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Kyriakopoulos CP, Kapelios CJ, Stauder EL, Taleb I, Hamouche R, Sideris K, Koliopoulou AG, Bonios MJ, Drakos SG. LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:3542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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Affiliation(s)
- Christos P. Kyriakopoulos
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Chris J. Kapelios
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
| | - Elizabeth L. Stauder
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Iosif Taleb
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Rana Hamouche
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
| | - Konstantinos Sideris
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
| | - Antigone G. Koliopoulou
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Divisions of Cardiology & Cardiothoracic Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Michael J. Bonios
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Divisions of Cardiology & Cardiothoracic Surgery, Onassis Cardiac Surgery Center, 17674 Athens, Greece
| | - Stavros G. Drakos
- Divisions of Cardiovascular Medicine and Cardiothoracic Surgery, University of Utah Health & School of Medicine, Salt Lake City, UT 84132, USA; (C.P.K.); (C.J.K.); (E.L.S.); (I.T.); (K.S.); (A.G.K.); (M.J.B.)
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT 84112, USA;
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Lim HS. The Physiologic Basis and Clinical Outcomes of Combined Impella and Veno-Arterial Extracorporeal Membrane Oxygenation Support in Cardiogenic Shock. Cardiol Ther 2020; 9:245-255. [PMID: 32424689 PMCID: PMC7584716 DOI: 10.1007/s40119-020-00175-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/17/2022] Open
Abstract
Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides effective hemodynamic support in cardiogenic shock, but in some cases may be complicated by left ventricular (LV) distension and pulmonary edema. The Impella, a catheter-mounted microaxial pump has been used to unload the LV. Recent studies have compared the clinical outcomes of VA-ECMO to the combination of Impella and VA-ECMO. The purpose of this review is threefold: firstly, to discuss the physiological effects of Impella support in addition to VA-ECMO, secondly to review published studies on the outcome of this combined support, and thirdly to provide a practical overview of the approach to combining Impella and VA-ECMO.
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Affiliation(s)
- Hoong Sern Lim
- University Hospital Birmingham, Edgbaston, Birmingham, UK.
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Kondo T, Okumura T, Oishi H, Arao Y, Kato H, Yamaguchi S, Kuwayama T, Haga T, Yokoi T, Hiraiwa H, Fukaya K, Sawamura A, Morimoto R, Mutsuga M, Fujimoto K, Usui A, Murohara T. Associations between hemodynamic parameters at rest and exercise capacity in patients with implantable left ventricular assist devices. Int J Artif Organs 2020; 44:174-180. [PMID: 32783493 DOI: 10.1177/0391398820949888] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hemodynamic parameters at rest are known to correlate poorly with peak oxygen uptake (VO2) in heart failure. However, we hypothesized that hemodynamic parameters at rest could predict exercise capacity in patients with left ventricular assist device (LVAD), because LVAD pump rotational speed does not respond during exercise. Therefore, we investigated the relationships between hemodynamic parameters at rest (measured with right heart catheterization) and exercise capacity (measured with cardiopulmonary exercise testing) in patients with implantable LVAD. METHODS We performed a retrospective medical record review of patients who received implantable LVAD at our institution from November 2013 to December 2017. RESULTS A total of 20 patients were enrolled in this study (15 males; mean age, 45.8 years; median duration of LVAD support, 356 days). The mean peak VO2 and cardiac index (CI) were 13.5 mL/kg/min and 2.6 L/min/m2, respectively. CI and hemoglobin level were significantly associated with peak VO2 (CI: r = 0.632, p = 0.003; hemoglobin: r = 0.520, p = 0.019). In addition, pulmonary capillary wedge pressure, right atrial pressure, and right ventricular stroke work index were also significantly associated with peak VO2. In multiple linear regression analysis, CI and hemoglobin level remained independent predictors of peak VO2 (CI: β = 0.559, p = 0.006; hemoglobin: β = 0.414, p = 0.049). CONCLUSIONS CI at rest and hemoglobin level are associated with poor exercise capacity in patients with LVAD.
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Affiliation(s)
- Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideo Oishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshihito Arao
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroo Kato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shogo Yamaguchi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tasuku Kuwayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomoaki Haga
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsuyoshi Yokoi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuro Fujimoto
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zarragoikoetxea I, Vicente R, Pajares A, Carmona P, Lopez M, Moreno I, Argente P, Hornero F, Valera F, Aguero J. Quantitative Transthoracic Echocardiography of the Response to Dobutamine in Cardiac Surgery Patients With Low Cardiac Output Syndrome. J Cardiothorac Vasc Anesth 2020; 34:87-96. [DOI: 10.1053/j.jvca.2019.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 08/07/2019] [Accepted: 08/12/2019] [Indexed: 12/15/2022]
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Sato Y, Yoshihisa A, Oikawa M, Nagai T, Yoshikawa T, Saito Y, Yamamoto K, Takeishi Y, Anzai T. Relation of Systolic Blood Pressure on the Following Day with Post-Discharge Mortality in Hospitalized Heart Failure Patients with Preserved Ejection Fraction. Int Heart J 2019; 60:876-885. [PMID: 31257340 DOI: 10.1536/ihj.18-699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The clinical scenario, which is based on systolic blood pressure (SBP) upon admission, is useful for classifying and determining initial treatment for acute heart failure (HF). However, the prognostic significance of SBP following the initial treatment is unclear.The Japanese Heart Failure Syndrome with Preserved Ejection Fraction (JASPER) registry is a nationwide, observational, and prospective registration of consecutive Japanese patients hospitalized with HF with preserved ejection fraction (HFpEF) and left ventricular ejection fraction ≥ 50%. We divided 525 patients into three groups based on their SBP on the day following hospitalization: high (SBP > 140 mmHg, n = 72, 13.7%); normal (100 ≤ SBP ≤ 140 mmHg, n = 379, 72.2%); and low (SBP < 100 mmHg, n = 74, 14.1%) groups. This analysis had two primary endpoints: (1) all-cause death and (2) all-cause death or rehospitalization for HF. In the Kaplan-Meier analysis, both of the endpoints were the highest in the low group (Log-Rank < 0.05, respectively). Compared to the normal and high groups, the low group demonstrated a higher prevalence of atrial fibrillation (67.1%, 63.9%, and 47.8%, P = 0.026) and the lowest left ventricular outflow tract velocity time integral determined by echocardiography (16.4 cm, 19.4 cm, and 23.3 cm, P = 0.001). In the multivariable Cox proportional hazard analysis, low SBP on the day following hospitalization was an independent predictor of all-cause death (hazard ratio 1.868, 95% confidence interval 1.024-3.407, P = 0.042) and the composite endpoint (hazard ratio 1.660, 95% confidence interval 1.103-2.500, P = 0.015).Classification based on SBP on the day following initial treatment predicts post-discharge prognosis in hospitalized patients with HFpEF.
