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Tang J, Wang P, Liu C, Peng J, Liu Y, Ma Q. Pharmacotherapy in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis. Chin Med J (Engl) 2024:00029330-990000000-01087. [PMID: 38811344 DOI: 10.1097/cm9.0000000000003118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Angiotensin receptor neprilysin inhibitors (ARNIs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers (BBs), and mineralocorticoid receptor antagonists (MRAs) are the cornerstones in treating heart failure with reduced ejection fraction (HFrEF). Sodium-glucose cotransporter 2 inhibitors (SGLT-2is) are included in HFrEF treatment guidelines. However, the effect of SGLT-2i and the five drugs on HFrEF have not yet been systematically evaluated. METHODS PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials (RCTs) from inception dates to September 23, 2022. Additional trials from previous relevant reviews and references were also included. The primary outcomes were changes in left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter/dimension (LVEDD), left ventricular end-systolic diameter/dimension (LVESD), left ventricular end-diastolic volume (LVEDV), and left ventricular end-systolic volume (LVESV), left ventricular end-systolic volume index (LVESVI), and left ventricular end-diastolic volume index (LVEDVI). Secondary outcomes were New York Heart Association (NYHA) class, 6-min walking distance (6MWD), B-type natriuretic peptide (BNP) level, and N-terminal pro-BNP (NT-proBNP) level. The effect sizes were presented as the mean difference (MD) with 95% confidence interval (CI). RESULTS We included 68 RCTs involving 16,425 patients. Compared with placebo, ARNI + BB + MRA + SGLT-2i was the most effective combination to improve LVEF (15.63%, 95% CI: 9.91% to 21.68%). ARNI + BB + MRA + SGLT-2i (5.83%, 95% CI: 0.53% to 11.14%) and ARNI + BB + MRA (3.83%, 95% CI: 0.72% to 6.90%) were superior to the traditional golden triangle "ACEI + BB + MRA" in improving LVEF. ACEI + BB + MRA + SGLT-2i was better than ACEI + BB + MRA (-8.05 mL/m2, 95% CI: -14.88 to -1.23 mL/m2) and ACEI + BB + SGLT-2i (-18.94 mL/m2, 95% CI: -36.97 to -0.61 mL/m2) in improving LVEDVI. ACEI + BB + MRA + SGLT-2i (-3254.21 pg/mL, 95% CI: -6242.19 to -560.47 pg/mL) was superior to ARB + BB + MRA in reducing NT-proBNP. CONCLUSIONS Adding SGLT-2i to ARNI/ACEI + BB + MRA is beneficial for reversing cardiac remodeling. The new quadruple drug "ARNI + BB + MRA + SGLT-2i" is superior to the golden triangle "ACEI + BB + MRA" in improving LVEF. REGISTRATION PROSPERO; No. CRD42022354792.
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Affiliation(s)
- Jia Tang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Ping Wang
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Chenxi Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Jia Peng
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Yubo Liu
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
| | - Qilin Ma
- Department of Cardiovascular Medicine, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan 410008, China
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2
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Dean M, Kim MJ, Dimauro S, Tannenbaum S, Graham G, Liang BT, Kim AS. Cardiac and noncardiac biomarkers in patients undergoing anthracycline chemotherapy - a prospective analysis. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:23. [PMID: 37106424 PMCID: PMC10133897 DOI: 10.1186/s40959-023-00174-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Biomarkers represent a potential tool to identify individuals at risk for anthracycline-induced cardiotoxicity (AICT) prior to symptom onset or left ventricular dysfunction. METHODS This study examined the levels of cardiac and noncardiac biomarkers before, after the last dose of, and 3-6 months after completion of doxorubicin chemotherapy. Cardiac biomarkers included 5th generation high-sensitivity cardiac troponin T (cTnT), N-terminal pro-brain natriuretic peptide, growth/differentiation factor-15 (GDF-15), and soluble suppression of tumorigenesis-2 (sST2). Noncardiac biomarkers included activated caspase-1 (CASP-1), activated caspase-3, C-reactive protein, tumor necrosis factor-α, myeloperoxidase (MPO), galectin-3, and 8-hydroxy-2'-deoxyguanosine. Echocardiographic data (LVEF and LVGLS) were obtained at pre- and post-chemotherapy. Subanalysis examined interval changes in biomarkers among high (cumulative doxorubicin dose ≥ 250 mg/m2) and low exposure groups. RESULTS The cardiac biomarkers cTnT, GDF-15, and sST2 and the noncardiac biomarkers CASP-1 and MPO demonstrated significant changes over time. cTnT and GDF-15 levels increased after anthracycline exposure, while CASP-1 and MPO decreased significantly. Subanalysis by cumulative dose did not demonstrate a larger increase in any biomarker in the high-dose group. CONCLUSIONS The results identify biomarkers with significant interval changes in response to anthracycline therapy. Further research is needed to understand the clinical utility of these novel biomarkers.
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Affiliation(s)
- Matthew Dean
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
- Virginia Commonwealth University Health System Internal Medicine Residency, 1101 E. Marshall St, Richmond, VA, 23298, USA
| | - Min Jung Kim
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
- Pat and Jim Calhoun Cardiology Center, UConn Health, 300 UConn Health Boulevard, Farmington, CT, USA
| | - Sharon Dimauro
- Pat and Jim Calhoun Cardiology Center, UConn Health, 300 UConn Health Boulevard, Farmington, CT, USA
| | - Susan Tannenbaum
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
- Carole & Ray Neag Comprehensive Cancer Center, UConn Health, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Garth Graham
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
| | - Bruce T Liang
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA
- Pat and Jim Calhoun Cardiology Center, UConn Health, 300 UConn Health Boulevard, Farmington, CT, USA
| | - Agnes S Kim
- Department of Medicine, Calhoun Cardiology Center, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, 06030, USA.
- Pat and Jim Calhoun Cardiology Center, UConn Health, 300 UConn Health Boulevard, Farmington, CT, USA.
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3
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Bertomeu-Gonzalez V, Moreno-Arribas J, Heras S, Fernandez-Ortiz N, Cazorla D, Quintanilla MA, Lopez-Ayala JM, Facila L, Zuazola P, Cordero A. Increased Risk of Heart Failure in Elderly Patients Treated with Beta-Blockers After AV Node Ablation. Am J Cardiovasc Drugs 2023; 23:157-164. [PMID: 36652190 PMCID: PMC10006059 DOI: 10.1007/s40256-022-00566-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/28/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Controversy exists regarding the indication of beta-blockers (BB) in different scenarios in patients with cardiovascular disease. We sought to evaluate the effect of BB on survival and heart failure (HF) hospitalizations in a sample of pacemaker-dependent patients after AV node ablation to control ventricular rate for atrial tachyarrhythmias. METHODS A retrospective study including consecutive patients that underwent AV node ablation was conducted in a single center between 2011 and 2019. The study's primary endpoints were the incidence of all-cause mortality, first HF hospitalization and the cumulative incidence of subsequent hospitalizations for HF. Competing risk analyses were employed. RESULTS A total of 111 patients with a mean age of 73.9 years were included in the study. After a median follow-up of 45.5 months, 43 patients had died (38.7%) and 31 had been hospitalized for HF (27.9%). The recurrent HF hospitalization rate was 74/1000 patients/year. Patients treated with BB had a non-significant trend to higher mortality rates and a higher risk of recurrent HF hospitalizations (incidence rate ratio 2.23, 95% confidence interval 1.12-4.44; p = 0.023). CONCLUSION After an AV node ablation, the use of BB is associated with an increased risk of HF hospitalizations in a cohort of elderly patients.
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Affiliation(s)
- Vicente Bertomeu-Gonzalez
- Cardiology Department, Hospital Clinica Benidorm, Benidorm, Spain.
- Department of Clinical Medicine, Miguel Hernandez University, Universidad Miguel Hernández de Elche, Ctra Valencia-Alicante S/N, 03550, San Juan de Alicante, Alicante, Spain.
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Jose Moreno-Arribas
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Santiago Heras
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Nerea Fernandez-Ortiz
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Diego Cazorla
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - María Amparo Quintanilla
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Jose Maria Lopez-Ayala
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Lorenzo Facila
- Cardiology Department, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
- Universitat de Valencia, Valencia, Spain
| | - Pilar Zuazola
- Department of Clinical Medicine, Miguel Hernandez University, Universidad Miguel Hernández de Elche, Ctra Valencia-Alicante S/N, 03550, San Juan de Alicante, Alicante, Spain
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
| | - Alberto Cordero
- Department of Clinical Medicine, Miguel Hernandez University, Universidad Miguel Hernández de Elche, Ctra Valencia-Alicante S/N, 03550, San Juan de Alicante, Alicante, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Hospital Universitario de San Juan de Alicante, San Juan de Alicante, Alicante, Spain
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4
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Fan Y, Khan NH, Farhan Ali Khan M, Ahammad MDF, Zulfiqar T, Virk R, Jiang E. Association of Hypertension and Breast Cancer: Antihypertensive Drugs as an Effective Adjunctive in Breast Cancer Therapy. Cancer Manag Res 2022; 14:1323-1329. [PMID: 35392356 PMCID: PMC8982807 DOI: 10.2147/cmar.s350854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/25/2022] [Indexed: 11/23/2022] Open
Abstract
Breast cancer (BC) is the most common malignancy affecting women, and its incidence in younger women is rising worldwide. Early-onset of BC is a multi-step process involving various biological aggressive tumors such as triple negative and human epidermal growth factor 2 (HER2)-positive cancers. BC prevention is still arduous across the globe. A series of observational studies have established a conclusive non-genetic clinical link between hypertension (HTN) and the development of invasive BC. Those clinical associations have driven a pharmacological seek to use the anti-hypertension (AHTN) drugs as an effective adjunctive in BC therapy. The use of AHTN, especially beta-blockers and thiazides, has been recognized as a potent anti-tumor drug to mitigate BC progression, reduce the side effects of cancer treatment, and stop the reoccurrence of cancer in the survivors. Considering the dire need to disseminate the research on how AHTN drugs can be opted as the effective adjunctive therapy to cure the BC, the current review aimed to provide an update on novel understandings on association and mechanisms of AHTN-drugs against BC as an additional cancer therapy.
