). Left ventricular (LV) diastolic indices included end-diastolic volume (EDV) and early diastolic filling ratio (EDFR). LV ejection time (LVET), inotropic index (dZ/dT2) and stroke volume (SV) were compared between the groups at peak exercise, and maximum workload for the icSCI group (isomax). RESULTS EDV (at peak exercise:131.4 ± 7.3 vs 188.78 ± 9.4, p < 0.001; at isomax: 131.4 ± 7.3 vs 169 ± 23, p = 0.0009) and EDFR (at peak exercise 73 ± 14% vs 119 ± 11%, p = 0.006; at isomax 94 ± 10; p = 0.009) were significantly reduced in icSCI compared to CON, respectively. Significant differences in LVET (icSCI: 273 ± 48 vs CON: 305 ± 68; p = 0.1) and dZ/dT2 (icSCI: 0.64 ± 0.11 vs CON: 0.85 ± 0.31; p = 0.1) were not observed at isomax, despite a significant decrease in SV in the subjects with icSCI (77.1 ± 6.05 mL vs 105.8 ± 9.2 mL, p < 0.00) CONCLUSION: Left ventricular filling was impaired in the subjects with icSCI as evidenced at both peak exercise and isomax. It is likely that restrictions on the skeletal muscle pump mechanized the impairment but increased left ventricular wall stiffness could not be excluded as a mediator.
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Affiliation(s)
- Monira I Aldhahi
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia
| | - Andrew A Guccione
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA
| | - Lisa M K Chin
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | | | - Randall E Keyser
- Department of Rehabilitation Science, George Mason University, 4400 University Drive, Fairfax, VA, 22030, USA.
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Ovchinnikov AG, Potekhina AV, Ibragimova NM, Barabanova EA, Yushchyuk EN, Ageev FT. [Mechanisms of exercise intolerance in patients with heart failure and preserved ejection fraction. Part II: The role of right heart chambers, vascular system and skeletal muscles]. ACTA ACUST UNITED AC 2019; 59:4-14. [PMID: 31526357 DOI: 10.18087/cardio.n393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 09/16/2019] [Indexed: 11/18/2022]
Abstract
The main clinical manifestation of heart failure with preserved ejection fraction is poor exercise tolerance. In addi-tion to the dysfunction of the left heart chambers, which were presented in the first part of this review, many other disorders are involved in poor exercise tolerance in such patients: impairments of the right heart, vascular system and skeletal muscle. The second part of this review presents the mechanisms for the development of these disorders, as well as possible ways to correct them.
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Affiliation(s)
- A G Ovchinnikov
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - A V Potekhina
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - N M Ibragimova
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
| | - E A Barabanova
- I. M. Sechenov First Moscow State Medical University (Sechenov University)
| | - E N Yushchyuk
- A. I. Evdokimov Moscow State University for Medicine and Dentistry
| | - F T Ageev
- FSBO National Medical research center of cardiology of the Ministry of healthcare of the Russian Federation
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Changes in left ventricular filling parameters before and after dialysis in patients with end stage renal disease. Int J Cardiovasc Imaging 2019; 35:1673-1681. [PMID: 31093896 DOI: 10.1007/s10554-019-01619-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/06/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study was to investigate the grading of diastolic dysfunction (DD) in relation to hemodialysis in patients with end stage renal disease (ESRD) on hemodialysis (HD) Cardiovascular disease is prevalent in patients with ESRD and accounts for significant morbidity and mortality. Left