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Affiliation(s)
- Yu Sato
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Akiomi Yoshihisa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Masayoshi Oikawa
- Department of Cardiovascular Medicine, Fukushima Medical University
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | | | - Yoshihiko Saito
- First Department of Internal Medicine, Nara Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
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Nakata TM, Kaji H, Matsuura N, Shimizu M, Tanaka R. Inotropic and lusitropic effects of incremental doses of dobutamine in dogs with right ventricular apical pacing-induced cardiac dysfunction. J Vet Pharmacol Ther 2019; 42:285-293. [PMID: 30724383 DOI: 10.1111/jvp.12752] [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: 10/30/2018] [Revised: 12/30/2018] [Accepted: 01/16/2019] [Indexed: 11/26/2022]
Abstract
This study aimed to assess the effects of incremental doses of dobutamine on diastolic function in healthy and rapid ventricular apical pacing (RVAP)-induced cardiac dysfunction anesthetized dogs. Inotropic and lusitropic effects of dobutamine (2, 4, 8, and 12 μg kg-1 min-1 ) were assessed through left ventricle (LV) pressure-volume relation and Doppler echocardiography in six female dogs before and after 8 weeks of RVAP. Peak rate of LV pressure fall (-dP/dtmin ) improved with doses >4 μg kg-1 min-1 in healthy (4,490 ± 970 vs. 3,265 ± 471 mmHg/s, p < 0.05) and >8 μg kg-1 min-1 in RVAP dogs (3,385 ± 1,122 vs. 1,864 ± 849 mmHg/s, p < 0.05) while the time constant of relaxation (tau) reduced with doses >4 μg kg-1 min-1 in both groups (healthy: 24.0 ± 3.7 vs. 28.2 ± 4.9 ms; RVAP: 32.6 ± 8.5 vs. 37.5 ± 11.4 ms, p < 0.05) comparing with baseline. Indices of relaxation (-dP/dtmin and tau) suggested preserved lusitropic response in contrast with markedly reduced indices of contractility in the RVAP group compared with healthy group at same infusion rates. Doppler echocardiography showed significant reduction of elastic recoil in failing hearts. The results of this study demonstrated maximal positive lusitropic effects of dobutamine at a dose of 8 μg kg-1 min-1 in ventricular pacing-induced cardiac dysfunction without further impairment of ventricular filling.
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Affiliation(s)
- Telma Mary Nakata
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Hideki Kaji
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Naoya Matsuura
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Miki Shimizu
- Department of Veterinary Radiology, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
| | - Ryou Tanaka
- Department of Veterinary Surgery, Tokyo University of Agriculture and Technology, Fuchu, Tokyo, Japan
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Kondo T, Yamada S, Asai C, Okumura T, Tanimura D, Murohara T. Skeletal Muscle Pump Function Is Associated With Exercise Capacity in Patients With Heart Failure. Circ J 2018; 82:1033-1040. [DOI: 10.1253/circj.cj-17-0927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Sumio Yamada
- Department of Rehabilitation Science, Nagoya University Graduate School of Medicine
| | - Chikako Asai
- Department of Rehabilitation, Toyohashi Heart Center
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
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Waddingham PH, Bhattacharyya S, Zalen JV, Lloyd G. Contractile reserve as a predictor of prognosis in patients with non-ischaemic systolic heart failure and dilated cardiomyopathy: a systematic review and meta-analysis. Echo Res Pract 2017; 5:1-9. [PMID: 29258998 PMCID: PMC5744622 DOI: 10.1530/erp-17-0054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/15/2017] [Indexed: 12/28/2022] Open
Abstract
Objective Patients with non-ischaemic systolic heart failure (HF) and idiopathic dilated cardiomyopathy (DCM) are a heterogenous group with varied morbidity and mortality. Prognostication in this group is challenging. We performed a systematic review and meta-analysis to examine the significance of the presence of contractile reserve as assessed via stress imaging on mortality and hospitalisation. Methods A search for studies that non-invasively assessed contractile reserve in patients with DCM or non-ischaemic HF with reduced ejection fraction, stress imaging with follow-up data comparing outcomes. A range of imaging modalities and stressors were included. We examined primary endpoints of mortality and secondary endpoints of combined cardiovascular events including HF progression or hospitalisation. Our analysis compared endpoints in patients with contractile reserve and those without it. Results Nine prospective cohort studies were identified describing a total of 787 patients. These studies are methodologically but not statistically heterogenous (I2 = 31%). Using a random effect model, the presence of contractile reserve was associated with a significantly lower risk of mortality and cardiovascular events odds ratios of 0.20 (CI 0.11, 0.39) (P < 0.00001) and 0.13 (CI 0.04, 0.40) (P = 0.0004), respectively. Conclusion Regardless of stressor and imaging modality and despite the significant methodological heterogeneity within the current data (imaging techniques and parameters), patients with non-ischaemic cardiomyopathy and reduced EF who demonstrate contractile reserve have a lower mortality, and lower events/hospitalisations. The presence of contractile reserve therefore offers a potential positive prognostic indicator when managing these patients.