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Affiliation(s)
- Yuanyuan Fan
- School of Life Sciences, Henan University, Kaifeng, Henan, 475004, People’s Republic of China
| | - Nazeer Hussain Khan
- School of Life Sciences, Henan University, Kaifeng, Henan, 475004, People’s Republic of China
| | | | - M D Faysal Ahammad
- Key Laboratory of Natural Medicine and Immune Engineering, School of Medicine, Henan University, Kaifeng, People’s Republic of China
| | - Tayyaba Zulfiqar
- Department of Pharmacy, Quaid I Azam University, Islamabad, Pakistan
| | - Razia Virk
- Department of Bio-Sciences, University Wah, Rawalpindi, Pakistan
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, 475004, People’s Republic of China
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5
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Bouwmeester S, van der Stam JA, van Loon SLM, van Riel NAW, Boer AK, Dekker LR, Scharnhorst V, Houthuizen P. Left atrial reservoir strain as a predictor of cardiac outcome in patients with heart failure: the HaFaC cohort study. BMC Cardiovasc Disord 2022; 22:104. [PMID: 35287575 PMCID: PMC8922911 DOI: 10.1186/s12872-022-02545-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/04/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The left atrium (LA) is a key player in the pathophysiology of systolic and diastolic heart failure (HF). Speckle tracking derived LA reservoir strain (LASr) can be used as a prognostic surrogate for elevated left ventricular filling pressure similar to NT-proBNP. The aim of the study is to investigate the correlation between LASr and NT-proBNP and its prognostic value with regards to the composite endpoint of HF hospitalization and all-cause mortality within 1 year. METHODS Outpatients, sent to the echocardiography core lab because of HF, were enrolled into this study. Patients underwent a transthoracic echocardiographic examination, commercially available software was used to measure LASr. Blood samples were collected directly after the echocardiographic examination to determine NT-proBNP. RESULTS We included 174 HF patients, 43% with reduced, 36% with mildly reduced, and 21% with preserved ejection fraction. The study population showed a strong inverse correlation between LASr and log-transformed NT-proBNP (r = - 0.75, p < 0.01). Compared to NT-proBNP, LASr predicts the endpoint with a comparable specificity (83% vs. 84%), however with a lower sensitivity (70% vs. 61%). CONCLUSION LASr is inversely correlated with NT-proBNP and a good echocardiographic predictor for the composite endpoint of hospitalization and all-cause mortality in patients with HF. TRIAL REGISTRATION https://www.trialregister.nl/trial/7268.
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Affiliation(s)
- Sjoerd Bouwmeester
- Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Jonna A van der Stam
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Saskia L M van Loon
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Natal A W van Riel
- Department of Biomedical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands.,Department of Vascular Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Arjen-Kars Boer
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Lukas R Dekker
- Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.,Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Volkher Scharnhorst
- Clinical Laboratory, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.,Department of Biomedical Engineering, Computational Biology, Eindhoven University of Technology, Eindhoven, The Netherlands.,Expert Center Clinical Chemistry Eindhoven, Eindhoven, The Netherlands
| | - Patrick Houthuizen
- Department of Cardiology, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Dridi H, Santulli G, Gambardella J, Jankauskas SS, Yuan Q, Yang J, Reiken S, Wang X, Wronska A, Liu X, Lacampagne A, Marks AR. IP3 receptor orchestrates maladaptive vascular responses in heart failure. J Clin Invest 2022; 132:e152859. [PMID: 35166236 PMCID: PMC8843748 DOI: 10.1172/jci152859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Patients with heart failure (HF) have augmented vascular tone, which increases cardiac workload, impairing ventricular output and promoting further myocardial dysfunction. The molecular mechanisms underlying the maladaptive vascular responses observed in HF are not fully understood. Vascular smooth muscle cells (VSMCs) control vasoconstriction via a Ca2+-dependent process, in which the type 1 inositol 1,4,5-trisphosphate receptor (IP3R1) on the sarcoplasmic reticulum (SR) plays a major role. To dissect the mechanistic contribution of intracellular Ca2+ release to the increased vascular tone observed in HF, we analyzed the remodeling of IP3R1 in aortic tissues from patients with HF and from controls. VSMC IP3R1 channels from patients with HF and HF mice were hyperphosphorylated by both serine and tyrosine kinases. VSMCs isolated from IP3R1VSMC-/- mice exhibited blunted Ca2+ responses to angiotensin II (ATII) and norepinephrine compared with control VSMCs. IP3R1VSMC-/- mice displayed significantly reduced responses to ATII, both in vivo and ex vivo. HF IP3R1VSMC-/- mice developed significantly less afterload compared with HF IP3R1fl/fl mice and exhibited significantly attenuated progression toward decompensated HF and reduced interstitial fibrosis. Ca2+-dependent phosphorylation of the MLC by MLCK activated VSMC contraction. MLC phosphorylation was markedly increased in VSMCs from patients with HF and HF mice but reduced in VSMCs from HF IP3R1VSMC-/- mice and HF WT mice treated with ML-7. Taken together, our data indicate that VSMC IP3R1 is a major effector of increased vascular tone, which contributes to increased cardiac afterload and decompensation in HF.
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MESH Headings
- Animals
- Calcium Signaling
- Heart Failure/genetics
- Heart Failure/metabolism
- Heart Failure/physiopathology
- Humans
- Inositol 1,4,5-Trisphosphate Receptors/genetics
- Inositol 1,4,5-Trisphosphate Receptors/metabolism
- Mice
- Mice, Knockout
- Muscle, Smooth, Vascular/metabolism
- Muscle, Smooth, Vascular/physiopathology
- Myocytes, Smooth Muscle/metabolism
- Vasoconstriction
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Affiliation(s)
- Haikel Dridi
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Gaetano Santulli
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Jessica Gambardella
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- International Translational Research and Medical Education (ITME) Consortium, Department of Advanced Biomedical Science, “Federico II” University, Naples, Italy
| | - Stanislovas S. Jankauskas
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Qi Yuan
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Jingyi Yang
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Steven Reiken
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Xujun Wang
- Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, Einstein Institute for Aging Research, New York, New York, USA
- Department of Molecular Pharmacology, Einstein-Sinai Diabetes Research Center (ES-DRC), Fleischer Institute for Diabetes and Metabolism (FIDAM), Einstein Institute for Neuroimmunology and Inflammation, Albert Einstein College of Medicine, New York, New York, USA
| | - Anetta Wronska
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Xiaoping Liu
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Alain Lacampagne
- PhyMedExp, University of Montpellier, CNRS, INSERM, CHRU Montpellier, Montpellier, France
| | - Andrew R. Marks
- Department of Physiology and Cellular Biophysics, Clyde and Helen Wu Center for Molecular Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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7
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Toschi-Dias E, Montano N, Tobaldini E, Trevizan PF, Groehs RV, Antunes-Correa LM, Nobre TS, Lobo DM, Sales ARK, Ueno-Pardi LM, de Matos LDNJ, Oliveira PA, Braga AMFW, Alves MJNN, Negrão CE, Rondon MUPB. Oscillatory Pattern of Sympathetic Nerve Bursts Is Associated With Baroreflex Function in Heart Failure Patients With Reduced Ejection Fraction. Front Neurosci 2021; 15:669535. [PMID: 34531714 PMCID: PMC8439256 DOI: 10.3389/fnins.2021.669535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/13/2021] [Indexed: 12/28/2022] Open
Abstract
Sympathetic hyperactivation and baroreflex dysfunction are hallmarks of heart failure with reduced ejection fraction (HFrEF). However, it is unknown whether the progressive loss of phasic activity of sympathetic nerve bursts is associated with baroreflex dysfunction in HFrEF patients. Therefore, we investigated the association between the oscillatory pattern of muscle sympathetic nerve activity (LFMSNA/HFMSNA) and the gain and coupling of the sympathetic baroreflex function in HFrEF patients. In a sample of 139 HFrEF patients, two groups were selected according to the level of LFMSNA/HFMSNA index: (1) Lower LFMSNA/HFMSNA (lower terciles, n = 46, aged 53 ± 1 y) and (2) Higher LFMSNA/HFMSNA (upper terciles, n = 47, aged 52 ± 2 y). Heart rate (ECG), arterial pressure (oscillometric method), and muscle sympathetic nerve activity (microneurography) were recorded for 10 min in patients while resting. Spectral analysis of muscle sympathetic nerve activity was conducted to assess the LFMSNA/HFMSNA, and cross-spectral analysis between diastolic arterial pressure, and muscle sympathetic nerve activity was conducted to assess the sympathetic baroreflex function. HFrEF patients with lower LFMSNA/HFMSNA had reduced left ventricular ejection fraction (26 ± 1 vs. 29 ± 1%, P = 0.03), gain (0.15 ± 0.03 vs. 0.30 ± 0.04 a.u./mmHg, P < 0.001) and coupling of sympathetic baroreflex function (0.26 ± 0.03 vs. 0.56 ± 0.04%, P < 0.001) and increased muscle sympathetic nerve activity (48 ± 2 vs. 41 ± 2 bursts/min, P < 0.01) and heart rate (71 ± 2 vs. 61 ± 2 bpm, P < 0.001) compared with HFrEF patients with higher LFMSNA/HFMSNA. Further analysis showed an association between the LFMSNA/HFMSNA with coupling of sympathetic baroreflex function (R = 0.56, P < 0.001) and left ventricular ejection fraction (R = 0.23, P = 0.02). In conclusion, there is a direct association between LFMSNA/HFMSNA and sympathetic baroreflex function and muscle sympathetic nerve activity in HFrEF patients. This finding has clinical implications, because left ventricular ejection fraction is less in the HFrEF patients with lower LFMSNA/HFMSNA.
