1
|
Barnes MVC, Pantazi P, Holder B. Circulating extracellular vesicles in healthy and pathological pregnancies: A scoping review of methodology, rigour and results. J Extracell Vesicles 2023; 12:e12377. [PMID: 37974377 PMCID: PMC10654380 DOI: 10.1002/jev2.12377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/27/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
Extracellular vesicles (EVs) play a crucial role in pregnancy, revealed by the presence of placental-derived EVs in maternal blood, their in vitro functionality, and their altered cargo in pregnancy pathologies. These EVs are thought to be involved in the development of pregnancy pathologies, such as pre-eclampsia, pre-term birth, and fetal growth restriction, and have been suggested as a source of biomarkers for gestational diseases. However, to accurately interpret their function and biomarker potential, it is necessary to critically evaluate the EV isolation and characterization methodologies used in pregnant cohorts. In this systematic scoping review, we collated the results from 152 studies that have investigated EVs in the blood of pregnant women, and provide a detailed analysis of the EV isolation and characterization methodologies used. Our findings indicate an overall increase in EV concentrations in pregnant compared to non-pregnant individuals, an increased EV count as gestation progresses, and an increased EV count in some pregnancy pathologies. We highlight the need for improved standardization of methodology, greater focus on gestational changes in EV concentrations, and further investigations into the functionality of EVs. Our review suggests that EVs hold great promise as diagnostic and translational tools for gestational diseases. However, to fully realize their potential, it is crucial to improve the standardization and reliability of EV isolation and characterization methodologies, and to gain a better understanding of their functional roles in pregnancy pathologies.
Collapse
Affiliation(s)
- Megan V. C. Barnes
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| | - Paschalia Pantazi
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| | - Beth Holder
- Institute of Reproductive and Developmental Biology, Department of MetabolismDigestion and Reproduction, Imperial College LondonLondonUK
| |
Collapse
|
2
|
Shen S. Prospective Advances of Extracellular Vesicles Investigation in Cardiovascular and Metabolic Research. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1418:231-240. [PMID: 37603283 DOI: 10.1007/978-981-99-1443-2_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Extracellular vesicles (EVs) play an important role in cardiovascular and metabolic diseases through intercellular communication. Although there has been extensive research on EVs, there are still some unsolved problems in the technologies of investigation of EVs. In this chapter, we reviewed the current knowledge of EVs functions in cardiovascular and metabolic pathophysiology and EVs as biomarkers and therapeutic agents in cardiovascular and metabolic diseases. We also addressed the challenges in isolation and identification of EVs as well as challenges in visualization and tracking of EVs. By addressing these challenges, we hope to have a more in-depth understanding of the biological functions of EVs.
Collapse
Affiliation(s)
- Shutong Shen
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
3
|
Dow R, Ridger V. Neutrophil microvesicles and their role in disease. Int J Biochem Cell Biol 2021; 141:106097. [PMID: 34655813 DOI: 10.1016/j.biocel.2021.106097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/08/2021] [Accepted: 10/11/2021] [Indexed: 12/19/2022]
Abstract
Microvesicles are formed through shedding from the plasma membrane, a process shared by almost all human cells. Microvesicles are highly abundant and have been detected in blood, urine, cerebrospinal fluid, and saliva. They contain a library of cargo derived from their parental cell during formation, including proteases, micro-RNAs and lipids and delivery of this parental cell-derived cargo to other cells can alter target cell function and drive disease. Cell specific molecules on the surface of microvesicles, obtained during microvesicle formation, allows their parental cell to be identified and populations of microvesicles to be investigated for roles in the pathogenesis of various diseases. For instance, recent work by our group has identified a role for neutrophil microvesicles in atherosclerosis. Microvesicle profiles could in future be associated with certain diseases and act as a biomarker to allow for earlier diagnosis. This short review will discuss some of the processes central to all microvesicles before focusing on neutrophil microvesicles, their potential role in cardiovascular disease and the mechanisms that may underpin this.
Collapse
Affiliation(s)
- Reece Dow
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Victoria Ridger
- Department of Infection Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK.
| |
Collapse
|
4
|
Zhu X, Wang Z, Ferrari MW, Ferrari‐Kuehne K, Bulter J, Xu X, Zhou Q, Zhang Y, Zhang J. Anticoagulation in cardiomyopathy: unravelling the hidden threat and challenging the threat individually. ESC Heart Fail 2021; 8:4737-4750. [PMID: 34498416 PMCID: PMC8712898 DOI: 10.1002/ehf2.13597] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 08/07/2021] [Accepted: 08/20/2021] [Indexed: 11/09/2022] Open
Abstract
Cardiomyopathy comprises a heterogeneous group of myocardial abnormalities, structural or functional in nature, in the absence of coronary artery disease and other abnormal loading conditions. These myocardial pathologies can result in premature death or disability from progressive heart failure, arrhythmia, stroke, or other embolic events. The European Cardiomyopathy Registry reports a high stroke risk in cardiomyopathy patients ranging from 2.1% to 4.5%, as well as high prevalence of atrial fibrillation ranging from 14.0% to 48.5%. There is a growing interest in evaluating the risk of thromboembolism depending on the type of cardiomyopathy, as well as if anticoagulation is indicated in patients with cardiomyopathy without atrial fibrillation. Data available do not unequivocally support anticoagulation therapy in all of these patients; the management of these patients remains challenging. Many published reports pertaining to the risk of thromboembolism and consecutive treatment strategies mainly focus on single cardiomyopathy subtype. We summarize essential pathophysiological knowledge and review current literature associated with thromboembolism in various cardiomyopathy subtypes, providing recommendations for the diagnostic evaluation as well as clinical management strategies in this field. Certain cardiomyopathy subtypes require anticoagulation independent of atrial fibrillation or CHA2 DS2 -VASc score. Despite the scarcity of evidence regarding the choice of anticoagulation regimen (vitamin K antagonist vs. non-vitamin K oral anticoagulants) in cardiomyopathy, it is discussed and reviewed in this article. Each patient should receive a tailored strategy based on thorough clinical evaluation, published evidence, and clinical experience, due to the current recommendations mostly developed on small-sample studies or empirical evidence. The future research priorities in this area are also addressed in this article.