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Affiliation(s)
| | | | - Jet Van Zalen
- Eastbourne District General Hospital, Kings Drive, Eastbourne, East Sussex, UK
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
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Morimoto R, Okumura T, Hirashiki A, Ishii H, Ichii T, Aoki S, Furusawa K, Hiraiwa H, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Takeshita K, Bando YK, Murohara T. Myocardial contractile reserve predicts left ventricular reverse remodeling and cardiac events in dilated cardiomyopathy. J Cardiol 2017; 70:303-309. [PMID: 28325519 DOI: 10.1016/j.jjcc.2017.02.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/17/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Catecholamine sensitivity estimated using a dobutamine stress test (DST) is recognized as a measure of the beta-adrenergic myocardial contractile reserve, which is involved with left ventricular reverse remodeling (LV-RR). We investigated whether the prognostic ability of the DST for LV-RR could predict cardiac events. METHODS There was a total of 192 enrolled patients with dilated cardiomyopathy (DCM). DCM was defined as a LV ejection fraction (LV-EF) ≤45% and LV end-diastolic dimension (LVDd) ≥55mm. One hundred patients were subjected to micromanometer-based measurement of the maximal first derivative of LV pressure (LVdP/dtmax), an index of LV contractility, at baseline and following the infusion of dobutamine (10μg/kg/min) via a pigtail catheter. Percentage changes in LVdP/dtmax from the baseline to peak values under dobutamine stress (ΔLVdP/dtmax) were also calculated. After excluding 17 patients who received cardiac resynchronization therapy within 3 months of undergoing DST (n=15) and who did not receive follow-up echocardiography (n=2), 83 patients were enrolled (52.5±12.3 years). RESULTS During the follow-up period (4.7±2.6 years), LV-RR was recognized in 49 of 83 patients (59.0%). A multivariate logistic regression analysis revealed that ΔLVdP/dtmax (hazard ratio: 1.024, p=0.007) and the symptom duration (hazard ratio: 0.977, p=0.003) were independent predictors of LV-RR. A receiver operating characteristic curve analysis revealed a ΔLVdP/dtmax cut-off value of 75.1% for LV-RR and a significantly lower cardiac event rate in the ΔLVdP/dtmax≥75.1% group (p=0.045). CONCLUSIONS ΔLVdP/dtmax estimated using DST was a useful predictor of LV-RR and cardiac events in patients with DCM.
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Affiliation(s)
- Ryota Morimoto
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of CKD Initiatives Internal Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirashiki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeo Ichii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Soichiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Hiraiwa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toru Kondo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Watanabe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoaki Kano
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Fukaya
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akinori Sawamura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kyosuke Takeshita
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuko K Bando
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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de Gonzalo-Calvo D, Quezada M, Campuzano O, Perez-Serra A, Broncano J, Ayala R, Ramos M, Llorente-Cortes V, Blasco-Turrión S, Morales F, Gonzalez P, Brugada R, Mangas A, Toro R. Familial dilated cardiomyopathy: A multidisciplinary entity, from basic screening to novel circulating biomarkers. Int J Cardiol 2017; 228:870-880. [PMID: 27889554 DOI: 10.1016/j.ijcard.2016.11.045] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 09/23/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022]
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Praktiknjo SD, Picard S, Deschepper CF. Comparisons of chromosome Y-substituted mouse strains reveal that the male-specific chromosome modulates the effects of androgens on cardiac functions. Biol Sex Differ 2016; 7:61. [PMID: 27980711 PMCID: PMC5143463 DOI: 10.1186/s13293-016-0116-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/09/2016] [Indexed: 01/06/2023] Open
Abstract
Background The C57BL/6J.YA/J mouse strain is a chromosome-substituted line where the original male-specific portion of chromosome Y (MSY) from C57BL/6J mice was substituted for that from A/J mice. In hearts from male C57BL/6J.YA/J and C57BL/6J mice, orchidectomy (ORX) affected in a strictly strain-specific fashion the expression a subset of genes showing enrichment for functional categories, including that of circadian rhythms and cardiac contractility. We further tested whether: (1) there were strain-specific differences in cardiac circadian rhythms; (2) strain-dependent differences in the effects of ORX on contractility genes translated into differences in cardiac functions; and (3) differential contractility responses occurred preferentially at times when circadian rhythms also showed strain-specific differences. Methods In hearts from the two above strains, we (1) profiled the expression levels of 15 circadian genes at 4-h intervals across a 24 h period; (2) tested the effects of either ORX or androgen replacement on expression of cardiac contractility genes, and that of ORX on myocardial functional reserve; and (3) verified whether the effects of MSY variants on cardiac contractility-related responses showed synchronicity with differences in circadian rhythms. Results Among the 15 tested circadian genes, a subset of them were affected by strain (and thus the genetic origin of MSY), which interacted with the amplitude of their peak of maximal expression at 2:00 PM. At that same time-point, ORX decreased (and androgen supplementation increased) the expression of three contractility-related genes, and decreased myocardial relaxation reserve in C57BL/6J.YA/J, but not in C57BL/6J mice. These effects were not detected at 10:00 AM, i.e., at another time-point when circadian genes showed no strain-specific differences. Conclusions The results indicate that in mice, androgens have activational effects on cardiac circadian rhythms, contractile gene expression, and myocardial functional reserve. All effects occurred preferentially at the same time of the day, but varied as a function of the genetic origin of MSY. Androgens may therefore be necessary but not sufficient to impart male-specific characteristics to some particular cardiac functions, with genetic material from MSY being one other necessary factor to fully define their range of actions. Electronic supplementary material The online version of this article (doi:10.1186/s13293-016-0116-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Samantha D Praktiknjo
