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Tersalvi G, Beltrani V, Grübler MR, Molteni A, Cristoforetti Y, Pedrazzini G, Treglia G, Biasco L. Positron Emission Tomography in Heart Failure: From Pathophysiology to Clinical Application. J Cardiovasc Dev Dis 2023; 10:220. [PMID: 37233187 PMCID: PMC10218989 DOI: 10.3390/jcdd10050220] [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: 03/31/2023] [Revised: 05/13/2023] [Accepted: 05/15/2023] [Indexed: 05/27/2023] Open
Abstract
Imaging modalities are increasingly being used to evaluate the underlying pathophysiology of heart failure. Positron emission tomography (PET) is a non-invasive imaging technique that uses radioactive tracers to visualize and measure biological processes in vivo. PET imaging of the heart uses different radiopharmaceuticals to provide information on myocardial metabolism, perfusion, inflammation, fibrosis, and sympathetic nervous system activity, which are all important contributors to the development and progression of heart failure. This narrative review provides an overview of the use of PET imaging in heart failure, highlighting the different PET tracers and modalities, and discussing fields of present and future clinical application.
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Affiliation(s)
- Gregorio Tersalvi
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Vittorio Beltrani
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Martin R. Grübler
- Department of Cardiology, Regional Hospital Neustadt, 2700 Wiener Neustadt, Austria
- Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Alessandra Molteni
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6850 Mendrisio, Switzerland
| | - Yvonne Cristoforetti
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giovanni Pedrazzini
- Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Clinic of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1015 Lausanne, Switzerland
| | - Luigi Biasco
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Division of Cardiology, Azienda Sanitaria Locale Torino 4, 10073 Ospedale di Ciriè, Italy
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Martins S, António N, Carvalheiro T, Laranjeira P, Rodrigues R, Gonçalves L, Tomaz C, Paiva A. Reduced numbers of regulatory T cells in chronic heart failure seems not to be restored by cardiac resynchronization therapy. BMC Cardiovasc Disord 2023; 23:89. [PMID: 36792985 PMCID: PMC9933267 DOI: 10.1186/s12872-023-03109-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 02/03/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND T cells have been implicated in the development and progression of inflammatory processes in chronic heart failure (CHF). Cardiac resynchronization therapy (CRT) has beneficial effects on symptoms and cardiac remodeling in CHF. However, its impact on the inflammatory immune response remains controversial. We aimed to study the impact of CRT on T cells in heart failure (HF) patients. METHODS Thirty-nine HF patients were evaluated before CRT (T0) and six months later (T6). Quantification of T cells, their subsets, and their functional characterization, after in vitro stimulation, were evaluated by flow cytometry. RESULTS T regulatory (Treg) cells were decreased in CHF patients (healthy group (HG): 1.08 ± 0.50 versus (heart failure patients (HFP)-T0: 0.69 ± 0.40, P = 0.022) and remaining diminished after CRT (HFP-T6: 0.61 ± 0.29, P = 0.003). Responders (R) to CRT presented a higher frequency of T cytotoxic (Tc) cells producing IL-2 at T0 compared with non-responders (NR) (R: 36.52 ± 12.55 versus NR: 24.71 ± 11.66, P = 0.006). After CRT, HF patients presented a higher percentage of Tc cells expressing TNF-α and IFN-γ (HG: 44.50 ± 16.62 versus R: 61.47 ± 20.54, P = 0.014; and HG: 40.62 ± 15.36 versus R: 52.39 ± 18.66, P = 0.049, respectively). CONCLUSION The dynamic of different functional T cell subpopulations is significantly altered in CHF, which results in an exacerbated pro-inflammatory response. Even after CRT, it seems that the inflammatory condition underlying CHF continues to evolve with the progression of the disease. This could be due, at least in part, to the inability to restore Treg cells levels. TRIAL REGISTRATION Observational and prospective study with no trial registration.
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Affiliation(s)
- Sílvia Martins
- grid.7427.60000 0001 2220 7094Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal ,grid.55834.3f0000 0001 2219 4158Ciências Biomédicas Laboratoriais, Instituto Politécnico de Castelo Branco, ESALD-Dr, Lopes Dias Health School, Castelo Branco, Portugal ,Department of Clinical Pathology, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal ,grid.8051.c0000 0000 9511 4342University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal
| | - Natália António
- grid.28911.330000000106861985Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Institute of Pharmacology and Experimental Therapeutics/iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Tiago Carvalheiro
- Centro do Sangue e da Transplantação de Coimbra, Instituto Português do Sangue e da Transplantação, Coimbra, Portugal
| | - Paula Laranjeira
- grid.8051.c0000 0000 9511 4342University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal ,grid.28911.330000000106861985Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal ,grid.88832.390000 0001 2289 6301Ciências Biomédicas Laboratoriais, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Coimbra, Portugal
| | - Ricardo Rodrigues
- Department of Clinical Pathology, Unidade Local de Saúde de Castelo Branco, 6000-085 Castelo Branco, Portugal
| | - Lino Gonçalves
- grid.28911.330000000106861985Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal ,grid.8051.c0000 0000 9511 4342Institute of Pharmacology and Experimental Therapeutics/iCBR, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Cândida Tomaz
- grid.7427.60000 0001 2220 7094Health Sciences Research Centre, University of Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal ,grid.7427.60000 0001 2220 7094Chemistry Department, University of Beira Interior, Covilhã, Portugal
| | - Artur Paiva
- University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, Coimbra, Portugal. .,Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. .,Ciências Biomédicas Laboratoriais, Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Coimbra, Portugal. .,Flow Cytometry Unit, Department of Clinical Pathology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, 3000-075, Coimbra, Portugal.
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3
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Radovanović NN, Pavlović SU, Milašinović G, Platiša MM. Effects of Cardiac Resynchronization Therapy on Cardio-Respiratory Coupling. ENTROPY 2021; 23:e23091126. [PMID: 34573751 PMCID: PMC8472383 DOI: 10.3390/e23091126] [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: 06/29/2021] [Revised: 08/06/2021] [Accepted: 08/08/2021] [Indexed: 11/25/2022]
Abstract
In this study, the effect of cardiac resynchronization therapy (CRT) on the relationship between the cardiovascular and respiratory systems in heart failure subjects was examined for the first time. We hypothesized that alterations in cardio-respiratory interactions, after CRT implantation, quantified by signal complexity, could be a marker of a favorable CRT response. Sample entropy and scaling exponents were calculated from synchronously recorded cardiac and respiratory signals 20 min in duration, collected in 47 heart failure patients at rest, before and 9 months after CRT implantation. Further, cross-sample entropy between these signals was calculated. After CRT, all patients had lower heart rate and CRT responders had reduced breathing frequency. Results revealed that higher cardiac rhythm complexity in CRT non-responders was associated with weak correlations of cardiac rhythm at baseline measurement over long scales and over short scales at follow-up recording. Unlike CRT responders, in non-responders, a significant difference in respiratory rhythm complexity between measurements could be consequence of divergent changes in correlation properties of the respiratory signal over short and long scales. Asynchrony between cardiac and respiratory rhythm increased significantly in CRT non-responders during follow-up. Quantification of complexity and synchrony between cardiac and respiratory signals shows significant associations between CRT success and stability of cardio-respiratory coupling.
