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Colombo PC, Castagna F, Onat D, Wong KY, Harxhi A, Hayashi Y, Friedman RA, Pinsino A, Ladanyi A, Mebazaa A, Jelic S, Arrigo M, Lejemtel TH, Papapanou P, Sabbah HN, Schmidt AM, Yuzefpolskaya M, Demmer RT. Experimentally Induced Peripheral Venous Congestion Exacerbates Inflammation, Oxidative Stress, and Neurohormonal and Endothelial Cell Activation in Patients With Systolic Heart Failure. J Card Fail 2024; 30:580-591. [PMID: 37625581 PMCID: PMC10884348 DOI: 10.1016/j.cardfail.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Venous congestion (VC) is a hallmark of symptomatic heart failure (HF) requiring hospitalization; however, its role in the pathogenesis of HF progression remains unclear. We investigated whether peripheral VC exacerbates inflammation, oxidative stress and neurohormonal and endothelial cell (EC) activation in patients with HF with reduced ejection fraction (HFrEF). METHODS AND RESULTS Two matched groups of patients with HFrEF and with no peripheral VC vs without recent HF hospitalization were studied. We modeled peripheral VC by inflating a cuff around the dominant arm, targeting ∼ 30 mmHg increase in venous pressure (venous stress test [VST]). Blood and ECs were sampled before and after 90 minutes of VST. We studied 44 patients (age 53 ± 12 years, 32% female). Circulating endothelin-1, tumor necrosis factor-α, interleukin-6, isoprostane, angiotensin II (ang-2), angiopoietin-2, vascular cell adhesion molecule-1, and CD146 significantly increased after the VST. Enhanced endothelin-1 and angiopoietin-2 responses to the VST were present in patients with vs without recent hospitalization and were prospectively associated with incident HF-related events; 6698 messenger ribonucleic acid (mRNA probe sets were differentially expressed in ECs after VST. CONCLUSIONS Experimental VC exacerbates inflammation, oxidative stress, neurohormonal and EC activation and promotes unfavorable transcriptome remodeling in ECs of patients with HFrEF. A distinct biological sensitivity to VC appears to be associated with high risk for HF progression.
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Affiliation(s)
- Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA.
| | - Francesco Castagna
- Department of Medicine, Division of Cardiology, Montefiore Medical Center, New York, New York, USA
| | - Duygu Onat
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ka Yuk Wong
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ante Harxhi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Yacki Hayashi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Richard A Friedman
- Herbert Irving Comprehensive Cancer Center Columbia University, New York, New York, USA
| | - Alberto Pinsino
- Department of Anesthesia, Division of Critical Care, Montefiore Medical Center, New York, New York, USA
| | - Annamaria Ladanyi
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexander Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP-HP Saint Louis and Lariboisière University Hospitals, Paris, France
| | - Sanja Jelic
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | | | - Thierry H Lejemtel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Panos Papapanou
- Department of Periodontology Columbia University Irving Medical Center, New York, New York, USA
| | - Hani N Sabbah
- Department of Medicine, Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ann Marie Schmidt
- Department of Medicine, Division of Endocrinology, New York University, New York, New York, USA
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Ryan T Demmer
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, USA; and Department of Epidemiology, Mailman School of Public Health Columbia University, New York, New York, USA
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2
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Li M, Huang H. Anesthetic Management of Patients with Dilated Cardiomyopathy Undergoing Noncardiac Surgery. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1567. [PMID: 37763685 PMCID: PMC10533037 DOI: 10.3390/medicina59091567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 09/29/2023]
Abstract
Dilated cardiomyopathy (DCM), a primary myocardial disease, is characterized by dilation of the left or both ventricles and systolic dysfunction with or without congestive heart failure. DCM per se is a well-recognized risk factor for sudden cardiac death and poor surgical outcomes following noncardiac surgery. Surgical trauma/stress represents unique challenges for DCM patient management. Unfortunately, there is a big knowledge gap in managing DCM patients undergoing non-cardiac surgery. Therefore, the aim of our review is to provide basic facts and current advances in DCM, as well as a practical guideline to perioperative care providers, for the management of surgical patients with DCM, who are quite rare compared with the general surgical population. This review summarizes recent advances in the medical management of DCM as well as perioperative assessment and management strategies for DCM patients undergoing noncardiac surgery. Optimal surgical outcomes depend on multiple-disciplinary care to minimize perioperative cardiovascular disturbances.
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Affiliation(s)
| | - Han Huang
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, China;
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Yeoh SE, Docherty KF, Campbell RT, Jhund PS, Hammarstedt A, Heerspink HJ, Jarolim P, Køber L, Kosiborod MN, Martinez FA, Ponikowski P, Solomon SD, Sjöstrand M, Bengtsson O, Greasley PJ, Sattar N, Welsh P, Sabatine MS, Morrow DA, McMurray JJ. Endothelin-1, Outcomes in Patients With Heart Failure and Reduced Ejection Fraction, and Effects of Dapagliflozin: Findings From DAPA-HF. Circulation 2023; 147:1670-1683. [PMID: 37039015 PMCID: PMC10212584 DOI: 10.1161/circulationaha.122.063327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND ET-1 (endothelin-1) is implicated in the pathophysiology of heart failure and renal disease. Its prognostic importance and relationship with kidney function in patients with heart failure with reduced ejection fraction receiving contemporary treatment are uncertain. We investigated these and the efficacy of dapagliflozin according to ET-1 level in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure). METHODS We investigated the incidence of the primary outcome (cardiovascular death or worsening heart failure), change in kidney function, and the effect of dapagliflozin according to baseline ET-1 concentration, adjusting in Cox models for other recognized prognostic variables in heart failure including NT-proBNP (N-terminal pro-B-type natriuretic peptide). We also examined the effect of dapagliflozin on ET-1 level. RESULTS Overall, 3048 participants had baseline ET-1 measurements: tertile 1 (T1; ≤3.28 pg/mL; n=1016); T2 (>3.28-4.41 pg/mL; n=1022); and T3 (>4.41 pg/mL; n=1010). Patients with higher ET-1 were more likely male, more likely obese, and had lower left ventricular ejection fraction, lower estimated glomerular filtration rate, worse functional status, and higher NT-proBNP and hs-TnT (high-sensitivity troponin-T). In the adjusted Cox models, higher baseline ET-1 was independently associated with worse outcomes and steeper decline in kidney function (adjusted hazard ratio for primary outcome of 1.95 [95% CI, 1.53-2.50] for T3 and 1.36 [95% CI, 1.06-1.75] for T2; both versus T1; estimated glomerular filtration rate slope: T3, -3.19 [95% CI, -3.66 to -2.72] mL/min per 1.73 m2 per y, T2, -2.08 [95% CI, -2.52 to -1.63] and T1 -2.35 [95% CI, -2.79 to -1.91]; P=0.002). The benefit of dapagliflozin was consistent regardless of baseline ET-1, and the placebo-corrected decrease in ET-1 with dapagliflozin was 0.13 pg/mL (95% CI, 0.25-0.01; P=0.029). CONCLUSIONS Higher baseline ET-1 concentration was independently associated with worse clinical outcomes and more rapid decline in kidney function. The benefit of dapagliflozin was consistent across the range of ET-1 concentrations measured, and treatment with dapagliflozin led to a small decrease in serum ET-1 concentration. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03036124.
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Affiliation(s)
- Su Ern Yeoh
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Kieran F. Docherty
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Ross T. Campbell
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Pardeep S. Jhund
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Ann Hammarstedt
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (A.H., M.S., O.B., P.J.G.)
| | - Hiddo J.L. Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands (H.J.L.H.)
- George Institute for Global Health, University of New South Wales, Sydney, Australia (H.J.L.H.)
| | - Petr Jarolim
- Department of Pathology (P.J.), Brigham and Women’s Hospital, Boston, MA
| | - Lars Køber
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
| | - Mikhail N. Kosiborod
- Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.)
| | | | - Piotr Ponikowski
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - Scott D. Solomon
- Division of Cardiovascular Medicine (S.D.S.), Brigham and Women’s Hospital, Boston, MA
| | - Mikaela Sjöstrand
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (A.H., M.S., O.B., P.J.G.)
- Thrombolysis in Myocardial Infarction Study Group (M.S.S., D.A.M.), Brigham and Women’s Hospital, Boston, MA
| | - Olof Bengtsson
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (A.H., M.S., O.B., P.J.G.)
| | - Peter J. Greasley
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (A.H., M.S., O.B., P.J.G.)
| | - Naveed Sattar
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Paul Welsh
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
| | - Marc S. Sabatine
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
- BioPharmaceuticals Research and Development, AstraZeneca, Gothenburg, Sweden (A.H., M.S., O.B., P.J.G.)
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, The Netherlands (H.J.L.H.)
- George Institute for Global Health, University of New South Wales, Sydney, Australia (H.J.L.H.)
- Department of Pathology (P.J.), Brigham and Women’s Hospital, Boston, MA
- Thrombolysis in Myocardial Infarction Study Group (M.S.S., D.A.M.), Brigham and Women’s Hospital, Boston, MA
- Division of Cardiovascular Medicine (S.D.S.), Brigham and Women’s Hospital, Boston, MA
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (L.K.)
- Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City (M.N.K.)
- Universidad Nacional de Córdoba, Argentina (F.A.M.)
- Center for Heart Diseases, University Hospital, Wroclaw Medical University, Poland (P.P.)
| | - David A. Morrow
- Thrombolysis in Myocardial Infarction Study Group (M.S.S., D.A.M.), Brigham and Women’s Hospital, Boston, MA
| | - John J.V. McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (S.E.Y., K.F.D., R.T.C., P.S.J., N.S., P.W., J.J.V.M.)