- Institut de recherches cliniques de Montréal (IRCM) and Dept of Medicine, Cardiovascular Biology Research Unit, Université de Montréal, 100 Pine Ave West, Montreal, QC H2W 1R7 Canada ; Present address: Berlin Institute for Medical Systems Biology (BIMSB), Max Delbrück Center for Molecular Medicine (MDC) in the Helmholtz Association, Robert-Rössle-Str. 10, D-13125 Berlin, Germany
| | - Sylvie Picard
- Institut de recherches cliniques de Montréal (IRCM) and Dept of Medicine, Cardiovascular Biology Research Unit, Université de Montréal, 100 Pine Ave West, Montreal, QC H2W 1R7 Canada
| | - Christian F Deschepper
- Institut de recherches cliniques de Montréal (IRCM) and Dept of Medicine, Cardiovascular Biology Research Unit, Université de Montréal, 100 Pine Ave West, Montreal, QC H2W 1R7 Canada
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Minoshima M, Noda A, Kobayashi M, Miyata S, Hirashiki A, Okumura T, Izawa H, Ishii H, Kondo T, Murohara T. Endomyocardial radial strain rate imaging during dobutamine stress echocardiography for the evaluation of contractile reserve in patients with dilated cardiomyopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:555-560. [PMID: 27417656 DOI: 10.1002/jcu.22376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/01/2016] [Indexed: 06/06/2023]
Abstract
PURPOSE Myocardial contractile reserve is associated with clinical prognosis in patients with dilated cardiomyopathy (DCM). We assessed myocardial contractile reserve using tissue Doppler strain rate imaging with dobutamine stress echocardiography in DCM patients. METHODS Simultaneous echocardiography and left ventricular (LV) catheterization during dobutamine stress were performed in 20 patients with DCM, and echocardiography was performed in 31 control subjects. Dobutamine was infused at a starting dose of 5 μg/kg/min for 5 minutes and then at 10 μg/kg/min. Peak endomyocardial radial strain (ɛ) and systolic strain rate (SRsys ) measured with echocardiography and the maximum first derivative of LV pressure (LV dP/dtmax ) derived from catheterization were used as indices of contractility. Their percentage change from baseline to the dose of 10 μg/kg/min was calculated. RESULTS The ɛ and SRsys were significantly smaller in DCM patients than in controls. The LV dP/dtmax , ɛ, and SRsys were significantly higher at the dose of 10 μg/kg/min than at baseline. The percentage change in SRsys was significantly correlated with the percentage change in LV dP/dtmax . CONCLUSIONS Strain rate imaging during dobutamine stress in DCM might prove noninvasively informative for the evaluation of myocardial contractile reserve and provide insight into LV systolic dysfunction. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:555-560, 2016.
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Affiliation(s)
- Makoto Minoshima
- Department of Pathophysiology Laboratory Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akiko Noda
- Department of Biomedical Sciences, Chubu University Graduate School of Life and Health Sciences, Kasugai, Japan.
| | - Masakazu Kobayashi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Seiko Miyata
- Department of Sleep Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihiro Hirashiki
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideo Izawa
- Department of Cardiology, Banbuntane-Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takahisa Kondo
- Department of Advanced Medicine in Cardiopulmonary Disease, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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13
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Zhao G, Li Y, Cui L, Li X, Jin Z, Han X, Fang E, Gao Y, Zhou D, Jiang H, Jin X, Piao G, Li X, Yang G, Jin J, Zhu E, Piao M, Piao L, Yuan K, Lei Y, Ding D, Jin C, Nan Y, Cheng X. Increased Circulating Cathepsin K in Patients with Chronic Heart Failure. PLoS One 2015; 10:e0136093. [PMID: 26302400 PMCID: PMC4547812 DOI: 10.1371/journal.pone.0136093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 07/29/2015] [Indexed: 12/22/2022] Open
Abstract
Cysteinyl cathepsin K (CatK) is one of the most potent mammalian collagenases involved in cardiovascular disease. Here, we investigated the clinical predictive value of serum CatK levels in patients with chronic heart failure (CHF). We examined 134 patients with CHF, measuring their serum CatK, troponin I, high-sensitive C-reactive protein, and pre-operative N-terminal pro-brain natriuretic peptide levels. The patients were divided into two groups: the 44 patients who showed a left ventricular (LV) ejection fraction (LVEF) < 40% (the “lowLVEF” group) and the 90 patients showing LVEF values ≥ 40% (the “highLVEF” group). The lowLVEF patients had significantly higher serum CatK levels compared to the highLVEF patients (58.4 ± 12.2 vs. 44.7 ± 16.4, P < 0.001). Overall, a linear regression analysis showed that CatK levels correlated negatively with LVEF (r = −0.4, P < 0.001) and positively with LV end-diastolic dimensions (r = 0.2, P < 0.01), LV end-systolic dimensions (r = 0.3, P < 0.001), and left atrial diameters (r = 0.3, P < 0.01). A multiple logistic regression analysis showed that CatK levels were independent predictors of CHF (odds ratio, 0.90; 95% confidence interval, 0.84–0.95; P < 0.01). These data indicate that elevated levels of CatK are closely associated with the presence of CHF and that the measurement of circulating CatK provides a noninvasive method of documenting and monitoring the extent of cardiac remodeling and dysfunction in patients with CHF.
