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Zhou Y, Duan S, Wang R, Chen J, Yao S. Nonlinear correlation between fatty liver index and carotid intima media thickness among individuals undergoing health examination. Front Endocrinol (Lausanne) 2023; 14:1120581. [PMID: 37056670 PMCID: PMC10086365 DOI: 10.3389/fendo.2023.1120581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 03/01/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Fatty liver index (FLI) is a predictor of non-alcohol fatty liver disease (NAFLD). This study aimed to assess the association between FLI and carotid intima media thickness (CIMT). METHODS In this cross-sectional study, we enrolled 277 individuals for health examination from the China-Japan Friendship Hospital. Blood sampling and ultrasound examinations were conducted. Multivariate logistic regression and restricted cubic spline analyses were performed to evaluate the association between FLI and CIMT. RESULTS Overall, 175 (63.2%) and 105 (37.9%) individuals had NAFLD and CIMT, respectively. The multivariate logistic regression analyses results showed that high FLI was independently associated with a high risk of increased CIMT, T2 vs. T1 (odds ratio [OR], 95% confidence interval [CI]): 2.41, 1.10-5.25, p = 0.027; T3 vs. T1 (OR, 95% CI): 1.58, 0.68-3.64, p = 0.285. The association between FLI and increased CIMT exhibited a J-shaped curve (nonlinear, p = 0.019). In the threshold analysis, the OR for developing increased CIMT was 1.031 (95% CI: 1.011-1.051, p = 0.0023) in participants with FLI < 64.247. CONCLUSION The relationship between FLI and increased CIMT in the health examination population is J-shaped, with an inflection point of 64.247.
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Affiliation(s)
- Yuanchen Zhou
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
| | - Shaojie Duan
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Rongrui Wang
- Graduate School of Beijing University of Chinese Medicine, Beijing, China
| | - Jialiang Chen
- Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Shukun Yao, ; Jialiang Chen,
| | - Shukun Yao
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University, Beijing, China
- Department of Gastroenterology, China-Japan Friendship Hospital, Beijing, China
- *Correspondence: Shukun Yao, ; Jialiang Chen,
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García-Torre A, Bueno-García E, López-Martínez R, Rioseras B, Díaz-Molina B, Lambert JL, Quirós C, Alonso-Álvarez S, Alonso-Arias R, Moro-García MA. CMV Infection Is Directly Related to the Inflammatory Status in Chronic Heart Failure Patients. Front Immunol 2021; 12:687582. [PMID: 34456907 PMCID: PMC8387659 DOI: 10.3389/fimmu.2021.687582] [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: 03/29/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
High levels of inflammation play an important role in chronic heart failure (CHF). Patients with CHF have elevated levels of pro-inflammatory cytokines circulating systemically, mainly TNF and IL-6. However, there are almost no studies that relate these levels to the functional status of patients in CHF, much less to their CMV serostatus. In this study, patients with CHF (n=40; age=54.9 ± 6.3; New York Heart Association functional classification (NYHA, I-III) and healthy controls (n=40; age=53.5 ± 7.1) were analyzed. The serum concentrations of nine pro- and anti-inflammatory cytokines were measured by Luminex® xMap Technology and the basal level of mRNA expression of some immune molecules was quantified by TaqMan™ Array in CD4+ T-lymphocytes. The concentration of these cytokines in culture supernatants in response to anti-CD3 and LPS was also measured. The percentage of CD28null T-cells was determined, as well as the antibody titer against CMV. We found a higher concentration of all cytokines studied in CHF serum compared to healthy controls, as well as a direct correlation between functional status in CHF patients and levels of inflammatory cytokines. Moreover, the highest cytokine concentrations were found in patients with higher concentrations of lymphocytes lacking CD28 molecule. The cytokine production was much higher in CMV+ patients, and the production of these cytokines was found mainly in the T-lymphocytes of CMV+ patients in response to anti-CD3. Anti-CMV antibody levels were positively correlated with cytokine levels. The baseline expression of specific mRNA of the main molecules involved in the Th1 response, as well as molecules related to the CD4+CD28 null subset was higher in CMV+ patients. The cytokine concentrations are higher in CHF CMV+ patients and these concentrations are related to the production of antibodies against CMV. These high levels of cytokines are also associated with the more differentiated CD28null lymphocyte populations. All this, together with the dynamics of the pathology itself, makes CMV+ patients present a worse functional status and possibly a worse evolution of the pathology.
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Affiliation(s)
- Alejandra García-Torre
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain
| | - Eva Bueno-García
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain
| | - Rocío López-Martínez
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Beatriz Rioseras
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Beatriz Díaz-Molina
- Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Section of Hemodynamics and Interventional Cardiology, Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - José Luis Lambert
- Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Section of Hemodynamics and Interventional Cardiology, Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Covadonga Quirós
- Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Sara Alonso-Álvarez
- Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Hematology and Haemotherapy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rebeca Alonso-Arias
- Immunology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.,Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Marco A Moro-García
- Department of Cardiac Pathology, Health Research Institute of the Principality of Asturias - ISPA, Oviedo, Spain.,Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Er LK, Lin MC, Tsai YC, Hsiao JK, Yang CY, Chang CC, Peng KY, Chueh JS, Wu VC. Association of visceral adiposity and clinical outcome among patients with aldosterone producing adenoma. BMJ Open Diabetes Res Care 2020; 8:8/1/e001153. [PMID: 32713841 PMCID: PMC7383952 DOI: 10.1136/bmjdrc-2019-001153] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 04/11/2020] [Accepted: 06/10/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Primary aldosteronism (PA) is a common form of secondary hypertension that has significant cardiovascular events and increased prevalence of metabolic syndrome and diabetics. Although plasma aldosterone concentration is positively correlated with visceral fat area (VFA) in non-PA individuals, the role of visceral adiposity associated with clinical success after surgery is not known. RESEARCH DESIGN AND METHODS We analyzed patients who underwent adrenalectomy for aldosterone-producing adenoma (APA) at the Taiwan PA Investigator group. VFA was calculated from the abdominal CT scan at APA diagnosis, and all patients received adrenalectomy. RESULTS The study involved 100 consecutive patients with APA (42 males; mean age 49.3 years) matched with 41 essential hypertension (EH) patients. Patients with APA had smaller VFA (p=0.010) than their EH counterparts. Multiple linear regression analysis revealed that the duration of hypertension (p=0.007), but not plasma aldosterone, was negatively correlated with VFA in patients with APA. Logistic regression analysis showed that log VFA (OR=0.065, p<0.001) and duration of hypertension before PA diagnosis (OR=0.919, p=0.011) can predict complete clinical success after adrenalectomy. Multifactor-adjusted generalized additive model demonstrated that log VFA <9.2 was associated with complete cure of hypertension. Furthermore, VFA was increased at 6 months after adrenalectomy (p=0.045). CONCLUSIONS Patients with APA had smaller VFA than their EH counterparts, and VFA increased after adrenalectomy. Clinical complete cure of hypertension after surgery was associated with smaller VFA and shorter duration of hypertension at PA diagnosis, suggesting a potential interplay of visceral adiposity and aldosterone of the patients with APA.