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Affiliation(s)
- Nikola N. Radovanović
- Pacemaker Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.U.P.); (G.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +381-11-366-3690; Fax: +381-11-362-9095
| | - Siniša U. Pavlović
- Pacemaker Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.U.P.); (G.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Goran Milašinović
- Pacemaker Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.U.P.); (G.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Mirjana M. Platiša
- Institute of Biophysics, Faculty of Medicine, University of Belgrade, 11129 Belgrade, Serbia;
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Asgardoon MH, Vasheghani-Farahani A, Sherafati A. Usefulness of Biomarkers for Predicting Response to Cardiac Resynchronization Therapy. Curr Cardiol Rev 2019; 16:132-140. [PMID: 31822259 PMCID: PMC7460709 DOI: 10.2174/1573403x15666191206163846] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 09/08/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023] Open
Abstract
Cardiac Resynchronization Therapy (CRT) is an effective treatment strategy for heart failure. It significantly improves clinical symptoms and decreases mortality and long-term morbidity. However, some patients do not respond properly to this treatment. In this review, the role of different biomarkers in predicting response to CRT is discussed. Some biomarkers, including natriuretic peptides and inflammatory markers have promising results but further trials are needed for more evaluation.
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Affiliation(s)
- Mohammad H Asgardoon
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Iranian Student Society for Immunodeficiencies, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Vasheghani-Farahani
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiac Electrophysiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alborz Sherafati
- Cardiac Primary Prevention Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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Boutagy NE, Feher A, Alkhalil I, Umoh N, Sinusas AJ. Molecular Imaging of the Heart. Compr Physiol 2019; 9:477-533. [PMID: 30873600 DOI: 10.1002/cphy.c180007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Multimodality cardiovascular imaging is routinely used to assess cardiac function, structure, and physiological parameters to facilitate the diagnosis, characterization, and phenotyping of numerous cardiovascular diseases (CVD), as well as allows for risk stratification and guidance in medical therapy decision-making. Although useful, these imaging strategies are unable to assess the underlying cellular and molecular processes that modulate pathophysiological changes. Over the last decade, there have been great advancements in imaging instrumentation and technology that have been paralleled by breakthroughs in probe development and image analysis. These advancements have been merged with discoveries in cellular/molecular cardiovascular biology to burgeon the field of cardiovascular molecular imaging. Cardiovascular molecular imaging aims to noninvasively detect and characterize underlying disease processes to facilitate early diagnosis, improve prognostication, and guide targeted therapy across the continuum of CVD. The most-widely used approaches for preclinical and clinical molecular imaging include radiotracers that allow for high-sensitivity in vivo detection and quantification of molecular processes with single photon emission computed tomography and positron emission tomography. This review will describe multimodality molecular imaging instrumentation along with established and novel molecular imaging targets and probes. We will highlight how molecular imaging has provided valuable insights in determining the underlying fundamental biology of a wide variety of CVDs, including: myocardial infarction, cardiac arrhythmias, and nonischemic and ischemic heart failure with reduced and preserved ejection fraction. In addition, the potential of molecular imaging to assist in the characterization and risk stratification of systemic diseases, such as amyloidosis and sarcoidosis will be discussed. © 2019 American Physiological Society. Compr Physiol 9:477-533, 2019.
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Affiliation(s)
- Nabil E Boutagy
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Attila Feher
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Imran Alkhalil
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Nsini Umoh
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA
| | - Albert J Sinusas
- Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, Section of Cardiovascular Medicine, New Haven, Connecticut, USA.,Yale University School of Medicine, Department of Radiology and Biomedical Imaging, New Haven, Connecticut, USA
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6
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Enina TN, Kuznetsov VA, Soldatova AM, Petelina TI, Krinochkin DV, Rychkov AY, Nochrina OY. Gender in cardiac resynchronisation therapy. J Cardiovasc Thorac Res 2018; 10:197-202. [PMID: 30680077 PMCID: PMC6335983 DOI: 10.15171/jcvtr.2018.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/11/2018] [Indexed: 12/27/2022] Open
Abstract
Introduction:
Gender differences in cardiac resynchronisation therapy (CRT) response are
not clear enough. This study aimed to assess gender influence on systemic inflammation,
neurohormonal activation, fibrosis in patients with congestive heart failure (CHF) and CRT.
Methods: We compared group I (61 men) and group II (16 women) of patients undergoing
CRT. Plasma levels of Nt-proBNP, interleukin (IL)-1β, IL-6, IL-10, tumor necrosis factor alpha
(TNF-α), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors
of metalloproteinase 1 and 4 (TIMP-1, TIMP-4), ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were
measured. According to dynamics of left ventricular end-systolic volume patients were classified
into non-responders, responders, super-responders.
Results: Women more likely had left bundle branch block (81.3 vs 47.5%, P = 0.016), were more
super-responders (66.7 vs 30.5%). Both groups showed decrease of IL-6 (P < 0.05), TNF-α
(P < 0.001; P < 0.05), NT-proBNP (P = 0.001; P < 0.05), Gal-3 (P < 0.05). In women there was
decrease of IL-6 by 44.4 vs 23.5% in men (PP = 0.029), TNF-α by 41.4 vs 30.9%, NT-proBNP by 73.3
vs 46% (P = 0.002), Gal-3 by 82.3 vs 64.9% (P < 0.05). Group I also showed decrease of IL-10 by
34.2% (P < 0.05). Group dynamics of TIMP-1 was opposite: men showed tendency to reduction of
TIMP-1 (P = 0.054), women showed increase of TIMP-1 (P < 0.05). Besides, men showed decrease
of MMP-9 (P < 0.05) and ratio MMP-9/TIMP-4 (P < 0.05).
Conclusion: The best response to CRT is associated with female gender explained by greater
decrease of neurohormonal activation, systemic inflammation and fibrosis. The revealed opposite
dynamics of TIMP-1 in the groups can demonstrate the existence of gender features of matrix
metalloproteinase system activity and their tissue inhibitors.