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Vincent R, Kumarathasan P, Goegan P, Bjarnason SG, Guénette J, Karthikeyan S, Thomson EM, Adamson IY, Watkinson WP, Battistini B, Miller FJ. Acute cardiovascular effects of inhaled ambient particulate matter: Chemical composition-related oxidative stress, endothelin-1, blood pressure, and ST-segment changes in Wistar rats. CHEMOSPHERE 2022; 296:133933. [PMID: 35157883 DOI: 10.1016/j.chemosphere.2022.133933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 06/14/2023]
Abstract
Short-term increases in particulate matter (PM) are associated with heightened morbidity and mortality from cardiovascular causes. Inhalation of PM is known to increase endothelin (ET)-1 levels. Yet, less is known about particle composition-related changes at the molecular level including the endothelinergic system and relationship with cardiovascular function changes. In this work, adult Wistar male rats were exposed for 4 h by nose-only inhalation to clean air, Ottawa urban particles (EHC-93, 48 mg/m3) and water-leached (EHC-93L, 49 mg/m3) particles, to examine the effect of particle compositional changes on oxidative stress, circulating ETs, blood pressure, and heart electrophysiology. Particle deposition in the respiratory compartment was estimated at 85 μg (25 ng/cm2). Lung cell proliferation was low in both treatment groups, indicating absence of acute injury. Inhalation of EHC-93 caused statistically significant elevations (p < 0.05) of oxidative stress markers, ET-1, ET-3, blood pressure, and a decrease of ST-segment duration in the ECG at 1.5 days post-exposure. Leached particles (EHC-93L) caused rapid but transient elevation (p < 0.05) of oxidative stress, ET-1, ET-2, and ET-3 at earlier time points, with no changes in blood pressure or ST-segment. These results demonstrate that inhalation of urban particles at an internal dose inadequate to cause acute lung injury can induce oxidative stress, enhance vasoactive endothelins, leading to vasopressor response, affecting cardiac electrophysiology in Wistar rats, consistent with the cardiovascular impacts of ambient particles in human populations. Change in particle potency after removal of soluble species, notably cadmium, zinc and polar organics suggests that the toxicodynamics of cardiovascular effects can be modified by physicochemical properties of particles.
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Affiliation(s)
- Renaud Vincent
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | | | - Patrick Goegan
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
| | - Stephen G Bjarnason
- Defence Research and Development Canada, Suffield Research Centre, Medicine Hat, Alberta, Canada.
| | - Josée Guénette
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
| | | | - Errol M Thomson
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada.
| | - Ian Y Adamson
- Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada.
| | | | | | - Frederick J Miller
- The Hamner Institutes for Health Sciences, Research Triangle Park, NC, USA.
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5
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Novel Biomarkers in Heart Failure: New Insight in Pathophysiology and Clinical Perspective. J Clin Med 2021; 10:jcm10132771. [PMID: 34202603 PMCID: PMC8268524 DOI: 10.3390/jcm10132771] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 12/18/2022] Open
Abstract
Heart failure (HF) is a complex clinical syndrome with a huge social burden in terms of cost, morbidity, and mortality. Brain natriuretic peptide (BNP) appears to be the gold standard in supporting the daily clinical management of patients with HF. Novel biomarkers may supplement BNP to improve the understanding of this complex disease process and, possibly, to personalize care for the different phenotypes, in order to ameliorate prognosis. In this review, we will examine some of the most promising novel biomarkers in HF. Inflammation plays a pivotal role in the genesis and progression of HF and, therefore, several candidate molecules have been investigated in recent years for diagnosis, prognosis, and therapy monitoring. Noncoding RNAs are attractive as biomarkers and their potential clinical applications may be feasible in the era of personalized medicine. Given the complex pathophysiology of HF, it is reasonable to expect that the future of biomarkers lies in the application of precision medicine, through wider testing panels and “omics” technologies, to further improve HF care delivery.
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6
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Abstract
PURPOSE OF REVIEW Inflammation has been shown to be an important factor in the development and progression of heart failure (HF), regardless of the etiology. There have been many studies that demonstrated roles of inflammatory biomarkers in diagnosis, prognosis of chronic and acute HF patients, and also markers of cardiotoxicity from chemotherapy. These cytokines are high-sensitivity C-reactive protein (hsCRP), myeloperoxidase (MPO), soluble growth stimulation expressed gene 2 (sST2), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNFα), growth differentiation factor-15 (GDF-15), endothelin-1 (ET-1), and galectin-3. In this review, we discuss the past and present insights of those inflammatory biomarkers in order to gain more understanding in pathogenesis of HF, risk stratification of HF patients, and early detection of cardiotoxicity from cancer therapy. RECENT FINDINGS Many inflammatory cytokines have been shown to be associated with mortality of both chronic and acute HF patients, and some of them are able to track treatment responses, especially sST2 and galectin-3, which are the only two inflammatory biomarkers recommended to use in clinical setting by the recent standard HF guidelines, while some studies described ET-1 and MPO as potential predictors of cardiotoxicity from cancer drugs. The prognostic implications of inflammatory biomarkers in HF patients have been demonstrated more consistently in chronic than acute HF, with some suggestions of ET-1 and MPO in patients receiving chemotherapy. However, further studies are necessary for the use of inflammatory biomarkers in routine clinical practice.
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Affiliation(s)
- Thanat Chaikijurajai
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA
- Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - W H Wilson Tang
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
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7
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Zymliński R, Sierpiński R, Metra M, Cotter G, Sokolski M, Siwołowski P, Garus M, Gajewski P, Tryba J, Samorek M, Jankowska EA, Biegus J, Ponikowski P. Elevated plasma endothelin-1 is related to low natriuresis, clinical signs of congestion, and poor outcome in acute heart failure. ESC Heart Fail 2020; 7:3536-3544. [PMID: 33063475 PMCID: PMC7755016 DOI: 10.1002/ehf2.13064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS Endothelin-1 (ET-1) is a potent vasoconstrictor, which regulates renal and vascular function. We aimed to relate plasma levels of ET-1 with the clinical picture and outcomes in acute heart failure (AHF). METHODS AND RESULTS We studied 113 patients with AHF [mean age 65 ± 13 (years), median (upper and lower quartiles) N-terminal pro-B-type natriuretic peptide, 5422 (2689; 8582) (pg/mL)], in whom plasma levels of ET-1 were serially measured at admission (10.8 ± 5.2), Day 1 (9.5 ± 3.4), and Day 2 (8.9 ± 3.8) (pg/mL). The population was divided into tertiles across baseline ET-1 levels. Patients in the highest ET-1 tertile had predominant clinical signs of peripheral congestion; however, no difference was observed in pulmonary congestion and severity of dyspnoea. They also presented lower spot urine sodium at admission (75 ± 35 vs. 99 ± 43 vs. 108 ± 30), 6 h (84 ± 34 vs. 106 ± 43 vs. 106 ± 35), and Day 1 (75 ± 38 vs. 96 ± 36 vs. 100 ± 35) (mmol/L), when compared with the second and first tertile, respectively (all P < 0.05); furthermore, they received higher doses of intravenous furosemide from Day 2 and had longer intravenous diuretics, as median switch to oral furosemide was 4 (3; 4) vs. 3 (2; 4) vs. 2 (2; 3) (days), respectively, P < 0.05. There was no difference in serum creatinine, urea, and renal injury biomarkers (kidney injury molecule-1, serum cystatin C, and urine neutrophil gelatinase-associated lipocalin) between the ET-1 tertiles. Higher values of ET-1 measured at each time point were related with a higher risk of 1 year mortality. CONCLUSIONS Elevation of ET-1 is related to clinical signs of peripheral congestion, low urine sodium excretion, and poor outcome in AHF.
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Affiliation(s)
- Robert Zymliński
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Marco Metra
- Cardiology, The Department of Medical and Surgical Specialties, Radiological Sciences and Public HealthUniversity of BresciaBresciaItaly
| | | | - Mateusz Sokolski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | | | - Mateusz Garus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Gajewski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Joanna Tryba
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Maria Samorek
- Student Scientific Organization, Department of Heart DiseasesWroclaw Medical UniversityWrocławPoland
| | - Ewa A. Jankowska
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Jan Biegus
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
| | - Piotr Ponikowski
- Department of Heart DiseasesWroclaw Medical UniversityBorowska 213Wrocław50‐556Poland
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8
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Tsutsui H, Isobe M, Ito H, Ito H, Okumura K, Ono M, Kitakaze M, Kinugawa K, Kihara Y, Goto Y, Komuro I, Saiki Y, Saito Y, Sakata Y, Sato N, Sawa Y, Shiose A, Shimizu W, Shimokawa H, Seino Y, Node K, Higo T, Hirayama A, Makaya M, Masuyama T, Murohara T, Momomura SI, Yano M, Yamazaki K, Yamamoto K, Yoshikawa T, Yoshimura M, Akiyama M, Anzai T, Ishihara S, Inomata T, Imamura T, Iwasaki YK, Ohtani T, Onishi K, Kasai T, Kato M, Kawai M, Kinugasa Y, Kinugawa S, Kuratani T, Kobayashi S, Sakata Y, Tanaka A, Toda K, Noda T, Nochioka K, Hatano M, Hidaka T, Fujino T, Makita S, Yamaguchi O, Ikeda U, Kimura T, Kohsaka S, Kosuge M, Yamagishi M, Yamashina A. JCS 2017/JHFS 2017 Guideline on Diagnosis and Treatment of Acute and Chronic Heart Failure - Digest Version. Circ J 2019; 83:2084-2184. [PMID: 31511439 DOI: 10.1253/circj.cj-19-0342] [Citation(s) in RCA: 411] [Impact Index Per Article: 82.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Affiliation(s)
- Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | | | - Hiroshi Ito
- Department of Cardiovascular and Respiratory Medicine, Akita University Graduate School of Medicine
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Division of Biophysiological Sciences, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
| | - Masafumi Kitakaze
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center
| | | | - Yasuki Kihara
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University
| | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yoshikatsu Saiki
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital
| | - Yoshiki Sawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Graduate School of Medical Sciences
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Kyushu University Graduate School of Medical Sciences
| | - Atsushi Hirayama
- The Division of Cardiology, Department of Medicine, Nihon University Graduate School of Medicine
| | | | - Tohru Masuyama
- Cardiovascular Division, Department of Internal Medicine, Hyogo College of Medicine
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | | | - Masafumi Yano
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Kenji Yamazaki
- Department of Cardiology Surgery, Tokyo Women's Medical University
| | - Kazuhiro Yamamoto
- Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University
| | | | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | - Masatoshi Akiyama
- Department of Cardiovascular Surgery, Tohoku University Graduate School of Medicine
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Shiro Ishihara
- Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital
| | - Takayuki Inomata
- Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital
| | | | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Tomohito Ohtani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takatoshi Kasai
- Cardiovascular Respiratory Sleep Medicine, Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Mahoto Kato
- Department of Cardiovascular Medicine, Nihon University Graduate School of Medicine
| | - Makoto Kawai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine
| | | | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine
| | - Toru Kuratani
- Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shigeki Kobayashi
- Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine
| | - Yasuhiko Sakata
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | | | - Koichi Toda
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Masaru Hatano
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | | | - Takeo Fujino
- Department of Advanced Cardiopulmonary Failure, Kyushu University Graduate School of Medical Sciences
| | - Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Osamu Yamaguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Akira Yamashina
- Medical Education Promotion Center, Tokyo Medical University
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Zhang CL, Xie S, Qiao X, An YM, Zhang Y, Li L, Guo XB, Zhang FC, Wu LL. Plasma endothelin-1-related peptides as the prognostic biomarkers for heart failure: A PRISMA-compliant meta-analysis. Medicine (Baltimore) 2017; 96:e9342. [PMID: 29390406 PMCID: PMC5815818 DOI: 10.1097/md.0000000000009342] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most studies reported that high plasma endothelin-1 (ET-1), big ET-1, and C-terminal proET-1 (CT-proET-1) were correlated with poor prognosis of heart failure (HF). However, available evidence remains controversial. To help solve the debate, we collected all the available studies and performed a meta-analysis. METHODS We searched the databases covering Embase, PubMed, Ovid, and Web of Science on June 28, 2017. The hazard ratio (HR) or risk ratio (RR) and its 95% confidence intervals (CIs) were collected and calculated by use of a random-effect model. Heterogeneity was assessed by Cochran's Q test, and publication bias was assessed by funnel plots with Egger's and Begg's linear regression test. RESULTS Thirty-two studies with 18,497 patients were included in the analysis. Results showed that circulating ET-1, big ET-1, and CT-proET-1 were positively correlated with high risk of adverse outcomes, with pooled RRs (95% CIs) of 2.22 (1.82-2.71, P < .001), 2.47 (1.93-3.17, P < .001), and 2.27 (1.57-3.29, P < .001), respectively. In the subgroup of death as primary outcome, the pooled RRs (95% CIs) were 2.13 (1.68-2.70, P < .001), 2.55 (1.82-3.57, P < .001), and 2.02 (1.39-2.92, P < .001) for ET-1, big ET-1, and CT-proET-1, respectively. No significant publication bias was observed in this study. CONCLUSION Our meta-analysis provided evidence that increased plasma levels of ET-1, big ET-1, and CT-proET-1 were associated with poor prognosis or mortality for HF populations.