Collapse
Affiliation(s)
- Xiaogang Zhu
- Department of Cardiology, Fu Xing HospitalCapital Medical UniversityBeijingChina
| | - Zhenhua Wang
- Department of CardiologyThe Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Markus W. Ferrari
- Clinic of Internal Medicine 1, HSKClinic of the City of Wiesbaden and the HELIOS GroupWiesbadenGermany
| | | | - Javed Bulter
- Department of MedicineUniversity of MississippiJacksonMSUSA
| | - Xiuying Xu
- Department of Cardiology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Quanzhong Zhou
- Department of Radiology, The Center for Medical Imaging of Guizhou ProvinceAffiliated Hospital of Zunyi Medical UniversityZunyiChina
| | - Yuhui Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College167 Beilishi RdBeijing100037China
| | - Jian Zhang
- Heart Failure Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College167 Beilishi RdBeijing100037China
| |
Collapse
|
5
|
Ruiz GP, Camara H, Fazolini NPB, Mori MA. Extracellular miRNAs in redox signaling: Health, disease and potential therapies. Free Radic Biol Med 2021; 173:170-187. [PMID: 33965563 DOI: 10.1016/j.freeradbiomed.2021.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Extracellular microRNAs (miRNAs) have emerged as important mediators of cell-to-cell communication and intertissue crosstalk. MiRNAs are produced by virtually all types of eukaryotic cells and can be selectively packaged and released to the extracellular medium, where they may reach distal cells to regulate gene expression cell non-autonomously. By doing so, miRNAs participate in integrative physiology. Oxidative stress affects miRNA expression, while miRNAs control redox signaling. Disruption in miRNA expression, processing or release to the extracellular compartment are associated with aging and a number of chronic diseases, such as obesity, type 2 diabetes, neurodegenerative diseases and cancer, all of them being conditions related to oxidative stress. Here we discuss the interplay between redox balance and miRNA function and secretion as a determinant of health and disease states, reviewing the findings that support this notion and highlighting novel and yet understudied venues of research in the field.
Collapse
Affiliation(s)
- Gabriel Palermo Ruiz
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil
| | - Henrique Camara
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil
| | - Narayana P B Fazolini
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil
| | - Marcelo A Mori
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas, Campinas, SP, Brazil; Experimental Medicine Research Cluster (EMRC), University of Campinas, Campinas, SP, Brazil; Obesity and Comorbidities Research Center (OCRC), University of Campinas, Campinas, SP, Brazil.
| |
Collapse
|
6
|
Cherubin S, Peoples T, Gillard J, Lakhal-Littleton S, Kurinczuk JJ, Nair M. Systematic review and meta-analysis of prolactin and iron deficiency in peripartum cardiomyopathy. Open Heart 2020; 7:openhrt-2020-001430. [PMID: 33060142 PMCID: PMC7566429 DOI: 10.1136/openhrt-2020-001430] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/03/2020] [Accepted: 09/04/2020] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We conducted a systematic review and meta-analysis of studies that compared levels of molecular biomarkers in women with peripartum cardiomyopathy (PPCM) to those in healthy pregnant and postpartum women to: (1) assess the evidence for prolactin (PRL) metabolism in PPCM, (2) ascertain the evidence for biomarkers of iron deficiency in PPCM, (3) identify other biomarkers associated with PPCM. METHODS We searched Medline, Embase, Cumulated Index to Nursing and Allied Health Literature (CINAHL) and the Global Health Library from inception without language restriction for studies that compared biomarkers levels in PPCM cases to healthy controls. Pooled standardised mean difference (SMD) was generated using a random effects model for the difference in levels of biomarkers. RESULTS Two studies assessed the association of PRL with PPCM, and reported that PPCM cases have higher levels of total PRL. No studies investigated iron metabolism in PPCM. Other biomarkers associated with PPCM included serum levels of natriuretic peptides (SMD=3.77, 95% CI 0.71 to 6.82), albumin (SMD=-0.67, 95% CI -1.01 to -0.32), C-reactive protein (SMD=1.67, 95% CI 0.22 to 3.12), selenium (SMD=-0.73, 95% CI -1.58 to 0.12), cardiac troponins (SMD=1.06, 95% CI 0.33 to 1.80), creatinine (SMD=0.51, 95% CI 0.33 to 0.69), white bloodcells (SMD=0.44, 95 % CI 0.07 to 0.82), haemoglobin (SMD=-0.45, 95% CI -0.64 to-0.26). CONCLUSIONS More robust molecular studies are needed to explore the association between prolactin and PPCM in human subjects and to determine the extent to which iron deficiency (with or without anaemia) contributes to the risk of PPCM.
Collapse
Affiliation(s)
- Sinaida Cherubin
- Nuffield Department of Population Health: National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Taylar Peoples
- Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Jessica Gillard
- Medical Science Division, Oxford University, Oxford, Oxfordshire, UK
| | | | - Jennifer J Kurinczuk
- Nuffield Department of Population Health: National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| | - Manisha Nair
- Nuffield Department of Population Health: National Perinatal Epidemiology Unit, Oxford University, Oxford, UK
| |
Collapse
|
7
|
Ricke-Hoch M, Pfeffer TJ, Hilfiker-Kleiner D. Peripartum cardiomyopathy: basic mechanisms and hope for new therapies. Cardiovasc Res 2019; 116:520-531. [DOI: 10.1093/cvr/cvz252] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/17/2019] [Accepted: 10/04/2019] [Indexed: 12/28/2022] Open
Abstract
Abstract
Peripartum cardiomyopathy (PPCM) is a life-threatening cardiomyopathy characterized by acute or slow progression of left ventricular (LV) systolic dysfunction (LV ejection fraction of <45%) late in pregnancy, during delivery, or in the first postpartum months, in women with no other identifiable causes of heart failure. PPCM patients display variable phenotypes and risk factor profiles, pointing to involvement of multiple mechanisms in the pathogenesis of the disease. The higher risk for PPCM in women with African ancestry, the prevalence of gene variants associated with cardiomyopathies, and the high variability in onset and disease progression in PPCM patients also indicate multiple mechanisms at work. Experimental data have shown that different factors can induce and drive PPCM, including inflammation and immunity, pregnancy hormone impairment, catecholamine stress, defective cAMP-PKA, and G-protein-coupled-receptor signalling, and genetic variants. However, several of these mechanisms may merge into a common major pathway, which includes unbalanced oxidative stress and the cleavage of the nursing hormone prolactin (PRL) into an angiostatic, pro-apoptotic, and pro-inflammatory 16 kDa-PRL fragment, resulting in subsequent vascular damage and heart failure. Based on this common pathway, potential disease-specific biomarkers and therapies have emerged. Despite commonalities, the variation in aetiology and mechanisms poses challenges for the diagnosis, treatment, and management of the disease. This review summarizes current knowledge on the clinical presentation of PPCM in the context of recent experimental research. It discusses the challenge to develop disease-specific biomarkers in the context of rapid changing physiology in the peripartum phase, and outlines possible future treatment and management strategies for PPCM patients.