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Affiliation(s)
- Tatiana N Enina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Vadim A Kuznetsov
- Director of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Anna M Soldatova
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Tatiana I Petelina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Dmitriy V Krinochkin
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Alexander Yu Rychkov
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
| | - Olga Yu Nochrina
- Scientific researcher in Instrumental Laboratory of Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk, Russia
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António N. Reduction of systemic inflammation after cardiac resynchronization therapy: A new form of response? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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8
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António N. Redução da inflamação sistémica após terapêutica de ressincronização cardíaca: uma nova forma de resposta? Rev Port Cardiol 2018. [DOI: 10.1016/j.repc.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Non-cardiac factors for prediction of response to cardiac resynchronization therapy: The value of baseline, and of serial changes, in red cell distribution width. Int J Cardiol 2017; 243:347-353. [DOI: 10.1016/j.ijcard.2017.05.123] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 12/31/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review was to summarize current advances in positron emission tomography (PET) cardiac autonomic nervous system (ANS) imaging, with a specific focus on clinical applications of novel and established tracers. RECENT FINDINGS [11C]-Meta-hydroxyephedrine (HED) has provided useful information in evaluation of normal and pathological cardiovascular function. Recently, [11C]-HED PET imaging was able to predict lethal arrhythmias, sudden cardiac death (SCD), and all-cause mortality in heart failure patients with reduced ejection fraction (HFrEF). In addition, initial [11C]-HED PET imaging studies have shown the potential of this agent in elucidating the relationship between impaired cardiac sympathetic nervous system (SNS) innervation and the severity of diastolic dysfunction in HF patients with preserved ejection fraction (HFpEF) and in predicting the response to cardiac resynchronization therapy (CRT) in HFrEF patients. Longer half-life 18F-labeled presynaptic SNS tracers (e.g., [18F]-LMI1195) have been developed to facilitate clinical imaging, although no PET radiotracers that target the ANS have gained wide clinical use in the cardiovascular system. Although the use of parasympathetic nervous system radiotracers in cardiac imaging is limited, the novel tracer, [11C]-donepezil, has shown potential utility in initial studies. Many ANS radioligands have been synthesized for PET cardiac imaging, but to date, the most clinically relevant PET tracer has been [11C]-HED. Recent studies have shown the utility of [11C]-HED in relevant clinical issues, such as in the elusive clinical syndrome of HFpEF. Conversely, tracers that target cardiac PNS innervation have been used less clinically, but novel tracers show potential utility for future work. The future application of [11C]-HED and newly designed 18F-labeled tracers for targeting the ANS hold promise for the evaluation and management of a wide range of cardiovascular diseases, including the prognostication of patients with HFpEF.
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Affiliation(s)
- Nabil E Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 375 Congress Avenue, New Haven, CT, 06519, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, 375 Congress Avenue, New Haven, CT, 06519, USA.
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, USA.
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Bell D, Gordon BJ, Lavery A, Megaw K, Kinney MO, Harbinson MT. Plasma levels of intermedin (adrenomedullin-2) in healthy human volunteers and patients with heart failure. Peptides 2016; 76:19-29. [PMID: 26767798 DOI: 10.1016/j.peptides.2015.12.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/23/2015] [Accepted: 12/15/2015] [Indexed: 01/17/2023]
Abstract
Intermedin/adrenomedullin-2 (IMD) is a member of the adrenomedullin/CGRP peptide family. Less is known about the distribution of IMD than for other family members within the mammalian cardiovascular system, particularly in humans. The aim was to evaluate plasma IMD levels in healthy subjects and patients with chronic heart failure. IMD and its precursor fragments, preproIMD(25-56) and preproIMD(57-92), were measured by radioimmunoassay in 75 healthy subjects and levels of IMD were also compared to those of adrenomedullin (AM) and mid-region proadrenomedullin(45-92) (MRproAM(45-92)) in 19 patients with systolic heart failure (LVEF<45%). In healthy subjects, plasma levels (mean+SE) of IMD (6.3+0.6 pg ml(-1)) were lower than, but correlated with those of AM (25.8+1.8 pg ml(-1); r=0.49, p<0.001). Plasma preproIMD(25-56) (39.6+3.1 pg ml(-1)), preproIMD(57-92) (25.9+3.8 pg ml(-1)) and MRproAM(45-92) (200.2+6.7 pg ml(-1)) were greater than their respective bioactive peptides. IMD levels correlated positively with BMI but not age, and were elevated in heart failure (9.8+1.3 pg ml(-1), p<0.05), similarly to MRproAM(45-92) (329.5+41.9 pg ml(-1), p<0.001) and AM (56.8+10.9 pg ml(-1), p<0.01). IMD levels were greater in heart failure patients with concomitant renal impairment (11.3+1.8 pg ml(-1)) than those without (6.5+1.0 pg ml(-1); p<0.05). IMD and AM were greater in patients receiving submaximal compared with maximal heart failure drug therapy and were decreased after 6 months of cardiac resynchronization therapy. In conclusion, IMD is present in the plasma of healthy subjects less abundantly than AM, but is similarly correlated weakly with BMI. IMD levels are elevated in heart failure, especially with concomitant renal impairment, and tend to be reduced by high intensity drug or pacing therapy.
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Affiliation(s)
- David Bell
- School of Medicine, Dentistry and Biomedical Sciences, The Queen's University of Belfast, Northern Ireland, UK.
| | | | - Anita Lavery
- Hillingdon Hospitals NHS Trust, London, England, UK
| | - Katie Megaw
- Southeastern Health and Social Care Trust, Northern Ireland, UK
| | - Michael O Kinney
- Belfast Health and Social Care Trust, Belfast City Hospital, Northern Ireland, UK
| | - Mark T Harbinson
- School of Medicine, Dentistry and Biomedical Sciences, The Queen's University of Belfast, Northern Ireland, UK; Belfast Health and Social Care Trust, Belfast City Hospital, Northern Ireland, UK
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12
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Martignani C, Diemberger I, Nanni C, Biffi M, Ziacchi M, Boschi S, Corzani A, Fanti S, Sambuceti G, Boriani G. Cardiac resynchronization therapy and cardiac sympathetic function. Eur J Clin Invest 2015; 45:792-9. [PMID: 26036750 DOI: 10.1111/eci.12471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/29/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is an established therapy for advanced congestive heart failure, improving both survival and hospitalization. The mechanism beneath these improvements still needs to be defined as about one-third of the patients do not benefit from resynchronization. Restoration of sympatho-vagal function can play a significant role in the process, but available data are limited. In this scenario, positron emission tomography scans with (11) C-hydroxyephedrine, a noradrenaline analogous, has the potential to characterize the modifications of the sympathetic nervous system induced by CRT in decompensated patients. MATERIALS AND METHODS Ten patients (six males, age 68 ± 10 years) with primary dilated cardiomyopathy were studied before and after resynchronization (acutely and after 3 months), from a clinical and echocardiographic point of view. Their cardiac sympathetic nerve activity was evaluated by (11) C-hydroxyephedrine positron emission tomography before resynchronization, at short and medium term after resynchronization. RESULTS Responders to CRT (patients showing ≥ 15% decrease in left ventricular end-systolic volume) showed a higher level of left ventricular radiotracer uptake both at baseline and after resynchronization with respect to nonresponders. This was coupled with a progressive improvement in homogeneity in left ventricular tracer uptake mainly in responders. CONCLUSIONS Cardiac resynchronization therapy improves cardiac sympathetic nerve activity in responders since its activation, while nonresponders do not show any significant change at any time of evaluation. CRT seems to be more effective in those patients with a still structurally preserved, yet functionally impaired, neuroautonomic system.
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Affiliation(s)
- Cristian Martignani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Igor Diemberger
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Cristina Nanni
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Mauro Biffi
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Stefano Boschi
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Alessandro Corzani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
| | - Gianmario Sambuceti
- Department of Health Science, Nuclear Medicine, IRCCS AOU San Martino - IST, University of Genoa, Genoa, Italy
| | - Giuseppe Boriani
- Institute of Cardiology, University Hospital S. Orsola-Malpighi Bologna, University of Bologna, Bologna, Italy
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13
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Lappegård KT, Bjørnstad H, Mollnes TE, Hovland A. Effect of Cardiac Resynchronization Therapy on Inflammation in Congestive Heart Failure: A Review. Scand J Immunol 2015; 82:191-8. [PMID: 26099323 DOI: 10.1111/sji.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process.