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Affiliation(s)
- Cheng-Lin Zhang
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
| | - Shang Xie
- Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology
| | - Xue Qiao
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
| | - Yuan-Ming An
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
| | - Yan Zhang
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
| | - Li Li
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
| | - Xiao-Bin Guo
- Department of Geriatrics, Peking University Third Hospital, Beijing, China
| | - Fu-Chun Zhang
- Department of Geriatrics, Peking University Third Hospital, Beijing, China
| | - Li-Ling Wu
- Department of Physiology and Pathophysiology, Key Laboratory of Molecular Cardiovascular Science, Beijing Key Laboratory of Cardiovascular Receptors Research, Ministry of Education
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10
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Wrigley B, Tapp L, Shantsila E, Gregory L. Increased expression of cell adhesion molecule receptors on monocyte subsets in ischaemic heart failure. Thromb Haemost 2017; 110:92-100. [DOI: 10.1160/th13-02-0088] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/28/2013] [Indexed: 11/05/2022]
Abstract
SummaryThe objective of this study was to evaluate the expression of cell adhesion molecule (CAM) receptors (integrins) on monocyte subsets in heart failure (HF) and examine their prognostic implication. Increased levels of soluble CAMs have been observed in patients with HF, but the precise mechanism of monocyte adhesion to the vascular endothelium remains unknown. Patients with acute HF (AHF, n=51) were compared to those with stable HF (SHF, n=42) and stable coronary artery disease (CAD, n=44) without HF. Expression of integrins-receptors to intercellular adhesion molecule-1 (ICAM-1R) and vascular CAM-1 (VCAM-1R) on monocyte subsets was assessed by flow cytometry. Monocyte subsets were defined as CD14++CD16–CCR2+ (‘classical’, Mon1), CD14++CD16+CCR2+ (‘intermediate’, Mon2), and CD14+CD16++CCR2– (‘non-classical’, Mon3). Compared to patients with SHF, those with AHF had significantly higher expression of ICAM-1R on Mon2 (p=0.01). Compared to those with stable CAD, patients with SHF had a significantly higher expression of ICAM-1R on Mon2 (p=0.025). Compared to SHF, patients with AHF had a similar expression of VCAM-1R on both Mon1 and Mon3 but significantly higher expression on Mon2 (p=0.019). There were no significant differences between SHF and CAD in monocyte expression of VCAM-1R. In multivariate Cox regression analysis, VCAM-1R expression on Mon2 was associated with adverse clinical outcome (death or rehospitalisation) in AHF [HR 1.07 (1.01–1.14), p=0.029]. In conclusion, HF is associated with increased monocyte expression of integrins-receptors to both ICAM-1 and VCAM-1, being particularly linked to Mon2 subset. Expression of VCAM-1R on Mon2 may have prognostic value in patients with AHF.
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11
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Falcão LM, Pinto F, Ravara L, van Zwieten PA. BNP and ANP as diagnostic and predictive markers in heart failure with left ventricular systolic dysfunction. J Renin Angiotensin Aldosterone Syst 2016; 5:121-9. [PMID: 15526247 DOI: 10.3317/jraas.2004.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The prevalence of chronic heart failure (CHF) with systolic dysfunction is increasing. Plasma natriuretic peptides have been envisaged as diagnostic and predictive markers. Aims To investigate the relationship between the levels of B-type natriuretic peptide (BNP) and A-type natriuretic peptide (ANP) and the clinical and functional parameters of CHF in outpatients with CHF at baseline, compared with normal healthy controls; to find out the differences in a randomised controlled trial between patients treated with an angiotensin-converting enzyme (ACE) inhibitor, captopril, or an angiotensin receptor blocker (ARB), irbesartan. These differences were assessed throughout the six-month treatment period and at the sixth month. Methods Plasma BNP (pmol/L) and ANP (pmol/L) were determined in 68 hypertensive patients with dilated cardiomyopathy, NYHA class III-IV and ejection fraction (EF) <40%, and in 26 normal controls. Statistical analysis for BNP and ANP was done by Student's t-test. The patient group was randomly subdivided into two subgroups of 34 patients, each treated with either an ARB, irbesartan, or an ACE inhibitor (ACE-I), captopril. BNP and ANP were measured in both subsamples and correlated with clinical, functional and neurohormonal parameters throughout a follow-up period of six months and at the sixth month. Results The mean EF in the patient sample was 33.43±6.52% and in the controls was 61.96 ±3.53% (p=0.000). The mean BNP (pmol/L) in patients was 44.78±54.36 and in the controls was 7.12±8.28 (p=0.000) and the mean ANP (pmol/L) was 30.32±25.97 in patients and 11.18±7.92 in controls (p=0.000). A statistically significant difference was found between patients and healthy controls. Significant correlations were found between natriuretic peptides and EF. Between the baseline phase and the sixth month, BNP and ANP decreased significantly in the ARB group. At the sixth month, both BNP and ANP were lower in the ARB group. Evidence of clinical benefit was found with both ARB or ACE-I treatment throughout the six months, with patients moving from classes III and IV to class II NYHA. Improvement of EF was also found, with transition of patients with lower EF (even <30%) to higher values. EF was higher in the ARB group at the sixth month. Conclusions BNP and ANP can be useful diagnostic tools in hypertensive CHF patients with moderate-to-severe LV dysfunction. The decrease in BNP and ANP in the ARB group throughout six months, as well as the lower value at the sixth month, suggest a prognostic value of these parameters.
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12
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Colombo PC, Doran AC, Onat D, Wong KY, Ahmad M, Sabbah HN, Demmer RT. Venous congestion, endothelial and neurohormonal activation in acute decompensated heart failure: cause or effect? Curr Heart Fail Rep 2016; 12:215-22. [PMID: 25740404 DOI: 10.1007/s11897-015-0254-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Venous congestion and endothelial and neurohormonal activation are known to occur in acute decompensated heart failure (ADHF), yet the temporal role of these processes in the pathophysiology of decompensation is not fully understood. Conventional wisdom presumes congestion to be a consequence of worsening cardiovascular function; however, the biomechanically driven effects of venous congestion are biologically plausible contributors to ADHF that remain largely unexplored in vivo. Recent experimental evidence from human models suggests that fluid accumulation and venous congestion are not simply consequences of poor cardiovascular function, but rather are fundamental pro-oxidant, pro-inflammatory, and hemodynamic stimuli that contribute to acute decompensation. The latest advances in the monitoring of volume status using implantable devices allow for the detection of venous congestion before symptoms arise. This may ultimately lead to improved treatment strategies including not only diuretics, but also specific, adjuvant interventions to counteract endothelial and neurohormonal activation during early preclinical decompensation.
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Affiliation(s)
- Paolo C Colombo
- Division of Cardiology, College of Physicians & Surgeons, Department of Medicine, Columbia University, 622 West 168th Street, PH 12-134, New York, NY, 10032, USA,
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13
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Cosmi F, Di Giulio P, Masson S, Finzi A, Marfisi RM, Cosmi D, Scarano M, Tognoni G, Maggioni AP, Porcu M, Boni S, Cutrupi G, Tavazzi L, Latini R. Regular Wine Consumption in Chronic Heart Failure. Circ Heart Fail 2015; 8:428-37. [DOI: 10.1161/circheartfailure.114.002091] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 04/17/2015] [Indexed: 12/16/2022]
Affiliation(s)
- Franco Cosmi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Paola Di Giulio
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Serge Masson
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Andrea Finzi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Rosa Maria Marfisi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Deborah Cosmi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Marco Scarano
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Gianni Tognoni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Aldo P. Maggioni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Maurizio Porcu
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Silvana Boni
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Giovanni Cutrupi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Luigi Tavazzi
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
| | - Roberto Latini
- From the Department of Cardiology, Ospedale di Cortona, Cortona, Italy (F.C., D.C.); Department of Cardiovascular Research, IRCCS—Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy (P.D.G., S.M., A.F., R.L.); Department of Clinical Pharmacology and Epidemiology, Fondazione Mario Negri Sud, Santa Maria Imbaro, Italy (R.M.M., M.S., G.T.); ANMCO Research Center, Florence, Italy (A.P.M.); Dipartimento Cardio-Toraco-Vascolare, Azienda Ospedaliera G. Brotzu—San Michele, Cagliari, Italy (M.P.)
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14
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Clementi A, Virzì GM, Brocca A, de Cal M, Pastori S, Clementi M, Granata A, Vescovo G, Ronco C. Advances in the pathogenesis of cardiorenal syndrome type 3. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2015; 2015:148082. [PMID: 25821551 PMCID: PMC4364019 DOI: 10.1155/2015/148082] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 02/23/2015] [Indexed: 12/23/2022]
Abstract
Cardiorenal syndrome (CRS) type 3 is a subclassification of the CRS whereby an episode of acute kidney injury (AKI) leads to the development of acute cardiac injury or dysfunction. In general, there is limited understanding of the pathophysiologic mechanisms involved in CRS type 3. An episode of AKI may have effects that depend on the severity and duration of AKI and that both directly and indirectly predispose to an acute cardiac event. Experimental data suggest that cardiac dysfunction may be related to immune system activation, inflammatory mediators release, oxidative stress, and cellular apoptosis which are well documented in the setting of AKI. Moreover, significant derangements, such as fluid and electrolyte imbalance, metabolic acidosis, and uremia, which are typical features of acute kidney injury, may impair cardiac function. In this review, we will focus on multiple factors possibly involved in the pathogenesis issues regarding CRS type 3.