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Affiliation(s)
- Edgar Toschi-Dias
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,Department of Internal Medicine, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlínico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Nicola Montano
- Department of Internal Medicine, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlínico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eleonora Tobaldini
- Department of Internal Medicine, Fondazione IRCSS Ca' Granda, Ospedale Maggiore Policlínico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Patrícia F Trevizan
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Raphaela V Groehs
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ligia M Antunes-Correa
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Thais S Nobre
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Denise M Lobo
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Allan R K Sales
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Linda M Ueno-Pardi
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Luciana D N J de Matos
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Patrícia A Oliveira
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Maria F W Braga
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Maria Janieire N N Alves
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos E Negrão
- Instituto do Coração (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.,School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
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8
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Bao J, Kan R, Chen J, Xuan H, Wang C, Li D, Xu T. Combination pharmacotherapies for cardiac reverse remodeling in heart failure patients with reduced ejection fraction: A systematic review and network meta-analysis of randomized clinical trials. Pharmacol Res 2021; 169:105573. [PMID: 33766629 DOI: 10.1016/j.phrs.2021.105573] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 12/22/2022]
Abstract
Pharmacotherapies, including angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor II blockers (ARBs), β-blockers (BBs), mineralocorticoid receptor antagonists (MRAs) and angiotensin receptor blocker-neprilysin inhibitor (ARNI), have played a pivotal role in reducing in-hospital and mortality in heart failure patients with reduced ejection fraction (HFrEF). However, effects of the five drug categories used alone or in combination for cardiac reverse remodeling (CRR) in these patients have not been systematically evaluated. A Bayesian network meta-analysis was conducted based on 55 randomized controlled trials published between 1989 and 2019 involving 12,727 patients from PubMed, EMBASE, Cochrane Library, and Clinicaltrials.gov. The study is registered with PROSPERO (CRD42020170457). Our primary outcomes were CRR indicators, including changes of left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and end-systolic volume (LVESV), indexed LVEDV (LVEDVI) and LVESV (LVESVI), and left ventricular end-diastolic dimension (LVEDD) and end-systolic dimension (LVESD); Secondary outcomes were functional capacity comprising New York Heart Association (NYHA) class and 6-min walking distance (6MWD); cardiac biomarkers involving B type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP). The effect sizes were presented as the mean difference with 95% credible intervals. According to the results, all dual-combination therapies except ACEI+ARB were significantly more associated with LVEF or NYHA improvement than placebo, ARB+BB and ARNI+BB were the top two effective dual-combinations in LVEF improvement (+7.59% [+4.27, +11.25] and +7.31% [+3.93, +10.97] respectively); ACEI+BB was shown to be superior to ACEI in reducing LVEDVI and LVESVI (-6.88 mL/m2 [-13.18, -1.89] and -10.64 mL/m2 [-18.73, -3.54] respectively); ARNI+BB showed superiority over ACEI+BB in decreasing the level of NT-proBNP (-240.11 pg/mL [-456.57, -6.73]). All tri-combinations were significantly more effective than placebo in LVEF improvement, and ARNI+BB+MRA ranked first (+21.13% [+14.34, +28.13]); ACEI+BB+MRA was significantly more associated with a decrease in LVEDD than ACEI (-6.57 mm [-13.10, -0.84]). A sensitivity analysis ignoring concomitant therapies for LVEF illustrated that all the five drug types except ARB were shown to be superior to placebo, and ARNI ranked first (+4.83% [+1.75, +7.99]). In conclusion, combination therapies exert more benefits on CRR for patients with HFrEF. Among them, ARNI+BB, ARB+BB, ARNI+BB+MRA and ARB+BB+MRA were the top two effective dual and triple combinations in LVEF improvement, respectively; The new "Golden Triangle" of ARNI+BB+MRA was shown to be superior to ACEI+BB+MRA or ARB+BB+MRA in LVEF improvement.
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Affiliation(s)
- Jieli Bao
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Rongsheng Kan
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Junhong Chen
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Haochen Xuan
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Chaofan Wang
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
| | - Dongye Li
- The Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, Jiangsu, PR China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China.
| | - Tongda Xu
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, PR China
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Why Do We Not Assess Sympathetic Nervous System Activity in Heart Failure Management: Might GRK2 Serve as a New Biomarker? Cells 2021; 10:cells10020457. [PMID: 33669936 PMCID: PMC7924864 DOI: 10.3390/cells10020457] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
Heart failure (HF) represents the end-stage condition of several structural and functional cardiovascular diseases, characterized by reduced myocardial pump function and increased pressure load. The dysregulation of neurohormonal systems, especially the hyperactivity of the cardiac adrenergic nervous system (ANS), constitutes a hallmark of HF and exerts a pivotal role in its progression. Indeed, it negatively affects patients’ prognosis, being associated with high morbidity and mortality rates, with a tremendous burden on global healthcare systems. To date, all the techniques proposed to assess the cardiac sympathetic nervous system are burdened by intrinsic limits that hinder their implementation in clinical practice. Several biomarkers related to ANS activity, which may potentially support the clinical management of such a complex syndrome, are slow to be implemented in the routine practice for several limitations due to their assessment and clinical impact. Lymphocyte G-protein-coupled Receptor Kinase 2 (GRK2) levels reflect myocardial β-adrenergic receptor function in HF and have been shown to add independent prognostic information related to ANS overdrive. In the present manuscript, we provide an overview of the techniques currently available to evaluate cardiac ANS in HF and future perspectives in this field of relevant scientific and clinical interest.
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Salzano A, D'Assante R, Israr MZ, Eltayeb M, D'Agostino A, Bernieh D, De Luca M, Rega S, Ranieri B, Mauro C, Bossone E, Squire IB, Suzuki T, Marra AM. Biomarkers in Heart Failure: Clinical Insights. Heart Fail Clin 2021; 17:223-243. [PMID: 33673947 DOI: 10.1016/j.hfc.2021.01.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Andrea Salzano
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy.
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | | | - Mohamed Eltayeb
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Anna D'Agostino
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Dennis Bernieh
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Salvatore Rega
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Brigida Ranieri
- IRCCS SDN Nuclear and Diagnostic Research Institute, Naples, Italy
| | - Ciro Mauro
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Eduardo Bossone
- AORN A Cardarelli, Cardiac Rehabilitation Unit, Naples, Italy
| | - Iain B Squire
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Toru Suzuki
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
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11
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Umazume T, Yamada T, Furuta I, Iwano H, Morikawa M, Watari H, Minakami H. Morphofunctional cardiac changes in singleton and twin pregnancies: a longitudinal cohort study. BMC Pregnancy Childbirth 2020; 20:750. [PMID: 33267789 PMCID: PMC7709235 DOI: 10.1186/s12884-020-03452-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/22/2020] [Indexed: 11/12/2022] Open
Abstract
Background This study aimed to compare the echocardiographic changes and cardiac biomarkers between women with singleton and twin pregnancies. Methods From April 2014 to March 2016, this longitudinal cohort study invited pregnant women who were scheduled to give birth at Hokkaido University Hospital. We analyzed prospectively collected data on simultaneously determined echocardiographic parameters and blood cardiac markers of 44 women with singleton and 22 women with twin pregnancies. Furthermore, we tested the mixed-effect models for echocardiographic parameters and cardiac biomarkers. Results During the third trimester and immediately postpartum (within 1 week after childbirth), the mean left atrial volume index and brain natriuretic peptide (BNP) level were significantly higher in women with twin pregnancies than in those with singleton pregnancies. Women with twin pregnancies also had significantly smaller second-trimester inferior vena cava diameters and significantly higher third−trimester creatinine levels than those with singleton pregnancies. BNP positively correlated with the left atrial volume index (β = 0.49, p < 0.01) and the ratio of early diastolic transmitral to mitral annular velocity (E/e’) (β = 0.41, p < 0.01). At 1 month after childbirth in women with singleton pregnancies, BNP and N-terminal precursor protein BNP (NT-proBNP) fragments immediately postpartum negatively correlated with the later E/e’ (r = − 0.33, p = 0.02 and r = − 0.36, p < 0.01, respectively). Conclusions The intravascular cardiac load reached maximum within 1 week after childbirth and was greater in women with twin pregnancies than in those with singleton pregnancies. BNP/NT-proBNP significantly positively correlated with LA volume index and E/e’. In women with singleton pregnancies, BNP secreted immediately after childbirth might improve the diastolic functions 1 month after childbirth.
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Affiliation(s)
- Takeshi Umazume
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan.
| | - Takahiro Yamada
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Itsuko Furuta
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hiroyuki Iwano
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Mamoru Morikawa
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hidemichi Watari
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Hisanori Minakami
- Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, N15W7, Kita-ku, Sapporo, 060-8638, Japan
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12
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Silverman DN, Plante TB, Infeld M, Callas PW, Juraschek SP, Dougherty GB, Meyer M. Association of β-Blocker Use With Heart Failure Hospitalizations and Cardiovascular Disease Mortality Among Patients With Heart Failure With a Preserved Ejection Fraction: A Secondary Analysis of the TOPCAT Trial. JAMA Netw Open 2019; 2:e1916598. [PMID: 31800067 PMCID: PMC6902757 DOI: 10.1001/jamanetworkopen.2019.16598] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE β-Blockers are prescribed to most patients with heart failure (HF) with a preserved ejection fraction (HFpEF), but their effect on HFpEF remains unclear. OBJECTIVE To determine the association of β-blocker use with HF hospitalizations and cardiovascular disease (CVD) mortality, overall and in strata of patients with an ejection fraction (EF) of 50% or greater or less than 50%. DESIGN, SETTING, AND PARTICIPANTS For 1761 participants from North and South America enrolled in the multicenter, double-blinded Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist randomized clinical trial of spironolactone for patients with HFpEF between August 10, 2006, and January 31, 2012, the association of baseline β-blocker use with HF hospitalization and CVD mortality was analyzed using unadjusted and adjusted Cox proportional hazards regression models, overall and in strata of patients with an EF of 50% or greater or less than 50%. Participants had symptomatic HF with a left ventricular EF of 45% or greater, with enrollment based on either hospitalization attributed to decompensated HF in the prior year or elevated natriuretic peptide levels. Statistical analysis was performed from January 31 to May 2, 2019. EXPOSURE Use of β-blockers. MAIN OUTCOMES AND MEASURES Incident HF hospitalization and CVD mortality. RESULTS Among 1761 participants included in the analysis (879 women and 882 men; mean [SD] age, 71.5 [9.6] years), 1394 (79.2%) reported β-blocker use and 1567 (89.0%) had an EF of 50% or greater. Hospitalizations for HF occurred for 399 participants (22.7%), and CVD mortality occurred for 229 participants (13.0%). Use of β-blockers was associated with a higher risk of HF hospitalization among patients with HFpEF with an EF of 50% or greater (hazard ratio, 1.74 [95% CI, 1.28-2.37]; P < .001) but not among patients with an EF between 45% and 49% (hazard ratio, 0.68 [95% CI, 0.28-1.63]; P = .39). There was a significant interaction between β-blocker use and EF threshold for incident HF hospitalizations (P = .03). Use of β-blockers was not associated with a change in CVD mortality. CONCLUSIONS AND RELEVANCE For patients with an EF of 50% or greater, β-blocker use was associated with an increased risk of HF hospitalizations but not CVD mortality. For patients with an EF between 45% and 49%, there was no such association.