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Affiliation(s)
- Guangxian Zhao
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Yuzi Li
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Lan Cui
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
- * E-mail: (LC); (XC)
| | - Xiang Li
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Zhenyi Jin
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Xiongyi Han
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Ennan Fang
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Yihua Gao
- Department of Clinical Examination, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Dongmei Zhou
- Department of Central Laboratory, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Haiying Jiang
- Department of Physiology and Pathophysiology, Yanbian University Medical College, Yanji, Jilin, P.R., China
| | - Xueying Jin
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Guanghao Piao
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Xiangshan Li
- Department of Central Laboratory, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Guang Yang
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Jiyong Jin
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Enbo Zhu
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Meina Piao
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Limei Piao
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Kuichang Yuan
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Yanna Lei
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Dazhi Ding
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Chengzhi Jin
- Department of Clinical Examination, Yanbian University Hospital, Yanji, Jilin, P.R., China
| | - Yongshan Nan
- Department of Anesthesiology, Yanbian University Hospital, Yanji, Jilin P.R., China
| | - Xianwu Cheng
- Department of Cardiology, Yanbian University Hospital, Yanji, Jilin, P.R., China
- * E-mail: (LC); (XC)
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Influenza virus-specific neutralizing IgM antibodies persist for a lifetime. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2014; 21:1481-9. [PMID: 25165027 DOI: 10.1128/cvi.00374-14] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Detection of immunoglobulin M (IgM) antibodies has long been used as an important diagnostic tool for identifying active viral infections, but their relevance in later stages has not been clearly defined in vivo. In this study, we followed the kinetics, longevity, and function of influenza virus-specific IgM antibodies for 2 years following sublethal infection of mice with live mouse-adapted A/PR/8/34 virus or immunization with formalin-inactivated virus. These groups mounted robust protective immune responses and survived lethal challenges with 50 × 50% lethal dose (LD50) mouse-adapted A/PR/8/34 virus 600 days after the primary exposure. Surprisingly, the virus-specific IgM antibodies persisted along with IgG antibodies, and we found a significantly higher number of IgM-positive (IgM(+)) virus-specific plasma cells than IgG(+) plasma cells that persisted for at least 9 months postexposure. The IgM antibodies were functional as they neutralized influenza virus in the presence of complement just as well as IgG antibodies did.
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Yamada T, Hirashiki A, Cheng XW, Okumura T, Shimazu S, Okamoto R, Shinoda N, Isobe S, Takeshita K, Naganawa S, Kondo T, Murohara T. Relationship of myocardial fibrosis to left ventricular and mitochondrial function in nonischemic dilated cardiomyopathy--a comparison of focal and interstitial fibrosis. J Card Fail 2014; 19:557-64. [PMID: 23910585 DOI: 10.1016/j.cardfail.2013.05.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/14/2013] [Accepted: 05/31/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND Mitochondrial damage is associated with histologic myocardial fibrosis. Late gadolinium enhancement (LGE) on cardiac magnetic resonance (CMR) can be used to identify focal fibrosis. We examined whether myocardial fibrosis on CMR and collagen volume fraction (CVF) from biopsies correlated with left ventricular (LV) and mitochondrial function in patients with nonischemic dilated cardiomyopathy (DCM). METHODS AND RESULTS Fifty-nine DCM patients underwent CMR, cardiac catheterization, and endomyocardial biopsy. Minimum first derivative of LV pressure (LVdP/dt(min)) was measured as an index of LV relaxation. Mitochondrial RNA expression was also analyzed. For quantitative analysis of myocardial fibrosis, percentage LGE (%LGE) and CVF were calculated. Patients were divided into 2 groups on the basis of the presence (LGE group; n = 27) or absence (non-LGE group; n = 32) of LGE. Mean CVF and absolute value of LVdP/dt(min) were significantly higher and lower, respectively, in the LGE group than in the non-LGE group. Multivariate analysis revealed that %LGE was an independent determinant of LVdP/dt(min). The abundance of mitochondrial enzyme mRNA was significantly lower in the LGE group. CONCLUSIONS Noninvasive CMR imaging is more useful in predicting diastolic dysfunction than invasive histologic assessments. In addition, it might indicate mitochondrial dysfunction in DCM.
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Affiliation(s)
- Takashi Yamada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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16
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Okumura T, Hirashiki A, Yamada S, Funahashi H, Ohshima S, Kono Y, Cheng XW, Takeshita K, Murohara T. Association between cardiopulmonary exercise and dobutamine stress testing in ambulatory patients with idiopathic dilated cardiomyopathy: a comparison with peak VO₂ and VE/VCO₂ slope. Int J Cardiol 2013; 162:234-9. [PMID: 21641058 DOI: 10.1016/j.ijcard.2011.05.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2010] [Revised: 02/18/2011] [Accepted: 05/13/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Both peak VO(2) and VE/VCO(2) slope are considered to be useful predictors of cardiovascular events. The left ventricular (LV) response to dobutamine stress testing (DST) also provides useful prognostic information. However, the relationship between these variables has not been fully investigated. Therefore, the aim of this study is to investigate the association between myocardial contractile reserve measured by DST and cardiopulmonary exercise testing (CPX) variables in patients with idiopathic dilated cardiomyopathy (IDCM). METHODS Thirty-eight patients were subjected to CPX as well as cardiac catheterization for measurement of LV pressure. The maximum first derivative of LV pressure (LV dP/dt(max)) was measured at baseline and during dobutamine infusion at incremental doses of 5, 10, and 15 μg kg(-1)min(-1). LV dP/dt(max) at baseline and the percentage increase in LV dP/dt(max) (ΔLV dP/dt(max)) induced by DST served as indices of LV contractility and myocardial contractile reserve, respectively. RESULTS Peak VO(2), and VE/VCO(2) slope were 18.6 mL kg(-1)min(-1) and 32.3, respectively. Peak VO(2) was not correlated with LV dP/dt(max) at baseline. However, peak VO(2) was significantly correlated with ΔLV dP/dt(max), and the correlation became more pronounced as the dose of dobutamine was increased. There was no correlation between VE/VCO(2) slope and ΔLV dP/dt(max). Multivariate regression analysis revealed that ΔLV dP/dt(max) was independently correlated with peak VO(2) (p=0.011). CONCLUSIONS Peak VO(2), but not VE/VCO(2) slope, may reflect myocardial contractile reserve in ambulatory patients with IDCM. This study population is small, and therefore large confirmatory studies are needed.