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Affiliation(s)
- Leay Kiaw Er
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
- School of Medicine, Tzu Chi University College of Medicine, Hualien, Taiwan
| | - Meng-Chun Lin
- Department of Internal Medicine, National Taiwan University Hospital, Chu-Tung Branch, Chu-Tung, Taiwan
| | - Yao-Chou Tsai
- Department of Urology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Urology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Jong-Kai Hsiao
- College of Medicine, Tzu Chi University, Hualien, Taiwan
- Department of Radiology, Taipei Tzu-Chi Hospital, Buddhist Tzu-Chi Medical Foundation, New Taipei City, Taiwan
| | - Chung-Yi Yang
- Department of Radiology, E-Da Hospital, Kaohsiung City, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City, Taiwan
| | - Chin-Chen Chang
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
- College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kang-Yung Peng
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jeff S Chueh
- Department of Urology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Vin-Cent Wu
- College of Medicine, National Taiwan University, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Wu CK, Lee JK, Hsu JC, Su MYM, Wu YF, Lin TT, Lan CW, Hwang JJ, Lin LY. Myocardial adipose deposition and the development of heart failure with preserved ejection fraction. Eur J Heart Fail 2019; 22:445-454. [PMID: 31696627 DOI: 10.1002/ejhf.1617] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/05/2019] [Accepted: 08/20/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS It has been proposed that an increase of myocardial adiposity is related to left ventricular (LV) diastolic dysfunction. The specific roles of myocardial steatosis including epicardial fat and intramyocardial fat for diastolic function are unknown in those patients suffering heart failure (HF) with reduced (HFrEF) or preserved ejection fraction (HFpEF). This study aims to determine the complex relationship between myocardial adiposity in patients with HFrEF or HFpEF. METHODS AND RESULTS Using cardiac magnetic resonance imaging (CMRI), myocardial steatosis was measured in 305 subjects (34 patients with HFrEF, 163 with HFpEF, and 108 non-HF controls). We also evaluated cardiac structure and diastolic and systolic function by echocardiography and CMRI. Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls [intramyocardial fat content (%), 1.56 (1.26, 1.89) vs. 0.75 (0.50, 0.87) and 1.0 (0.79, 1.15), P < 0.05]. Intramyocardial fat amount (%) was higher in HFpEF women than in men [1.91% (1.17%, 2.32%) vs. 1.22 (0.87%, 2.02%), P = 0.01]. When estimated by CMRI (left ventricular peak filling rate), echocardiographic E/e' level, or left atrial volume index, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients, and this was independent of age, co-morbidities, body mass index, gender, and myocardial fibrosis (standardized coefficient: β = -0.34, P = 0.03; β = 0.29, P = 0.025; and β = 0.25, P = 0.02, respectively). CONCLUSIONS Patients with HFpEF had significantly more intramyocardial fat than HFrEF patients or non-HF controls. Independent of risk factors or gender, intramyocardial fat correlated with LV diastolic dysfunction parameters in HFpEF patients.
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Affiliation(s)
- Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jung-Chi Hsu
- Division of Cardiology, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Mao-Yuan M Su
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Fan Wu
- Department of Family Medicine, Taipei City Hospital, Renai Branch, Taipei, Taiwan
| | - Ting-Tse Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital Hsin-Chu Branch, Hsin-Chu City, Taiwan.,Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan
| | - Chen-Wei Lan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Lian-Yu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Biomarkers of Inflammation in Left Ventricular Diastolic Dysfunction. DISEASE MARKERS 2019; 2019:7583690. [PMID: 31275453 PMCID: PMC6589287 DOI: 10.1155/2019/7583690] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/21/2019] [Accepted: 05/07/2019] [Indexed: 02/06/2023]
Abstract
Left ventricular diastolic dysfunction (LVDD) is an important precursor to many different cardiovascular diseases. Diastolic abnormalities have been studied extensively in the past decade, and it has been confirmed that one of the mechanisms leading to heart failure is a chronic, low-grade inflammatory reaction. The triggers are classical cardiovascular risk factors, grouped under the name of metabolic syndrome (MetS), or other systemic diseases that have an inflammatory substrate such as chronic obstructive pulmonary disease. The triggers could induce myocardial apoptosis and reduce ventricular wall compliance through the release of cytokines by multiple pathways such as (1) immune reaction, (2) prolonged cell hypoxemia, or (3) excessive activation of neuroendocrine and autonomic nerve function disorder. The systemic proinflammatory state causes coronary microvascular endothelial inflammation which reduces nitric oxide bioavailability, cyclic guanosine monophosphate content, and protein kinase G (PKG) activity in adjacent cardiomyocytes favoring hypertrophy development and increases resting tension. So far, it has been found that inflammatory cytokines associated with the heart failure mechanism include TNF-α, IL-6, IL-8, IL-10, IL-1α, IL-1β, IL-2, TGF-β, and IFN-γ. Some of them could be used as diagnosis biomarkers. The present review aims at discussing the inflammatory mechanisms behind diastolic dysfunction and their triggering conditions, cytokines, and possible future inflammatory biomarkers useful for diagnosis.