Collapse
Affiliation(s)
- Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Tobias J Pfeffer
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| |
Collapse
|
8
|
Sugahara M, Kagiyama N, Hasselberg NE, Blauwet LA, Briller J, Cooper L, Fett JD, Hsich E, Wells G, McNamara D, Gorcsan J. Global Left Ventricular Strain at Presentation Is Associated with Subsequent Recovery in Patients with Peripartum Cardiomyopathy. J Am Soc Echocardiogr 2019; 32:1565-1573. [PMID: 31563436 DOI: 10.1016/j.echo.2019.07.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a serious complication of pregnancy associated with variable degrees of left ventricular (LV) recovery. The aim of this study was to test the hypothesis that global LV strain at presentation has prognostic value in patients with PPCM. METHODS One hundred patients with PPCM aged 30 ± 6 years were enrolled in the multicenter Investigation in Pregnancy Associated Cardiomyopathy study along with 21 normal female control subjects. Speckle-tracking global longitudinal strain (GLS) and global circumferential strain (GCS) analysis was performed. The predefined primary combined outcome variable was death, transplantation, LV assist device implantation, or evidence of persistent LV dysfunction (LV ejection fraction [LVEF] < 50%) at 1 year. RESULTS GLS measurement was feasible in 110 subjects: 89 of 90 patients with PPCM (99%) with echocardiographic data and all 21 control subjects. Of 84 patients (94%) with 1-year follow-up, 21 (25%) had unfavorable primary outcomes: four LV assist device placements, two deaths, and 15 patients with persistent LV dysfunction. GLS at presentation with a cutoff of 10.6% (absolute value) was specifically associated with the subsequent primary outcome with 75% sensitivity and 95% specificity. GCS at presentation with a cutoff of 10.1% was associated with the primary outcome with 78% sensitivity and 84% specificity. GLS and GCS remained significantly associated with outcomes after adjusting for LVEF (GLS odds ratio, 2.07; P < .001; GCS odds ratio, 1.37; P = .005). GLS was significantly additive to LVEF (C statistic = 0.76-0.91, net reclassification improvement = 1.32, P < .001). CONCLUSIONS GLS and GCS in patients with PPCM at presentation were associated with subsequent clinical outcomes, including death, LV assist device implantation, and evidence of persistent LV dysfunction. Strain measures may add prognostic information over LVEF for risk stratification.
Collapse
Affiliation(s)
- Masataka Sugahara
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Nobuyuki Kagiyama
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Nina E Hasselberg
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lori A Blauwet
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joan Briller
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Leslie Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, Florida
| | - James D Fett
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eileen Hsich
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Gretchen Wells
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Dennis McNamara
- School of Medicine, Unversity of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
| | | |
Collapse
|
9
|
Bauersachs J, König T, Meer P, Petrie MC, Hilfiker‐Kleiner D, Mbakwem A, Hamdan R, Jackson AM, Forsyth P, Boer RA, Mueller C, Lyon AR, Lund LH, Piepoli MF, Heymans S, Chioncel O, Anker SD, Ponikowski P, Seferovic PM, Johnson MR, Mebazaa A, Sliwa K. Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. Eur J Heart Fail 2019; 21:827-843. [DOI: 10.1002/ejhf.1493] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/21/2019] [Accepted: 04/23/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Johann Bauersachs
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Tobias König
- Department of Cardiology and AngiologyHannover Medical School Hannover Germany
| | - Peter Meer
- Department of CardiologyUniversity Medical Center Groningen Groningen The Netherlands
| | - Mark C. Petrie
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | | | - Amam Mbakwem
- Department of MedicineCollege of Medicine, University of Lagos Nigeria
| | - Righab Hamdan
- Department of CardiologyBeirut Cardiac Institute Lebanon
| | - Alice M. Jackson
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | - Paul Forsyth
- Department of CardiologyInstitute of Cardiovascular and Medical Sciences, Glasgow University Glasgow UK
| | - Rudolf A. Boer
- Department of CardiologyUniversity Medical Center Groningen Groningen The Netherlands
| | - Christian Mueller
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB)University Hospital Basel, University of Basel Switzerland
| | | | - Lars H. Lund
- Department of MedicineKarolinska Institutet and Heart and Vascular Theme, Karolinska University Hospital Stockholm Sweden
| | | | - Stephane Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases, Faculty of Health, Medicine and Life SciencesMaastricht University Maastricht The Netherlands
- Department of Cardiovascular SciencesCentre for Molecular and Vascular Biology Leuven Belgium
- The Netherlands Heart InstituteNl‐HI Utrecht The Netherlands
| | - Ovidiu Chioncel
- Institute of Emergency for Cardiovascular DiseaseUniversity of Medicine Carol Davila Bucharest Romania
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of Cardiology (CVK), Berlin‐Brandenburg Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) Partner Site BerlinCharité Universitätsmedizin Berlin Berlin Germany
| | - Piotr Ponikowski
- Department of CardiologyMedical University, Clinical Military Hospital Wroclaw Poland
| | - Petar M. Seferovic
- University of Belgrade Faculty of Medicine and Heart Failure CenterBelgrade University Medical Center Belgrade Serbia
| | - Mark R. Johnson
- Department of Obstetrics, Imperial College School of MedicineChelsea and Westminster Hospital London UK
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care Medicine, AP‐HPSaint Louis Lariboisière University Hospitals, University Paris Diderot Paris France
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Cardiology and MedicineUniversity of Cape Town Cape Town South Africa
| |
Collapse
|
10
|
Abstract
Purpose of Review Peripartum cardiomyopathy (PPCM) is an idiopathic disorder defined as heart failure occurring in women during the last month of pregnancy and up to 5 months postpartum. In this review, we outline recent reports about the disease pathogenesis and management and highlight the use of diagnosis and prognosis biomarkers. Recent Findings Novel data strengthen the implication of endothelial function in PPCM pathogenesis. The first international registry showed that patient presentations were similar globally, with heterogeneity in patient management and outcome. Summary Despite large improvement in patient management and treatment, there is still a sub-group of women who die from PPCM or who will not recover their cardiac function. Remarkable advances in the comprehension of disease incidence, pathogenesis, and prognosis could be determined with multi-center and international registries. Clinical Trials ClinicalTrials.gov Identifier: NCT02590601
Collapse
|
11
|
Abstract
Microparticles are a distinctive group of small vesicles, without nucleus, which are involved as significant modulators in several physiological and pathophysiological mechanisms. Plasma microparticles from various cellular lines have been subject of research. Data suggest that they are key players in development and manifestation of cardiovascular diseases and their presence, in high levels, is associated with chronic inflammation, endothelial damage and thrombosis. The strong correlation of microparticle levels with several outcomes in cardiovascular diseases has led to their utilization as biomarkers. Despite the limited clinical application at present, their significance emerges, mainly because their detection and enumeration methods are improving. This review article summarizes the evidence derived from research, related with the genesis and the function of microparticles in the presence of various cardiovascular risk factors and conditions. The current data provide a substrate for several theories of how microparticles influence various cellular mechanisms by transferring biological information.