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Affiliation(s)
- Daniel N. Silverman
- Department of Medicine and Biostatistics Unit, Larner College of Medicine, University of Vermont, Burlington
| | - Timothy B. Plante
- Department of Medicine and Biostatistics Unit, Larner College of Medicine, University of Vermont, Burlington
| | - Margaret Infeld
- Department of Medicine and Biostatistics Unit, Larner College of Medicine, University of Vermont, Burlington
| | - Peter W. Callas
- Department of Medicine and Biostatistics Unit, Larner College of Medicine, University of Vermont, Burlington
| | - Stephen P. Juraschek
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Geoff B. Dougherty
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Markus Meyer
- Department of Medicine and Biostatistics Unit, Larner College of Medicine, University of Vermont, Burlington
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Xu B, Kawata T, Daimon M, Kimura K, Nakao T, Lee SC, Hirokawa M, Yoshinaga A, Watanabe M, Yatomi Y, Komuro I. Prognostic Value of a Simple Echocardiographic Parameter, the Right Ventricular Systolic to Diastolic Duration Ratio, in Patients with Advanced Heart Failure with Non-Ischemic Dilated Cardiomyopathy. Int Heart J 2018; 59:968-975. [PMID: 30022771 DOI: 10.1536/ihj.17-475] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The prognostic value of the right ventricular (RV) systolic to diastolic duration ratio (S/D ratio) in patients with advanced heart failure is not clear.We enrolled 45 patients with DCM (40 ± 13 years, 33 male) who were admitted to our hospital for evaluation or treatment of heart failure. The RV systolic and diastolic durations were measured using continuous Doppler imaging of tricuspid regurgitation, and the RV S/D ratio was calculated. Cardiac events were defined as cardiac death or left ventricular assist device implantation within the first year. Twenty-eight cardiac events occurred. The RV S/D ratio was significantly higher in the event group than in the event-free group (1.8 ± 0.8 versus 1.2 ± 0.5, P = 0.008). Univariate analysis showed that the RV S/D ratio, plasma brain natriuretic peptide concentration, left atrial volume index, and mitral deceleration time were associated with these events. Receiver operating characteristic curve analysis revealed that the optimal RV S/D cutoff value to predict events was 1.2 (sensitivity 79%, specificity 65%, area under the curve 0.745). Kaplan-Meier analysis indicated a significantly higher event rate in patients with an RV S/D ratio > 1.2 (log-rank test, P = 0.003). The addition of an RV S/D ratio > 1.2 improved the prognostic utility of a model that included conventional variables (P = 0.014).In patients with advanced heart failure with DCM, the RV S/D ratio was higher in patients with events than in those without events. The addition of the RV S/D ratio to conventional parameters may provide better prognostic information.
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Affiliation(s)
- Boqing Xu
- Department of Clinical Laboratory, Graduate School of Medicine, The University of Tokyo
| | - Takayuki Kawata
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Masao Daimon
- Department of Clinical Laboratory, Graduate School of Medicine, The University of Tokyo
| | - Koichi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Tomoko Nakao
- Department of Clinical Laboratory, Graduate School of Medicine, The University of Tokyo
| | - Seitetz C Lee
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Aya Yoshinaga
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Masafumi Watanabe
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Yutaka Yatomi
- Department of Clinical Laboratory, Graduate School of Medicine, The University of Tokyo
| | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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14
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Hinder M, Yi BA, Langenickel TH. Developing Drugs for Heart Failure With Reduced Ejection Fraction: What Have We Learned From Clinical Trials? Clin Pharmacol Ther 2018; 103:802-814. [PMID: 29315510 PMCID: PMC5947521 DOI: 10.1002/cpt.1010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/21/2017] [Accepted: 12/24/2017] [Indexed: 12/11/2022]
Abstract
There remains a large unmet need for new therapies in the treatment of heart failure with reduced ejection fraction (HFrEF). In the early drug development phase, the therapeutic potential of a drug is not yet fully understood and trial endpoints other than mortality are needed to guide drug development decisions. While a true surrogate marker for mortality in heart failure (HF) remains elusive, the successes and failures of previous trials can reveal markers that support clinical Go/NoGo decisions.
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Affiliation(s)
- Markus Hinder
- Novartis Institutes for BioMedical Research, Translational Medicine, Basel, Switzerland
| | - B Alexander Yi
- Novartis Institutes for BioMedical Research, Translational Medicine, Cambridge, Massachusetts, USA
| | - Thomas H Langenickel
- Novartis Institutes for BioMedical Research, Translational Medicine, Basel, Switzerland
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15
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Echocardiographic assessment of right ventricular function in routine practice: Which parameters are useful to predict one-year outcome in advanced heart failure patients with dilated cardiomyopathy? J Cardiol 2017; 70:316-322. [DOI: 10.1016/j.jjcc.2017.02.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 01/03/2017] [Accepted: 02/02/2017] [Indexed: 11/23/2022]
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16
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Billebeau G, Vodovar N, Sadoune M, Launay JM, Beauvais F, Cohen-Solal A. Effects of a cardiac rehabilitation programme on plasma cardiac biomarkers in patients with chronic heart failure. Eur J Prev Cardiol 2017; 24:1127-1135. [PMID: 28452560 DOI: 10.1177/2047487317705488] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Cardiac rehabilitation (CR) improves the symptoms, exercise capacity and quality of life of chronic heart failure (CHF) patients. Its effects on new plasma biomarkers of prognostic importance are unknown. The present study aimed at analysing the effects of a structured CR programme on plasma cardiac biomarkers in a large population of patients with CHF and reduced left ventricular ejection fraction (LVEF). Methods We enrolled 107 consecutive CHF patients with LVEF ≤ 45% in an ambulatory CR programme. Peak VO2 and plasma levels of Galectin-3, mid-regional proANP (MR-proADM), soluble suppressor of tumorigenicity 2 (sST2) and mid-regional pro-adrenomedullin (MR-proANP) were assessed at inclusion and at the end of CR. Twenty-four unenrolled patients were managed with standard medical care and evaluated over the same period (no-CR group). Results Galectin-3, sST2, MR-proADM and MR-proANP plasma levels decreased after CR, with respective median reductions of 6.3% for Galectin 3 ( p < 0.001), 7.4% for sST2 ( p = 0.036), 6.4% for MR-proADM ( p = 0.001) and 16% for MR-proANP ( p < 0.001). MR-proADM was negatively correlated with peak VO2 (ρ = -0.529, 95% confidence interval [CI] -0.654 to -0.375, p < 0.001), and so were their relative variations along the course of CR (ρ = -0.357, 95% CI -0.518 to -0.172, p < 0.001). No change occurred in terms of biomarkers in the no-CR group. Conclusions Plasma cardiac biomarkers such as Galectin-3, MR-proADM, sST2 and MR-proANP all decreased after CR in CHF patients, suggesting an overall improvement in the neuro-hormonal profile.
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Affiliation(s)
- Gilles Billebeau
- 1 Department of Cardiology, Lariboisière Hospital, Paris, France.,2 Inserm UMRS 942, 75010 Paris, France
| | - Nicolas Vodovar
- 2 Inserm UMRS 942, 75010 Paris, France.,3 DHU FIRE, Paris, France
| | | | - Jean-Marie Launay
- 2 Inserm UMRS 942, 75010 Paris, France.,3 DHU FIRE, Paris, France.,4 Department of Biochemistry, Lariboisière Hospital, Paris, France.,5 Centre for Biological Resources BB-0033-00064, Lariboisière Hospital, Paris, France
| | - Florence Beauvais
- 1 Department of Cardiology, Lariboisière Hospital, Paris, France.,2 Inserm UMRS 942, 75010 Paris, France
| | - Alain Cohen-Solal
- 1 Department of Cardiology, Lariboisière Hospital, Paris, France.,2 Inserm UMRS 942, 75010 Paris, France.,3 DHU FIRE, Paris, France.,6 Paris Diderot University, Sorbonne Paris Cité, 75205 Paris, France
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Lee JC. Therapeutic effect of prostaglandin E1 in monocrotaline-induced pulmonary arterial hypertension rats. Anat Cell Biol 2017; 50:60-68. [PMID: 28417056 PMCID: PMC5386927 DOI: 10.5115/acb.2017.50.1.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/06/2017] [Accepted: 03/08/2017] [Indexed: 02/08/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe pulmonary vascular disease characterized by sustained increase in pulmonary arterial pressure and excessive thickening and remodeling of distal small pulmonary arteries. During disease progression, PAH include increase in mean pulmonary arterial pressure, right ventricular (RV) enlargement, increased pulmonary vascular resistance, and smooth muscle hypertrophy in pulmonary arterioles. Several anti-PAH therapies targeting various pathways involved in PAH progression have been approved by the Food and Drug Adminstration. However, many of the currently available anti-PAH drugs suffer from a number of limitations, including short biological half-life, and poor pulmonary selectivity. Prostaglandin E1 (PGE1) is a potent vasodilator with selectivity toward pulmonary circulation when it is administered via the pulmonary route. However, PGE1 has a very short half-life of 5–10 minutes. Therefore, we hypothesized that long-term effect of PGE1 could reduce mal-adaptive structural remodeling of the lung and heart and prevent ventricular arrhythmias in monocrotaline-induced rat model of PAH. Our results revealed that PGE1 reduced ventricular hypertrophy, protein expressions of endothelin-1 and endothelin receptor A, and the expression of fibrosis. These results support the notion that PGE1 can improve the functional properties of RV, highlighting its potential benefits for heart and lung impairment.
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Affiliation(s)
- Jae Chul Lee
- Department of Plastic and Reconstructive Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.,Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea
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18
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End points in heart failure-are we doing it right? Eur J Clin Pharmacol 2017; 73:651-659. [PMID: 28280889 DOI: 10.1007/s00228-017-2228-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 02/27/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Heart Failure (HF) continues to be associated with high mortality and morbidity. We attempted to identify the most common end points used in phase 3 clinical trials of heart failure and discuss their merits and demerits. METHODS Literature evaluation was done using the databases PubMed and Clinicaltrials.gov from January 2010 to December 2016 to identify randomised clinical trials (RCTs) evaluating the effect of therapeutic drugs on heart failure. Following the literature search, the data on the primary end points were extracted from each of the selected trials. The most recurrent and important end points of Phase III clinical trials for HF over the last six years were identified for further discussion. RESULTS From our search, it was observed that the most common end points used in trials with acute heart failure (AHF) were composite end point, dyspnea, CV death and most common end points used in trials with chronic heart failure (CHF) were composite end point, 6 minute walk test (6MWT), CV death or HFH, Vo2 max, all cause mortality, left ventricular ejection fraction (LVEF), and dyspnea. CONCLUSION Choosing the appropriate end points is a critical step in the study design that could turn the tide in the beleaguered drug development pipeline of HF, resulting in the right molecule reaching the HF community.
