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Huang HJ, Hsu BG, Wang CH, Tsai JP, Chen YH, Hung SC, Lin YL. Diabetes mellitus modifies the association between chronic kidney disease-mineral and bone disorder biomarkers and aortic stiffness in peritoneal dialysis patients. Sci Rep 2024; 14:4554. [PMID: 38402283 PMCID: PMC10894213 DOI: 10.1038/s41598-024-55364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 02/22/2024] [Indexed: 02/26/2024] Open
Abstract
This study aimed to investigate the relationship of four chronic kidney disease-mineral and bone disorder (CKD-MBD) biomarkers, including intact parathyroid hormone (PTH), fibroblast growth factor 23 (FGF23), soluble klotho, and fetuin-A, with aortic stiffness in peritoneal dialysis (PD) patients, comparing those with and without diabetes mellitus (DM). A total of 213 patients (mean age 58 ± 14 years; 81 (38.0%) patients with DM) were enrolled. Their aortic pulse wave velocity (PWV) was measured using pressure applanation tonometry, while serum intact PTH, FGF23, α-klotho, and fetuin-A levels were measured using enzyme-linked immunosorbent assay. Overall, patients with DM had higher aortic PWV than those without (9.9 ± 1.8 vs. 8.6 ± 1.4 m/s, p < 0.001). Among the four CKD-MBD biomarkers, FGF23 levels were significantly lower in DM group (462 [127-1790] vs. 1237 [251-3120] pg/mL, p = 0.028) and log-FGF23 independently predicted aortic PWV in DM group (β: 0.61, 95% confidence interval: 0.06-1.16, p = 0.029 in DM group; β: 0.10, 95% confidence interval: - 0.24-0.45, p = 0.546 in nonDM group; interaction p = 0.016). In conclusion, the association between FGF23 and aortic PWV was significantly modified by DM status in PD patients.
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Affiliation(s)
- Hsiang-Jung Huang
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
| | - Bang-Gee Hsu
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
| | - Chih-Hsien Wang
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan
| | - Jen-Pi Tsai
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
| | - Yi-Hsin Chen
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, 40201, Taiwan
| | - Szu-Chun Hung
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, 23142, Taiwan
| | - Yu-Li Lin
- Department of Internal Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, 97004, Taiwan.
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 97004, Taiwan.
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3
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Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, Cohen IS, Ruggiero N, Walinsky P, Vishnevsky A, Dickie K, Davis M, Forsberg F, Dave JK. Evaluation of Intracardiac Pressures Using Subharmonic-aided Pressure Estimation with Sonazoid Microbubbles. Radiol Cardiothorac Imaging 2024; 6:e230153. [PMID: 38358329 PMCID: PMC10912883 DOI: 10.1148/ryct.230153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 12/13/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
Purpose To investigate if the right ventricular (RV) systolic and left ventricular (LV) diastolic pressures can be obtained noninvasively using the subharmonic-aided pressure estimation (SHAPE) technique with Sonazoid microbubbles. Materials and Methods Individuals scheduled for a left and/or right heart catheterization were prospectively enrolled in this institutional review board-approved clinical trial from 2017 to 2020. A standard-of-care catheterization procedure was performed by advancing fluid-filled pressure catheters into the LV and aorta (n = 25) or RV (n = 22), and solid-state high-fidelity pressure catheters into the LV and aorta in a subset of participants (n = 18). Study participants received an infusion of Sonazoid microbubbles (GE HealthCare), and SHAPE data were acquired using a validated interface developed on a SonixTablet (BK Medical) US scanner, synchronously with the pressure catheter data. A conversion factor, derived using cuff-based pressure measurements with a SphygmoCor XCEL PWA (ATCOR) and subharmonic signal from the aorta, was used to convert the subharmonic signal into pressure values. Errors between the pressure measurements obtained using the SHAPE technique and pressure catheter were compared. Results The mean errors in pressure measurements obtained with the SHAPE technique relative to those of the fluid-filled pressure catheter were 1.6 mm Hg ± 1.5 [SD] (P = .85), 8.4 mm Hg ± 6.2 (P = .04), and 7.4 mm Hg ± 5.7 (P = .09) for RV systolic, LV minimum diastolic, and LV end-diastolic pressures, respectively. Relative to the measurements with the solid-state high-fidelity pressure catheter, the mean errors in LV minimum diastolic and LV end-diastolic pressures were 7.2 mm Hg ± 4.5 and 6.8 mm Hg ± 3.3 (P ≥ .44), respectively. Conclusion These results indicate that SHAPE with Sonazoid may have the potential to provide clinically relevant RV systolic and LV diastolic pressures. Keywords: Ultrasound-Contrast, Cardiac, Aorta, Left Ventricle, Right Ventricle ClinicalTrials.gov registration no.: NCT03245255 © RSNA, 2024.