Collapse
Affiliation(s)
- Christos Voukalis
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Eduard Shantsila
- a Institute of Cardiovascular Sciences , University of Birmingham , Birmingham , UK
| | - Gregory Y H Lip
- b Liverpool Centre for Cardiovascular Science , University of Liverpool and Liverpool Heart & Chest Hospital , Liverpool , UK.,c Department of Clinical Medicine, Aalborg Thrombosis Research Unit , Aalborg University , Aalborg , Denmark
| |
Collapse
|
12
|
Barrachina MN, Calderón-Cruz B, Fernandez-Rocca L, García Á. Application of Extracellular Vesicles Proteomics to Cardiovascular Disease: Guidelines, Data Analysis, and Future Perspectives. Proteomics 2019; 19:e1800247. [PMID: 30467982 DOI: 10.1002/pmic.201800247] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/09/2018] [Indexed: 02/06/2023]
Abstract
Extracellular vesicles (EVs) are a heterogeneous population of vesicles composed of a lipid bilayer that carry a large repertoire of molecules including proteins, lipids, and nucleic acids. In this review, some guidelines for plasma-derived EVs isolation, characterization, and proteomic analysis, and the application of the above to cardiovascular disease (CVD) studies are provided. For EVs analysis, blood samples should be collected using a 21-gauge needle, preferably in citrate tubes, and plasma stored for up to 1 year at -80°, using a single freeze-thaw cycle. For proteomic applications, differential centrifugation (including ultracentrifugation steps) is a good option for EVs isolation. EVs characterization is done by transmission electron microscopy, particle enumeration techniques (nanoparticle-tracking analysis, dynamic light scattering), and flow cytometry. Regarding the proteomics strategy, a label-free and gel-free quantitative method is a good choice due to its accuracy and because it minimizes the amount of sample required for clinical applications. Besides the above, main EVs proteomic findings in cardiovascular-related diseases are presented and analyzed in this review, paying especial attention to overlapping results between studies. The latter might offer new insights into the clinical relevance and potential of novel EVs biomarkers identified to date in the context of CVD.
Collapse
Affiliation(s)
- Maria N Barrachina
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade Santiago de Compostela, Santiago de Compostela, 15782, Spain.,Instituto de Investigación, Sanitaria de Santiago (IDIS), Santiago de Compostela, 15706, Spain
| | - Beatriz Calderón-Cruz
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade Santiago de Compostela, Santiago de Compostela, 15782, Spain.,Instituto de Investigación, Sanitaria de Santiago (IDIS), Santiago de Compostela, 15706, Spain
| | - Lucía Fernandez-Rocca
- Clinical Analysis Laboratory, Maciel Hospital, Faculty of Chemistry, University of the Republic, Montevideo, 11000, Uruguay
| | - Ángel García
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Universidade Santiago de Compostela, Santiago de Compostela, 15782, Spain.,Instituto de Investigación, Sanitaria de Santiago (IDIS), Santiago de Compostela, 15706, Spain
| |
Collapse
|
13
|
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M, Iung B, Johnson MR, Kintscher U, Kranke P, Lang IM, Morais J, Pieper PG, Presbitero P, Price S, Rosano GMC, Seeland U, Simoncini T, Swan L, Warnes CA. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy. Eur Heart J 2018; 39:3165-3241. [PMID: 30165544 DOI: 10.1093/eurheartj/ehy340] [Citation(s) in RCA: 1148] [Impact Index Per Article: 191.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
|
14
|
Simon C, Greening DW, Bolumar D, Balaguer N, Salamonsen LA, Vilella F. Extracellular Vesicles in Human Reproduction in Health and Disease. Endocr Rev 2018; 39:292-332. [PMID: 29390102 DOI: 10.1210/er.2017-00229] [Citation(s) in RCA: 128] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/25/2018] [Indexed: 02/07/2023]
Abstract
Extensive evidence suggests that the release of membrane-enclosed compartments, more commonly known as extracellular vesicles (EVs), is a potent newly identified mechanism of cell-to-cell communication both in normal physiology and in pathological conditions. This review presents evidence about the formation and release of different EVs, their definitive markers and cargo content in reproductive physiological processes, and their capacity to convey information between cells through the transfer of functional protein and genetic information to alter phenotype and function of recipient cells associated with reproductive biology. In the male reproductive tract, epididymosomes and prostasomes participate in regulating sperm motility activation, capacitation, and acrosome reaction. In the female reproductive tract, follicular fluid, oviduct/tube, and uterine cavity EVs are considered as vehicles to carry information during oocyte maturation, fertilization, and embryo-maternal crosstalk. EVs via their cargo might be also involved in the triggering, maintenance, and progression of reproductive- and obstetric-related pathologies such as endometriosis, polycystic ovarian syndrome, preeclampsia, gestational diabetes, and erectile dysfunction. In this review, we provide current knowledge on the present and future use of EVs not only as biomarkers, but also as therapeutic targeting agents, mainly as vectors for drug or compound delivery into target cells and tissues.