ventricular hypertrophy (LVH) is common in ESRD but little is known about the impact of HD on currently recommended grading schemes for DD. Comprehensive echocardiographic data was obtained in consecutive patients with ESRD before (n = 247) and immediately after (n = 239) standard HD regimen. Grading of DD was performed according to current recommendations both pre- and post HD. Prior to HD, DD was classified as present in 83 patients (34%), indeterminate in 51 patients (21%) and absent in 113 patients (45%). Patients with DD at baseline compared to those without were older [67.3 years (13.1) vs. 63.2 (14.3), p = 0.037], were more likely to have diabetic- or hypertensive ESRD (43.4% vs. 35.4%, p = ns) and LVMi was significantly higher [119 g/cm2 (27.5) vs. 103 g/cm2 (24.3), p < 0.001]. After HD [mean HD time = 221 min (27.6), mean ultrafiltration volume = 2 L (1.1)], 39 patients (16%) exhibited sustained DD. These patients were older [69.4 years (14.5) vs. 65.0 years (13.9), p = 0.071], were more likely to have diabetic- or hypertensive ESRD (59% vs. 36%, p = 0.010). Myocardial adverse remodeling was more advanced with higher LVMi [127.4 g/m2 (27.5) vs. 106.5 g/m2 (25.3), p < 0.001], lower LVEF [44.7% (11.0) vs. 54.5% (8.7), p < 0.001] and more impaired GLS [- 13.4% (4.3) vs. - 15.8% (4.0), p = 0.006]. Echocardiographic evaluation of diastolic function in patients with ESRD on HD is critically dependent on timing relative to dialysis. The presence of sustained DD after volume unloading by HD identifies a population of patients with an adverse phenotype of blunted vascular response and severe cardiac remodeling.
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Clinical significance of brachial-ankle pulse-wave velocity in patients with heart failure with preserved left ventricular ejection fraction. J Hypertens 2019; 36:560-568. [PMID: 29084082 DOI: 10.1097/hjh.0000000000001589] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although pulse-wave velocity (PWV) is a recognized risk predictor for cardiovascular diseases, its association with cardiovascular outcomes in heart failure with preserved left ventricular ejection fraction (HFpEF) is unclear. METHODS AND RESULTS The 502 patients with HFpEF finally enrolled in this study (mean follow-up duration: 1017 days) were divided into those with or without peripheral artery disease (PAD). The latter were further grouped according to brachial-ankle PWV (baPWV) quintiles using an ankle-brachial pressure index device. Kaplan-Meier analysis revealed a significantly higher risk of all-cause mortality and total cardiovascular events (both P = 0.01) in HFpEF patients with than without PAD. Multivariate Cox hazard analysis, including predictors identified as significant by simple Cox hazard analysis, identified PAD as a significant and independent predictor of cardiovascular events (hazard ratio: 1.85; 95% confidence interval: 1.01-3.39; P = 0.04). In an analysis of HFpEF patients without PAD grouped according to baPWV quintiles, estimated glomerular filtration rate (r = 0.21, P < 0.01) and hemoglobin (r = 0.18, P = 0.01) levels correlated negatively with baPWV. In the Kaplan-Meier analysis, patients with a baPWV more than 1900 cm/s and those with the lowest baPWV (<1300 cm/s) had a significantly higher frequency of total cardiovascular events than patients with 1300 baPWV or less which is less than 1900, indicating a J-shaped association between baPWV and total cardiovascular events as well as similarities to HFpEF patients with PAD. By contrast, the lowest baPWV group had the highest risk of heart failure-related events, accompanied by the highest brain natriuretic peptide levels. CONCLUSION Identifying complications of PAD and measuring baPWV values in HFpEF patients can improve risk stratification.