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Affiliation(s)
- K T Lappegård
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - H Bjørnstad
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - T E Mollnes
- Research Laboratory, Nordland Hospital, Bodø and K.G. Jebsen TREC, University of Tromsø, Tromsø, Norway.,Department of Immunology, Oslo University Hospital and K.G. Jebsen IRC, University of Oslo, Oslo, Norway.,Centre of Molecular Inflammation Research, Norwegian University of Science and Technology, Trondheim, Norway
| | - A Hovland
- Cardiac Care Unit, Division of Internal Medicine, Nordland Hospital, Bodø, Norway.,Institute of Clinical Medicine, University of Tromsø, Tromsø, Norway
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14
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Grosman-Rimon L, Jacobs I, Tumiati LC, McDonald MA, Bar-Ziv SP, Fuks A, Kawajiri H, Lazarte J, Ghashghai A, Shogilev DJ, Cherney DZ, Rao V. Longitudinal assessment of inflammation in recipients of continuous-flow left ventricular assist devices. Can J Cardiol 2014; 31:348-56. [PMID: 25746024 DOI: 10.1016/j.cjca.2014.12.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The long-term effects of continuous-flow left ventricular assist device (CF-LVAD) support on trends of inflammatory markers over time are unknown. We examined the hypothesis that the levels of inflammatory markers in CF-LVAD recipients are higher than in healthy controls and that these levels increase over time with long-term CF-LVAD support. METHODS We examined the levels of inflammatory markers longitudinally at baseline before CF-LVAD implantation and at 3, 6, and 9 months after implantation. We then compared the levels of inflammatory markers to those in a healthy control group. RESULTS Compared with baseline values before CF-LVAD implantation, left ventricular end-diastolic diameter (LVEDd) and left ventricular end-systolic diameter (LVESd) decreased significantly at 3, 6, and 9 months after CF-LVAD implantation. Brain natriuretic peptide (BNP) levels dropped significantly after CF-LVAD implantation but did not normalize. Improvements in ejection fraction at 3, 6, and 9 months after CF-LVAD implantation did not reach significance. Monocyte chemoattractant protein-1, interferon γ-induced protein, and C-reactive protein levels were higher in the CF-LVAD recipients at each of the time points (baseline before CF-LVAD implantation and 3, 6, and 9 months after implantation) compared with levels in healthy controls. In CF-LVAD recipients, serum interleukin-8, tumour necrosis factor-α, and macrophage inflammatory protein-β increased significantly at 9 months, and macrophage-derived chemokine increased at 6 months after CF-LVAD implantation compared with baseline. CONCLUSIONS Despite improvements in LV dimensions and BNP levels, markers of inflammation remained higher in CF-LVAD recipients. High levels of inflammation in CF-LVAD recipients may result from heart failure preconditioning or the long-term device support, or both. Because inflammation may be detrimental to CF-LVAD recipients, future studies should determine whether inflammatory pathways are reversible.
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Affiliation(s)
- Liza Grosman-Rimon
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Ira Jacobs
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Laura C Tumiati
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Michael A McDonald
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Stacey Pollock Bar-Ziv
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada
| | - Avi Fuks
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Hiroyuki Kawajiri
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Julieta Lazarte
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Arash Ghashghai
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Daniel J Shogilev
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Z Cherney
- Division of Nephrology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Vivek Rao
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
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Brouwers C, Versteeg H, Meine M, Heijnen CJ, Kavelaars AM, Pedersen SS, Mommersteeg PMC. Association between brain natriuretic peptide, markers of inflammation and the objective and subjective response to cardiac resynchronization therapy. Brain Behav Immun 2014; 40:211-8. [PMID: 24704567 DOI: 10.1016/j.bbi.2014.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 03/10/2014] [Accepted: 03/23/2014] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Studies suggest that cardiac resynchronization therapy (CRT) can induce a decrease in brain natriuretic peptide (BNP) and systemic inflammation, which may be associated with CRT-response. However, the evidence is inconclusive. We examined levels of BNP and inflammatory markers from pre-CRT implantation to 14months follow-up in CRT-responders and nonresponders, defined by two response criteria. METHODS We studied 105 heart failure patients implanted with a CRT-defibrillator (68% men; age=65.4±10.1years). The objective CRT-response was defined as a reduction of ⩾15% in left ventricular end systolic volume; subjective CRT-response was defined as an improvement of ⩾10 points in patient-reported health status assessed with the Kansas City Cardiomyopathy Questionnaire. Plasma BNP and markers of inflammation (CRP, IL-6, TNFα, sTNFr1 and sTNFr2) were measured at three time points. RESULTS Pre-implantation concentrations of TNFα were significantly lower for subjective responders compared to nonresponders (p=.05), but there was no difference in BNP and the other inflammatory markers at baseline. Objective CRT-response was significantly associated with lower BNP levels over time (F=27.31, p<.001), and subjective CRT-response with lower TNFα levels (F=5.67, p=.019). CONCLUSION Objective and subjective response to CRT was associated with lower levels of BNP and TNFα, respectively, but not with other markers of inflammation. This indicates that response to CRT is not automatically related to a stronger overall decrease in inflammation. Large-scale studies are warranted that further examine the relation between the clinical effects of CRT on inflammatory markers, as the latter have been associated with poor prognosis in heart failure.
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Affiliation(s)
- Corline Brouwers
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Henneke Versteeg
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mathias Meine
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cobi J Heijnen
- Laboratory Neurodevelopmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands; Neuroimmunology of Cancer-Related Symptoms (NICRS) Laboratory, Department of Symptom Research, University of Teas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Annemieke M Kavelaars
- Laboratory Neurodevelopmental Origins of Disease, University Medical Center Utrecht, Utrecht, The Netherlands; Neuroimmunology of Cancer-Related Symptoms (NICRS) Laboratory, Department of Symptom Research, University of Teas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Susanne S Pedersen
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Cardiology, Odense University Hospital, Odense, Denmark; Institute of Psychology, University of Southern Denmark, Odense, Denmark.
| | - Paula M C Mommersteeg
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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O'Meara E, Rouleau JL, White M, Roy K, Blondeau L, Ducharme A, Neagoe PE, Sirois MG, Lavoie J, Racine N, Liszkowski M, Madore F, Tardif JC, de Denus S. Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circ Heart Fail 2014; 7:773-81. [PMID: 25027873 DOI: 10.1161/circheartfailure.114.001100] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anemia is a highly prevalent and strong independent prognostic marker in heart failure (HF), yet this association is not completely understood. Whether anemia is simply a marker of disease severity and concomitant chronic kidney disease or represents the activation of other detrimental pathways remains uncertain. We sought to determine which pathophysiological pathways are exacerbated in patients with HF, reduced ejection fraction (HFrEF) and anemia in comparison with those without anemia. METHODS AND RESULTS In a prospective study involving 151 patients, selected biomarkers were analyzed, each representing proposed contributive mechanisms in the pathophysiology of anemia in HF. We compared clinical, echocardiographic, and circulating biomarkers profiles among patients with HFrEF and anemia (group 1), HFrEF without anemia (group 2), and chronic kidney disease with preserved EF, without established HF (chronic kidney disease control group 3). We demonstrate here that many processes other than those related to chronic kidney disease are involved in the anemia-HF relationship. These are linked to the pathophysiological mechanisms pertaining to left ventricular systolic dysfunction and remodeling, systemic inflammation and volume overload. We found that levels of interleukin-6 and interleukin-10, specific markers of cardiac remodeling (procollagen type III N-terminal peptide, matrix metalloproteinase-2, tissue inhibitor of matrix metalloproteinase 1, left atrial volume), myocardial stretch (NT-proBNP [N-terminal probrain natriuretic peptide]), and myocyte death (troponin T) are related to anemia in HFrEF. CONCLUSIONS Anemia is strongly associated not only with markers of more advanced and active heart disease but also with the level of renal dysfunction in HFrEF. Increased myocardial remodeling, inflammation, and volume overload are the hallmarks of patients with anemia and HF. CLINICAL TRIAL REGISTRATION URL http://www.clinicaltrials.gov. Unique identifier: NCT00834691.