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6
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Liu D, Li Q, Dong J, Li D, Xu X, Xing W, Zhang X, Cao W, Hou H, Wang H, Song M, Tao L, Kang X, Meng Q, Wang W, Guo X, Wang Y. The Association Between Normal BMI With Central Adiposity And Proinflammatory Potential Immunoglobulin G N-Glycosylation. Diabetes Metab Syndr Obes 2019; 12:2373-2385. [PMID: 31814749 PMCID: PMC6861528 DOI: 10.2147/dmso.s216318] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 10/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The mechanism by which normal body mass index (BMI) with central adiposity (NWCA) increases the risk of the diseases has not been completely elucidated. The inflammatory role of immunoglobulin G (IgG) N-glycosylation in obesity defined by BMI or central adiposity defined by waist-to-hip ratio (WHR) was reported, respectively. We undertook this three-center cross-sectional study to determine the association between the IgG N-glycans and NWCA. METHODS The participants were categorized into four different phenotypes: normal BMI with normal WHR (NW), normal BMI with central adiposity (NWCA), obesity with normal WHR (ONCA) and obesity with central adiposity (OCA). The IgG N-glycans were analyzed using ultra-performance liquid chromatography analysis of released glycans, and differences among groups were compared. RESULTS In total, 17 out of 24 initial IgG N-glycans were significantly different among the four groups (NW, ONCA, NWCA and OCA) (P<0.05/6*78=0.0001). The changes of IgG glycans in central obesity (12 GPs) were more than those in obesity (3 GPs). In addition, lower galactosylation and bisecting GlcNAc and higher fucosylation were associated with increased risk of NWCA. CONCLUSION Central obesity was involved in more changes of IgG N-glycosylation representing stronger inflammation than obesity, which might make a greater contribution to the risk of related disorders. NWCA was associated with an increased pro-inflammatory of IgG N-glycosylation, which was accompanied by the development of central obesity and other related disorders.
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Affiliation(s)
- Di Liu
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Qihuan Li
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
- Meinian Institute of Health, Beijing100191, People’s Republic of China
| | - Jing Dong
- Center for Physical Examination, Xuanwu Hospital, Capital Medical University, Beijing100050, People’s Republic of China
| | - Dong Li
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian271016, Shandong Province, People’s Republic of China
| | - Xizhu Xu
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian271016, Shandong Province, People’s Republic of China
| | - Weijia Xing
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian271016, Shandong Province, People’s Republic of China
| | - Xiaoyu Zhang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Weijie Cao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Haifeng Hou
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian271016, Shandong Province, People’s Republic of China
| | - Hao Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
- School of Medical and Health Sciences, Edith Cowan University, Perth6027, Australia
| | - Manshu Song
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Lixin Tao
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Xiaoping Kang
- The Rehabilitation Center, Beijing Xiaotangshan Hospital, Beijing102211, People’s Republic of China
| | - Qun Meng
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
| | - Wei Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian271016, Shandong Province, People’s Republic of China
- School of Medical and Health Sciences, Edith Cowan University, Perth6027, Australia
| | - Xiuhua Guo
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
- Xiuhua Guo School of Public Health, Capital Medical University, 10 Youanmen Xitoutiao, Beijing100069, People’s Republic of ChinaTel +86 10 83911504 Email
| | - Youxin Wang
- Beijing Key Laboratory of Clinical Epidemiology, School of Public Health, Capital Medical University, Beijing100069, People’s Republic of China
- Correspondence: Youxin Wang School of Public Health, Capital Medical University, 10 Youanmen Xitoutiao, Beijing100069, People’s Republic of ChinaTel +86 10 83911779 Email
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Kurisu S, Nitta K, Sumimoto Y, Ikenaga H, Ishibashi K, Fukuda Y, Kihara Y. Implications of electrocardiographic frontal QRS axis on left ventricular diastolic parameters derived from electrocardiogram-gated myocardial perfusion single photon emission computed tomography. Ann Nucl Med 2018; 32:404-409. [PMID: 29713999 DOI: 10.1007/s12149-018-1257-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 04/25/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Current electrocardiographic (ECG) machines report various variables including frontal QRS axis automatically. We tested the hypothesis that QRS axis is associated with left ventricular (LV) diastolic parameters derived from ECG-gated myocardial perfusion single photon emission computed tomography (SPECT) independent of myocardial ischemia. METHODS Ninety-three patients with preserved LV ejection fraction and no evidence of myocardial ischemia were enrolled based on ECG-gated SPECT. Peak filling rate (PFR), one-third mean filling rate (1/3 MFR) and time to peak filling (TTPF) were obtained as LV diastolic parameters. RESULTS There were 82 male and 11 female patients with a mean age of 69 ± 9 years. QRS axis ranged from - 40° to 85° (36° ± 31°). QRS axis was correlated with PFR (r = 0.28, p < 0.01), 1/3 MFR (r = 0.25, p = 0.02) and TTPF (r = - 0.21, p = 0.04). QRS axis was also correlated with age (r = - 0.23, p = 0.03), body mass index (BMI) (r = - 0.36, p < 0.01) and LV mass index (LVMI) (r = - 0.27, p < 0.01). Linear regression analysis showed that QRS axis was associated with PFR, 1/3 MFR and TTPF for LV diastolic function, but was not associated with these LV diastolic parameters after adjustment of various confounders. CONCLUSIONS Our data suggest that QRS axis depends on age, BMI or LVMI, and serves as a surrogate marker of LV diastolic function.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan.