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Affiliation(s)
- Anna Clementi
- Department of Nephrology and Dialysis, San Giovanni Di Dio, Agrigento 92100, Italy
| | - Grazia Maria Virzì
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Italy
| | - Alessandra Brocca
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
- Department of Medicine (DIMED), University of Padova, Padova 35128, Italy
| | - Massimo de Cal
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
| | - Silvia Pastori
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
| | - Maurizio Clementi
- Clinical Genetics Unit, Department of Women's and Children's Health, University of Padua, Italy
| | - Antonio Granata
- Department of Nephrology and Dialysis, San Giovanni Di Dio, Agrigento 92100, Italy
| | - Giorgio Vescovo
- Internal Medicine, San Bortolo Hospital, Vicenza 36100, Italy
| | - Claudio Ronco
- Department of Nephrology, Dialysis and Transplant, San Bortolo Hospital, Vicenza 36100, Italy
- International Renal Research Institute Vicenza (IRRIV), Italy
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15
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Neves FMDO, Meneses GC, Sousa NEA, Pessoa Bezerra de Menezes RRP, Parahyba MC, Martins AMC, Libório AB. Syndecan-1 in Acute Decompensated Heart Failure – Association With Renal Function and Mortality –. Circ J 2015; 79:1511-1519. [DOI: 10.1253/circj.cj-14-1195] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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16
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Li X, Chen C, Gan F, Wang Y, Ding L, Hua W. Plasma NT pro-BNP, hs-CRP and big-ET levels at admission as prognostic markers of survival in hospitalized patients with dilated cardiomyopathy: a single-center cohort study. BMC Cardiovasc Disord 2014; 14:67. [PMID: 24885051 PMCID: PMC4041639 DOI: 10.1186/1471-2261-14-67] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/06/2014] [Indexed: 11/17/2022] Open
Abstract
Background Circulating N-terminal pro-B-type natriuretic peptide (NT pro-BNP), high- sensitivity C-reactive protein (hs-CRP) and big endothelin (big-ET) have been shown to be increased in heart failure and to contribute to both hemodynamic deterioration and cardiovascular remodeling. Here, we examined the prognostic value of the three neurohormones at admission in a population of hospitalized patients with dilated cardiomyopathy (DCM). Methods and results This cohort study was undertaken in 622 hospitalized patients with DCM in Fuwai Hospital from January 2005 to September 2011 (female 26.5%, 51.4 ± 14.6 years old). Standard demographics, echocardiography and routine blood samples were obtained shortly after admission. NT pro-BNP, hs-CRP and big-ET were measured, and their concentrations in relation to all-cause mortality were assessed through a mean follow-up of 2.6 ± 1.6 years. Kaplan-Meier curves showed that the all-cause mortality rates were higher in patients with NT pro-BNP > 2247 pmol/L compared to patients with NT pro-BNP < 2247 pmol/L (11.9% vs 34.8%, log-rank χ2 = 35.588, P < 0.001), in patients with hs-CRP > 3.90 mg/L compared to patients with hs-CRP < 3.90 mg/L (12.8% vs 33.6%, log-rank χ2 = 39.662, P < 0.001) and in patients with big-ET > 0.95 pmol/L compared to patients with big-ET <0.95 pmol/L (12.5% vs 31.0%, log-rank χ2 = 17.890, P < 0.001). High circulating concentrations of NT pro-BNP (HR 2.217, 95% CI 1.015-4.846, P = 0.046) and hs-CRP (HR 1.922, 95% CI 1.236-2.988, P = 0.004), but not big-ET, in addition to left atrial diameter and fasting blood glucose, were independent predictors of the outcome defined as all-cause mortality. Conclusions In a large population of patients with DCM, the circulating concentrations of NT pro-BNP and hs-CRP, but not big-ET, were independent markers of all-cause mortality.
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Affiliation(s)
| | | | | | | | | | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
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17
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Colombo PC, Onat D, Harxhi A, Demmer RT, Hayashi Y, Jelic S, LeJemtel TH, Bucciarelli L, Kebschull M, Papapanou P, Uriel N, Schmidt AM, Sabbah HN, Jorde UP. Peripheral venous congestion causes inflammation, neurohormonal, and endothelial cell activation. Eur Heart J 2014; 35:448-54. [PMID: 24265434 PMCID: PMC3924182 DOI: 10.1093/eurheartj/eht456] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
AIMS Volume overload and venous congestion are typically viewed as a consequence of advanced and of acute heart failure (HF) and renal failure (RF) although it is possible that hypervolaemia itself might be a critical intermediate in the pathophysiology of these diseases. This study aimed at elucidating whether peripheral venous congestion is sufficient to promote changes in inflammatory, neurohormonal, and endothelial phenotype similar to those observed in HF and RF. METHODS To experimentally model peripheral venous congestion, we developed a new method (so-called venous stress test) and applied the methodology on 24 healthy subjects (14 men, age 35 ± 2 years). Venous arm pressure was increased to ∼30 mmHg above the baseline level by inflating a tourniquet cuff around the dominant arm (test arm). Blood and endothelial cells (ECs) were sampled from test and control arm (lacking an inflated cuff) before and after 75 min of venous congestion, using angiocatheters and endovascular wires. Magnetic beads coated with EC-specific antibodies were used for EC separation; amplified mRNA was analysed by Affymetrix HG-U133 Plus 2.0 Microarray. RESULTS Plasma interleukin-6 (IL-6), endothelin-1 (ET-1), angiotensin II (AII), vascular cell adhesion molecule-1 (VCAM-1), and chemokine (C-X-C motif) ligand 2 (CXCL2) were significantly increased in the congested arm. A total of 3437 mRNA probe sets were differentially expressed (P < 0.05) in venous ECs before vs. after testing, including ET-1, VCAM-1, and CXCL2. CONCLUSION Peripheral venous congestion causes release of inflammatory mediators, neurohormones, and activation of ECs. Overall, venous congestion mimicked, notable aspects of the phenotype typical of advanced and of acute HF and RF.
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Affiliation(s)
- Paolo C. Colombo
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA,Corresponding author. Tel: +1 2123052638, Fax: +1 2123057439,
| | - Duygu Onat
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ante Harxhi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ryan T. Demmer
- Department of Epidemiology, Mailman School of Public Health Columbia University, New York, NY, USA
| | - Yacki Hayashi
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Sanja Jelic
- Division of Pulmonary, Columbia University Medical Center, New York, NY, USA
| | - Thierry H. LeJemtel
- Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
| | | | | | - Panos Papapanou
- Department of Periodontology, Columbia University Medical Center, New York, NY, USA
| | - Nir Uriel
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Ann Marie Schmidt
- Division of Endocrinology, Department of Medicine, New York University, New York, NY, USA
| | - Hani N. Sabbah
- Division of Cardiovascular Medicine, Department of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Ulrich P. Jorde
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
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Martins T, Vitorino R, Moreira-Gonçalves D, Amado F, Duarte JA, Ferreira R. Recent insights on the molecular mechanisms and therapeutic approaches for cardiac cachexia. Clin Biochem 2014; 47:8-15. [DOI: 10.1016/j.clinbiochem.2013.10.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 10/22/2013] [Accepted: 10/23/2013] [Indexed: 12/22/2022]
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Colombo PC, Ganda A, Lin J, Onat D, Harxhi A, Iyasere JE, Uriel N, Cotter G. Inflammatory activation: cardiac, renal, and cardio-renal interactions in patients with the cardiorenal syndrome. Heart Fail Rev 2013; 17:177-90. [PMID: 21688186 DOI: 10.1007/s10741-011-9261-3] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although inflammation is a physiologic response designed to protect us from infection, when unchecked and ongoing it may cause substantial harm. Both chronic heart failure (CHF) and chronic kidney disease (CKD) are known to cause elaboration of several pro-inflammatory mediators that can be detected at high concentrations in the tissues and blood stream. The biologic sources driving this chronic inflammatory state in CHF and CKD are not fully established. Traditional sources of inflammation include the heart and the kidneys which produce a wide range of pro-inflammatory cytokines in response to neurohormones and sympathetic activation. However, growing evidence suggests that non-traditional biomechanical mechanisms such as venous and tissue congestion due to volume overload are also important as they stimulate endotoxin absorption from the bowel and peripheral synthesis and release of pro-inflammatory mediators. Both during the chronic phase and, more rapidly, during acute exacerbations of CHF and CKD, inflammation and congestion appear to amplify each other resulting in a downward spiral of worsening cardiac, vascular, and renal functions that may negatively impact patients' outcome. Anti-inflammatory treatment strategies aimed at attenuating end organ damage and improving clinical prognosis in the cardiorenal syndrome have been disappointing to date. A new therapeutic paradigm may be needed, which involves different anti-inflammatory strategies for individual etiologies and stages of CHF and CKD. It may also include specific (short-term) anti-inflammatory treatments that counteract inflammation during the unsettled phases of clinical decompensation. Finally, it will require greater focus on volume overload as an increasingly significant source of systemic inflammation in the cardiorenal syndrome.
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Affiliation(s)
- Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, College of Physicians and Surgeons, New York, NY, USA.
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Savic-Radojevic A, Radovanovic S, Pekmezovic T, Pljesa-Ercegovac M, Simic D, Djukic T, Matic M, Simic T. The role of serum VCAM-1 and TNF-α as predictors of mortality and morbidity in patients with chronic heart failure. J Clin Lab Anal 2013; 27:105-12. [PMID: 23349048 DOI: 10.1002/jcla.21570] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 12/14/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To assess the prognostic significance of four inflammatory markers (TNF-α, high sensitive C-reactive protein (hs-CRP), intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1)) in chronic heart failure (CHF) patients with respect to individual outcomes, especially disease exacerbation and mortality. METHODS Plasma adhesion molecules, ICAM-1, and VCAM-1, together with TNF-α and hs-CRP were determined in 120 CHF patients and 69 healthy controls. Endothelial function was also estimated by flow-mediated brachial artery dilatation. RESULTS Increased levels of all investigated inflammatory markers were found in CHF patients compared to controls, with the rise more pronounced in New York Heart association (NYHA) functional IV class. Significant correlations were obtained for VCAM-1 and brain natriuretic peptide (r = 0.191; P = 0.038), as well as, ICAM-1 and endothelium-dependent vasodilatation (r = -0.235; P = 0.01). Kaplan-Meier analysis showed disease exacerbation in patients with TNF-α levels >2.78 pg/ml significantly shorter compared to those with TNF-α levels <2.78 pg/ml (log-rank test = 8.270; P = 0.004), while similar association was observed for patients with hs-CRP levels >4.76 mg/l (log-rank test = 5.052; P = 0.025) and VCAM-1 levels >1200 ng/l (log-rank test = 5.45; P = 0.020) with respect to mortality. Cox regression analysis demonstrated only VCAM-1 (HR = 4.7; 95% confidence interval (CI): 1.1-18.7; P = 0.030) as independent death predictor, while TNF-α was associated with disease exacerbation (HR = 8.2; 95%CI: 1.1-23.0; P = 0.045). CONCLUSIONS VCAM-1 appears to be useful in risk stratification of CHF patients and in screening, to identify subjects at risk for heart failure related events.