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Affiliation(s)
- Eileen O'Meara
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada.
| | - Jean L Rouleau
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Michel White
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Karine Roy
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Lucie Blondeau
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Anique Ducharme
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Paul-Eduard Neagoe
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Martin G Sirois
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Joël Lavoie
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Normand Racine
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Mark Liszkowski
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - François Madore
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Claude Tardif
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
| | - Simon de Denus
- From the Montreal Heart Institute, Department of Medicine (E.O'M., J.L.R., M.W., K.R., A.D., J.L., N.R., M.L., J.-C.T., S.d.D.), Department of Pharmacology (P.-E.N., M.G.S.), Department of Biostatistics Montreal Heart Innovations Coordinating Center (MHICC) (L.B.), and Department of Nephrology, Hôpital du Sacré-Cœur de Montréal (F.M.), Université de Montréal, Montreal, Quebec, Canada
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Boriani G, Ziacchi M, Diemberger I, Valzania C, Biffi M, Martignani C. Cardiac resynchronization therapy. J Cardiovasc Med (Hagerstown) 2014; 15:269-72. [DOI: 10.2459/jcm.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Smit MD, Maass AH, Hillege HL, Wiesfeld AC, Van Veldhuisen DJ, Van Gelder IC. Prognostic importance of natriuretic peptides and atrial fibrillation in patients receiving cardiac resynchronization therapy. Eur J Heart Fail 2014; 13:543-50. [PMID: 21330294 DOI: 10.1093/eurjhf/hfr006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Marcelle D. Smit
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
| | - Alexander H. Maass
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
| | - Hans L. Hillege
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
| | - Ans C.P. Wiesfeld
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
| | - Dirk J. Van Veldhuisen
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
| | - Isabelle C. Van Gelder
- Department of Cardiology, Thoraxcenter; University Medical Center Groningen, University of Groningen; PO Box 30,001 9700 RB Groningen The Netherlands
- Interuniversity Cardiology Institute of The Netherlands; Utrecht The Netherlands
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Goetze JP, Alehagen U, Flyvbjerg A, Rehfeld JF. Chromogranin A as a biomarker in cardiovascular disease. Biomark Med 2014; 8:133-40. [DOI: 10.2217/bmm.13.102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Rordorf R, Savastano S, Sanzo A, Spazzolini C, De Amici M, Camporotondo R, Ghio S, Vicentini A, Petracci B, De Regibus V, Taravelli E, Landolina M, Schwartz PJ. Tumor Necrosis Factor-α Predicts Response to Cardiac Resynchronization Therapy in Patients With Chronic Heart Failure. Circ J 2014; 78:2232-9. [DOI: 10.1253/circj.cj-14-0023] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Roberto Rordorf
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | - Simone Savastano
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | - Antonio Sanzo
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | - Carla Spazzolini
- Department of Molecular Medicine, Cardiology Section, University of Pavia
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin
| | - Mara De Amici
- Department of Pediatrics, IRCCS Fondazione Policlinico S. Matteo
| | | | - Stefano Ghio
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | | | - Barbara Petracci
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | | | - Erika Taravelli
- Department of Cardiology, IRCCS Fondazione Policlinico S. Matteo
| | | | - Peter J. Schwartz
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin
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Regoli F, Regoli D, Moccetti T. Biological Markers to Predict Cardiac Resynchronization Therapy Effect. Circ J 2014; 78:2154-6. [DOI: 10.1253/circj.cj-14-0771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Domenico Regoli
- Department of Experimental and Clinical Medicine, University of Ferrara
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Osmancik P, Herman D, Stros P, Linkova H, Vondrak K, Paskova E. Changes and Prognostic Impact of Apoptotic and Inflammatory Cytokines in Patients Treated with Cardiac Resynchronization Therapy. Cardiology 2013; 124:190-8. [DOI: 10.1159/000346621] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 12/17/2012] [Indexed: 11/19/2022]
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Khanbabaie R, Jahanshahi M. Revolutionary impact of nanodrug delivery on neuroscience. Curr Neuropharmacol 2012; 10:370-92. [PMID: 23730260 PMCID: PMC3520046 DOI: 10.2174/157015912804143513] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/09/2012] [Accepted: 08/28/2012] [Indexed: 12/23/2022] Open
Abstract
Brain research is the most expanding interdisciplinary research that is using the state of the art techniques to overcome limitations in order to conduct more accurate and effective experiments. Drug delivery to the target site in the central nervous system (CNS) is one of the most difficult steps in neuroscience researches and therapies. Taking advantage of the nanoscale structure of neural cells (both neurons and glia); nanodrug delivery (second generation of biotechnological products) has a potential revolutionary impact into the basic understanding, visualization and therapeutic applications of neuroscience. Current review article firstly provides an overview of preparation and characterization, purification and separation, loading and delivering of nanodrugs. Different types of nanoparticle bioproducts and a number of methods for their fabrication and delivery systems including (carbon) nanotubes are explained. In the second part, neuroscience and nervous system drugs are deeply investigated. Different mechanisms in which nanoparticles enhance the uptake and clearance of molecules form cerebrospinal fluid (CSF) are discussed. The focus is on nanodrugs that are being used or have potential to improve neural researches, diagnosis and therapy of neurodegenerative disorders.