| | - Kazuhiro Nitta
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yoji Sumimoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Hiroki Ikenaga
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ken Ishibashi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yukihiro Fukuda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
| | - Yasuki Kihara
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi-cho, Minami-ku, Hiroshima, 734-8551, Japan
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Castro ADAE, Skare TL, Yamauchi FI, Tachibana A, Ribeiro SPP, Fonseca EKUN, Sakuma AT, Peixoto MR, Rodrigues MAS, Barreiros MAM. DIAGNOSTIC VALUE OF C-REACTIVE PROTEIN AND THE INFLUENCE OF VISCERAL FAT IN PATIENTS WITH OBESITY AND ACUTE APPENDICITIS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2018; 31:e1339. [PMID: 29513800 PMCID: PMC5863996 DOI: 10.1590/0102-672020180001e1339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/30/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND The C reactive protein (CRP) is one of the most accurate inflammatory markers in acute appendicitis (AA). Obesity leads to a pro-inflammatory state with increased CRP, which may interfere with the interpretation of this laboratory test in AA. AIM To assess sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CRP in patients with AA and their correlation to body mass index (BMI) and body fat composition. METHOD This is a retrospective study based on clinical records and imaging studies of 191 subjects with histopathologically confirmed AA compared to 249 controls who underwent abdominal computed tomography (CT). Clinical and epidemiological data, BMI, and CRP values were extracted from medical records. CT scans were assessed for AA findings and body composition measurements. RESULTS CRP values increased according to patients' BMI, with varying sensitivity from 79.78% in subjects with normal or lean BMI, 87.87% in overweight, and 93.5% in individuals with obesity. A similar pattern was observed for NPV: an increase with increasing BMI, 69.3% in individuals with normal or lean BMI, 84.3% in overweight, and 91.3% in individuals with obesity. There was a positive correlation between CRP and visceral fat area in patients with AA. CONCLUSIONS Variations exist for sensitivity, specificity, PPV, and NPV values of CRP in patients with AA, stratified by BMI. An increase in visceral fat area is associated with elevated CRP across the BMI spectrum.
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Affiliation(s)
- Adham do Amaral E Castro
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | - Thelma Larocca Skare
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
| | | | - Adriano Tachibana
- Imaging Department, Hospital Israelita Albert Einstein, São Paulo, SP
| | | | | | - Andressa Tamy Sakuma
- Post-Graduate Program in Principles of Surgery, Evangelic Faculty of Paraná/University Evangelic Hospital of Curitiba/Medical Research Institute, Curitiba, PR, Brazil
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Mocan M, Anton F, Suciu Ș, Răhăian R, Blaga SN, Fărcaș AD. Multimarker Assessment of Diastolic Dysfunction in Metabolic Syndrome Patients. Metab Syndr Relat Disord 2017; 15:507-514. [PMID: 29099655 DOI: 10.1089/met.2017.0060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) has been associated with left ventricular diastolic dysfunction (LVDD) with preserved systolic function. This study aims at identifying the predictive factors for LVDD in MetS patients. METHODS The studied group comprised 72 consecutive hospitalized patients (2010-2011) diagnosed with MetS based on AHA/NHLBI/IDF 2009 definition, free of cardiovascular disease (36.11% males, age 59.19 ± 5.26 years), who underwent echocardiographic examination. Laboratory measurements of high-sensitivity C-reactive protein (hs-CRP), fibrinogen (Fbg) and interleukin-6 (IL-6), 8-isoprostaglandin-F2alpa (8-isoPGF2α), uric acid, glutathione peroxidases, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured. RESULTS LVDD was identified in 47 (65.27%) of the MetS patients. The diastolic blood pressure (DBP) was the strongest prediction factor for LVDD (areas under the receiver operating curve [AUC]: 0.73, odds ratios [OR]: 1.065). The number of MetS criteria was also significantly predictive for LVDD (AUC: 0.65, OR: 2.029, P < 0.04). IL-6, hs-CRP, Fbg, and NT-proBNP were predictive for LVDD when receiver operating curve (ROC) analyses were used. The multimarker model comprising age, sex, SBP and DBP, waist, circumference, triglycerides along with hs-CRP, IL-6, and NT-proBNP had the best predictive capacity (AUC: 0.88, P = 0.0001). In multivariate analysis, IL-6 remained an independent predictive biomarker for LVDD (OR: 2.045). CONCLUSION Both MetS components and biomarkers of inflammation (IF) are predictive factors for LVDD. The best predictive multimarker model for LVDD in MetS patients is composed of waist, triglycerides (TGL), SBP, DBP, fasting glucose, IL-6, hs-CRP, and NT-proBNP. IL-6 remains an independent predictive biomarker for LVDD in MetS patients, underlining the importance of IF in the evolution of MetS to subclinical cardiac damage.
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Affiliation(s)
- Mihaela Mocan
- 1 Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca , Cluj-Napoca, Romania .,2 Division of Internal Medicine, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Florin Anton
- 1 Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca , Cluj-Napoca, Romania .,3 Division of Cardiology, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Șoimița Suciu
- 4 Department of Physiology, University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca , Cluj-Napoca, Romania
| | - Rodica Răhăian
- 5 Division of Immunology, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Sorin Nicu Blaga
- 1 Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca , Cluj-Napoca, Romania .,2 Division of Internal Medicine, Emergency County Hospital Cluj, Cluj-Napoca, Romania
| | - Anca Daniela Fărcaș
- 1 Department of Internal Medicine, University of Medicine and Pharmacy Iuliu Hatieganu Cluj-Napoca , Cluj-Napoca, Romania .,3 Division of Cardiology, Emergency County Hospital Cluj, Cluj-Napoca, Romania
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Nakanishi K, Fukuda S, Tanaka A, Otsuka K, Taguchi H, Shimada K. Relationships Between Periventricular Epicardial Adipose Tissue Accumulation, Coronary Microcirculation, and Left Ventricular Diastolic Dysfunction. Can J Cardiol 2017; 33:1489-1497. [DOI: 10.1016/j.cjca.2017.08.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/02/2017] [Accepted: 08/02/2017] [Indexed: 01/23/2023] Open
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Affiliation(s)
- Fernando Ide Yamauchi
- MD, Attending Radiologist at Instituto de Radiologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InRad/HC-FMUSP), Attending Radiologist in the Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. (E-mail: )
| | - Adham do Amaral E Castro
- PhD, MD, Attending Radiologist in the Department of Radiology, Hospital Israelita Albert Einstein, Attending Radiologist in the Department of Diagnostic Imaging , Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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12
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Shemirani H, Tavakol S, Atapoor A, Golshahi J. The Role of Inflammatory Processes in Occurrence of Left Ventricular Failure in Patients with Chronic Kidney Disease. Adv Biomed Res 2017; 6:13. [PMID: 28299305 PMCID: PMC5343607 DOI: 10.4103/2277-9175.200788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Recently, the relationship between increased level of inflammatory mediators and occurrence of left ventricular failure in patients with kidney disease has been suggested. The present study attempted to assess relationship between inflammatory mediators and occurrence of left ventricular failure in patients with chronic kidney disease. Materials and Methods: This cross-sectional study was performed at Noor and Hazrat Aliasghar hospital in Isfahan between September 2012 to September 2013 on patients aged >19 years that referred for following their chronic kidney disease. Serum level of inflammatory parameters including C-reactive protein (CRP) and Interleukin-6 (IL-6) was measured using spectrophotometer. All patients were also assessed using M-mode echocardiography to determine left ventricular ejection fraction (LVEF). Results: The group with significant reduced LVEF showed lower GFR when compared to the normal LVEF group (40.73 ± 20.61% versus 44.43 ± 17.98%, P = 0.032). Comparing GFR across the three groups with normal LVEF (>55%), with mild LV dysfunction (LVEF: 45 – 55) those with significant LV dysfunction (LVEF < 45%) showed significantly lower GFR level in latter group compared with normal LVEF and mild LV dysfunction group (P = 0.026). Although the level of serum CRP was significantly higher in patients with significant left ventricular failure than other groups (P = 0.018). Conclusion: Inflammatory processes can potentially affect left ventricular function in patients with chronic kidney disease. In this regard, increased level of CRP may be a main factor for predicting severity of left ventricular failure in these patients.