Collapse
Affiliation(s)
- Carlos Simon
- Igenomix Foundation, Valencia, Spain.,Instituto de Investigación Sanitaria Hospital Clínico (INCLIVA), Valencia, Spain.,Department of Pediatrics, Obstetrics and Gynecology, School of Medicine, Valencia University, Valencia, Spain.,Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| | - David W Greening
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - David Bolumar
- Igenomix Foundation, Valencia, Spain.,Instituto de Investigación Sanitaria Hospital Clínico (INCLIVA), Valencia, Spain
| | - Nuria Balaguer
- Igenomix Foundation, Valencia, Spain.,Instituto de Investigación Sanitaria Hospital Clínico (INCLIVA), Valencia, Spain
| | - Lois A Salamonsen
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia.,Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Felipe Vilella
- Igenomix Foundation, Valencia, Spain.,Instituto de Investigación Sanitaria Hospital Clínico (INCLIVA), Valencia, Spain.,Department of Obstetrics and Gynecology, Stanford University, Palo Alto, California
| |
Collapse
|
15
|
Chen Y, Li G, Liu ML. Microvesicles as Emerging Biomarkers and Therapeutic Targets in Cardiometabolic Diseases. GENOMICS PROTEOMICS & BIOINFORMATICS 2018; 16:50-62. [PMID: 29462670 PMCID: PMC6000161 DOI: 10.1016/j.gpb.2017.03.006] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 03/03/2017] [Accepted: 03/23/2017] [Indexed: 12/20/2022]
Abstract
Microvesicles (MVs, also known as microparticles) are small vesicles that originate from plasma membrane of almost all eukaryotic cells during apoptosis or activation. MVs can serve as extracellular vehicles to transport bioactive molecules from their parental cells to recipient target cells, thereby serving as novel mediators for intercellular communication. Importantly, more and more evidence indicates that MVs could play important roles in early pathogenesis and subsequent progression of cardiovascular and metabolic diseases. Elevated plasma concentrations of MVs, originating from red blood cells, leukocytes, platelets, or other organs and tissues, have been reported in various cardiometabolic diseases. Circulating MVs could serve as potential biomarkers for disease diagnosis or therapeutic monitoring. In this review, we summarized recently-published studies in the field and discussed the role of MVs in the pathogenesis of cardiometabolic diseases. The emerging values of MVs that serve as biomarker for non-invasive diagnosis and prognosis, as well as their roles as novel therapeutic targets in cardiometabolic diseases, were also described.
Collapse
Affiliation(s)
- Yan Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Ming-Lin Liu
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, Temple University School of Medicine, Philadelphia, PA 19140, USA; Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19140, USA; Philadelphia VA Medical Center, Philadelphia, PA 19140, USA.
| |
Collapse
|
16
|
Assanelli D. Serial measures of microparticles during intense physical activity in untrained subjects with different endothelial abnormalities: new useful biomarkers for individual evaluation? Eur J Prev Cardiol 2018; 25:637-638. [PMID: 29411630 DOI: 10.1177/2047487318757548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Deodato Assanelli
- Chair of Sport Internal Medicine, Department of Sport-Internal Medicine, Universita degli Studi di Brescia, Italy
| |
Collapse
|
17
|
Vítková V, Živný J, Janota J. Endothelial cell-derived microvesicles: potential mediators and biomarkers of pathologic processes. Biomark Med 2018; 12:161-175. [PMID: 29327597 DOI: 10.2217/bmm-2017-0182] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This review focuses on the formation, composition and function of endothelial microvesicles (MV), often called microparticles (MP). MV release is a controlled event and is considered a hallmark of cellular activation or alteration. MV may affect the function of target cells through surface interaction and receptor activation, cellular fusion and the delivery of intravesicular cargo. Endothelial MV are released as a consequence of endothelial activation during inflammation and have been described to affect hemostasis, various aspects of inflammatory reaction, vessel formation, apoptosis and cell survival, endothelial cell differentiation and function. Recent data suggest the potential use of MV in diagnostics, assessment of severity and prediction of outcomes in inflammatory diseases and their utilization as targets, mediators and vectors in therapy.
Collapse
Affiliation(s)
- Veronika Vítková
- First Faculty of Medicine, Institute of Pathological Physiology, Charles University, Prague, Czech Republic.,Thomayer Department of Neonatology, Thomayer Hospital Prague, Czech Republic
| | - Jan Živný
- First Faculty of Medicine, Institute of Pathological Physiology, Charles University, Prague, Czech Republic
| | - Jan Janota
- First Faculty of Medicine, Institute of Pathological Physiology, Charles University, Prague, Czech Republic.,Thomayer Department of Neonatology, Thomayer Hospital Prague, Czech Republic
| |
Collapse
|
18
|
Schwarz V, Düsing P, Liman T, Werner C, Herm J, Bachelier K, Krüll M, Brechtel L, Jungehulsing GJ, Haverkamp W, Böhm M, Endres M, Haeusler KG, Laufs U. Marathon running increases circulating endothelial- and thrombocyte-derived microparticles. Eur J Prev Cardiol 2017; 25:317-324. [PMID: 29183152 DOI: 10.1177/2047487317744364] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Acute vascular effects of high intensity physical activity are incompletely characterized. Circulating microparticles are cellular markers for vascular activation and damage. Methods Microparticles were analysed in 99 marathon runners (49 ± 6 years, 22% female) of the prospective Berlin Beat of Running study. Blood samples were taken within three days before, immediately after and within two days after the marathon run. Endothelial-derived microparticles were labelled with CD144, CD31 and CD62E, platelet-derived microparticles with CD62P and CD42b, leukocyte-derived microparticles with CD45 and monocyte-derived microparticles with CD14. Results Marathon running induced leukocytosis (5.9 ± 0.1 to 14.8 ± 0.3 109/l, p < 0.0001) and increased platelet counts (239 ± 4.6 to 281 ± 5.9 109/l, p < 0.0001) immediately after the marathon. Blood monocytes increased and lymphocytes decreased after the run ( p < 0.0001). Endothelial-derived microparticles were acutely increased ( p = 0.008) due to a 23% increase of apoptotic endothelial-derived microparticles ( p = 0.007) and returned to baseline within two days after the marathon. Thrombocyte-derived microparticles acutely increased by 38% accompanied by an increase in activated and apoptotic thrombocyte-derived microparticles ( p ≤ 0.0001) each. Both monocyte- and leukocyte-derived microparticles were decreased immediately after marathon run ( p < 0.0001) and remained below baseline until day 2. Troponin T increased from 12 to 32 ng/l ( p < 0.0001) immediately after the run and returned to baseline after two days. Conclusion Circulating apoptotic endothelial- and thrombocyte-derived microparticles increased after marathon running consistent with an acute pro-thrombotic and pro-inflammatory state. Exercise-induced vascular damage reflected by microparticles could indicate potential mechanisms of post-exertional cardiovascular complications. Further studies are warranted to investigate microparticles as markers to identify individuals prone to such complications.