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Affiliation(s)
- Reza Khanbabaie
- Nanotechnology Research Institute, Babol University of Technology, Babol, Iran
- Faculty of Basic Science, Department of Physics, Babol University of Technology, Babol, Iran
- Department of Physics, University of Ottawa, Ottawa, Canada
| | - Mohsen Jahanshahi
- Nanotechnology Research Institute, Babol University of Technology, Babol, Iran
- Faculty of Chemical Engineering, Babol University of Technology, Babol, Iran
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Influence of cardiac resynchronization therapy on indices of inflammation, the prothrombotic state and tissue remodeling in systolic heart failure: A pilot study. Thromb Res 2011; 128:391-4. [DOI: 10.1016/j.thromres.2011.05.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Revised: 05/27/2011] [Accepted: 05/30/2011] [Indexed: 11/23/2022]
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Effect of cardiac resynchronization therapy on broad neurohormone biomarkers in heart failure. J Interv Card Electrophysiol 2011; 30:241-9. [DOI: 10.1007/s10840-011-9551-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 01/26/2011] [Indexed: 10/18/2022]
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Bhattacharya S, Abebe K, Simon M, Saba S, Adelstein E. Role of cardiac resynchronization in end-stage heart failure patients requiring inotrope therapy. J Card Fail 2010; 16:931-7. [PMID: 21111981 PMCID: PMC3072753 DOI: 10.1016/j.cardfail.2010.07.253] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 06/04/2010] [Accepted: 07/26/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Outcomes among inotrope-treated heart failure (HF) patients receiving cardiac resynchronization therapy (CRT) have not been well characterized, particularly in those requiring intravenous inotropes at the time of implant. METHODS We analyzed 759 consecutive CRT-defibrillator recipients who were categorized as never on inotropes (NI; n = 585), weaned from inotropes before implant (PI; n = 124), or on inotropes at implant (II; n = 50). Survival free from heart transplant or ventricular assist device and overall survival were compared using the Social Security Death Index. A patient cohort who underwent unsuccessful CRT implantation and received a standard defibrillator (SD; n = 94) comprised a comparison group. Propensity score analysis was used to control for intergroup baseline differences. RESULTS Compared with the other cohorts, II patients had more comorbidities. Both survival endpoints differed significantly (P < .001) among the 4 cohorts; II patients demonstrated shorter survival than NI patients, with the PI and SD groups having intermediate survival. After adjusting for propensity scores, overall differences and patterns in survival endpoints persisted (P < .01), but the only statistically significant pairwise difference was overall survival between the NI and II groups at 12 months (hazard ratio 2.95, 95% confidence interval 1.05-8.35). CRT recipients ever on inotropes (PI and II) and SD patients ever requiring inotropes (n = 17) experienced similar survival endpoints. Among II patients, predictors of hospital discharge free from inotropes after CRT included male gender, older age, and ability to tolerate β-blockade. CONCLUSIONS Inotrope-dependent HF patients show significantly worse survival despite CRT than inotrope-naïve patients, in part because of more comorbid conditions at baseline. CRT may not provide a survival advantage over a standard defibrillator among patients who have received inotropes before CRT. Weaning from inotropes and initiating neurohormonal antagonists before CRT should be an important goal among inotrope-dependent HF patients.
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Affiliation(s)
| | - Kaleab Abebe
- Center for Research on Health Care Data Center, University of Pittsburgh
| | - Marc Simon
- University of Pittsburgh Cardiovascular Institute
| | - Samir Saba
- University of Pittsburgh Cardiovascular Institute
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Aarønæs M, Aakhus S, Aass H, Moum T, Wergeland R, Gullestad L, Kongsgård E. Assessment of response criteria to cardiac resynchronization therapy (CRT) and prediction of response. SCAND CARDIOVASC J 2010; 44:337-45. [DOI: 10.3109/14017431.2010.508537] [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] [Indexed: 12/31/2022]
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Francia P, Balla C, Ricotta A, Uccellini A, Frattari A, Modestino A, Borro M, Simmaco M, Salvati A, De Biase L, Volpe M. Plasma osteopontin reveals left ventricular reverse remodelling following cardiac resynchronization therapy in heart failure. Int J Cardiol 2010; 153:306-10. [PMID: 20863582 DOI: 10.1016/j.ijcard.2010.08.048] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 06/18/2010] [Accepted: 08/17/2010] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) promotes left ventricular (LV) reverse remodelling and affects myocardial collagen turnover in heart failure (HF) patients. Osteopontin (OPN) is a matrix glycoprotein required for the activation of fibroblasts upon TGF-β1 stimulation. In humans, plasma OPN and OPN-expressing lymphocytes correlate with the severity of HF. We sought to evaluate whether plasma OPN and TGF-β1 reflect LV reverse remodelling following CRT. METHODS Eighteen patients (12 men, mean age 65 ± 11 years) undergoing CRT were studied. Patients underwent baseline clinical and echocardiographic evaluation, and assessment of plasma OPN and TGF-β1. The evaluation was repeated 8.5 ± 4 months after device implantation. Eight healthy age- and sex-matched subjects served as controls. RESULTS In HF patients, baseline plasma OPN and TGF-β1 were higher as compared to control subjects (OPN: 99 ± 48 vs 59 ± 22 ng/ml; p<0.05; TGF-β1: 15.9 ± 8.0 vs 9.3 ± 5.6 ng/ml; p<0.05). At follow-up, 12 patients responded to CRT and showed LV reverse remodelling, whereas 6 did not. Plasma OPN decreased in CRT responders (108 ± 47 vs 84 ± 37 ng/ml; p=0.03) and increased in non-responders (79 ± 58 vs 115 ± 63 ng/ml; p<0.01). TGF-β1 showed a trend towards reduction in responders (17.5 ± 8.7 vs 10.2 ± 8.9 ng/ml; p=0.08) and was unchanged in non-responders. A significant correlation (r=-0.56; p=0.01) was found between relative changes of LVESV and plasma OPN. CONCLUSIONS CRT-induced LV reverse remodelling is reflected by changes in plasma OPN. Circulating OPN may represent a marker of LV dilation/impairment and an indicator of the response to HF therapies promoting LV reverse remodelling.
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Affiliation(s)
- Pietro Francia
- Cardiology, 2nd Faculty of Medicine, Sapienza University, Sant'Andrea Hospital, Rome, Italy
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Dalzell JR, Jackson CE, McDonagh TA, Gardner RS. Novel biomarkers in heart failure: an overview. Biomark Med 2010; 3:453-63. [PMID: 20477516 DOI: 10.2217/bmm.09.42] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Heart failure is a complex systemic syndrome resulting from significant impairment of cardiac function. A vast array of biological pathways is now known to be involved in heart failure, including deleterious pathways promoting its development and progression, as well as compensatory cardioprotective pathways. Some of the components of these pathways are now recognized as biomarkers of this condition, and can aid diagnosis, prognostication and guide management. As the understanding of the pathophysiology of heart failure progresses, further candidate biomarkers are being identified. This article reviews the literature regarding the more recently identified biomarkers and outlines areas requiring further study.
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Affiliation(s)
- Jonathan R Dalzell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK.