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Affiliation(s)
- Hassan Shemirani
- Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sara Tavakol
- Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abdolamir Atapoor
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Jafar Golshahi
- Interventional Cardiology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Polsinelli VB, Shah SJ. Advances in the pharmacotherapy of chronic heart failure with preserved ejection fraction: an ideal opportunity for precision medicine. Expert Opin Pharmacother 2017; 18:399-409. [PMID: 28129699 DOI: 10.1080/14656566.2017.1288717] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Heart failure with preserved ejection fraction (HFpEF), which comprises approximately 50% of all heart failure patients, is a challenging and complex clinical syndrome that is often thought to lack effective treatments. Areas covered: Despite the common mantra that HFpEF has no effective treatments, closer inspection of HFpEF clinical trials reveals that several of the drugs tested are associated with benefits in exercise capacity and quality of life, and reduction in heart failure hospitalization. Here we review major randomized controlled trials in HFpEF, focusing on renin-angiotensin-aldosterone system antagonists, organic nitrates, digoxin, beta-blockers, and phosphodiesterase-5 inhibitors. In addition, we review several classes of drugs currently in development for HFpEF such as neprilysin inhibitors, inorganic nitrates (nitrites), and soluble guanylate cyclase stimulators. Expert opinion: HFpEF should not be viewed as lacking effective treatments. While there have been no breakthrough clinical trials showing a reduction in mortality, several existing medications are likely to benefit specific subgroups of HFpEF patients. HFpEF is now well known to be a heterogeneous syndrome; thus, the clinical management of HFpEF patients and future HFpEF clinical trials will both likely require a nuanced, phenotype-specific approach instead of a one-size-fits-all tactic. Drug development for HFpEF therefore represents an exciting opportunity for personalized medicine.
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Affiliation(s)
- Vincenzo B Polsinelli
- a Division of Cardiology, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
| | - Sanjiv J Shah
- a Division of Cardiology, Department of Medicine , Northwestern University Feinberg School of Medicine , Chicago , IL , USA
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Miranda VPN, Amorim PRDS, Oliveira NCB, Peluzio MDCG, Priore SE. EFFECT OF PHYSICAL ACTIVITY ON CARDIOMETABOLIC MARKERS IN ADOLESCENTS: SYSTEMATIC REVIEW. REV BRAS MED ESPORTE 2016. [DOI: 10.1590/1517-869220162203149448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT The accumulation of body fat is a major risk factor for cardiometabolic diseases. Obesity can be considered a chronic systemic inflammatory disease in adults and younger people. The control of subclinical inflammation process through the practice of physical activity (PA) can mitigate the effects of risk factors that trigger atherosclerosis that worsens with advancing age. The objective of this study was to conduct a systematic review of the influence of physical activity and/or exercise on cardiometabolic markers and othrer risk factors of cardiovascular disease in adolescents. A systematic review was conducted in electronic databases Scopus, Pubmed, Conchrane Collection and SciELO. The terms used in the search were "cardiovascular diseases AND inflammation AND adolescents AND physical activity OR exercise". A total of 24 original articles were evaluated, being 14 longitudinal and 10 cross-sectional studies. Overall, 16 articles (66.66%) showed that PA, exercise and/or sedentary behavior may have influenced or have been related to the concentration of cardiometabolic markers. All studies that examined lifestyle changes showed reduction of cardiometabolic markers. Some limitations were observed: reduced samples, lack of dietary prescription, evaluation and control of volume and intensity of exercise. Most of the studies analyzed showed that the physical activity could influence and decrease the concentrations of cardiometabolic markers in adolescents. However, studies with representative sample size and precise control in assessing the level of physical activity and/or exercise are required to determine accurately the changes that the more active lifestyle can bring on inflammatory process, as well as other risk factors for cardiometabolic diseases in adolescents.
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Qi J, Yang B, Ren C, Fu J, Zhang J. Swimming Exercise Alleviated Insulin Resistance by Regulating Tripartite Motif Family Protein 72 Expression and AKT Signal Pathway in Sprague-Dawley Rats Fed with High-Fat Diet. J Diabetes Res 2016; 2016:1564386. [PMID: 27843952 PMCID: PMC5098085 DOI: 10.1155/2016/1564386] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 08/14/2016] [Accepted: 10/03/2016] [Indexed: 01/07/2023] Open
Abstract
We aimed to investigate whether swimming exercise could improve insulin resistance (IR) by regulating tripartite motif family protein 72 (TRIM72) expression and AKT signal pathway in rats fed with high-fat diet. Five-week-old rats were classified into 3 groups: standard diet as control (CON), high-fat diet (HFD), and HFD plus swimming exercise (Ex-HFD). After 8 weeks, glucose infusion rate (GIR), markers of oxidative stress, mRNA and protein expression of TRIM72, protein of IRS, p-AKTSer473, and AKT were determined in quadriceps muscles. Compared with HFD, the GIR, muscle SOD, and GSH-Px were significantly increased (p < 0.05, resp.), whereas muscle MDA and 8-OHdG levels were significantly decreased (p < 0.05 and p < 0.01) in Ex-HFD. Expression levels of TRIM72 mRNA and protein in muscles were significantly reduced (p < 0.05 and p < 0.01), whereas protein expression levels of IRS-1, p-AKTSer473, and AKT were significantly increased in Ex-HFD compared with HFD (p < 0.01, p < 0.01, and p < 0.05). These results suggest that an 8-week swimming exercise improves HFD-induced insulin resistance maybe through a reduction of TRIM72 in skeletal muscle and enhancement of AKT signal transduction.