Collapse
Affiliation(s)
- Viktoria Schwarz
- 1 Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Philip Düsing
- 1 Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Thomas Liman
- 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Christian Werner
- 1 Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Juliane Herm
- 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Katrin Bachelier
- 1 Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Matthias Krüll
- 4 SMS Sports Medicine Berlin, Medical Institute of the BMW BERLIN-MARATHON, Germany
| | | | | | - Wilhelm Haverkamp
- 7 Department of Cardiology, Charité - Universitätsmedizin Berlin Campus Virchow-Klinikum, Germany
| | - Michael Böhm
- 1 Department for Internal Medicine III, Cardiology, Angiology and Intensive Care Medicine, Saarland University, Homburg/Saar, Germany
| | - Matthias Endres
- 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany.,8 German Center for Neurodegenerative Diseases (DZNE) & German Center for Cardiovascular Diseases (DZHK), Partner Site, Berlin, Germany
| | - Karl Georg Haeusler
- 2 Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.,3 Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Ulrich Laufs
- 9 Department of Cardiology, Universitätsklinikum Leipzig, Germany
| |
Collapse
|
19
|
Shantsila E, Montoro-García S, Gallego P, Lip GYH. Circulating microparticles: challenges and perspectives of flow cytometric assessment. Thromb Haemost 2017; 111:1009-14. [DOI: 10.1160/th13-11-0937] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 01/07/2014] [Indexed: 12/18/2022]
Abstract
SummaryCirculating blood microparticles are likely to play a significant role as messengers of biological information. Their accurate quantification and characterisation is challenging and needs to be carefully designed with preferable usage of fresh minimally-processed blood samples. Utilisation of flow cytometers specifically designed for analysis of small-size particles is likely to provide considerable methodological advantages and should be the preferable option. This viewpoint manuscript provides a critical summary of the key methodological aspects of microparticle analysis.Note: The review process for this viewpoint article was fully handled by Christian Weber, Editor in Chief.
Collapse
|
20
|
Jansen F, Nickenig G, Werner N. Extracellular Vesicles in Cardiovascular Disease: Potential Applications in Diagnosis, Prognosis, and Epidemiology. Circ Res 2017; 120:1649-1657. [PMID: 28495995 DOI: 10.1161/circresaha.117.310752] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Extracellular vesicles originate from diverse subcellular compartments and are released in the extracellular space. By transferring their cargoes into target cells and tissues, they now emerge as novel regulators of intercellular communication between adjacent and remote cells. Because vesicle composition and biological content are specific signatures of cellular activation and injury, their potential as diagnostic and prognostic biomarkers has raised significant interest in cardiovascular diseases. Characterization of circulating vesicles- or nonvesicles-bound nucleic acids represents a valuable tool for diagnosing and monitoring cardiovascular diseases, recently referred to as a liquid biopsy. Circulating extracellular vesicles offer a noninvasive and almost continuous access to circulating information on the disease state in epidemiological investigations. Finally, genetic engineering and cell-specific application of extracellular vesicles could display a novel therapeutic option for the treatment of cardiovascular diseases. In this review, we summarize the current knowledge about extracellular vesicles as diagnostic and prognostic biomarkers, as well as their potential applications for longitudinal epidemiological studies in cardiovascular diseases.
Collapse
Affiliation(s)
- Felix Jansen
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Georg Nickenig
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany
| | - Nikos Werner
- From the Department of Internal Medicine II, Rheinische Friedrich-Wilhelms University, Bonn, Germany.
| |
Collapse
|
21
|
Bachelier K, Biehl S, Schwarz V, Kindermann I, Kandolf R, Sauter M, Ukena C, Yilmaz A, Sliwa K, Bock CT, Klingel K, Böhm M. Parvovirus B19-induced vascular damage in the heart is associated with elevated circulating endothelial microparticles. PLoS One 2017; 12:e0176311. [PMID: 28531186 PMCID: PMC5439674 DOI: 10.1371/journal.pone.0176311] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 04/07/2017] [Indexed: 12/20/2022] Open
Abstract
Background Diagnosis of viral myocarditis is difficult by clinical criteria but facilitated by detection of inflammation and viral genomes in endomyocardial biopsies. Parvovirus B19 (B19V) targets endothelial cells where viral nucleic acid is exclusively detected in the heart. Microparticles (MPs) are released after cell damage or activation of specific cells. We aimed to investigate whether circulating endothelial MPs (EMPs) in human and experimental models of myocarditis are associated with B19V myocarditis. Methods MPs were investigated in patients with myocarditis (n = 54), divided into two groups: B19V+ (n = 23) and B19V- (n = 31) and compared with healthy controls (HCTR, n = 25). MPs were also investigated in B19V transgenic mice (B19V-NS1+) and mice infected with coxsackievirus B3 (CVB3). MPs were analyzed with fluorescent activated cell sorting (FACS). Results In human samples, EMP subpopulation patterns were significantly different in B19V+ compared to B19V- and HCTR (p<0.001), with an increase of apoptotic but not activated EMPs. Other MPs such as platelet- (PMPs) leukocyte-(LMPs) and monocyte-derived MPs (MMPs) showed less specific patterns. Significantly different levels of EMPs were observed in transgenic B19V-NS1+ mice compared with CVB3-infected mice (p<0.001). Conclusion EMP subpopulations are different in B19V+ myocarditis in humans and transgenic B19V mice reflecting vascular damage. EMP profiles might permit differentiation between endothelial-cell-mediated diseases like myocardial B19V infection and other causes of myocarditis.