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Affiliation(s)
- Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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17
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Pingitore A, Aquaro GD, Lorenzoni V, Gallotta M, De Marchi D, Molinaro S, Cospite V, Passino C, Emdin M, Lombardi M, Lionetti V, L'Abbate A. Influence of preload and afterload on stroke volume response to low-dose dobutamine stress in patients with non-ischemic heart failure: A cardiac MR study. Int J Cardiol 2013; 166:475-81. [DOI: 10.1016/j.ijcard.2011.11.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 11/01/2011] [Accepted: 11/24/2011] [Indexed: 01/25/2023]
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18
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Low-dose dobutamine induces left ventricular mechanical dyssynchrony in patients with dilated cardiomyopathy and a narrow QRS: A study using real-time three-dimensional echocardiography. J Cardiol 2013; 61:275-80. [DOI: 10.1016/j.jjcc.2012.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/29/2012] [Accepted: 12/04/2012] [Indexed: 02/04/2023]
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19
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Hayashi D, Ohshima S, Isobe S, Cheng XW, Unno K, Funahashi H, Shinoda N, Okumura T, Hirashiki A, Kato K, Murohara T. Increased (99m)Tc-sestamibi washout reflects impaired myocardial contractile and relaxation reserve during dobutamine stress due to mitochondrial dysfunction in dilated cardiomyopathy patients. J Am Coll Cardiol 2013; 61:2007-17. [PMID: 23501381 DOI: 10.1016/j.jacc.2013.01.074] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2012] [Revised: 12/20/2012] [Accepted: 01/08/2013] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study investigated whether the technitium-99m sestamibi (MIBI) washout rate (WR) would predict mitochondrial damage and myocardial dysfunction in patients with dilated cardiomyopathy (DCM). BACKGROUND Myocardial mitochondrial damage reduces adenosine triphosphate production, resulting in myocardial dysfunction. Increased myocardial (99m)Tc-MIBI washout is reportedly caused by mitochondrial dysfunction. METHODS Twenty DCM patients (New York Heart Association functional class I-III) underwent myocardial (99m)Tc-MIBI scintigraphy and cardiac catheterization. Myocardial MIBI uptake was quantified as an early and delayed heart-to-mediastinum ratio, and WR was calculated. Maximum first derivative of left ventricular (LV) pressure (LV dP/dtmax) (an index of myocardial contractility) and LV pressure half-time (T1/2) (an index of myocardial relaxation) were calculated by the left ventricular pressure curve at baseline and during dobutamine infusion (15 μg/kg/min at maximum). Endomyocardial biopsy specimens were obtained for quantitative mRNA analysis and electron microscopy. The patients were divided into two groups as follows: 1) group A of 10 patients showing a WR ≤ 24.3% (median value) and 2) group B of 10 patients showing a WR >24.3%. RESULTS WR was significantly correlated with the percentage changes in LV dP/dtmax (%LV dP/dtmax) (r: -0.59; p = 0.01) and T1/2 (r: -0.57; p = 0.03) from baseline to peak dobutamine stress. The %LV dP/dtmax was significantly greater in group B than in group A. The abundance of mRNAs for mitochondrial electron transport-related enzymes was more significantly reduced in group B than in group A. Electron microscopy revealed significant correlations between WR and the severity of mitochondrial damage (r: 0.88; p = 0.048) and glycogen accumulation (r: 0.90; p = 0.044). CONCLUSIONS Increased (99m)Tc-MIBI washout may predict mitochondrial dysfunction and the impairment of myocardial contractile and relaxation reserves during dobutamine stress in DCM patients.