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Affiliation(s)
- Ana Savic-Radojevic
- Institute of Medical and Clinical Biochemistry, Faculty of Medicine, University of Belgrade, Serbia
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Abstract
Understanding of chronic heart failure (HF) has progressed from a syndrome of disordered hemodynamics caused by alterations in the structure of the heart to one that involves intertwined molecular pathways in disarray. Accordingly, the assessment and treatment of patients with chronic HF has shifted from a focus on hemodynamics to modification of maladaptive molecular processes. Accumulating evidence shows that molecular biomarkers of disease could provide a unique window into the pathophysiology of chronic HF, potentially improving our ability to predict adverse outcomes, provide novel drug targets, and even help gauge therapeutic efficacy. The more 'traditional' biomarkers such as cardiac troponin, natriuretic peptides, and C-reactive protein have been studied in large cohorts of patients with chronic HF and have relatively established clinical applications. In this Review, we summarize the properties, clinical data, and potential applications of some emerging biomarkers that could uniquely indicate the level of biomechanical stretch, inflammation, ventricular remodeling, myocardial injury, and renal dysfunction that occurs in chronic HF. We will also discuss the potential role for these biomarkers within a multimarker-based strategy that could, in the future, lead to better care for these patients.
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The paradox of left ventricular assist device unloading and myocardial recovery in end-stage dilated cardiomyopathy: implications for heart failure in the elderly. Heart Fail Rev 2012; 17:615-33. [DOI: 10.1007/s10741-012-9300-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Rosner MH, Ronco C, Okusa MD. The Role of Inflammation in the Cardio-Renal Syndrome: A Focus on Cytokines and Inflammatory Mediators. Semin Nephrol 2012; 32:70-8. [DOI: 10.1016/j.semnephrol.2011.11.010] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Uehara Y, Azuma Y, Minai K, Yoshida H, Yoshimura M, Shimizu M. Endothelin-1 prolongs intracellular calcium transient decay in neonatal rat cardiac myocytes. Heart Vessels 2011; 27:98-105. [DOI: 10.1007/s00380-011-0133-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 03/04/2011] [Indexed: 01/08/2023]
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Jankowska EA, Filippatos GS, von Haehling S, Papassotiriou J, Morgenthaler NG, Cicoira M, Schefold JC, Rozentryt P, Ponikowska B, Doehner W, Banasiak W, Hartmann O, Struck J, Bergmann A, Anker SD, Ponikowski P. Identification of chronic heart failure patients with a high 12-month mortality risk using biomarkers including plasma C-terminal pro-endothelin-1. PLoS One 2011; 6:e14506. [PMID: 21264211 PMCID: PMC3022013 DOI: 10.1371/journal.pone.0014506] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Accepted: 12/15/2010] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES We hypothesised that assessment of plasma C-terminal pro-endothelin-1 (CT-proET-1), a stable endothelin-1 precursor fragment, is of prognostic value in patients with chronic heart failure (CHF), beyond other prognosticators, including N-terminal pro-B-type natriuretic peptide (NT-proBNP). METHODS We examined 491 patients with systolic CHF (age: 63±11 years, 91% men, New York Heart Association [NYHA] class [I/II/III/IV]: 9%/45%/38%/8%, 69% ischemic etiology). Plasma CT-proET-1 was detected using a chemiluminescence immunoassay. RESULTS Increasing CT-proET-1 was a predictor of increased cardiovascular mortality at 12-months of follow-up (standardized hazard ratio 1.42, 95% confidence interval [CI] 1.04-1.95, p = 0.03) after adjusting for NT-proBNP, left ventricular ejection fraction (LVEF), age, creatinine, NYHA class. In receiver operating characteristic curve analysis, areas under curve for 12-month follow-up were similar for CT-proET-1 and NT-proBNP (p = 0.40). Both NT-proBNP and CT-proET-1 added prognostic value to a base model that included LVEF, age, creatinine, and NYHA class. Adding CT-proET-1 to the base model had stronger prognostic power (p<0.01) than adding NT-proBNP (p<0.01). Adding CT-proET-1 to NT-proBNP in this model yielded further prognostic information (p = 0.02). CONCLUSIONS Plasma CT-proET-1 constitutes a novel predictor of increased 12-month cardiovascular mortality in patients with CHF. High CT-proET-1 together with high NT-proBNP enable to identify patients with CHF and particularly unfavourable outcomes.
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Affiliation(s)
- Ewa A Jankowska
- Department of Heart Diseases, Wroclaw Military Hospital, Wroclaw, Poland.
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Komukai K, O-Uchi J, Morimoto S, Kawai M, Hongo K, Yoshimura M, Kurihara S. Role of Ca(2+)/calmodulin-dependent protein kinase II in the regulation of the cardiac L-type Ca(2+) current during endothelin-1 stimulation. Am J Physiol Heart Circ Physiol 2010; 298:H1902-7. [PMID: 20304814 DOI: 10.1152/ajpheart.01141.2009] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Endothelin-1 (ET-1) shows a positive inotropic effect on cardiac muscle. Although the L-type Ca(2+) current (I(Ca)) is one of the important determinants of cardiac excitation-contraction coupling, the effect of ET-1 on the I(Ca) is not always clear. The controversial results appear to be due to different patch-clamp methods. The present study measured the effect of ET-1 on the I(Ca) of rat ventricular myocytes using the perforated patch-clamp technique. The holding potential was set to -40 mV, and depolarization was applied every 10 s. ET-1 (10 nM) increased the I(Ca) in a monophasic manner. The current reached a steady state 15 min after the application of ET-1, when the measurement was done. Endothelin receptor subtype expression was also investigated using Western immunoblotting. ET(A)-receptor protein was expressed, but ET(B)-receptor protein was not expressed, in the cell membranes of rat ventricular myocytes. The effect of ET-1 on the I(Ca) was inhibited by a selective ET(A)-receptor antagonist, BQ-123, but not by a selective ET(B)-receptor antagonist, BQ-788. The effect was inhibited by protein kinase C (PKC) inhibitor chelerythrine and Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) inhibitor KN-93, but not by its inactive analog KN-92. The effect of ET-1 was also blocked by another CaMKII inhibitor, autocamtide-2-related inhibitory peptide. These results suggest that ET-1 increases the I(Ca) via the ET(A)-receptor-PKC-CaMKII pathway.
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Affiliation(s)
- Kimiaki Komukai
- Division of Cardiology, The Jikei Univ. School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461 Japan.
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Zhao YT, Shao L, Teng LL, Hu B, Luo Y, Yu X, Zhang DF, Zhang H. Effects of n-3 Polyunsaturated Fatty Acid Therapy on Plasma Inflammatory Markers and N-Terminal Pro-brain Natriuretic Peptide in Elderly Patients with Chronic Heart Failure. J Int Med Res 2009; 37:1831-41. [PMID: 20146881 DOI: 10.1177/147323000903700619] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Several previous studies have suggested that n-3 polyunsaturated fatty acids ( n-3 PUFA) can exert favourable effects in patients with heart failure, but the mechanisms involved are not fully understood. This study was designed to investigate the effects of n-3 PUFA on circulating inflammatory markers and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with heart failure. Seventy-six patients with heart failure were randomly assigned to receive 2 g/day of n-3 PUFA or placebo for 3 months. Treatment with n-3 PUFA significantly decreased plasma levels of tumour necrosis factor, interleukin-6, intercellular adhesion molecule 1 and NT-proBNP. Left ventricular ejection fraction showed a small, non-significant improvement. High-sensitivity C-reactive protein levels decreased significantly in smokers after n-3 PUFA treatment. Thus, n-3 PUFA can reduce levels of plasma inflammatory markers and NT-proBNP as biomarkers of risk stratification in patients with heart failure. n-3 PUFA may offer a novel therapy for heart failure.
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Affiliation(s)
| | - L Shao
- Department of Gerontology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - LL Teng
- Department of Gerontology, Shanghai East Hospital, Tongji University, Shanghai, China
| | | | | | | | | | - H Zhang
- Department of Gerontology, Shanghai East Hospital, Tongji University, Shanghai, China
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von Haehling S, Schefold JC, Lainscak M, Doehner W, Anker SD. Inflammatory Biomarkers in Heart Failure Revisited: Much More than Innocent Bystanders. Heart Fail Clin 2009; 5:549-60. [DOI: 10.1016/j.hfc.2009.04.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Huang WP, Yin WH, Chen JW, Jen HL, Young MS, Lin SJ. Fenofibrate attenuates endothelial monocyte adhesion in chronic heart failure: an in vitro study. Eur J Clin Invest 2009; 39:775-83. [PMID: 19531154 DOI: 10.1111/j.1365-2362.2009.02176.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Inflammation is implicated in chronic heart failure (CHF). In this study, the potential inhibitory effect of peroxisome proliferator-activated receptor-alpha (PPARalpha) activator fenofibrate on monocyte adhesion in CHF patients was investigated in vitro. MATERIALS AND METHODS Isolated peripheral blood mononuclear cells (PBMCs) were collected from 36 patients (aged 65 +/- 8 years) with symptomatic CHF and from 12 healthy control subjects. The cultured human aortic endothelial cells (HAECs) were stimulated with or without 2 ng mL(-1) tumour necrosis factor-alpha (TNF-alpha) and the inhibitory effects of fenofibrate at 25, 50, 100 and 200 microM on endothelial mononuclear cell adhesion were tested. Furthermore, the HAECs were stimulated with 70% sera obtained from CHF patients and control individuals, respectively, with or without pretreatments with fenofibrate. The endothelial expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) was then confirmed by mRNA expression and Western blot. RESULTS We found that the increased adhesion of PBMCs to TNF-alpha-stimulated HAECs in CHF patients was reduced when the HAECs were pretreated with fenofibrate (31% inhibition, P = 0.0121). However, pretreatment of the isolated PBMCs collected from CHF patients with fenofibrate failed to suppress their adherence to TNF-alpha-stimulated HAECs. Furthermore, stimulation of cultured HAECs with CHF patient sera significantly increased VCAM-1 and ICAM-1 expression, which could also be inhibited by fenofibrate. CONCLUSIONS The fenofibrate directly inhibits monocyte binding by TNF-alpha-activated HAECs, probably through preventing up-regulation of cell adhesion molecules by endothelial cells in response to inflammatory stimuli. This PPARalpha activator may have the potential to ameliorate vascular inflammation in patients with CHF.