Collapse
Affiliation(s)
- Katrin Bachelier
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
| | - Susanne Biehl
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
| | - Viktoria Schwarz
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
| | - Ingrid Kindermann
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
| | - Reinhard Kandolf
- Universitätsklinikum Tübingen, Abteilung Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Tübingen, Germany
| | - Martina Sauter
- Universitätsklinikum Tübingen, Abteilung Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Tübingen, Germany
| | - Christian Ukena
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
| | - Ali Yilmaz
- Universitätsklinikum Münster, Department für Kardiologie und Angiologie, Münster, Germany
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa and MRC Inter-Cape Heart Group, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Claus-Thomas Bock
- Universitätsklinikum Tübingen, Abteilung Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Tübingen, Germany
| | - Karin Klingel
- Universitätsklinikum Tübingen, Abteilung Molekulare Pathologie, Institut für Pathologie und Neuropathologie, Tübingen, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/ Saar, Universität des Saarlandes, Saarlandes, Germany
- * E-mail:
| |
Collapse
|
22
|
Ersbøll AS, Damm P, Gustafsson F, Vejlstrup NG, Johansen M. Peripartum cardiomyopathy: a systematic literature review. Acta Obstet Gynecol Scand 2017; 95:1205-1219. [PMID: 27545093 DOI: 10.1111/aogs.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 08/16/2016] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease defined by heart failure towards the end of pregnancy or in the months following delivery. We aim to raise awareness of the condition and give the clinician an overview of current knowledge on the mechanisms of pathophysiology, diagnostics and clinical management. MATERIAL AND METHODS Systematic literature searches were performed in PubMed and Embase up to June 2016. Cohorts of more than 20 women with PPCM conducted after 2000 were selected to report contemporary outcomes and prognostic data. Guidelines and reviews that provided comprehensive overviews were included, too. RESULTS New research on the pathophysiological mechanisms of PPCM points towards a two-hit multifactorial cause involving genetic factors and an antiangiogenic hormonal environment of late gestation with high levels of prolactin and sFlt-1. The prevalence of concomitant preeclampsia is high (often 30-45%) and symptoms can be similar, posing diagnostic difficulties. Most women (71-98%) present postpartum. Echocardiography is essential for diagnosis, and cardiac magnetic resonance imaging may provide new insights to pathophysiology and prognosis. Management is multidisciplinary and involves advanced heart failure therapy. Treatment, timing and mode of delivery in pregnant women depend on disease severity. The risk of relapse in subsequent pregnancies is >20%, and women are often advised against a new pregnancy. CONCLUSIONS PPCM has a huge impact on cardiovascular health and reproductive life perspective. New insights into genetics, molecular pathophysiological mechanisms and clinical studies have resulted in potential disease-specific therapies, but many questions remain unanswered.
Collapse
Affiliation(s)
- Anne S Ersbøll
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. .,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.
| | - Peter Damm
- Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Finn Gustafsson
- Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Niels G Vejlstrup
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Cardiology, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Marianne Johansen
- Center for Pregnancy and Heart Disease, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark.,Department of Obstetrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| |
Collapse
|
23
|
Schwarz V, Bachelier K, Schirmer SH, Werner C, Laufs U, Böhm M. Red Wine Prevents the Acute Negative Vascular Effects of Smoking. Am J Med 2017; 130:95-100. [PMID: 27633722 DOI: 10.1016/j.amjmed.2016.08.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/28/2016] [Accepted: 08/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Moderate consumption of red wine is associated with fewer cardiovascular events. We investigated whether red wine consumption counteracts the adverse vascular effects of cigarette smoking. METHODS Participants smoked 3 cigarettes alone or after drinking a titrated volume of red wine. Clinical chemistry, blood counts, plasma cytokine enzyme-linked immunosorbent assays, immunomagnetic separation of CD14+ monocytes for gene expression analysis, fluorescence-activated cell sorting for microparticles, and isolation of circulating mononuclear cells to measure telomerase activity were performed, and urine cotinine levels were quantified. RESULTS Compared with baseline, leukocytosis (P = .019), neutrophilia (P <.001), lymphopenia (P <.001), and eosinopenia (P = .008) were observed after only smoking. Endothelial and platelet-, monocyte-, and leukocyte-derived microparticles (P <.001 each) were elevated. In monocytes, messenger RNA expression of interleukin (IL)-6 (2.6- ± 0.57-fold), tumor necrosis factor alpha (2.2- ± 0.62-fold), and IL-1b (2.3- ± 0.44-fold) were upregulated, as was IL-6 (1.2 ± 0.12-fold) protein concentration in plasma. Smoking acutely inhibited mononuclear cell telomerase activity. Markers of endothelial damage, inflammation, and cellular aging were completely attenuated by red wine consumption. CONCLUSION Cigarette smoke results in acute endothelial damage, vascular and systemic inflammation, and indicators of the cellular aging processes in otherwise healthy nonsmokers. Pretreatment with red wine was preventive. The findings underscore the magnitude of acute damage exerted by cigarette smoking in "occasional lifestyle smokers" and demonstrate the potential of red wine as a protective strategy to avert markers of vascular injury.
Collapse
Affiliation(s)
- Viktoria Schwarz
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland.
| | - Katrin Bachelier
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland
| | - Stephan H Schirmer
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland
| | - Christian Werner
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland
| | - Ulrich Laufs
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland
| | - Michael Böhm
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße, Homburg, Deutschland
| |
Collapse
|
24
|
Damp J, Givertz MM, Semigran M, Alharethi R, Ewald G, Felker GM, Bozkurt B, Boehmer J, Haythe J, Skopicki H, Hanley-Yanez K, Pisarcik J, Halder I, Gorcsan J, Rana S, Arany Z, Fett JD, McNamara DM. Relaxin-2 and Soluble Flt1 Levels in Peripartum Cardiomyopathy: Results of the Multicenter IPAC Study. JACC-HEART FAILURE 2016; 4:380-8. [PMID: 26970832 DOI: 10.1016/j.jchf.2016.01.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 12/28/2015] [Accepted: 01/08/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study explored the association of vascular hormones with myocardial recovery and clinical outcomes in peripartum cardiomyopathy (PPCM). BACKGROUND PPCM is an uncommon disorder with unknown etiology. Angiogenic imbalance may contribute to its pathophysiology. METHODS In 98 women with newly diagnosed PPCM enrolled in the Investigation in Pregnancy Associated Cardiomyopathy study, serum was obtained at baseline for analysis of relaxin-2, prolactin, soluble fms-like tyrosine kinase 1 (sFlt1), and vascular endothelial growth factor (VEGF). Left ventricular ejection fraction (LVEF) was assessed by echocardiography at baseline and 2, 6, and 12 months. RESULTS Mean age was 30 ± 6 years, with a baseline of LVEF 0.35 ± 0.09. Relaxin-2, prolactin, and sFlt1 were elevated in women presenting early post-partum, but decreased rapidly and were correlated inversely with time from delivery to presentation. In tertile analysis, higher relaxin-2 was associated with smaller left ventricular systolic diameter (p = 0.006) and higher LVEF at 2 months (p = 0.01). This was particularly evident in women presenting soon after delivery (p = 0.02). No relationship was evident for myocardial recovery and prolactin, sFlt1 or VEGF levels. sFlt1 levels were higher in women with higher New York Heart Association functional class (p = 0.01) and adverse clinical events (p = 0.004). CONCLUSIONS In women with newly diagnosed PPCM, higher relaxin-2 levels soon after delivery were associated with myocardial recovery at 2 months. In contrast, higher sFlt1 levels correlated with more severe symptoms and major adverse clinical events. Vascular mediators may contribute to the development of PPCM and influence subsequent myocardial recovery. (Investigation in Pregnancy Associate Cardiomyopathy [IPAC]; NCT01085955).