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19
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The Role of Omega-3 Polyunsaturated Fatty Acids in Heart Failure: A Meta-Analysis of Randomised Controlled Trials. Nutrients 2016; 9:nu9010018. [PMID: 28042816 PMCID: PMC5295062 DOI: 10.3390/nu9010018] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 12/19/2022] Open
Abstract
Many new clinical trials about the effect of omega-3 polyunsaturated fatty acids (PUFAs) in heart failure (HF) patients have shown inconsistent results. Therefore, a meta-analysis of randomised controlled trials (RCTs) was performed to determine the benefits of omega-3 PUFAs in HF patients. Articles were obtained from PubMed, EMBASE, and the Cochrane Library. RCTs comparing omega-3 PUFAs with placebo for HF were included. Two reviewers independently extracted the data from the selected publications. The I² statistic was used to assess heterogeneity. The pooled mean difference and associated 95% confidence intervals were calculated, and a fixed or random-effects model was used for the meta-analysis. A total of nine RCTs involving 800 patients were eligible for inclusion. Compared with patients taking placebo, HF patients who received omega-3 PUFAs experienced decreased brain natriuretic peptide levels and serum norepinephrine levels. Although the left ventricular ejection fraction (LVEF) and clinical outcomes (Tei index, peak oxygen consumption) did not improve, subgroup analysis showed that the LVEF increased in dilated cardiomyopathy (DCM) patients. Overall, omega-3 PUFA supplements might be beneficial in HF patients, especially in DCM patients, but further studies are needed to confirm these benefits.
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Abstract
OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical efficacy, and safety of eplerenone, a new selective aldosterone blocker. DATA SOURCES: Primary literature and review articles were obtained via MEDLINE search (1966–April 2002). Additional studies and abstracts were identified from the bibliographies of reviewed literature. STUDY SELECTION AND DATA EXTRACTION: Studies and review articles related to eplerenone, aldosterone, aldosterone antagonist, and spironolactone were reviewed. Data pertinent to this article were included. DATA SYNTHESIS: Eplerenone is a selective aldosterone blocker. Recent data have demonstrated the deleterious effects of aldosterone in several chronic disease states including hypertension and heart failure. Animal studies using eplerenone have shown a positive role for aldosterone antagonism in the treatment of hypertension, heart failure, myocardial infarction, renal disease, and atherosclerosis. In humans, eplerenone appears to be effective for the treatment of hypertension. An ongoing study will examine the effect of eplerenone for heart failure. To date, the incidence of adverse effects with eplerenone has been slightly lower than with spironolactone. CONCLUSIONS: Eplerenone appears to be a promising drug in a new class of agents called selective aldosterone blockers. The drug may be approved for treatment of hypertension in 2002. Additional studies are ongoing that may provide information on other clinical uses for this medication.
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Affiliation(s)
- Alan J Zillich
- Division of Clinical and Administrative Pharmacy and Department of Family Medicine, College of Pharmacy, University of Iowa, Iowa City, IA 52242, USA.
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Peripheral endothelial function may predict the effectiveness of beta-blocker therapy in patients with idiopathic dilated cardiomyopathy. Int J Cardiol 2016; 221:128-33. [PMID: 27400309 DOI: 10.1016/j.ijcard.2016.06.164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 06/24/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Beta-blockers have improved the prognosis of patients with dilated cardiomyopathy as they improve left ventricular (LV) systolic function and structure, which are crucial for myocardial recovery. However, to date, no accurate methods can predict the effectiveness of β-blocker therapy. Our goal was to evaluate whether peripheral endothelial function could be a useful predictor for β-blocker responses and related LV reverse remodeling (LVRR) in patients with idiopathic dilated cardiomyopathy (IDC). METHODS Fifty-two IDC patients were recruited and underwent brachial artery flow-mediated dilation (FMD). Beta-blockers were titrated to doses tolerable for each patient. LV function and structure were measured by echocardiography. A positive response to β-blockers was defined as an increase of ≥10% in LV ejection fraction (LVEF). LVRR was defined as an increase of ≥10% in LVEF and a decrease of ≥15% in LV end-systolic volume (LVESV). RESULTS Baseline FMD was 8.4±3.0% in IDC patients and significantly lower than healthy controls. At three-month follow-up, 54% of patients had a positive β-blocker response and 40% achieved LVRR. Patients with a positive response to β-blockers or with LVRR had significantly higher baseline FMD values than those without. FMD was the most significant predictor of changes in LVEF and LVESV. The sensitivity and specificity of baseline FMD to predict β-blocker responses was 64.3% and 83.3%, respectively, and to predict LVRR was 61.9% and 80.6%, respectively. Beta-blockers themselves did not influence FMD values. CONCLUSIONS FMD could serve as an independent predictor for monitoring β-blocker therapy effectiveness in IDC patients.
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Lee JC, Kim KC, Choe SY, Hong YM. Reduced immunoreactivities of B-type natriuretic peptide in pulmonary arterial hypertension rats after ranolazine treatment. Anat Cell Biol 2016; 49:7-14. [PMID: 27051563 PMCID: PMC4819080 DOI: 10.5115/acb.2016.49.1.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 01/25/2016] [Accepted: 03/07/2016] [Indexed: 02/05/2023] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe pulmonary vascular disease characterized by sustained increase in the pulmonary arterial pressure and excessive thickening and remodeling of the distal small pulmonary arteries. During disease progression, structural remodeling of the right ventricular (RV) impairs pump function, creates pro-arrhythmic substrates and triggers for arrhythmias. Notably, RV failure and lethal arrhythmias are major contributors to cardiac death in PAH that are not directly addressed by currently available therapies. Ranolazine (RAN) is an anti-anginal, anti-ischemic drug that has cardioprotective effects of heart dysfunction. RAN also has anti-arrhythmic effects due to inhibition of the late sodium current in cardiomyocytes. Therefore, we hypothesized that RAN could reduce the mal-adaptive structural remodeling of the RV, and prevent triggered ventricular arrhythmias in the monocrotaline-induced rat model of PAH. RAN reduced ventricular hypertrophy, reduced levels of B-type natriuretic peptide, and decreased the expression of fibrosis. In addition, RAN prevented cardiovascular death in rat model of PAH. These results support the notion that RAN can improve the functional properties of the RV, highlighting its potential benefits in the setting of heart impairment.
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Affiliation(s)
- Jae Chul Lee
- Department of Biology, School of Life Sciences, Chungbuk National University, Cheongju, Korea.; Department of Surgery, Brain Korea 21 PLUS Project for Medical Sciences and HBP Surgery and Liver Transplantation, Korea University College of Medicine, Seoul, Korea.; Department of Anatomy, Seoul National University College of Medicine, Seoul, Korea.; Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwan Chang Kim
- Department of Thoracic and Cardiovascular Surgery, Ewha Womans University School of Medicine, Seoul, Korea
| | - Soo Young Choe
- Department of Biology, School of Life Sciences, Chungbuk National University, Cheongju, Korea
| | - Young Mi Hong
- Department of Pediatrics, Ewha Womans University School of Medicine, Seoul, Korea
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Shiraishi Y, Kohsaka S, Harada K, Miyamoto T, Tanimoto S, Iida K, Sakai T, Miyazaki T, Yagawa M, Matsushita K, Furihata S, Sato N, Fukuda K, Yamamoto T, Nagao K, Takayama M. Correlation of Pre- and In-Hospital Systolic Blood Pressure in Acute Heart Failure Patients and the Prognostic Implications – Report From the Tokyo Cardiac Care Unit Network Emergency Medical Service Database –. Circ J 2016; 80:2473-2481. [DOI: 10.1253/circj.cj-16-0837] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yasuyuki Shiraishi
- Tokyo CCU Network Scientific Committee
- Department of Cardiology, Keio University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
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Kasahara Y, Izawa KP, Watanabe S, Osada N, Omiya K. The Relation of Respiratory Muscle Strength to Disease Severity and Abnormal Ventilation During Exercise in Chronic Heart Failure Patients. Res Cardiovasc Med 2015; 4:e28944. [PMID: 26528451 PMCID: PMC4623381 DOI: 10.5812/cardiovascmed.28944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 05/08/2015] [Accepted: 06/07/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breathlessness is a common problem in chronic heart failure (CHF) patients, and respiratory muscle strength has been proposed to play an important role in causing breathlessness in these patients. OBJECTIVES The aim of this study was to investigate the relation between respiratory muscle strength and the severity of CHF, and the influence of respiratory muscle strength on abnormal ventilation during exercise in CHF patients. PATIENTS AND METHODS In this case series study, we assessed clinically stable CHF outpatients (N = 66, age: 57.7 ± 14.6 years). The peak oxygen consumption (peak VO2), the slope relating minute ventilation to carbon dioxide production (VE/VCO2 slope), and the slope relating tidal volume to respiratory rate (TV/RR slope) were measured during cardiopulmonary exercise testing. Respiratory muscle strength was assessed by measuring the maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP). RESULTS The MIP and MEP decreased significantly as the New York Heart Association functional class increased (MIP, P = 0.021; MEP, P < 0.01). The MIP correlated with the TV/RR slope (r = 0.57, P < 0.001) and the VE/VCO2 slope (r = -0.44, P < 0.001), and the MEP also correlated with the TV/RR slope (r = 0.53, P < 0.001) and the VE/VCO2 slope (r = -0.25, P < 0.040). Stepwise multiple regression analysis revealed that age and MIP were statistically significant predictors of the TV/RR and VE/VCO2 slopes (both P < 0.05). CONCLUSIONS Respiratory muscle strength is related to the severity of CHF, and associated with rapid and shallow ventilation or excessive ventilation during exercise.