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Affiliation(s)
- W P Huang
- Division of Cardiology, Cheng-Hsin Rehabilitation Medical Centre, Taipei, Taiwan
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Clerico A, Vittorini S, Passino C, Emdin M. New and emerging biomarkers of heart failure. Crit Rev Clin Lab Sci 2009; 46:107-28. [DOI: 10.1080/10408360902722342] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bergamini C, Cicoira M, Rossi A, Vassanelli C. Oxidative stress and hyperuricaemia: pathophysiology, clinical relevance, and therapeutic implications in chronic heart failure. Eur J Heart Fail 2009; 11:444-52. [PMID: 19346534 DOI: 10.1093/eurjhf/hfp042] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Heart failure (HF) is a state of chronic deterioration of oxidative mechanisms due to enhanced oxidative stress and consequent subcellular alterations. In this condition, oxidant-producing enzymes, in particular xanthine oxidase (XO), the major cardiovascular source of reactive oxygen species (ROS), are up-regulated. Growing evidence shows that this impaired oxidative metabolism due to enhanced ROS release is implicated in the development of cardiac hypertrophy, myocardial fibrosis, left ventricular remodelling, and contractility impairment responsible for worsening of cardiac function in CHF. Uric acid (UA) has long been linked with cardiovascular diseases, and hyperuricaemia is a common finding in patients with CHF. Hyperuricaemia is associated with impairment of peripheral blood flow and reduced vasodilator capacity, which relate closely to clinical status and reduced exercise capacity. Recent studies also suggest an association between UA levels and parameters of diastolic function; more importantly, UA has emerged as a strong independent prognostic factor in patients with CHF. In this review, we describe the up-to-date experimental and clinical studies that have begun to test whether the inhibition of XO translates into meaningful beneficial pathophysiological changes. This treatment gives evidence that myocardial energy, endothelial dysfunction, and vasodilator reactivity to exercise are improved by reducing markers of oxidative stress responsible for vascular dysfunction, so it represents an interesting therapeutic alternative for better outcome in CHF patients.
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Affiliation(s)
- Corinna Bergamini
- Department of Biomedical and Surgical Sciences, Division of Cardiology, Ospedale Civile Maggiore, University of Verona, Piazzale Stefani 1, Verona, Italy
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The immune system and chronic heart failure: is the heart in control? J Am Coll Cardiol 2009; 53:1013-20. [PMID: 19298913 DOI: 10.1016/j.jacc.2008.11.046] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2008] [Revised: 10/09/2008] [Accepted: 11/02/2008] [Indexed: 11/21/2022]
Abstract
Despite current treatment options, the clinical course of patients with chronic heart failure is notoriously difficult to predict. Among those with similar etiologies, ejection fractions, and patient demographics, our understanding of why such variations in outcomes exist remains limited. Evidence that has been progressively gathered implicates an important role of the immune system in the propagation of heart failure. This has been derived mainly from observations that cytokines are progressively elevated in patients with poor outcomes. However, attempts at introducing various immunomodulatory therapies as a new treatment strategy have been largely unsuccessful to date. This possibly reflects a failure in recognizing the complexity of the immune system's role in chronic heart failure, which has led to an oversimplified approach to treatment. This review critically analyzes the immune treatments attempted to date and hypothesizes what is required to develop a successful future treatment strategy.
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Chrysohoou C, Pitsavos C, Barbetseas J, Kotroyiannis I, Brili S, Vasiliadou K, Papadimitriou L, Stefanadis C. Chronic systemic inflammation accompanies impaired ventricular diastolic function, detected by Doppler imaging, in patients with newly diagnosed systolic heart failure (Hellenic Heart Failure Study). Heart Vessels 2009; 24:22-6. [PMID: 19165564 DOI: 10.1007/s00380-008-1080-7] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2008] [Accepted: 06/06/2008] [Indexed: 12/14/2022]
Abstract
We sought to evaluate the relationship between plasma cytokine levels (sCD14, tumor necrosis factor [TNF]-alpha, and interleukin [IL]-6) and tissue Doppler derived indices of left ventricular systolic and diastolic function in patients with newly diagnosed heart failure. We enrolled 101 consecutive patients (mean age 65+/-13 years) with newly diagnosed heart failure who were hospitalized in our institute. Echocardiographic assessment was performed in all patients during the third day of their initial hospitalization. The pulsed tissue Doppler imaging (TDI) of the systolic and diastolic function of mitral annulus was characterized by the systolic wave Smv, and the diastolic waves: Emv and Amv. Left atrial kinetic energy (LAKE), an index of left atrial function, was calculated using the equation 1/2 x LASV x 1.06 x Amv(2); where LASV is left atrial systolic volume. Furthermore the ratio E/Emv and the flow propagation velocity were also calculated; where E is the rapid mitral filling wave, detected by pulse Doppler. Soluble plasma levels of CD14, TNF-alpha, and IL-6 were measured in all patients during their third day of hospitalization. Linear regression analysis, after adjustment for sex, age, left ventricular ejection function, body mass index, arterial hypertension, smoking, physical activity, creatinine clearance, diabetes mellitus, and blood lipid levels, revealed that IL-6 levels were inversely associated with LAKE (b= - 5422.4+/-2031.5, P=0.03), Sm (b= -0.375+/-0.1, P=0.03), and flow propagation (b= -5.404+/-0.621, P=0.001). CD14 levels were inversely associated with flow propagation (b = -17.655+/-2.6, P=0.001), and positively associated with E/Emv ratio (b=2.58+/-3.6, P=0.002) and A/Amv ratio (b=0.629+/-0.6, P=0.04). TNF-alpha was inversely associated with Smv (b-1.189+/-0.3, P=0.005). This study reveals that increased plasma levels of CD14, IL-6 and TNF-alpha are associated with impaired left atrial function and more advanced left ventricular diastolic and systolic dysfunction, in patients with newly diagnosed heart failure.
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Affiliation(s)
- Christina Chrysohoou
- First Cardiology Clinic, Hippokratio Hospital, University of Athens, Athens, Greece.
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Comellas AP, Briva A, Dada LA, Butti ML, Trejo HE, Yshii C, Azzam ZS, Litvan J, Chen J, Lecuona E, Pesce LM, Yanagisawa M, Sznajder JI. Endothelin-1 impairs alveolar epithelial function via endothelial ETB receptor. Am J Respir Crit Care Med 2008; 179:113-22. [PMID: 18948426 DOI: 10.1164/rccm.200804-540oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RATIONALE Endothelin-1 (ET-1) is increased in patients with high-altitude pulmonary edema and acute respiratory distress syndrome, and these patients have decreased alveolar fluid reabsorption (AFR). OBJECTIVES To determine whether ET-1 impairs AFR via activation of endothelial cells and nitric oxide (NO) generation. METHODS Isolated perfused rat lung, transgenic rats deficient in ETB receptors, coincubation of lung human microvascular endothelial cells (HMVEC-L) with rat alveolar epithelial type II cells or A549 cells, ouabain-sensitive 86Rb+ uptake. MEASUREMENTS AND MAIN RESULTS The ET-1-induced decrease in AFR was prevented by blocking the endothelin receptor ETB, but not ETA. Endothelial-epithelial cell interaction is required, as direct exposure of alveolar epithelial cells (AECs) to ET-1 did not affect Na,K-ATPase function or protein abundance at the plasma membrane, whereas coincubation of HMVEC-L and AECs with ET-1 decreased Na,K-ATPase activity and protein abundance at the plasma membrane. Exposing transgenic rats deficient in ETB receptors in the pulmonary vasculature (ET-B(-/-)) to ET-1 did not decrease AFR or Na,K-ATPase protein abundance at the plasma membrane of AECs. Exposing HMVEC-L to ET-1 led to increased NO, and the ET-1-induced down-regulation of Na,K-ATPase was prevented by the NO synthase inhibitor l-NAME, but not by a guanylate cyclase inhibitor. CONCLUSIONS We provide the first evidence that ET-1, via an endothelial-epithelial interaction, leads to decreased AFR by a mechanism involving activation of endothelial ETB receptors and NO generation leading to alveolar epithelial Na,K-ATPase down-regulation in a cGMP-independent manner.
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Affiliation(s)
- Alejandro P Comellas
- Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Tsutamoto T, Tanaka T, Sakai H, Nishiyama K, Fujii M, Yamamoto T, Nakae I, Ohnishi M, Wada A, Horie M. Beneficial effect of perindopril on cardiac sympathetic nerve activity and brain natriuretic peptide in patients with chronic heart failure: comparison with enalapril. Circ J 2008; 72:740-6. [PMID: 18441453 DOI: 10.1253/circj.72.740] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In patients with chronic heart failure (CHF), it remains unclear whether perindopril is more cardioprotective than enalapril. METHODS AND RESULTS Forty-five stable CHF outpatients undergoing conventional therapy including enalapril therapy were randomized to 2 groups [group I (n=24): continuous enalapril treatment; group II (n=21): enalapril was changed to perindopril]. Cardiac sympathetic nerve activity was evaluated using cardiac 123I-metaiodobenzylguanidine (MIBG) scintigraphy, hemodynamic parameters and neurohumoral factors before and 6 months after treatment. There was no difference in baseline characteristics between the 2 groups. In group I, there were no changes in MIBG parameters, left ventricular ejection fraction (LVEF) or plasma level of brain natriuretic peptide (BNP). In contrast, in group II the delayed heart/mediastinum count ratio was significantly increased (2.0+/-0.07 vs 2.15+/-0.07, p=0.013) and the washout rate was significantly decreased (33.0+/-1.4 vs 30.5+/-1.2, p=0.030) after 6 months compared with the baseline value. In addition, LVEF was significantly increased and the plasma BNP level was significantly decreased. CONCLUSION These findings suggest that for the treatment of CHF, perindopril is superior to enalapril with respect of cardiac sympathetic nerve activity and BNP.