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Affiliation(s)
- Jie Qi
- College of Physical Education, Shanghai Normal University, Shanghai 200234, China
| | - Bo Yang
- Department of Food Science and Nutrition, Zhejiang University, Hangzhou 310053, China
| | - Cailing Ren
- Rehabilitation College of Gannan Medical University, Jiangxi 341000, China
| | - Jian Fu
- College of Physical Education, Yangzhou University, Jiangsu 225009, China
| | - Jun Zhang
- College of Physical Education, Shanghai Normal University, Shanghai 200234, China
- *Jun Zhang:
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Tsai CT, Wu CK, Lee JK, Chang SN, Kuo YM, Wang YC, Lai LP, Chiang FT, Hwang JJ, Lin JL. TNF-α down-regulates sarcoplasmic reticulum Ca²⁺ ATPase expression and leads to left ventricular diastolic dysfunction through binding of NF-κB to promoter response element. Cardiovasc Res 2015; 105:318-29. [PMID: 25712896 DOI: 10.1093/cvr/cvv008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
AIMS TNF-alpha (TNF-α) causes left ventricular diastolic dysfunction. Down-regulation of sarcoplasmic reticulum Ca(2+)-ATPase 2a protein (SERCA2a) expression is one of the major mechanisms underlying diastolic dysfunction. We investigated whether TNF-α modulates SERCA2a expression and alters cardiac diastolic function, and its detailed signalling pathway. METHODS AND RESULTS We used both in vitro cellular cardiomyocyte model and in vivo rat model to address this issue. We found that TNF-α decreased the levels of both SERCA2a mRNA and protein in the cardiomyocytes, with corresponding impairment of diastolic calcium reuptake, a cellular phenotype of cardiac diastolic function. An ∼2 kb promoter of the SERCA2a gene (atp2a2) along with its serial deletions was cloned into the luciferase reporter system. TNF-α significantly decreased the promoter activity, and truncation of the SERCA2a gene promoter with the putative nuclear factor kappa-B (NF-κB) response element abolished TNF-α-induced SERCA2a gene suppression. Chromatin immunoprecipitation and gel retardation also confirmed the binding of NF-κB to this putative-binding site. TNF-α increased the phosphorylation of IKK and the degradation of IκB, resulted in NF-κB nuclear translocation, and decreased SERCA2a gene promoter activity. This process was attenuated by NF-κB blockers and simvastatin. In the in vivo rat model, lipopolysaccharide treatment significantly elevated the serum TNF-α level, as well as phosphorylation of IKK, resulting in a decrease in myocardial SERCA2a expression, diastolic calcium reuptake, and diastolic dysfunction. Oral treatment with simvastatin led to an increase in SERCA2a expression, alleviation, and prevention of the diastolic dysfunction. CONCLUSIONS TNF-α suppresses SERCA2a gene expression via the IKK/IκB/NF-κB pathway and binding of NF-κB to the SERCA2a gene promoter, and its effect is blocked by simvastatin, demonstrating the potential therapeutic effect of statins in treating inflammation-related diastolic dysfunction.
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Affiliation(s)
- Chia-Ti Tsai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Sheng-Nan Chang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County 640, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Min Kuo
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Chih Wang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
| | - Jiunn-Lee Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
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Galectin-3 level and the severity of cardiac diastolic dysfunction using cellular and animal models and clinical indices. Sci Rep 2015; 5:17007. [PMID: 26582585 PMCID: PMC4652206 DOI: 10.1038/srep17007] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/14/2015] [Indexed: 11/08/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFPEF) is characterized by myocardial interstitial fibrosis. A total of 146 patients with HFPEF, were recruited. HFPEF severity was determined using Doppler imaging (E/Em) and also cardiac magnetic resonance imaging (CMRI). Canine modeling of HFPEF was induced by aortic banding. Hemodynamic and echocardiographic data were obtained before and after pressure loading and myocardial Galectin-3 was determined. Mechanical stretch of cultured cardiomyocytes served as the cellular model of HFPEF. Patients with severe HFPEF had significantly higher plasma Galectin-3 levels. Significant correlation between plasma Galectin-3 and E/Em in advanced HFPEF patients was noted. After 2 weeks of pressure overload in canine models, the protein expression of Galectin-3 from LV myocardial tissue was significantly increased (p < 0.01) compared with controls. Galectin-3 expression paralleled the severity of LV diastolic dysfunction by evaluation of CMRI (r = -0.58, p = 0.003) and tissue fibrosis (r = 0.59, p = 0.002). After adjusting for confounders for diastolic dysfunction, Galectin-3 levels were still associated with diastolic parameters both in humans (p < 0.001) and canine model (p = 0.041). Mechanical stretch increased Galectin-3 secretion in cultured cardiomyocytes. Both plasma and myocardial Galectin-3 levels correlated with severity of cardiac diastolic dysfunction.