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Affiliation(s)
- Yusuke Kasahara
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
| | | | - Satoshi Watanabe
- Department of Rehabilitation Medicine St. Marianna University School of Medicine Hospital, Kawasaki, Japan
| | - Naohiko Osada
- Division of Cardiology, St. Marianna University School of Medicine Toyoko Hospital, Kawasaki, Japan
| | - Kazuto Omiya
- Division of Cardiology, Department of Internal Medicine (NO, KO), St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Yokohama, Japan
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Izawa KP, Watanabe S, Omiya K, Yamada S, Oka K, Tamura M, Samejima H, Osada N, Iijima S. Health-related quality of life in relation to different levels of disease severity in patients with chronic heart failure. JOURNAL OF THE JAPANESE PHYSICAL THERAPY ASSOCIATION 2015; 8:39-45. [PMID: 25792942 DOI: 10.1298/jjpta.8.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Accepted: 09/18/2004] [Indexed: 11/23/2022]
Abstract
The purpose of the present study was to compare differences in physiological outcomes and health-related quality of life (HRQOL) in relation to degree of illness in patients with chronic heart failure (CHF) and to compare HRQOL in CHF patients with that of a normal Japanese population. One hundred and twenty-five patients with stable CHF (93 men, 32 women, mean age 63.3 ± 12.4 years) with left ventricular ejection fraction (LVEF) of less than 40% were enrolled in the present study. We used New York Heart Association (NYHA) functional class as an index of degree of illness. In 64 of the 125 patients, physiological outcome measures included peak oxygen uptake (peak O2) and E/CO2 slope. HRQOL was assessed with the medical outcome study short form-36 (SF-36) Japanese version. In addition, SF-36 scores of CHF patients were compared against Japanese standard values. Age and LVEF did not differ according to NYHA functional class. The eight SF-36 subscale scores and peak O2 decreased with increases in the NYHA functional classes, whereas E/CO2 slope increased with increases in NYHA functional class (p<0.05). Of the 8 SF-36 subscales measured in CHF patients, only the bodily pain score attained that of the normal Japanese population. These findings suggest that HRQOL decreases as NYHA functional class increases and other physiological measures worsen. In addition, HRQOL values of CHF patients were low in comparison with standard values of a normal Japanese population.
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Affiliation(s)
- Kazuhiro P Izawa
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
| | - Satoshi Watanabe
- Department of Rehabilitation Medicine, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, Japan
| | - Kazuto Omiya
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Sumio Yamada
- Institute of Medical Sciences, University of Nagoya, Nagoya 461-8673, Japan
| | - Koichiro Oka
- Tokyo Metropolitan Institute of Gerontology, Tokyo 173-0015, Japan
| | - Masachika Tamura
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Hisanori Samejima
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Naohiko Osada
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki 216-8511, Japan
| | - Setsu Iijima
- Institute of Disability Sciences, University of Tsukuba, Ibaraki 112-0012, Japan
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Fahim MA, Hayen A, Horvath AR, Dimeski G, Coburn A, Johnson DW, Hawley CM, Campbell SB, Craig JC. N-terminal pro-B-type natriuretic peptide variability in stable dialysis patients. Clin J Am Soc Nephrol 2015; 10:620-9. [PMID: 25714960 DOI: 10.2215/cjn.09060914] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/07/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Monitoring N-terminal pro-B-type natriuretic peptide (NT-proBNP) may be useful for assessing cardiovascular risk in dialysis patients. However, its biologic variation is unknown, hindering the accurate interpretation of serial concentrations. The aims of this prospective cohort study were to estimate the within- and between-person coefficients of variation of NT-proBNP in stable dialysis patients, and derive the critical difference between measurements needed to exclude biologic and analytic variation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Fifty-five prevalent hemodialysis and peritoneal dialysis patients attending two hospitals were assessed weekly for 5 weeks and then monthly for 4 months between October 2010 and April 2012. Assessments were conducted at the same time in the dialysis cycle and entailed NT-proBNP testing, clinical review, electrocardiography, and bioimpedance spectroscopy. Patients were excluded if they became unstable. RESULTS This study analyzed 136 weekly and 113 monthly NT-proBNP measurements from 40 and 41 stable patients, respectively. Results showed that 22% had ischemic heart disease; 9% and 87% had left ventricular systolic and diastolic dysfunction, respectively. Respective between- and within-person coefficients of variation were 153% and 27% for weekly measurements, and 148% and 35% for monthly measurements. Within-person variation was unaffected by dialysis modality, hydration status, inflammation, or cardiac comorbidity. NT-proBNP concentrations measured at weekly intervals needed to increase by at least 46% or decrease by 84% to exclude change due to biologic and analytic variation alone with 90% certainty, whereas monthly measurements needed to increase by at least 119% or decrease by 54%. CONCLUSIONS The between-person variation of NT-proBNP was large and markedly greater than within-person variation, indicating that NT-proBNP testing might better be applied in the dialysis population using a relative-change strategy. Serial NT-proBNP concentrations need to double or halve to confidently exclude change due to analytic and biologic variation alone.
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Affiliation(s)
- Magid A Fahim
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia;
| | - Andrew Hayen
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Andrea R Horvath
- School of Public Health, University of Sydney, Sydney, Australia; Department of Clinical Chemistry, Prince of Wales Hospital, South Eastern Area Laboratory Services, Sydney, Australia; and School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Goce Dimeski
- School of Medicine and Chemical Pathology, Pathology Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | | | - David W Johnson
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | - Carmel M Hawley
- Departments of Nephrology and School of Medicine and Translational Research Institute, University of Queensland, Brisbane, Queensland, Australia
| | | | - Jonathan C Craig
- School of Public Health, University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
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The Role of Biomarkers in Valvular Heart Disease: Focus on Natriuretic Peptides. Can J Cardiol 2014; 30:1027-34. [DOI: 10.1016/j.cjca.2014.07.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 01/26/2023] Open
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Taneja AK, Gaze D, Coats AJ, Dumitrascu D, Spinarova L, Collinson P, Roughton M, Flather MD. Effects of nebivolol on biomarkers in elderly patients with heart failure. Int J Cardiol 2014; 175:253-60. [DOI: 10.1016/j.ijcard.2014.05.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 05/05/2014] [Accepted: 05/11/2014] [Indexed: 10/25/2022]
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Lindberg S, Jensen JS, Bjerre M, Pedersen SH, Frystyk J, Flyvbjerg A, Mogelvang R. Cardio-adipose tissue cross-talk: relationship between adiponectin, plasma pro brain natriuretic peptide and incident heart failure. Eur J Heart Fail 2014; 16:633-8. [PMID: 24723498 DOI: 10.1002/ejhf.82] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 02/10/2014] [Accepted: 02/14/2014] [Indexed: 11/11/2022] Open
Abstract
AIMS There is increasing evidence of cross-talk between the heart, body metabolism, and adipose tissue, but the precise mechanisms are poorly understood. Natriuretic peptides (NPs) have recently emerged as the prime candidate for a mediator. In patients with heart failure (HF), infusion of NPs increases adiponectin secretion, indicating that NPs may improve adipose tissue function and in this way function as a cardio-protective agent in HF. Accordingly we investigated the interplay between plasma adiponectin, plasma proBNP, and development of HF. METHODS AND RESULTS We prospectively followed 5574 randomly selected men and women from the community without ischaemic heart disease or HF. Plasma adiponectin and proBNP were measured at study entry. Median follow-up time was 8.5 years (interquartile range 8.0-9.1 years). During follow-up 271 participants developed symptomatic HF. Plasma adiponectin and proBNP were strongly associated (P < 0.001). Participants with increasing adiponectin had increased risk of incident HF (P < 0.001). After adjustment for confounding risk factors (including age, gender, smoking status, body mass ratio, waist-hip ratio, glucose, glycated haemoglobin, systolic and diastolic blood pressure, lipid profile, high sensitivity C-reactive protein, estimated glomerular filtration rate, and physical activity) by Cox regression analysis, adiponectin remained an independent predictor of HF: the hazard ratio (HR) per 1 standard deviation (SD) increase in adiponectin was 1.20 [95% confidence interval (CI) 1.06-1.30; P = 0.003]. However, the association vanished when plasma proBNP was included in the analysis, HR 1.08 (95% CI 0.95-1.23; P = 0.26). CONCLUSIONS In conclusion, plasma adiponectin and proBNP are strongly associated. Increasing plasma adiponectin is associated with increased risk of HF. However, concomitantly elevated proBNP levels appear to explain the positive association between adiponectin and risk of HF.
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Affiliation(s)
- Søren Lindberg
- Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark; Department of Cardiology P, Gentofte University Hospital, Copenhagen, Denmark
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Ogihara Y, Yamada N, Dohi K, Matsuda A, Tsuji A, Ota S, Ishikura K, Nakamura M, Ito M. Utility of right ventricular Tei-index for assessing disease severity and determining response to treatment in patients with pulmonary arterial hypertension. J Cardiol 2014; 63:149-53. [DOI: 10.1016/j.jjcc.2013.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 06/06/2013] [Accepted: 07/02/2013] [Indexed: 10/26/2022]
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Park JJ, Choi DJ, Yoon CH, Oh IY, Jeon ES, Kim JJ, Cho MC, Chae SC, Ryu KH, Yoo BS, Kang SM, Oh BH. Prognostic value of C-reactive protein as an inflammatory and N-terminal probrain natriuretic peptide as a neurohumoral marker in acute heart failure (from the Korean Heart Failure registry). Am J Cardiol 2014; 113:511-7. [PMID: 24315115 DOI: 10.1016/j.amjcard.2013.10.022] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 01/18/2023]
Abstract
The neurohumoral and inflammatory pathways are regarded as the main mechanisms for the progression of heart failure. We sought to investigate the prognostic value of high-sensitivity C-reactive protein (hs-CRP) and N-terminal probrain natriuretic peptide (NT-proBNP) by evaluating their relation with 12-month mortality rate in this prospective cohort study from 24 academic hospitals in Korea. In 1,608 patients with acute heart failure (AHF), the median hs-CRP and NT-proBNP values were 0.77 mg/dl (interquartile range 0.29 to 2.84) and 4,638 pg/ml (interquartile range 1,945 to 10,852), respectively. During the 12-month follow-up, 213 patients (13.3%) died. The mortality rate increased from the lowest to the highest hs-CRP quartiles (Q1 7.4%, Q2 9.5%, Q3 16.9%, Q4 19.3%, p <0.001) and NT-proBNP quartiles (Q1 7.0%, Q2 13.4%, Q3 11.6%, Q4 20.4%, p <0.001). After adjustment, both hs-CRP (hazard ratio [HR] 1.811, 95% confidence interval [CI] 1.138 to 2.882) and NT-proBNP (HR 1.971, 95% CI 1.219 to 3.187) were independent predictors of 12-month mortality among others. When combining both hs-CRP and NT-proBNP and stratifying the patients according to their median values, patients with elevation of both hs-CRP and NT-proBNP values had 2.4-fold increased hazards (HR 2.382, 95% CI 1.509 to 3.761) compared with those without elevation of both markers. In Korean patients with AHF, patients with increased levels of both hs-CRP and NT-proBNP had worse clinical outcomes. The combination of the neurohumoral and inflammatory markers may provide a better strategy for risk stratification of Asian patients with AHF.