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Affiliation(s)
- Takayoshi Tsutamoto
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
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Yin WH, Chen JW, Young MS, Lin SJ. Increased endothelial monocyte adhesiveness is related to clinical outcomes in chronic heart failure. Int J Cardiol 2007; 121:276-83. [PMID: 17188380 DOI: 10.1016/j.ijcard.2006.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 11/02/2006] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vascular inflammation and endothelial dysfunction are evident in patients with chronic heart failure (CHF). We hypothesized that circulating peripheral blood mononuclear cells (PBMCs) may be activated and the resultant increased endothelial monocyte adhesion may be functionally and pathophysiologically relevant in CHF. In the present study, we investigated the clinical significance of the activity of PBMCs in patients with CHF. METHODS PBMCs were isolated from 34 CHF patients, from 10 healthy volunteers (normal control group) and from 17 patients admitted for investigation of suspected coronary artery disease (disease control group). In each patient, the adhesiveness of PBMCs to cultured human aortic endothelial cells (HAECs) with or without tumor necrosis factor-alpha (TNF-alpha) stimulation was determined. Major adverse cardiac events (death, heart transplantation or hospitalization with worsening heart failure) were determined in the 34 CHF patients during a median follow-up period of 182 days. RESULTS Compared with those from both control groups and from mild CHF patients, PBMCs isolated from severe CHF patients adhered more to the HAECs. The endothelial adhesiveness of PBMCs correlated positively with the circulating levels of CAMs and can supply prognostic information in CHF patients. The difference between event-free curves based on the median levels of endothelial-PBMC adhesion was significant (log rank test, p=0.0139). CONCLUSIONS Endothelial adhesiveness of PBMCs is increased and correlated to clinical outcomes, and may be pathophysiologically relevant to the progression of CHF.
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Affiliation(s)
- Wei-Hsian Yin
- Division of Cardiology, Department of Internal Medicine, Cheng-Hsin Rehabilitation Medical Center, Taipei-Veterans General Hospital, Taiwan
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Tan LH, Jefferies JL, Liang JF, Denfield SW, Dreyer WJ, Mott AR, Grenier MA, Dickerson HA, Price JF, Towbin JA, Ou CN, Chang AC. Concentrations of brain natriuretic peptide in the plasma predicts outcomes of treatment of children with decompensated heart failure admitted to the Intensive Care unit. Cardiol Young 2007; 17:397-406. [PMID: 17572924 DOI: 10.1017/s1047951107000601] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES It is known that levels of brain natriuretic peptide predict outcomes of treatment for adults with decompensated heart failure. We hypothesized that it could predict outcomes in children with this condition. METHODS We divided retrospectively 82 patients with serial measurements of brain natriuretic peptide into 3 groups: those who survived and did not need readmission within less than 60 days; those who survived but needed readmission within less than 60 days; and those who died in hospital or within less than 60 days. Initial and final levels of the peptide correlated with adverse outcomes. RESULTS The percent change in level of the peptide was minus 78 percent, minus 38 percent, and 138 percent in the readmission-free group, the readmitted, and nonsurviving groups, respectively. Final levels were significantly lower in the readmission-free group than in the readmitted and nonsurviving groups (p equals 0.013 and p is less than 0.00001, respectively) and in the readmitted group than in the nonsurvivors (p equals 0.013). On univariate analysis, the final level, the change in level, and the percentage change in level significantly predicted outcomes (p equals 0.0002, 0.0072 and 0.0005, respectively). On multivariate analysis, only the final level of the peptide significantly predicted outcomes (p equals 0.01). CONCLUSIONS A final level of brain natriuretic peptide of greater than or equal to 760 picograms per millilitre strongly predicted an adverse outcome. Patients with higher final levels may be at higher risk of death and readmission, suggesting that this variable effectively predicts the response to treatment and prognosis in children with heart failure.
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Affiliation(s)
- Lin-Hua Tan
- Department of Surgical Intensive Care Unit, Children's Hospital College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Abstract
We have compiled from literature and other sources a list of 1261 proteins believed to be differentially expressed in human cancer. These proteins, only some of which have been detected in plasma to date, represent a population of candidate plasma biomarkers that could be useful in early cancer detection and monitoring given sufficiently sensitive specific assays. We have begun to prioritize these markers for future validation by frequency of literature citations, both total and as a function of time. The candidates include proteins involved in oncogenesis, angiogenesis, development, differentiation, proliferation, apoptosis, hematopoiesis, immune and hormonal responses, cell signaling, nucleotide function, hydrolysis, cellular homing, cell cycle and structure, the acute phase response and hormonal control. Many have been detected in studies of tissue or nuclear components; nevertheless we hypothesize that most if not all should be present in plasma at some level. Of the 1261 candidates only 9 have been approved as "tumor associated antigens" by the FDA. We propose that systematic collection and large-scale validation of candidate biomarkers would fill the gap currently existing between basic research and clinical use of advanced diagnostics.
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Affiliation(s)
- Malu Polanski
- The Plasma Proteome Institute, P.O. Box: 53450, Washington DC, 20009-3450, USA
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Masson S, Latini R, Anand IS, Barlera S, Judd D, Salio M, Perticone F, Perini G, Tognoni G, Cohn JN. The prognostic value of big endothelin-1 in more than 2,300 patients with heart failure enrolled in the Valsartan Heart Failure Trial (Val-HeFT). J Card Fail 2006; 12:375-80. [PMID: 16762801 DOI: 10.1016/j.cardfail.2006.02.013] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2005] [Revised: 12/22/2005] [Accepted: 02/27/2006] [Indexed: 12/16/2022]
Abstract
BACKGROUND Endothelin is elevated in heart failure and contributes to neurohormonal activation, hemodynamic deterioration, and cardiovascular remodeling. Here, we examined its prognostic value in a large population of patients with chronic heart failure. METHODS AND RESULTS Big endothelin-1 (Big ET-1) and 4 other neurohormones were measured at study entry in 2359 patients enrolled in the Valsartan Heart Failure Trial (Val-HeFT) and their concentrations related to outcome over a median follow-up of 23 months. Baseline concentration of Big ET-1 (median 0.80 pmol/L) was proportional to severity of disease (New York Heart Association class, left ventricular structure and function). High circulating concentrations of brain natriuretic peptide (BNP), creatinine and bilirubin, advanced New York Heart Association class, elevated body mass index, and the presence of atrial fibrillation were independently associated to higher concentrations of Big ET-1. Big ET-1 (ranking second just behind BNP among neurohormonal factors) was an independent predictor of outcome defined as all-cause mortality (hazard ratio 1.49, 95% CI 1.20-1.84, P = .0003) or the combined endpoint of mortality and morbidity (hazard ratio 1.43, 95% CI 1.20-1.69, P < .0001) and provided incremental prognostic value compared with BNP. CONCLUSIONS In a large population of patients with symptomatic heart failure, the circulating concentration of Big ET-1, a precursor of the paracrine and bioactive peptide ET-1, was an independent marker of mortality and morbidity. In this setting, BNP remained the strongest neurohormonal prognostic factor.
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Affiliation(s)
- Serge Masson
- Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
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Motte S, McEntee K, Naeije R. Endothelin receptor antagonists. Pharmacol Ther 2006; 110:386-414. [PMID: 16219361 DOI: 10.1016/j.pharmthera.2005.08.012] [Citation(s) in RCA: 110] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2005] [Accepted: 08/23/2005] [Indexed: 01/08/2023]
Abstract
Endothelin receptor antagonists (ERAs) have been developed to block the effects of endothelin-1 (ET-1) in a variety of cardiovascular conditions. ET-1 is a powerful vasoconstrictor with mitogenic or co-mitogenic properties, which acts through the stimulation of 2 subtypes of receptors [endothelin receptor subtype A (ETA) and endothelin receptor subtype B (ETB) receptors]. Endogenous ET-1 is involved in a variety of conditions including systemic and pulmonary hypertension (PH), congestive heart failure (CHF), vascular remodeling (restenosis, atherosclerosis), renal failure, cancer, and cerebrovascular disease. The first dual ETA/ETB receptor blocker, bosentan, has already been approved by the Food and Drug Administration for the treatment of pulmonary arterial hypertension (PAH). Trials of endothelin receptor antagonists in heart failure have been completed with mixed results so far. Studies are ongoing on the effects of selective ETA antagonists or dual ETA/ETB antagonists in lung fibrosis, cancer, and subarachnoid hemorrhage. While non-peptidic ET-1 receptor antagonists suitable for oral intake with excellent bioavailability have become available, proven efficacy is limited to pulmonary hypertension, but it is possible that these agents might find a place in the treatment of several cardiovascular and non-cardiovascular diseases in the coming future.
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Affiliation(s)
- Sophie Motte
- Laboratory of Physiology (CP-604), Free University Brussels, Erasmus Campus, Lennik Road 808, B-1070 Brussels, Edmonton, Canada
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Ishikawa C, Tsutamoto T, Wada A, Fujii M, Ohno K, Sakai H, Yamamoto T, Horie M. Inhibition of aldosterone and endothelin-1 by carperitide was attenuated with more than 1 week of infusion in patients with congestive heart failure. J Cardiovasc Pharmacol 2006; 46:513-8. [PMID: 16160606 DOI: 10.1097/01.fjc.0000177980.83810.2e] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Short-term infusion of carperitide (atrial natriuretic peptide) has beneficial effects on neurohumoral factors; however, it remains unclear whether the effects are sustained for long-term infusion. To evaluate the effects of long-term infusion of carperitide on neurohumoral factors in patients with chronic congestive heart failure (CHF), we measured neurohumoral factors before and 1 hour after stopping carperitide infusion in 42 CHF patients. Carperitide infusion was continued for more than 2 days until there was symptomatic improvement of CHF. Patients were divided into 2 groups by the median value of infusion duration: group 1 (less than 7 days, n=21) and group 2 (more than 7 days, n=21). In group 1, aldosterone (ALD) and endothelin-1 (ET-1) were significantly increased after stopping carperitide. In contrast, ALD and ET-1 did not change after stopping carperitide in group 2. The molar ratio of cyclic guanosine monophosphate/atrial natriuretic peptide before stopping carperitide was significantly lower in group 2 than in group 1. Suppression of ALD and ET-1 was maintained for 7 days of carperitide infusion, but the beneficial effect on neurohumoral factors was attenuated after more than 7 days, probably through down-regulation of biologic receptors coupled with guanylate cyclase in CHF patients.