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Ikonomidis I, Aboyans V, Blacher J, Brodmann M, Brutsaert DL, Chirinos JA, De Carlo M, Delgado V, Lancellotti P, Lekakis J, Mohty D, Nihoyannopoulos P, Parissis J, Rizzoni D, Ruschitzka F, Seferovic P, Stabile E, Tousoulis D, Vinereanu D, Vlachopoulos C, Vlastos D, Xaplanteris P, Zimlichman R, Metra M. The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association. Eur J Heart Fail 2019; 21:402-424. [PMID: 30859669 DOI: 10.1002/ejhf.1436] [Citation(s) in RCA: 191] [Impact Index Per Article: 38.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 01/09/2019] [Accepted: 01/10/2019] [Indexed: 02/06/2023] Open
Abstract
Ventricular-arterial coupling (VAC) plays a major role in the physiology of cardiac and aortic mechanics, as well as in the pathophysiology of cardiac disease. VAC assessment possesses independent diagnostic and prognostic value and may be used to refine riskstratification and monitor therapeutic interventions. Traditionally, VAC is assessed by the non-invasive measurement of the ratio of arterial (Ea) to ventricular end-systolic elastance (Ees). With disease progression, both Ea and Ees may become abnormal and the Ea/Ees ratio may approximate its normal values. Therefore, the measurement of each component of this ratio or of novel more sensitive markers of myocardial (e.g. global longitudinal strain) and arterial function (e.g. pulse wave velocity) may better characterize VAC. In valvular heart disease, systemic arterial compliance and valvulo-arterial impedance have an established diagnostic and prognostic value and may monitor the effects of valve replacement on vascular and cardiac function. Treatment guided to improve VAC through improvement of both or each one of its components may delay incidence of heart failure and possibly improve prognosis in heart failure. In this consensus document, we describe the pathophysiology, the methods of assessment as well as the clinical implications of VAC in cardiac diseases and heart failure. Finally, we focus on interventions that may improve VAC and thus modify prognosis.
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Affiliation(s)
- Ignatios Ikonomidis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Jacque Blacher
- Diagnosis and Therapeutic Center, Hypertension and Cardiovascular Prevention Unit, Paris-Descartes University, Hôtel-Dieu Hospital, AP-HP, Paris, France
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Dirk L Brutsaert
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Julio A Chirinos
- Perelman School of Medicine and Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, PA, USA
| | - Marco De Carlo
- Cardiac Catheterization Laboratory, Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, CHU SantTilman, Liège, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - John Lekakis
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dania Mohty
- Department of Cardiology, Dupuytren University Hospital, Limoges, France.,Inserm 1094, Limoges School of Medicine, Limoges, France
| | - Petros Nihoyannopoulos
- NHLI - National Heart and Lung Institute, Imperial College London, London, UK.,1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - John Parissis
- Heart Failure Unit, School of Medicine and Department of Cardiology, National and Kapodistrian University of Athens, Athens University Hospital Attikon, Athens, Greece
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Frank Ruschitzka
- Department of Cardiology, University Hospital, Zurich, University Heart Center, Zurich, Switzerland
| | - Petar Seferovic
- Cardiology Department, Clinical Centre Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Eugenio Stabile
- Department of Advanced Biomedical Sciences, 'Federico II' University, Naples, Italy
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dragos Vinereanu
- University of Medicine and Pharmacy 'Carol Davila', and Department of Cardiology, University and Emergency Hospital, Bucharest, Romania
| | - Charalambos Vlachopoulos
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Dimitrios Vlastos
- Second Cardiology Department, Echocardiography Department and Laboratory of Preventive Cardiology, Athens University Hospital Attikon, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Panagiotis Xaplanteris
- 1st Department of Cardiology, Hippokration Hospital, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Reuven Zimlichman
- Department of Medicine and Hypertension Institute, Brunner Institute for Cardiovascular Research, Sackler Faculty of Medicine, The E. Wolfson Medical Center, Institute for Quality in Medicine, Israeli Medical Association, Tel Aviv University, Tel Aviv, Israel
| | - Marco Metra
- Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
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Imazu M, Nakano A, Ito S, Hamasaki T, Kitakaze M. Effects of Teneligliptin on the Progressive Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Mellitus in Open-Label, Marker-Stratified Randomized, Parallel-Group Comparison, Standard Treatment-Controlled Multicenter Trial (TOPLEVEL Study): Rationale and Study Design. Cardiovasc Drugs Ther 2019; 33:363-370. [DOI: 10.1007/s10557-019-06871-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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