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Associations of obesity and body fat distribution with incident atrial fibrillation in the biracial health aging and body composition cohort of older adults. Am Heart J 2015; 170:498-505.e2. [PMID: 26385033 DOI: 10.1016/j.ahj.2015.06.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/09/2015] [Indexed: 01/19/2023]
Abstract
UNLABELLED Obesity is a well-recognized risk factor for atrial fibrillation (AF), yet adiposity measures other than body mass index (BMI) have had limited assessment in relation to AF risk. We examined the associations of adiposity measures with AF in a biracial cohort of older adults. Given established racial differences in obesity and AF, we assessed for differences by black and white race in relating adiposity and AF. METHODS We analyzed data from 2,717 participants of the Health, Aging, and Body Composition Study. Adiposity measures were BMI, abdominal circumference, subcutaneous and visceral fat area, and total and percent fat mass. We determined the associations between the adiposity measures and 10-year incidence of AF using Cox proportional hazards models and assessed for their racial differences in these estimates. RESULTS In multivariable-adjusted models, 1-SD increases in BMI, abdominal circumference, and total fat mass were associated with a 13% to 16% increased AF risk (hazard ratio [HR] 1.14, 95% CI 1.02-1.28; HR 1.16, 95% CI 1.04-1.28; and HR 1.13, 95% CI 1.002-1.27). Subcutaneous and visceral fat areas were not significantly associated with incident AF. We did not identify racial differences in the associations between the adiposity measures and AF. CONCLUSION Body mass index, abdominal circumference, and total fat mass are associated with risk of AF for 10years among white and black older adults. Obesity is one of a limited number of modifiable risk factors for AF; future studies are essential to evaluate how obesity reduction can modify the incidence of AF.
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Wu CK, Lee JK, Wu YF, Tsai CT, Chiang FT, Hwang JJ, Lin JL, Hung KY, Huang JW, Lin JW. Left ventricular diastolic dysfunction in peritoneal dialysis: a forgotten risk factor. Medicine (Baltimore) 2015; 94:e819. [PMID: 25997054 PMCID: PMC4602859 DOI: 10.1097/md.0000000000000819] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Left ventricular diastolic dysfunction (LVDD) is common among patients undergoing peritoneal dialysis (PD). We examined the relationship between LVDD, major adverse cardiovascular events (MACE), and mortality in PD patients. A total of 149 patients undergoing PD with preserved left ventricular systolic function were included and followed for 3.5 years. LVDD was diagnosed (according to the European Society of Cardiology guidelines) by conventional and tissue Doppler echocardiography. Serum high-sensitivity C-reactive protein (hsCRP) was measured. The location and volume of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra. Subjects with LVDD had higher levels of hsCRP, and more visceral and peritoneal fat than controls. The relationship between adjusted visceral adipose tissue and LVDD became nonsignificant when hsCRP and baseline demographic data were introduced into the logistic regression model (odds ratio = 1.52, P = 0.07). Subsequent hierarchical multivariate Cox regression analysis showed that LVDD was one of the most powerful determinants of MACE and mortality after adjusting for all confounding factors (hazard ratio [HR]: 1.71, 95% confidence interval [CI]: 1.43-3.51, P = 0.02 and HR: 2.25, 95% CI: 1.45-2.91, P = 0.04, respectively). Systemic inflammation (hsCRP) was also significantly associated with MACE and mortality (HR: 2.03, P = 0.03 and HR: 2.16, P = 0.04, respectively). LVDD is associated with systemic inflammation and increased visceral fat in patients undergoing PD. LVDD is also a sensitive, independent indicator of future MACE and mortality in PD patients.
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Affiliation(s)
- Cho-Kai Wu
- From the Division of Cardiology (C-KW, J-KL, C-TT, F-TC, J-JH, J-LL, J-WL), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Cardiovascular Center (C-KW, J-KL, C-TT, F-TC, J-JH, J-LL), National Taiwan University Hospital; Department of Family Medicine (Y-FW), Taipei City Hospital, Renai Branch; Division of Nephrology (K-YH, J-WH), Department of Internal Medicine, National Taiwan University College of Medicine and Hospital; Department of Internal Medicine (J-WL), National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Yun-Lin, Taipei, Taiwan
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Lin HH, Lee JK, Yang CY, Lien YC, Huang JW, Wu CK. Accumulation of epicardial fat rather than visceral fat is an independent risk factor for left ventricular diastolic dysfunction in patients undergoing peritoneal dialysis. Cardiovasc Diabetol 2013; 12:127. [PMID: 24001037 PMCID: PMC3766214 DOI: 10.1186/1475-2840-12-127] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 08/10/2013] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Symptoms of heart failure with preserved left ventricular systolic function are common among patients undergoing peritoneal dialysis (PD). Epicardial fat (EpF) is an ectopic fat depot with possible paracrine or mechanical effects on myocardial function. The aim of our current study is to assess the association between EpF and Left ventricular diastolic dysfunction (LVDD) in patients undergoing PD and to clarify the relationships among EpF, inflammation, and LVDD in this population. METHODS This was a cross-sectional study of 149 patients with preserved left ventricular systolic function who were undergoing PD. LVDD was diagnosed (according to the European Society of Cardiology guidelines) and EpF thickness measured by echocardiography. The patients without LVDD were used as controls. The serum inflammatory biomarker high-sensitivity C-reactive protein (hsCRP) was measured. The location and amount of adipose tissue were assessed by computed tomography (CT) at the level of the fourth lumbar vertebra. RESULTS Subjects with LVDD had higher levels of hsCRP, more visceral and peritoneal fat, and thicker EpF (all p < 0.001) than controls. Visceral adipose tissue, hsCRP, and EpF all correlated significantly (p < 0.05) with LVDD. Multivariate regression analysis rendered the relationship between visceral adipose tissue and LVDD insignificant, whereas EpF was the most powerful determinant of LVDD (odds ratio = 2.41, 95% confidence interval = 1.43-4.08, p < 0.01). EpF thickness also correlated significantly with the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e'; r = 0.27, p < 0.01). CONCLUSION EpF thickness is significantly independently associated with LVDD in patients undergoing PD and may be involved in its pathogenesis.
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Affiliation(s)
- Heng-Hsu Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital No, 7, Chung-Shan South Road Taipei 100, Taipei, Taiwan.