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El‐Saed A, Voigt A, Shalaby A. Usefulness of brain natriuretic peptide level at implant in predicting mortality in patients with advanced but stable heart failure receiving cardiac resynchronization therapy. Clin Cardiol 2009; 32:E33-8. [PMID: 19816874 PMCID: PMC6653145 DOI: 10.1002/clc.20490] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 04/24/2008] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Brain natriuretic peptide (BNP) level has emerged as a predictor of death and hospital readmission in patients with heart failure (HF). The value of baseline BNP assessment in advanced HF patients receiving cardiac resynchronization defibrillator therapy (CRT-D) has not been firmly established. HYPOTHESIS We hypothesized that a baseline BNP level would predict all cause mortality and HF hospitalization in HF patients receiving cardiac resynchronization therapy. METHODS A retrospective chart review of all patients having BNP assessment prior to implantation of a CRT-D for standard indications during 2004 and 2005 was conducted at the Veterans Affairs Pittsburgh Healthcare System. The primary endpoint was all-cause mortality and the secondary endpoint was HF-related hospitalization. We used findings from the receiver operating characteristic (ROC) curve to define low (<492 pg/mL) and high (> or =492 pg/mL) BNP groups. RESULTS Out of 173 CRT-D recipients, 115 patients (mean age 67.0 +/- 10.7 years, New York Heart Association [NYHA] class 2.9 +/- 0.3, left ventricular ejection fraction [LVEF] 22.5% +/- 9.6%, QRS 148.3 +/- 30.4 ms) had preimplantation BNP measured (mean 559 +/- 761 pg/mL and median 315 pg/mL). During a mean follow-up time of 17.5 +/- 6.5 mo, 27 deaths (23.5%) and 31 HF hospitalizations (27.0%) were recorded. Compared to those with low BNP (n = 74), those of high BNP (n = 41) were older, had lower LVEF, higher creatinine levels, suffered more deaths, and HF hospitalizations. In multivariate regression models, higher BNP remained a significant predictor of both the primary endpoint (hazard ratio [HR]: 2.89, 95% confidence interval [CI] 1.06-7.88, p = 0.038) and secondary endpoint (HR: 4.23, 95% CI: 1.68-10.60, p = 0.002). CONCLUSIONS Baseline BNP independently predicted mortality and HF hospitalization in a predominantly older white male population of advanced HF patients receiving CRT-D. Elevated BNP levels may identify a vulnerable HF population with a particularly poor prognosis despite CRT-D.
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Affiliation(s)
- Aiman El‐Saed
- Graduate School of Public Health, University of Pittsburgh
| | - Andrew Voigt
- Cardiovascular Institute, University of Pittsburgh Medical Center
| | - Alaa Shalaby
- Cardiovascular Institute, University of Pittsburgh Medical Center
- Division of Cardiology, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Gademan MGJ, van Bommel RJ, Borleffs CJW, Man S, Haest JCW, Schalij MJ, van der Wall EE, Bax JJ, Swenne CA. Biventricular pacing-induced acute response in baroreflex sensitivity has predictive value for midterm response to cardiac resynchronization therapy. Am J Physiol Heart Circ Physiol 2009; 297:H233-7. [DOI: 10.1152/ajpheart.00113.2009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a previous study we demonstrated that the institution of biventricular pacing in chronic heart failure (CHF) acutely facilitates the arterial baroreflex. The arterial baroreflex has important prognostic value in CHF. We hypothesized that the acute response in baroreflex sensitivity (BRS) after the institution of cardiac resynchronization therapy (CRT) has predictive value for midterm response. One day after implantation of a CRT device in 33 CHF patients (27 male/6 female; age, 66.5 ± 9.5 yr; left ventricular ejection fraction, 28 ± 7%) we measured noninvasive BRS and heart rate variability (HRV) in two conditions: CRT device switched on and switched off (on/off order randomized). Echocardiography was performed before implantation (baseline) and 6 mo after implantation (follow-up). CRT responders were defined as patients in whom left ventricular end-systolic volume at follow-up had decreased by ≥15%. Responders (69.7%) and nonresponders (30.3%) had similar baseline characteristics. In responders, CRT increased BRS by 30% ( P = 0.03); this differed significantly ( P = 0.02) from the average BRS change (−2%) in the nonresponders. CRT also increased HRV by 30% in responders ( P = 0.02), but there was no significant difference found compared with the increase in HRV (8%) in the nonresponders. Receiver-operating characteristic curve analysis revealed that the percent BRS increase had predictive value for the discrimination of responders and nonresponders (area under the curve, 0.69; 95% confidence interval, 0.51–0.87; maximal accuracy, 0.70). Our study demonstrates that a CRT-induced acute BRS increase has predictive value for the echocardiographic response to CRT. This finding suggests that the autonomic nervous system is actively involved in CRT-related reverse remodeling.
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Frankenstein L, Zugck C, Schellberg D, Nelles M, Froehlich H, Katus H, Remppis A. Prevalence and prognostic significance of adrenergic escape during chronic beta-blocker therapy in chronic heart failure. Eur J Heart Fail 2009; 11:178-84. [PMID: 19168516 DOI: 10.1093/eurjhf/hfn028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Like aldosterone escape to ACE-inhibitors, adrenergic escape (AE) to beta-blockers appears conceivable in chronic heart failure (CHF), as generalized systemic neurohumoral activation has been described as the pathophysiological basis of this syndrome. The aim of this study was to examine the prevalence and prognostic value of AE with respect to different beta-blocker agents and doses. METHODS AND RESULTS This was a prospective, observational study of 415 patients with systolic CHF receiving chronic stable beta-blocker therapy. AE was defined by norepinephrine levels above the upper limit of normal. Irrespective of the individual beta-blocker agents used and the dose equivalent taken, the prevalence of AE was 31-39%. Norepinephrine levels neither correlated with heart rate (r=0.02; 95% CI: -0.08-0.11; P=0.74) nor were they related to underlying rhythm (P=0.09) or the individual beta-blocker agent used (P=0.87). The presence of AE was a strong and independent indicator of mortality (adjusted HR: 1.915; 95% CI: 1.387-2.645; chi2: 15.60). CONCLUSION We verified the presence of AE in CHF patients on chronic stable beta-blocker therapy, irrespective of the individual beta-blocker agent and the dose equivalent. As AE might indicate therapeutic failure, the determination of AE could help to identify those patients with CHF that might benefit from more aggressive treatment modalities. Heart rate, however, is not a surrogate for adrenergic escape.
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Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmology, University of Heidelberg, 69120 Heidelberg, Germany.
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Cha YM, Oh J, Miyazaki C, Hayes DL, Rea RF, Shen WK, Asirvatham SJ, Kemp BJ, Hodge DO, Chen PS, Chareonthaitawee P. Cardiac resynchronization therapy upregulates cardiac autonomic control. J Cardiovasc Electrophysiol 2008; 19:1045-52. [PMID: 18479331 DOI: 10.1111/j.1540-8167.2008.01190.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To determine the effect of cardiac resynchronization therapy (CRT) on sympathetic nervous function in heart failure (HF). BACKGROUND Neurohormonal dysregulation and cardiac autonomic dysfunction are associated with HF and contribute to HF progression and its poor prognosis. We hypothesized that mechanical resynchronization improves cardiac sympathetic function in HF. METHODS Sixteen consecutive patients receiving CRT for advanced cardiomyopathy and 10 controls were included in this prospective study. NYHA class, 6-minute walk distance, echocardiographic parameters, plasma norepinephrine (NE) were assessed at baseline, 3-month and 6-month follow-up. Cardiac sympathetic function was determined by (123)iodine metaiodobenzylguanidine ((123)I-MIBG) scintigraphy and 24-hour ambulatory electrocardiography. RESULTS Along with improvement in NYHA class (3.1 +/- 0.3 to 2.1 +/- 0.4, P < 0.001) and LVEF (23 +/- 6% to 33 +/- 12%, P < 0.001), delayed heart/mediastinum (H/M) (123)I-MIBG ratio increased significantly (1.8 +/- 0.7 to 2.1 +/- 0.6, P = 0.04) while the H/M (123)I-MIBG washout rate decreased significantly (54 +/- 25% to 34 +/- 24%, P = 0.01) from baseline to 6-month follow-up. The heart rate variability (HRV) measured in SD of normal-to-normal intervals also increased significantly from baseline (82 +/- 30 ms) to follow-up (111 +/- 32 ms, P = 0.04). The improvement in NYHA after CRT was significantly associated with baseline (123)I-MIBG H/M washout rate (r = 0.65, P = 0.03). The improvement in LVESV index was associated with baseline (123)I-MIBG delayed H/M ratio (r =-0.67, P = 0.02) and H/M washout rate (r = 0.65, P = 0.03). CONCLUSION After CRT, improvements in cardiac symptoms and LV function were accompanied by rebalanced cardiac autonomic control as measured by (123)I-MIBG and HRV.