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Affiliation(s)
- Jin Joo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Chang-Hwan Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Il-Young Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Eun-Seok Jeon
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, South Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, South Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea
| | - Kyu-Hyung Ryu
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, South Korea
| | - Byung-Su Yoo
- Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
| | - Seok-Min Kang
- Division of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Byung-Hee Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
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Prognostic value of sequential measurements of amino-terminal prohormone of B-type natriuretic peptide in ambulatory heart failure patients. Eur J Heart Fail 2014; 10:404-11. [DOI: 10.1016/j.ejheart.2008.02.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Revised: 12/18/2007] [Accepted: 02/28/2008] [Indexed: 11/23/2022] Open
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Predictive value of admission N-terminal pro-B-type natriuretic peptide and renal function in older people hospitalized for dyspnoea. DISEASE MARKERS 2013; 35:735-40. [PMID: 24324290 PMCID: PMC3845254 DOI: 10.1155/2013/687467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated the relationship between NT-pro-BNP, glomerular filtration rate (GFR), and all-cause mortality rates in a cohort of older people discharged from an internal medicine unit after admission for dyspnoea. PATIENTS AND METHODS NT-pro-BNP was evaluated in serum samples of 134 patients aged 80 ± 6 years who presented to a single academic centre with worsening dyspnoea. History data and anthropometric, clinical, and biochemical parameters including GFR were collected at the time of admission. 119 out of 134 were discharged alive from hospital and were included in the follow-up of 779 ± 370 days. RESULTS 35 out of 119 subjects died after a follow-up of 266 ± 251 days. Cox proportional hazards model showed that GFR and Ln (NT-pro-BNP) were predictors for all-cause mortality with estimated hazard ratios of 0.969 (95% confidence interval: 0.950-0.988; P = 0.001) and 2.360 (95% confidence interval: 1.208-4.610; P = 0.012), respectively. Patients characterized by high NT-pro-BNP levels and GFR ≥ 60 mL/min/1.73 m(2) showed a dramatic reduction in survival duration compared with the groups with different combinations of the two variables (P = 0.008). CONCLUSIONS In the elderly, NT-pro-BNP and GFR are predictors of all-cause mortality after admission because of dyspnoea. Since the fact that subjects with high NT-pro-BNP and GFR ≥ 60 mL/min/1.73 m(2) exhibited a reduced survival, high admission NT-pro-BNP suggests future negative outcome.
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Ulimoen SR, Enger S, Pripp AH, Abdelnoor M, Arnesen H, Gjesdal K, Tveit A. Calcium channel blockers improve exercise capacity and reduce N-terminal Pro-B-type natriuretic peptide levels compared with beta-blockers in patients with permanent atrial fibrillation. Eur Heart J 2013; 35:517-24. [DOI: 10.1093/eurheartj/eht429] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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İşcen S. Comment on B-Type Natriuretic Peptide Predicts Left Atrial Appendage Thrombus in Patients with Nonvalvular Atrial Fibrillation. Echocardiography 2013; 30:1121. [DOI: 10.1111/echo.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Sinan İşcen
- Department of Cardiology; Dıyarbakır Mılıtary Hospıtal; Yehişehir Diyarbakır Turkey
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Brenyo A, Barsheshet A, Rao M, Huang DT, Zareba W, McNitt S, Hall WJ, Peterson DR, Solomon SD, Moss AJ, Goldenberg I. Brain Natriuretic Peptide and Cardiac Resynchronization Therapy in Patients With Mildly Symptomatic Heart Failure. Circ Heart Fail 2013; 6:998-1004. [DOI: 10.1161/circheartfailure.112.000174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Andrew Brenyo
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Alon Barsheshet
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Mohan Rao
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - David T. Huang
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Wojciech Zareba
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Scott McNitt
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - W. Jackson Hall
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Derick R. Peterson
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Scott D. Solomon
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Arthur J. Moss
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
| | - Ilan Goldenberg
- From the Division of Cardiology (A. Brenyo, A. Barsheshet, M.R., D.T.H., W.Z., S.M., A.J.M., I.G.), and the Department of Biostatistics (W.J.H., D.R.P.), University of Rochester Medical Center, Rochester, NY; and the Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (S.D.S.)
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Clark BJ, Bull TM, Benson AB, Stream AR, Macht M, Gaydos J, Meadows C, Burnham EL, Moss M. Growth differentiation factor-15 and prognosis in acute respiratory distress syndrome: a retrospective cohort study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2013; 17:R92. [PMID: 23706007 PMCID: PMC3706804 DOI: 10.1186/cc12737] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 05/24/2013] [Indexed: 01/08/2023]
Abstract
Introduction We sought to determine whether higher levels of the novel biomarker growth differentiation factor-15 (GDF-15) are associated with poor outcomes and the presence of pulmonary vascular dysfunction (PVD) in patients with acute respiratory distress syndrome (ARDS). Methods We conducted a retrospective cohort study in patients enrolled in the Acute Respiratory Distress Syndrome Network Fluid and Catheter Treatment (FACT) Trial. Patients enrolled in the FACT Trial who received a pulmonary artery catheter (PAC), had plasma available from the same study day and sufficient hemodynamic data to determine the presence of PVD were included. Logistic regression was used to determine the association between GDF-15 level and 60-day mortality. Results Of the 513 patients enrolled in the FACT Trial assigned to receive a PAC, 400 were included in this analysis. Mortality at 60 days was significantly higher in patients whose GDF-15 levels were in the third (28%) or fourth (49%) quartile when compared to patients with GDF-15 levels in the first quartile (12%) (P <0.001). Adjusting for severity of illness measured by APACHE III score, the odds of death for patients with GDF-15 levels in the fourth quartile when compared to the first quartile was 4.26 (95% CI 2.18, 10.92, P <0.001). When added to APACHE III alone for prediction of 60-day mortality, GDF-15 levels increased the area under the receiver operating characteristic curve from 0.72 to 0.77. At an optimal cutoff of 8,103 pg/mL, the sensitivity and specificity of GDF-15 for predicting 60-day mortality were 62% (95% CI 53%, 71%) and 76% (95% CI 71%, 81%), respectively. Levels of GDF-15 were not useful in identifying the presence of PVD, as defined by hemodynamic measurements obtained by a PAC. Conclusions In patients with ARDS, higher levels of GDF-15 are significantly associated with poor outcome but not PVD.
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Jiang K, Shah K, Daniels L, Maisel AS. Review on natriuretic peptides: where we are, where we are going. ACTA ACUST UNITED AC 2013; 2:1137-53. [PMID: 23496424 DOI: 10.1517/17530059.2.10.1137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Tremendous advances have been made in our understanding of the pathophysiology and treatment of congestive heart failure. However, diagnosis of the disease still remains difficult, even with a comprehensive physical examination. Symptoms such as dyspnea are nonspecific and insensitive indicators for heart failure, which can go largely undetected. Several studies have suggested the need for new diagnostic capabilities, especially with the increasing prevalence of heart failure in the US. The discovery of natriuretic peptides as diagnostic biomarkers has been one of the most critical advances for the management of heart failure. Both B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide have the potential to diagnose heart failure, assess prognostic risk of rehospitalization and mortality, and even help guide treatment. Their relative cost-effectiveness and availability have also facilitated their acceptance into many emergency departments, clinics and in-patient units as standard care when evaluating patients with suspected heart failure. Our understanding of the natriuretic peptide system is still in its infancy, but natriuretic peptides have emerged as important diagnostic and prognostic tools that have generated interest in finding broader applications for their use. OBJECTIVE The purpose of this review is to discuss the clinical approaches and future applications of natriuretic peptides in diagnosing and managing treatment of congestive heart failure. METHOD A comprehensive review of studies to assess the utility of natriuretic peptides for diagnosis and prognosis of heart failure and other conditions. CONCLUSION Natriuretic peptides are powerful tools to aid the physician in the diagnosis, prognosis and management of heart failure in both in-patient and out-patient settings. However, natriuretic peptides should be used as an adjunct test as many circumstances can also influence changes in natriuretic peptide levels.
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Affiliation(s)
- Kevin Jiang
- VA San Diego Medical Center and the University of California, Division of Cardiology, Department of Medicine, VAMC, 3350 La Jolla Village Dr, San Diego, CA 92161, USA +1 858 552 8585 ; +1 858 552 7490 ;
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Kojuri J, Ostovan MA, Rezaian GR, Archin Dialameh P, Zamiri N, Sharifkazemi MB, Jannati M. Effect of omega-3 on brain natriuretic peptide and echocardiographic findings in heart failure: Double-blind placebo-controlled randomized trial. J Cardiovasc Dis Res 2013; 4:20-4. [PMID: 24023466 DOI: 10.1016/j.jcdr.2013.02.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Accepted: 08/27/2012] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Possible beneficial effects of dietary omega-3 supplementation on patients with congestive heart failure (CHF) were investigated. METHODS AND RESULTS 100 patients with CHF who had a tri-chamber pacemaker and automated defibrillator were initially recruited, and 70 agreed to participate.38 patients received 2 g/day of omega-3 and 32 received placebo capsules. BNP level, 6-min walk test and echocardiographic parameters were recorded at baseline and after 6 months of treatment. BNP levels decreased significantly after 6 months in the omega-3 group, from 1766.2 ± 1978.1 pg/mL to 1159.4 ± 1430.9 pg/dL (P < 0.005). Tei index and late diastolic velocity index were significantly improved in treated group. Mortality and hospitalization rates did not differ. CONCLUSION The beneficial effects of omega-3 supplementation in patients with CHF were not as clear as hypothesized; however, omega-3 fatty acids can result in small changes in plasma BNP levels and modest improvements in echocardiographically assessed diastolic function (Clinical trial.gov registration: NCT01227837).
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Affiliation(s)
- J Kojuri
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran ; Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Gaggin HK, Januzzi JL. Biomarkers and diagnostics in heart failure. Biochim Biophys Acta Mol Basis Dis 2013; 1832:2442-50. [PMID: 23313577 DOI: 10.1016/j.bbadis.2012.12.014] [Citation(s) in RCA: 261] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/29/2012] [Accepted: 12/22/2012] [Indexed: 12/16/2022]
Abstract
Heart failure (HF) biomarkers have dramatically impacted the way HF patients are evaluated and managed. B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) are the gold standard biomarkers in determining the diagnosis and prognosis of HF, and studies on natriuretic peptide-guided HF management look promising. An array of additional biomarkers has emerged, each reflecting different pathophysiological processes in the development and progression of HF: myocardial insult, inflammation and remodeling. Novel biomarkers, such as mid-regional pro atrial natriuretic peptide (MR-proANP), mid-regional pro adrenomedullin (MR-proADM), highly sensitive troponins, soluble ST2 (sST2), growth differentiation factor (GDF)-15 and Galectin-3, show potential in determining prognosis beyond the established natriuretic peptides, but their role in the clinical care of the patient is still partially defined and more studies are needed. This article is part of a Special Issue entitled: Heart failure pathogenesis and emerging diagnostic and therapeutic interventions.