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Celik T, Fici F. The association between inflammation and left ventricular diastolic dysfunction in patients with hypertension: another piece of the puzzle. Nutr Metab Cardiovasc Dis 2013; 23:e26-e27. [PMID: 23578829 DOI: 10.1016/j.numecd.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
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Dissecting the mechanisms of left ventricular diastolic dysfunction and inflammation in peritoneal dialysis patients. PLoS One 2013; 8:e62722. [PMID: 23675418 PMCID: PMC3652869 DOI: 10.1371/journal.pone.0062722] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/25/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Patients with symptoms of heart failure and preserved left ventricular (LV) systolic function are commonly encountered in clinical practice especially in peritoneal dialysis (PD) patients. We hypothesized that adiposity might influence LV diastolic function through systemic inflammation in this specific group. METHODS We designed a cross-sectional study in 173 prevalent PD patients. LV diastolic dysfunction was diagnosed by echocardiography. PD patient without LV diastolic dysfunction served as the control group. Serum inflammatory biomarkers were examined including tissue necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). The location and amount of adipose tissue were assessed by computerized tomography (CT) at the level of the fourth lumbar vertebra. RESULTS Subjects with LV diastolic dysfunction had higher levels of the pro-inflammation cytokines and more visceral and peritoneal fat (all P<0.001) than control subjects. A significant correlation was found between visceral adipose tissue and pro-inflammatory cytokines (r = 0.70; P<0.001). Multivariable regression analysis found that the relationship between visceral adipose tissue and LV diastolic dysfunction became insignificant when either TNF-α or IL-6 were introduced into the model, although TNF-α and IL-6 were both significantly associated with LV diastolic dysfunction even after adjusting for visceral fat (OR = 1.51; 95% CI = 1.09-2.02; P = 0.033 and OR = 1.62; 95% CI = 1.09-1.82; P = 0.031, respectively). CONCLUSIONS Larger amounts of adipose tissue were associated with higher serum pro-inflammatory levels in PD patients, which might be related to the development of LV diastolic dysfunction. Modulating inflammatory reactions in PD patients can be a useful therapeutic approach for managing LV diastolic dysfunction.
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Sjöberg Lind Y, Lind PM, Salihovic S, van Bavel B, Lind L. Circulating levels of persistent organic pollutants (POPs) are associated with left ventricular systolic and diastolic dysfunction in the elderly. ENVIRONMENTAL RESEARCH 2013; 123:39-45. [PMID: 23562393 DOI: 10.1016/j.envres.2013.02.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 02/28/2013] [Accepted: 02/28/2013] [Indexed: 05/02/2023]
Abstract
BACKGROUND AND OBJECTIVE Major risk factors for congestive heart failure (CHF) are myocardial infarction, hypertension, diabetes, atrial fibrillation, smoking, left ventricular hypertrophy (LVH) and obesity. However, since these risk factors only explain part of the risk of CHF, we investigated whether persistent organic pollutants (POPs) might also play a role. METHODS In the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study, left ventricular ejection fraction, (EF), E/A-ratio and isovolumic relaxation time (IVRT), were determined by echocardiography and serum samples of 21 POPs were analyzed in serum measured by high-resolution chromatography coupled to high-resolution mass spectrometry (HRGC/HRMS) in 998 subjects all aged 70 years. RESULTS In this cross-sectional analysis, high levels of several of the polychlorinated biphenyls (PCB congeners 99, 118, 105, 138, 153, and 180) and octachlorodibenzo-p-dioxin (OCDD) were significantly related to a decreased EF. Some POPs were also related to a decreased E/A-ratio (PCBs 206 and 209). All the results were adjusted for gender, hypertension, diabetes, smoking, LVH and BMI, and subjects with myocardial infarction or atrial fibrillation were excluded from the analysis. CONCLUSIONS Circulating levels of POPs were related to impairments in both left ventricular systolic and diastolic function independently of major congestive heart failure risk factors, suggesting a possible role of POPs in heart failure.
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Affiliation(s)
- Ylva Sjöberg Lind
- Department of Emergency Medicine, Linköping University Hospital, Linköping, Sweden
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Melchiorre K, Sutherland GR, Liberati M, Thilaganathan B. Maternal Cardiovascular Impairment in Pregnancies Complicated by Severe Fetal Growth Restriction. Hypertension 2012; 60:437-43. [DOI: 10.1161/hypertensionaha.112.194159] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fetal growth restriction and preeclampsia are both conditions of placental etiology and associated to increased risk for the long-term development of cardiovascular disease in the mother. At presentation, preeclampsia is associated with maternal global diastolic dysfunction, which is determined, at least in part, by increased afterload and myocardial stiffness. The aim of this study is to test the hypothesis that women with normotensive fetal growth-restricted pregnancies also exhibit global diastolic dysfunction. This was a prospective case-control study conducted over a 3-year period involving 29 preterm fetal growth-restricted pregnancies, 25 preeclamptic with fetal growth restriction pregnancies, and 58 matched control pregnancies. Women were assessed by conventional echocardiography and tissue Doppler imaging at diagnosis of the complication and followed-up at 12 weeks postpartum. Fetal growth-restricted pregnancies are characterized by a lower cardiac index and higher total vascular resistance index than expected for gestation. Compared with controls, fetal growth-restricted pregnancy was associated with significantly increased prevalence (
P
<0.001) of asymptomatic left ventricular diastolic dysfunction (28% versus 4%) and widespread impaired myocardial relaxation (59% versus 21%). Unlike preeclampsia, cardiac geometry and intrinsic myocardial contractility were preserved in fetal growth-restricted pregnancy. Fetal growth-restricted pregnancies are characterized by a low output, high resistance circulatory state, as well as a higher prevalence of asymptomatic global diastolic dysfunction and poor cardiac reserve. These findings may explain the increased long-term cardiovascular risk in these women who have had fetal growth-restricted pregnancies. Further studies are needed to clarify the postnatal natural history of cardiac dysfunction in these women.
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Affiliation(s)
- Karen Melchiorre
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - George Ross Sutherland
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - Marco Liberati
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
| | - Basky Thilaganathan
- From the Fetal Maternal Medicine Unit, Departments of Obstetrics and Gynecology (K.M., B.T.), and Cardiology and Cardiothoracic Surgery (K.M., G.R.S.), St Georges Hospital, University of London, London, United Kingdom; Department of Obstetrics and Gynecology (K.M., M.L.), University of Chieti, Chieti, Italy
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