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Affiliation(s)
- Daisuke Hayashi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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20
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Myocardial 123I-MIBG scintigraphy predicts an impairment in myocardial functional reserve during dobutamine stress in patients with idiopathic dilated cardiomyopathy. Eur J Nucl Med Mol Imaging 2012; 40:262-70. [DOI: 10.1007/s00259-012-2256-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 09/17/2012] [Indexed: 01/01/2023]
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21
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Suzuki T, Koike A, Nagayama O, Sakurada K, Tsuneoka H, Kato J, Yamashita T, Yamazaki J. Overshoot phenomena of respiratory gas variables during exercise recovery in cardiac patients. Circ J 2012; 76:876-83. [PMID: 22322878 DOI: 10.1253/circj.cj-11-1279] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Transient increases (overshoot) in respiratory gas variables have been observed during exercise recovery, but their clinical significance is not clearly understood. Our group evaluated the relationship between the presence of overshoot of respiratory gas variables and the parameters obtained from cardiopulmonary exercise testing (CPX). METHODS AND RESULTS In total, 227 patients with various cardiac diseases underwent CPX. The overshoot phenomena of O₂ uptake (·VO₂), ·VO₂/heart rate (O₂-pulse), and CO₂ output (·VCO₂) were analyzed by respiratory gas analysis during recovery after maximal exercise. The overshoot of ·VO₂, O₂-pulse, and ·VCO₂ were recognized in 11 (5%), 43 (19%), and 12 (5%) patients, respectively. Compared with the patients without a ·VO₂ overshoot, those with a ·VO₂ overshoot had a significantly lower peak ·VO₂ (12.3±3.7 vs. 17.9±6.2ml·min⁻¹·kg⁻¹, P=0.003), lower anaerobic threshold (9.4±1.7 vs. 12.4±3.3 ml·min⁻¹·kg⁻¹, P=0.001), higher ·VE-·VCO₂ slope (38.0±5.2 vs. 33.2±9.6, P=0.013), and lower left ventricular ejection fraction (LVEF) (39.9±22.8 vs. 55.8±16.8%, P=0.003). Similar findings were obtained for the patients with an O₂-pulse overshoot and those with a ·VCO₂ overshoot. CONCLUSIONS The overshoot phenomena of respiratory gas variables during recovery after maximal exercise are correlated with impaired cardiopulmonary function during exercise in cardiac patients.
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Affiliation(s)
- Takeya Suzuki
- Department of Cardiovascular Medicine, Toho University Omori Medical Center
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Thorstensen A, Dalen H, Amundsen BH, Støylen A. Peak systolic velocity indices are more sensitive than end-systolic indices in detecting contraction changes assessed by echocardiography in young healthy humans. ACTA ACUST UNITED AC 2011; 12:924-30. [DOI: 10.1093/ejechocard/jer178] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The concept of ventricular reserve in heart failure and pulmonary hypertension: an old metric that brings us one step closer in our quest for prediction. Curr Opin Cardiol 2011; 26:123-31. [PMID: 21297465 DOI: 10.1097/hco.0b013e3283437485] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ventricular reserve is emerging a strong predictor of outcome in heart failure and cardiovascular disease. Ventricular reserve is the term used to describe the extent of increase or change in ventricular function that occurs during exercise or pharmacological stress (typically with dobutamine). RECENT FINDINGS The interest in ventricular reserve lies in its ability to assess viability in coronary artery disease, to predict clinical outcome and response to therapy in patients with heart failure and to screen patients for early cardiovascular disease. SUMMARY In this paper, we will review the emerging role of ventricular reserve in heart failure and pulmonary hypertension. We will also explore the mechanisms involved in the pathophysiology of impaired ventricular reserve and discuss future directions of research in the field.
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Liles JT, Ida KK, Joly KM, Chapo J, Plato CF. Age exacerbates chronic catecholamine-induced impairments in contractile reserve in the rat. Am J Physiol Regul Integr Comp Physiol 2011; 301:R491-9. [PMID: 21593430 DOI: 10.1152/ajpregu.00756.2010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Contractile reserve decreases with advancing age and chronic isoproterenol (ISO) administration is a well-characterized model of cardiac hypertrophy known to impair cardiovascular function. This study evaluated whether nonsenescent, mature adult rats are more susceptible to detrimental effects of chronic ISO administration than younger adult rats. Rats received daily injections of ISO (0.1 mg/kg sc) or vehicle for 3 wk. ISO induced a greater impairment in contractile reserve [maximum of left ventricular pressure development (Δ+dP/dt(max))] in mature adult ISO-treated (MA-ISO) than in young adult ISO-treated rats (YA-ISO) in response to infusions of mechanistically distinct inotropes (digoxin, milrinone; 20-200 μl·kg(-1)·min(-1)), while basal and agonist-induced changes in heart rate and systolic arterial pressure (SAP) were not different across groups. ISO decreased expression of the calcium handling protein, sarco(endo)plasmic reticulum Ca(2+)-ATPase-2a, in MA-ISO compared with YA, YA-ISO, and MA rats. Chronic ISO also induced greater increases in cardiac hypertrophy [left ventricular (LV) index: 33 ± 3 vs. 22 ± 5%] and caspase-3 activity (34 vs. 5%) in MA-ISO relative to YA-ISO rats. Moreover, β-myosin heavy chain (β-MHC) and atrial natriuretic factor (ANF) mRNA expression was significantly elevated in MA-ISO. These results demonstrate that adult rats develop greater impairments in systolic performance than younger rats when exposed to chronic catecholamine excess. Reduced contractile reserve may result from calcium dysregulation, increased caspase-3 activity, or increased β-MHC and ANF expression. Although several studies report age-related declines in systolic performance in older and senescent animals, the present study demonstrates that catecholamine excess induces reductions in systolic performance significantly earlier in life.
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Affiliation(s)
- John T Liles
- Gilead Sciences, Inc., 1651 Page Mill Road, Palo Alto, CA 94304, USA.