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Affiliation(s)
- Yong-Mei Cha
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Molon G, Adamo E, De Ferrari GM, Accardi F, Dalla Vecchia E, Sallusti L, Ciaffoni S, Barbieri E. Effects of cardiac resynchronization therapy on insulin-like growth factor-1 in patients with advanced heart failure. J Cardiovasc Med (Hagerstown) 2007; 8:917-22. [PMID: 17906477 DOI: 10.2459/jcm.0b013e328014a883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Although a more favorable neurohormonal balance may contribute to improving symptoms following cardiac resynchronization therapy (CRT), no information is available regarding the effects of CRT on insulin-like growth factor-1 (IGF-1). This study assessed the effects of CRT on IGF-1 levels and their correlation with changes in quality of life and left ventricular (LV) function. METHODS AND RESULTS Patients with cardiomyopathy in New York Heart Association class III or IV (n = 18; age 71 +/- 10 years), left ventricular ejection fraction (LVEF) < or = 40% and QRS > or = 130 ms or ventricular dyssynchrony were enrolled in the study and followed up for 6 months. After 3 months, there was an improvement in LVEF (from 29 +/- 7 to 33 +/- 10%, P = 0.0136) and quality of life (from 33 +/- 14 to 13 +/- 12, P = 0.0000) and an increase in IGF-1 levels (from 137 +/- 79 to 175 +/- 111 ng/ml, P = 0.01353). The change in quality of life correlated with changes in IGF-1 levels (P = 0.02) but not with LVEF changes. CONCLUSIONS In patients with advanced heart failure, CRT leads to a significant increase in plasma IGF-1 levels within 3 months. This increase is correlated with the improvement in quality of life, whereas the increase in LVEF is not. This finding suggests that IGF-1 may play a role as a mediator in the early phase of symptomatic improvement after CRT.
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Affiliation(s)
- Giulio Molon
- Department of Cardiology, Sacro Cuore Hospital, don Calabria, Via don A. Sempreboni, Negrar, Verona, Italy.
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Frankenstein L, Nelles M, Slavutsky M, Schellberg D, Doesch A, Katus H, Remppis A, Zugck C. Beta-Blockers Influence the Short-term and Long-term Prognostic Information of Natriuretic Peptides and Catecholamines in Chronic Heart Failure Independent From Specific Agents. J Heart Lung Transplant 2007; 26:1033-9. [DOI: 10.1016/j.healun.2007.07.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Revised: 07/16/2007] [Accepted: 07/18/2007] [Indexed: 01/24/2023] Open
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Michelucci A, Ricciardi G, Sofi F, Gori AM, Pirolo F, Pieragnoli P, Giaccardi M, Colella A, Porciani MC, Di Biase L, Padeletti L, Abbate R, Gensini GF. Relation of inflammatory status to major adverse cardiac events and reverse remodeling in patients undergoing cardiac resynchronization therapy. J Card Fail 2007; 13:207-10. [PMID: 17448418 DOI: 10.1016/j.cardfail.2006.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2006] [Revised: 11/16/2006] [Accepted: 11/21/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND Inflammatory markers are involved in heart failure (HF) pathophysiology. However, the link between these markers and reverse remodeling as well as major adverse cardiac events (HF death, sudden death, and unplanned cardiac rehospitalizations) in patients who undergo cardiac resynchronization therapy (CRT) has not been evaluated. METHODS AND RESULTS We recorded major adverse cardiac events of 140 patients (on optimized medical therapy, left ventricular ejection fraction 29.9 +/- 9.6%, New York Heart Association Class III-IV, with intraventricular dyssynchrony) who underwent CRT (enrolled since April 2004). Moreover, we evaluated before and after 6 months of CRT: interleukin-6, high-sensitivity C-reactive protein, New York Heart Association class, quality of life (score on Minnesota Living with Heart Failure questionnaire), 6-minute walking test, left ventricular end-diastolic and end-systolic volumes (nonindexed and indexed by body surface area), and left ventricular ejection fraction. Adverse cardiac events were observed in 40 patients (28.6%): 22 deaths and 18 cardiac unplanned rehospitalizations. Only patients without adverse events during follow-up showed a significant reduction of inflammatory markers and left ventricular volumes (reverse remodeling), despite a significant improvement of clinical status observed in both groups of patients. CONCLUSIONS The reduction of inflammatory status seems to be linked to reverse remodeling as well as to a better clinical prognosis in patients with HF who underwent CRT.
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Affiliation(s)
- Antonio Michelucci
- Department of Medical and Surgical Critical Care, University of Florence, Florence, Italy
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Boriani G, Diemberger I, Biffi M, Martignani C, Ziacchi M, Bertini M, Valzania C, Bronzetti G, Rapezzi C, Branzi A. How, why, and when may atrial defibrillation find a specific role in implantable devices? A clinical viewpoint. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:422-33. [PMID: 17367364 DOI: 10.1111/j.1540-8159.2007.00685.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This viewpoint article discusses the potential for incorporation of atrial defibrillation capabilities in modern multi-chamber devices. In the late 1990s, the possibility of using shock-only therapy to treat selected patients with recurrent atrial fibrillation (AF) was explored in the context of the stand-alone atrial defibrillator. The failure of this strategy can be attributed to the technical limitations of the stand-alone device, low tolerance of atrial shocks, difficulties in patient selection, a lack of predictive knowledge about the evolution of AF, and, last but not least, commercial considerations. An open question is how atrial defibrillation capability may now assume a specific new role in devices implanted for sudden death prevention or cardiac resynchronization. For patients who already have indications for implantable devices, device-based atrial defibrillation appears attractive as a "backup" option for managing AF when preventive pharmacological/electrical measures fail. This and several other personalized hybrid therapeutic approaches await exploration, though assessment of their efficacy is methodologically challenging. Achievement of acceptance by patients is an essential premise for any updated atrial defibrillation strategy. Strategies that are being investigated to improve patient tolerance include waveform shaping, pharmacologic modulation of pain, and patient-activated defibrillation (patients might also perceive the problem of discomfort somewhat differently in the context of a backup therapy). The economic impact of implementing atrial defibrillation features in available devices is progressively decreasing, and financial feasibility need not be a major issue. Future studies should examine clinically relevant outcomes and not be limited (as occurred with stand-alone defibrillators) to technical or other soft endpoints.
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Affiliation(s)
- Giuseppe Boriani
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S. Orsola-Malpighi, Bologna, Italy.
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