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Affiliation(s)
- Hanna K Gaggin
- Cardiology Division, Massachusetts General Hospital, 55 Fruit Street, Yawkey 5700, Boston, MA, USA.
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Caselli C, Lionetti V, Cabiati M, Prescimone T, Aquaro GD, Ottaviano V, Bernini F, Mattii L, Del Ry S, Giannessi D. Regional evidence of modulation of cardiac adiponectin level in dilated cardiomyopathy: pilot study in a porcine animal model. Cardiovasc Diabetol 2012; 11:143. [PMID: 23164042 PMCID: PMC3537584 DOI: 10.1186/1475-2840-11-143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 11/07/2012] [Indexed: 12/30/2022] Open
Abstract
Background The role of systemic and myocardial adiponectin (ADN) in dilated cardiomyopathy is still debated. We tested the regulation of both systemic and myocardial ADN and the relationship with AMP-activated protein kinase (AMPK) activity in a swine model of non-ischemic dilated cardiomyopathy. Methods and results Cardiac tissue was collected from seven instrumented adult male minipigs by pacing the left ventricular (LV) free wall (180 beats/min, 3 weeks), both from pacing (PS) and opposite sites (OS), and from five controls. Circulating ADN levels were inversely related to global and regional cardiac function. Myocardial ADN in PS was down-regulated compared to control (p < 0.05), yet ADN receptor 1 was significantly up-regulated (p < 0.05). No modifications of AMPK were observed in either region of the failing heart. Similarly, myocardial mRNA levels of PPARγ, PPARα, TNFα, iNOS were unchanged compared to controls. Conclusions Paradoxically, circulating ADN did not show any cardioprotective effect, confirming its role as negative prognostic biomarker of heart failure. Myocardial ADN was reduced in PS compared to control in an AMPK-independent fashion, suggesting the occurrence of novel mechanisms by which reduced cardiac ADN levels may regionally mediate the decline of cardiac function.
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Affiliation(s)
- Chiara Caselli
- Consiglio Nazionale delle Ricerche (CNR), Institute of Clinical Physiology, Laboratory of Cardiovascular Biochemistry, Pisa, Italy
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Watanabe K, Dohi K, Sugimoto T, Yamada T, Sato Y, Ichikawa K, Sugiura E, Kumagai N, Nakamori S, Nakajima H, Hoshino K, Machida H, Okamoto S, Onishi K, Nakamura M, Nobori T, Ito M. Short-term effects of low-dose tolvaptan on hemodynamic parameters in patients with chronic heart failure. J Cardiol 2012; 60:462-9. [PMID: 23068288 DOI: 10.1016/j.jjcc.2012.09.002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 07/10/2012] [Accepted: 08/26/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND We evaluated the short-term effects of low-dose tolvaptan treatment on hemodynamic parameters in patients with chronic heart failure (HF). METHODS We studied 22 patients (69 ± 10 years) with chronic HF and excess fluid retention despite receiving appropriate medical therapy, including loop and/or thiazide diuretics. The therapeutic effects of low-dose (7.5mg) once-daily tolvaptan on hemodynamics associated with changes in fluid balance and neurohumoral activations were investigated after a seven day treatment period. RESULTS After the treatment period, body weight decreased (-2.7 ± 2.3 kg) associated with increases in daily urine output. Whereas plasma arginine-vasopressin levels, serum aldosterone concentration, and plasma renin activity mildly increased, plasma levels of B-type natriuretic peptide and atrial natriuretic peptide significantly decreased after tolvaptan treatment. Serum electrolytes were not adversely affected by tolvaptan treatment. Although cardiac index and systemic vascular resistance index remained unchanged, mean pulmonary artery wedge pressure (22 ± 7 mmHg vs. 17 ± 7 mmHg, p<0.05), mean right atrial pressure (12 ± 5 mmHg vs. 9 ± 5 mmHg, p<0.05), mean pulmonary artery pressure (32 ± 9 mmHg vs. 25 ± 7 mmHg, p<0.05), and pulmonary vascular resistance index (332 ± 207 dynes/cm(-5)/m(2) vs. 245 ± 110 dynes/cm(-5)/m(2), p<0.05) significantly decreased after tolvaptan treatment. The extent of the reduction in pulmonary vascular resistance index after tolvaptan treatment strongly correlated with baseline values. CONCLUSIONS Short-term treatment with low-dose tolvaptan improved hemodynamic parameters and correlated with significant fluid removal in patients with chronic HF.
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Affiliation(s)
- Kiyotaka Watanabe
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Tsu, Japan
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Wolf J, Gerlach N, Weber K, Klima A, Wess G. Lowered N-terminal pro-B-type natriuretic peptide levels in response to treatment predict survival in dogs with symptomatic mitral valve disease. J Vet Cardiol 2012; 14:399-408. [PMID: 22858663 DOI: 10.1016/j.jvc.2012.05.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 04/29/2012] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In humans with congestive heart failure (CHF), better outcome is correlated with lower natriuretic peptide (NP) levels after starting treatment and greater percentage reduction of NP levels. Therefore, the aim of this study was to determine the relationship between absolute and relative changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and pro-atrial natriuretic peptide 31-67 (proANP 31-67) and overall cardiac survival in patients with symptomatic myxomatous mitral valve disease (MMVD). Furthermore, we sought to compare clinical and echocardiographic status of 12-month survivors and non-survivors. ANIMALS, MATERIALS AND METHODS 26 dogs with CHF due to MMVD. Initial NP levels, as well as absolute and percentage changes of follow-up NP levels (between 7 and 30 days after treatment start) and heart failure (HF) class were tested as potential predictors of overall cardiac survivorship. Additionally, various echocardiographic parameters, creatinine concentrations and furosemide doses were compared between 12-month survivors and non-survivors. RESULTS Dogs with follow-up NT-proBNP level <965 pmol/l had a significantly longer overall cardiac survival than patients with NT-proBNP level >965 pmol/l (P = 0.03). Dogs in a higher HF class had a significantly (P = 0.03) higher probability of shorter survival independent of their NP levels. When dogs were grouped by 12-month survival, only follow-up NT-proBNP levels were significantly different between groups. CONCLUSIONS HF class at presentation and NT-proBNP levels after initiating treatment are predictive of mortality in patients with symptomatic MMVD. ProANP 31-67 levels, percentage reduction in NPs levels, creatinine or urea concentration, echocardiographic parameters and furosemide dose did not predict outcome.
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Affiliation(s)
- Johanna Wolf
- Clinic of Small Animal Medicine, LMU University, Veterinaerstr. 13, 80539 Munich, Germany
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Heart Failure Outcomes and Benefits of NT-proBNP-Guided Management in the Elderly: Results From the Prospective, Randomized ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) Study. J Card Fail 2012; 18:626-34. [DOI: 10.1016/j.cardfail.2012.05.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/13/2012] [Accepted: 05/11/2012] [Indexed: 11/23/2022]
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Exercise Oscillatory Breathing and NT-proBNP Levels in Stable Heart Failure Provide the Strongest Prediction of Cardiac Outcome When Combining Biomarkers With Cardiopulmonary Exercise Testing. J Card Fail 2012; 18:313-20. [DOI: 10.1016/j.cardfail.2012.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 01/02/2012] [Accepted: 01/09/2012] [Indexed: 11/30/2022]
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Izawa KP, Watanabe S, Oka K, Hiraki K, Morio Y, Kasahara Y, Takeichi N, Tsukamoto T, Osada N, Omiya K. Relation between physical activity and exercise capacity of ≥5 metabolic equivalents in middle- and older-aged patients with chronic heart failure. Disabil Rehabil 2012; 34:2018-24. [DOI: 10.3109/09638288.2012.667502] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Upper and Lower Extremity Muscle Strength Levels Associated With an Exercise Capacity of 5 Metabolic Equivalents in Male Patients With Heart Failure. J Cardiopulm Rehabil Prev 2012; 32:85-91. [DOI: 10.1097/hcr.0b013e31824bd886] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Januzzi JL. The role of natriuretic peptide testing in guiding chronic heart failure management: review of available data and recommendations for use. Arch Cardiovasc Dis 2012; 105:40-50. [PMID: 22369917 DOI: 10.1016/j.acvd.2011.10.007] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 10/15/2011] [Indexed: 11/17/2022]
Abstract
The care of patients with heart failure can be challenging, with few objective tools available to assist in therapy decision-making. Natriuretic peptides are powerfully prognostic biomarkers in patients with heart failure and may represent an objective target for therapy. Accordingly, the use of biomarker-guided care with either B-type natriuretic peptide (BNP) or amino-terminal pro-B-type natriuretic peptide (NT-proBNP) has been recently explored. Over the past few years, a number of studies with heterogeneous inclusion criteria, methods and results have been performed. We have reviewed the available literature, summarizing the results of biomarker-guided heart failure trials and deriving recommendations for optimal application of biomarker-guided heart failure care based on the experience gained. In general, positive studies had low BNP or NT-proBNP target concentrations (∼100 pg/mL and ∼1000 pg/mL, respectively) and achieved lower natriuretic peptide concentrations compared with standard care. Patients in the biomarker-guided arms of the studies typically received more aggressive heart failure care and had no excess adverse outcomes. In the recent ProBNP Outpatient Tailored Chronic Heart Failure Therapy (PROTECT) study, patients treated with biomarker-guided care also had improved quality of life and significantly better reverse remodeling on echocardiography compared with patients who received standard care. In conclusion, heart failure therapy guided by a goal to reduce natriuretic peptide concentrations below prognostically-meaningful levels results in more aggressive heart failure care, is well tolerated and is associated with superior outcomes.
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Affiliation(s)
- James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Yawkey 5984, Boston, MA 02114, USA.
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Loncar G, von Haehling S, Tahirovic E, Inkrot S, Mende M, Sekularac N, Lainscak M, Apostolovic S, Putnikovic B, Edelmann F, Wachter R, Dimkovic S, Waagstein F, Gelbrich G, Düngen HD. Effect of beta blockade on natriuretic peptides and copeptin in elderly patients with heart failure and preserved or reduced ejection fraction: Results from the CIBIS-ELD trial. Clin Biochem 2012; 45:117-22. [DOI: 10.1016/j.clinbiochem.2011.11.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 11/05/2011] [Accepted: 11/15/2011] [Indexed: 11/25/2022]
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