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25
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Vandecaetsbeek I, Vangheluwe P, Raeymaekers L, Wuytack F, Vanoevelen J. The Ca2+ pumps of the endoplasmic reticulum and Golgi apparatus. Cold Spring Harb Perspect Biol 2011; 3:cshperspect.a004184. [PMID: 21441596 DOI: 10.1101/cshperspect.a004184] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The various splice variants of the three SERCA- and the two SPCA-pump genes in higher vertebrates encode P-type ATPases of the P(2A) group found respectively in the membranes of the endoplasmic reticulum and the secretory pathway. Of these, SERCA2b and SPCA1a represent the housekeeping isoforms. The SERCA2b form is characterized by a luminal carboxy terminus imposing a higher affinity for cytosolic Ca(2+) compared to the other SERCAs. This is mediated by intramembrane and luminal interactions of this extension with the pump. Other known affinity modulators like phospholamban and sarcolipin decrease the affinity for Ca(2+). The number of proteins reported to interact with SERCA is rapidly growing. Here, we limit the discussion to those for which the interaction site with the ATPase is specified: HAX-1, calumenin, histidine-rich Ca(2+)-binding protein, and indirectly calreticulin, calnexin, and ERp57. The role of the phylogenetically older and structurally simpler SPCAs as transporters of Ca(2+), but also of Mn(2+), is also addressed.
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Affiliation(s)
- Ilse Vandecaetsbeek
- Laboratory of Ca-transport ATPases, Department of Molecular Cell Biology, K.U. Leuven, Leuven, Belgium
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26
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Altered microRNA expression associated with reduced catecholamine sensitivity in patients with chronic heart failure. J Cardiol 2011; 57:338-44. [DOI: 10.1016/j.jjcc.2011.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2010] [Revised: 01/05/2011] [Accepted: 01/12/2011] [Indexed: 12/18/2022]
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27
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Bevan AK, Hutchinson KR, Foust KD, Braun L, McGovern VL, Schmelzer L, Ward JG, Petruska JC, Lucchesi PA, Burghes AHM, Kaspar BK. Early heart failure in the SMNDelta7 model of spinal muscular atrophy and correction by postnatal scAAV9-SMN delivery. Hum Mol Genet 2010; 19:3895-905. [PMID: 20639395 DOI: 10.1093/hmg/ddq300] [Citation(s) in RCA: 164] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Proximal spinal muscular atrophy (SMA) is a debilitating neurological disease marked by isolated lower motor neuron death and subsequent atrophy of skeletal muscle. Historically, SMA pathology was thought to be limited to lower motor neurons and the skeletal muscles they control, yet there are several reports describing the coincidence of cardiovascular abnormalities in SMA patients. As new therapies for SMA emerge, it is necessary to determine whether these non-neuromuscular systems need to be targeted. Therefore, we have characterized left ventricular (LV) function of SMA mice (SMN2+/+; SMNΔ7+/+; Smn-/-) and compared it with that of their unaffected littermates at 7 and 14 days of age. Anatomical and physiological measurements made by electrocardiogram and echocardiography show that affected mouse pups have a dramatic decrease in cardiac function. At 14 days of age, SMA mice have bradycardia and develop a marked dilated cardiomyopathy with a concomitant decrease in contractility. Signs of decreased cardiac function are also apparent as early as 7 days of age in SMA animals. Delivery of a survival motor neuron-1 transgene using a self-complementary adeno-associated virus serotype 9 abolished the symptom of bradycardia and significantly decreased the severity of the heart defect. We conclude that severe SMA animals have compromised cardiac function resulting at least partially from early bradycardia, which is likely attributable to aberrant autonomic signaling. Further cardiographic studies of human SMA patients are needed to clarify the clinical relevance of these findings from this SMA mouse.
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Affiliation(s)
- Adam K Bevan
- Department of Gene Therapy, The Research Institute, Nationwide Children’s Hospital, Columbus, OH 43205, USA
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Hirashiki A, Izawa H, Cheng XW, Unno K, Ohshima S, Murohara T. Dobutamine-induced mechanical alternans is a marker of poor prognosis in idiopathic dilated cardiomyopathy. Clin Exp Pharmacol Physiol 2010; 37:1004-9. [DOI: 10.1111/j.1440-1681.2010.05425.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Vandecaetsbeek I, Raeymaekers L, Wuytack F, Vangheluwe P. Factors controlling the activity of the SERCA2a pump in the normal and failing heart. Biofactors 2009; 35:484-99. [PMID: 19904717 DOI: 10.1002/biof.63] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Heart failure is the leading cause of death in western countries and is often associated with impaired Ca(2+) handling in the cardiomyocyte. In fact, cardiomyocyte relaxation and contraction are tightly controlled by the activity of the cardiac sarco(endo)plasmic reticulum (ER/SR) Ca(2+) pump SERCA2a, pumping Ca(2+) from the cytosol into the lumen of the ER/SR. This review addresses three important facets that control the SERCA2 activity in the heart. First, we focus on the alternative splicing of the SERCA2 messenger, which is strictly regulated in the developing heart. This splicing controls the formation of three SERCA2 splice variants with different enzymatic properties. Second, we will discuss the role and regulation of SERCA2a activity in the normal and failing heart. The two well-studied Ca(2+) affinity modulators phospholamban and sarcolipin control the activity of SERCA2a within a narrow window. An aberrantly high or low Ca(2+) affinity is often observed in and may even trigger cardiac failure. Correcting SERCA2a activity might therefore constitute a therapeutic approach to improve the contractility of the failing heart. Finally, we address the controversies and unanswered questions of other putative regulators of the cardiac Ca(2+) pump, such as sarcalumenin, HRC, S100A1, Bcl-2, HAX-1, calreticulin, calnexin, ERp57, IRS-1, and -2.
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Affiliation(s)
- Ilse Vandecaetsbeek
- Department of Molecular Cell Biology, Laboratory of Ca(2+)-transport ATPases, K.U.Leuven, Leuven, Belgium
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Francis GS, Desai MY. Contractile Reserve: Are We Beginning to Understand It? JACC Cardiovasc Imaging 2008; 1:727-8. [DOI: 10.1016/j.jcmg.2008.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2008] [Revised: 07/11/2008] [Accepted: 09/03/2008] [Indexed: 01/08/2023]
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