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Affiliation(s)
- Chitose Ishikawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Tsukinowa, Seta, Otsu 520-2192, Japan
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Flevari P, Theodorakis G, Paraskevaidis I, Kolokathis F, Kostopoulou A, Leftheriotis D, Kroupis C, Livanis E, Kremastinos DT. Coronary and peripheral blood flow changes following biventricular pacing and their relation to heart failure improvement. ACTA ACUST UNITED AC 2006; 8:44-50. [PMID: 16627408 DOI: 10.1093/europace/euj015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS To study the effect of cardiac resynchronization therapy (CRT) on coronary and peripheral arterial circulation and to assess whether their changes are related to the improvement in patients' functional capacity and prognostically important biochemical markers. METHODS AND RESULTS Twenty-five patients were studied (New York Heart Association classes III and IV, left ventricular ejection fraction <35%, QRS>120 ms, mean age 66 +/- 2.1 years). Coronary blood flow (CBF), forearm blood flow (FBF), and their reserve were measured by transoesophageal echocardiography (in cm/s) and venous occlusion plethysmography (in mL/100 mL/min) at baseline and following 3 months of CRT. N-terminal-pro-brain natriuretic peptide (Nt-pro-BNP) and serum adhesion molecules, sICAM-1 and sVCAM-1 levels were also assessed. CRT induced a non-significant increase in resting CBF (baseline vs. CRT: 52.1 +/- 5.5 vs. 58.2 +/- 3.6, P: NS), whereas hyperaemic CBF was increased by CRT (baseline vs. CRT: 67.8 +/- 6.8 vs. 79.8 +/- 6.2, P < 0.05). Significant increases were observed in resting FBF (baseline vs. CRT: 1.6 +/- 0.2 vs. 2.6 +/- 0.2, P < 0.05) and hyperaemic FBF (baseline vs. CRT: 2.1 +/- 0.2 vs. 3.2 +/- 0.3, P < 0.05). The per cent difference in hyperaemic FBF was related to the per cent change in Nt-pro-BNP (r = -0.71, P < 0.05) and the per cent improvement in exercise duration (r = 0.80, P < 0.05). CONCLUSION CRT induces favourable changes in coronary and peripheral arterial function. Changes in peripheral blood flow are related to patients' improvement and may be prognostically significant.
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Affiliation(s)
- Panayota Flevari
- 2nd Cardiac Clinic, Onassis Cardiac Surgery Center, Sygrou 356, Athens, Greece.
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Garcia S, Chirinos J, Jimenez J, Del Carpio Muñoz F, Canoniero M, Jy W, Jimenez J, Horstman L, Ahn Y. Phenotypic assessment of endothelial microparticles in patients with heart failure and after heart transplantation: switch from cell activation to apoptosis. J Heart Lung Transplant 2005; 24:2184-9. [PMID: 16364869 DOI: 10.1016/j.healun.2005.07.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2005] [Revised: 07/04/2005] [Accepted: 07/13/2005] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Endothelial microparticles (EMPs) are sub-microscopic membrane vesicles that are shed from the surface of endothelial cells during activation, injury and/or apoptosis. Endothelial cells release phenotypically and quantitatively distinct endothelial microparticles (EMPs) in activation and apoptosis. Therefore, the phenotypic assessment of EMPs can provide useful information reflecting the nature of endothelial injury. We tested the hypothesis that heart transplantation (HT) modifies the pattern of endothelial injury seen in patients with congestive heart failure (CHF). METHODS Flow cytometry was used to measure EMPs identified by E-selectin (CD62) and platelet-endothelial cell adhesion molecule 1 (CD31) in 23 patients with advanced heart failure and in 23 HT recipients. A cohort of 23 healthy individuals served as controls. RESULTS Heart failure patients were found to have significantly higher levels of EMP62E (577 counts/microl) than controls (192 counts/microl) and post-transplant patients (152 counts/microl) (p < 0.0001). Levels of endothelial microparticles expressing CD31 were significantly different among study groups (analysis of variance [ANOVA], p = 0.001). Heart failure patients had significantly higher levels (1,526 counts/microl) than controls (395 counts/microl) (p < 0.01). Levels of EMP31 remained elevated after heart transplant (935 counts/microl) (p = non-significant). The EMP62/EMP31 ratio, an index of activation (high ratio) or apoptosis (low ratio), was significantly different between the groups (ANOVA, p = 0.01). Post-transplant patients had significantly lower ratios (0.16) than CHF patients (0.38) and controls (0.49). CONCLUSIONS Cardiac transplantation is associated with a different pattern of endothelial cell injury than that seen in heart failure. The phenotypic assessment of EMPs in post-transplant patients is consistent with increased apoptotic activity.
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Affiliation(s)
- Santiago Garcia
- Division of Cardiology, Department of Internal Medicine, University of Miami, Leonard M. Miller School of Medicine, Miami, Florida 33016, USA.
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Delfino RJ, Sioutas C, Malik S. Potential role of ultrafine particles in associations between airborne particle mass and cardiovascular health. ENVIRONMENTAL HEALTH PERSPECTIVES 2005; 113:934-46. [PMID: 16079061 PMCID: PMC1280331 DOI: 10.1289/ehp.7938] [Citation(s) in RCA: 446] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Numerous epidemiologic time-series studies have shown generally consistent associations of cardiovascular hospital admissions and mortality with outdoor air pollution, particularly mass concentrations of particulate matter (PM) < or = 2.5 or < or = 10 microm in diameter (PM2.5, PM10). Panel studies with repeated measures have supported the time-series results showing associations between PM and risk of cardiac ischemia and arrhythmias, increased blood pressure, decreased heart rate variability, and increased circulating markers of inflammation and thrombosis. The causal components driving the PM associations remain to be identified. Epidemiologic data using pollutant gases and particle characteristics such as particle number concentration and elemental carbon have provided indirect evidence that products of fossil fuel combustion are important. Ultrafine particles < 0.1 microm (UFPs) dominate particle number concentrations and surface area and are therefore capable of carrying large concentrations of adsorbed or condensed toxic air pollutants. It is likely that redox-active components in UFPs from fossil fuel combustion reach cardiovascular target sites. High UFP exposures may lead to systemic inflammation through oxidative stress responses to reactive oxygen species and thereby promote the progression of atherosclerosis and precipitate acute cardiovascular responses ranging from increased blood pressure to myocardial infarction. The next steps in epidemiologic research are to identify more clearly the putative PM casual components and size fractions linked to their sources. To advance this, we discuss in a companion article (Sioutas C, Delfino RJ, Singh M. 2005. Environ Health Perspect 113:947-955) the need for and methods of UFP exposure assessment.
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Affiliation(s)
- Ralph J Delfino
- Epidemiology Division, Department of Medicine, University of California, Irvine, Irvine, California 92697-7550, USA.
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Abstract
PURPOSE OF REVIEW This paper reviews recent advances in heart failure biomarkers for identification of disease precursors, subclinical disease, and onset or progression of overt disease. RECENT FINDINGS Heart failure biomarkers can be categorized empirically as neurohormonal mediators, markers of myocyte injury and remodeling, and indicators of systemic inflammation. Brain natriuretic peptide is the most widely studied, with a potentially important but evolving role for determining prognosis and as a surrogate endpoint in clinical trials. Strong evidence exists for use of brain natriuretic peptide in the diagnosis of acute heart failure and for improved clinical outcomes with a brain natriuretic peptide-guided approach to heart failure care. The use of brain natriuretic peptide as a screening tool for asymptomatic left ventricular systolic dysfunction, or to distinguish systolic from diastolic heart failure, is not supported by current data. Markers of myocyte injury, including troponins, heart-type fatty acid binding protein, and myosin light chain-1, may further improve heart failure prognostication in conjunction with plasma brain natriuretic peptide. Biomarkers of matrix remodeling and inflammation have emerged as potential preclinical indicators to identify individuals at risk of developing clinical heart failure. A role for cellular adhesion molecules may also emerge in identifying those at risk for cardiovascular thrombotic complications, such as stroke. SUMMARY The spectrum of heart failure biomarkers and their potential clinical applications continues to grow. Ongoing research on multimarker strategies will likely identify biomarker combinations that are optimal at various stages during the evolution of heart failure, ranging from their use for screening, diagnosis, determining prognosis, and guiding management.
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Affiliation(s)
- Douglas S Lee
- National Heart, Lung and Blood Institutes, Framingham Heart Study, Framingham, MA 01702-5827, USA
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Anderson L. Candidate-based proteomics in the search for biomarkers of cardiovascular disease. J Physiol 2005; 563:23-60. [PMID: 15611012 PMCID: PMC1665562 DOI: 10.1113/jphysiol.2004.080473] [Citation(s) in RCA: 266] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2004] [Accepted: 12/16/2004] [Indexed: 11/08/2022] Open
Abstract
The key concept of proteomics (looking at many proteins at once) opens new avenues in the search for clinically useful biomarkers of disease, treatment response and ageing. As the number of proteins that can be detected in plasma or serum (the primary clinical diagnostic samples) increases towards 1000, a paradoxical decline has occurred in the number of new protein markers approved for diagnostic use in clinical laboratories. This review explores the limitations of current proteomics protein discovery platforms, and proposes an alternative approach, applicable to a range of biological/physiological problems, in which quantitative mass spectrometric methods developed for analytical chemistry are employed to measure limited sets of candidate markers in large sets of clinical samples. A set of 177 candidate biomarker proteins with reported associations to cardiovascular disease and stroke are presented as a starting point for such a 'directed proteomics' approach.
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Katayama T, Yano K, Nakashima H, Takagi C, Honda Y, Suzuki S, Iwasaki Y. Clinical Significance of Acute-Phase Endothelin-1 in Acute Myocardial Infarction Patients Treated With Direct Coronary Angioplasty. Circ J 2005; 69:654-8. [PMID: 15914941 DOI: 10.1253/circj.69.654] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The aim of the present study was to investigate the relationship between plasma concentrations of endothelin (ET)-1 and clinical outcome (including mortality) and left ventricular (LV) systolic function in acute myocardial infarction (AMI). METHODS AND RESULTS The study group comprised 110 consecutive first-AMI patients who were successfully reperfused by primary coronary intervention. Plasma ET-1 concentrations were evaluated 24 h from onset and the patients were divided into 2 groups according to the median value, either a high group (H group: > or = 2.90 pg/ml plasma ET-1; n = 55) or low group (L group: < 2.90 pg/ml plasma ET-1; n = 55). Major complications and LV systolic function were monitored in the 2 groups. Both highly sensitive C-reactive protein (hs-CRP) and brain natriuretic peptide (BNP) showed a significant positive correlation with ET-1 (BNP: r = 048, p < 0.0001, hs-CRP: r = 0.43, p < 0.001). Chronic stage left ventricular ejection fraction (LVEF) and left ventricular end-diastolic volume index (LVEDVI) were significantly poorer in the H group (LVEF: 51+/-15% vs 60+/-13%, p = 0.003, LVEDVI: 74+/-19 ml/m2 vs 66+/-14 ml/m2, p < 0.05). There were significantly more major complications in the H group than in the L group (cardiogenic shock: 18% vs 5%, p = 0.04; cardiac death: 13% vs 0%, p < 0.01). CONCLUSIONS In the setting of AMI, plasma ET-1 concentrations may be closely related to LV systolic dysfunction and poor patient outcome, including mortality.
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Affiliation(s)
- Toshiro Katayama
- Department of Cardiovascular Medicine and Course of Medical and Dental Science, Graduate School of Biomedical Science, Nagasaki University, Nagasaki, Japan.
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