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Affiliation(s)
- Cara Esposito
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Priscilla Machado
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Maureen E. McDonald
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Michael P. Savage
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - David Fischman
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Praveen Mehrotra
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Ira S. Cohen
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Nicholas Ruggiero
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Paul Walinsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Alec Vishnevsky
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Kristopher Dickie
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Marguerite Davis
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Flemming Forsberg
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
| | - Jaydev K. Dave
- From the Departments of Radiology (C.E., P.M., F.F., J.K.D.), Medical
Imaging and Radiation Sciences (M.E.M.), and Medicine (M.P.S., D.F., P.M.,
I.S.C., N.R., P.W., A.V., M.D.), Thomas Jefferson University, Philadelphia, Pa;
Clarius Mobile Health, Vancouver, Canada (K.D.); and Department of Radiology,
Mayo Clinic, Rochester, Minn (J.K.D)
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Huang PY, Huang CS, Lin YL, Chen YH, Hung SC, Tsai JP, Hsu BG. Positive Association of Serum Galectin-3 with the Development of Aortic Stiffness of Patients on Peritoneal Dialysis. J Clin Med 2023; 12:jcm12103519. [PMID: 37240626 DOI: 10.3390/jcm12103519] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/09/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
A novel cardiovascular stress biomarker known as galectin-3 might be useful for anticipating adverse cardiovascular outcomes. The objective of the current investigation was to assess the association between serum galectin-3 levels and aortic stiffness (AS) in 196 patients on peritoneal dialysis. An enzyme-linked immunosorbent examination and a cuff-based volumetric displacement were employed to determine the levels of serum galectin-3 and the carotid-femoral pulse wave velocity (cfPWV), respectively. The AS group had 48 patients in total (24.5%) with cfPWV greater than 10 m/s. The AS group, when compared with the group without AS, had a significantly higher prevalence of diabetes mellitus and hypertension in addition to greater fasting glucose levels, waist circumference, systolic blood pressure, and serum galectin-3 levels. Multivariate logistic and linear regression analysis demonstrated that serum glactin-3 levels, in addition to gender and age, were significantly and independently associated with cfPWV and AS. Serum galectin-3 levels were linked with AS, according to a receiver operating characteristic curve analysis, with an area under the curve of 0.648 (95% confidence interval, 0.576-0.714; p = 0.0018). In summary, there was a significant correlation between serum galectin-3 levels and cfPWV in patients undergoing peritoneal dialysis therapy for end-stage kidney disease.
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Affiliation(s)
- Po-Yu Huang
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Chen-Sen Huang
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
| | - Yu-Li Lin
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
| | - Yi-Hsin Chen
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 40201, Taiwan
| | - Szu-Chun Hung
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei 23142, Taiwan
| | - Jen-Pi Tsai
- Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi 62247, Taiwan
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
| | - Bang-Gee Hsu
- School of Medicine, Tzu Chi University, Hualien 97004, Taiwan
- Division of Nephrology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 97004, Taiwan
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5
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Esposito C, Machado P, McDonald ME, Savage MP, Fischman D, Mehrotra P, Cohen IS, Ruggiero N, Walinsky P, Vishnevsky A, Dickie K, Davis M, Forsberg F, Dave JK. Noninvasive Evaluation of Cardiac Chamber Pressures Using Subharmonic-Aided Pressure Estimation With Definity Microbubbles. JACC Cardiovasc Imaging 2023; 16:224-235. [PMID: 36648035 DOI: 10.1016/j.jcmg.2022.09.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 08/04/2022] [Accepted: 09/16/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Noninvasive and accurate assessment of intracardiac pressures has remained an elusive goal of noninvasive cardiac imaging. OBJECTIVES The purpose of this study was to investigate if errors in intracardiac pressures obtained noninvasively using contrast microbubbles and the subharmonic-aided pressure estimation (SHAPE) technique are <5 mm Hg. METHODS In a nonrandomized institutional review board-approved clinical trial (NCT03243942), patients scheduled for a left-sided and/or right-sided heart catheterization procedure and providing written informed consent were included. A standard-of-care catheterization procedure was performed advancing clinically used pressure catheters into the left and/or right ventricles and/or the aorta. After pressure catheter placement, patients received an infusion of Definity microbubbles (n = 56; 2 vials diluted in 50 mL of saline; infusion rate: 4-10 mL/min) (Lantheus Medical Imaging). Then SHAPE data was acquired using a validated interface developed on a SonixTablet scanner (BK Medical Systems) synchronously with the pressure catheter data. A conversion factor (mm Hg/dB) was derived from SHAPE data and measurements with a SphygmoCor XCEL PWA device (ATCOR Medical) and was combined with SHAPE data from the left and/or the right ventricles to obtain clinically relevant systolic and diastolic ventricular pressures. RESULTS The mean value of absolute errors for left ventricular minimum and end diastolic pressures were 2.9 ± 2.0 and 1.7 ± 1.2 mm Hg (n = 26), respectively, and for right ventricular systolic pressures was 2.2 ± 1.5 mm Hg (n = 11). Two adverse events occurred during Definity infusion; both were resolved. CONCLUSIONS These results indicate that the SHAPE technique with Definity microbubbles is encouragingly efficacious for obtaining intracardiac pressures noninvasively and accurately. (Noninvasive, Subharmonic Intra-Cardiac Pressure Measurement; NCT03243942).
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Affiliation(s)
- Cara Esposito
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Maureen E McDonald
- Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael P Savage
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - David Fischman
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Praveen Mehrotra
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ira S Cohen
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Nicholas Ruggiero
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Paul Walinsky
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alec Vishnevsky
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Marguerite Davis
- Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jaydev K Dave
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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