Collapse
Affiliation(s)
- Julie Damp
- Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee.
| | - Michael M Givertz
- Division of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Marc Semigran
- Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rami Alharethi
- Division of Cardiology, Intermountain Medical Center, Salt Lake City, Utah
| | - Gregory Ewald
- Division of Cardiology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Biykem Bozkurt
- Section of Cardiovascular Medicine, Baylor College of Medicine, Houston, Texas
| | - John Boehmer
- Division of Cardiology, Penn State Hershey Medical Center, Hershey, Pennsylvania
| | - Jennifer Haythe
- Division of Cardiology, Columbia University, New York, New York
| | - Hal Skopicki
- Division of Cardiology, Stony Brook Medical Center, Stony Brook, New York
| | - Karen Hanley-Yanez
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Pisarcik
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Indrani Halder
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - John Gorcsan
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sarosh Rana
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois
| | - Zoltan Arany
- Division of Cardiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - James D Fett
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dennis M McNamara
- Heart and Vascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
25
|
Contributions of phosphatidylserine-positive platelets and leukocytes and microparticles to hypercoagulable state in gastric cancer patients. Tumour Biol 2015; 37:7881-91. [DOI: 10.1007/s13277-015-4667-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 12/16/2015] [Indexed: 12/16/2022] Open
|
26
|
Bank IEM, Timmers L, Gijsberts CM, Zhang YN, Mosterd A, Wang JW, Chan MY, De Hoog V, Lim SK, Sze SK, Lam CSP, De Kleijn DPV. The diagnostic and prognostic potential of plasma extracellular vesicles for cardiovascular disease. Expert Rev Mol Diagn 2015; 15:1577-88. [DOI: 10.1586/14737159.2015.1109450] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
27
|
Bouabdallaoui N, Mouquet F, Lebreton G, Demondion P, Le Jemtel TH, Ennezat PV. Current knowledge and recent development on management of peripartum cardiomyopathy. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:359-366. [PMID: 26474841 DOI: 10.1177/2048872615612465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Heart failure with left ventricular dysfunction occurring during pregnancy or during the post-partum period in patients without history of cardiovascular disease defines peripartum cardiomyopathy (PPCM). PPCM carries a high morbidity and mortality rate as well as the possibility of recovery ad integrum. Its incidence shows ethnic variations, with a greater prevalence of the disease among women with African descent. Pathogenesis of PPCM remains poorly understood. Both "oxidative stress-prolactin axis" and "anti-angiogenic-signaling excess" hypotheses are currently being investigated. Novel diagnostic strategies and biomarkers are currently being evaluated. Besides conventional treatment of heart failure, targeted therapies such as pharmacological prolactin blockade are under evaluation. The aim of this short review is to highlight current management as targeted therapy has far been disappointing.
Collapse
Affiliation(s)
| | | | - Guillaume Lebreton
- 1 Cardio-Thoracic Surgery Department, Pitié-Salpétrière Hospital, France
| | - Pierre Demondion
- 1 Cardio-Thoracic Surgery Department, Pitié-Salpétrière Hospital, France
| | | | - Pierre V Ennezat
- 4 Department of Cardiology, Centre Hospitalier Universitaire de Grenoble, France
| |
Collapse
|
28
|
Libhaber E, Sliwa K, Bachelier K, Lamont K, Böhm M. Low systolic blood pressure and high resting heart rate as predictors of outcome in patients with peripartum cardiomyopathy. Int J Cardiol 2015; 190:376-82. [PMID: 25966297 DOI: 10.1016/j.ijcard.2015.04.081] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 04/10/2015] [Accepted: 04/10/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Patients with peripartum cardiomyopathy (PPCM) present with low blood pressure (SBP) often preventing uptitration of heart failure medication. We aimed to study prediction of risk and the contribution of high resting heart rate (HR) and low SBP to risk in recent onset of PPCM. METHODS Clinical assessment with HR and SBP, echocardiography and laboratory results were obtained at baseline and at six months on 206 patients with recent onset PPCM enrolled at two tertiary care centers in South Africa. Poor outcome was defined as the combined endpoint of death, LVEF<35% or remaining in New York Heart Association (NYHA) functional class III/IV at six months. Complete LV recovery was defined as LVEF ≥ 55% at six months. RESULTS Poor outcome was observed in 110 of 220 patients (53%), with 26 patients dying at six months (12.6%). There were 98 (47.5%) patients with SBP ≤ 110 mmHg. Patients with high HR (HR ≥ 100) and low SBP (< 110 mmHg) tended to have worse outcomes than patients below the HR median and high SBP. PPCM patients with low SBP and high HR were less likely to be on ACE-inhibitors (n = 35, 69% versus n = 129, 84%, p = 0.024) and on the beta blocker carvedilol (n = 24, 47% versus n = 98, 64%, p = 0.047). Low SBP, high HR and left ventricular end diastolic diameter at baseline were predictors of poor outcome. Patients with low SBP and high HR had the highest mortality (p = 0.0023). CONCLUSIONS These findings suggest increased risk in patients with PPCM presenting with low SBP and high HR on standard heart failure medication possibly having implications on HF management.
Collapse
Affiliation(s)
- Elena Libhaber
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa
| | - Katrin Bachelier
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, D 66424 Homburg, Saar, Germany
| | - Kim Lamont
- Soweto Cardiovascular Research Unit, University of the Witwatersrand, South Africa
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Kirrberger Str. 1, D 66424 Homburg, Saar, Germany.
| |
Collapse
|
29
|
Łasińska-Kowara M, Lango R, Kowalik M, Jarmoszewicz K. Accelerated heart function recovery after therapeutic plasma exchange in patient treated with biventricular mechanical circulatory support for severe peripartum cardiomyopathy. Eur J Cardiothorac Surg 2014; 46:1035-6. [PMID: 24780740 DOI: 10.1093/ejcts/ezu178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We describe a case of severe peripartum cardiomyopathy treated with biventricular mechanical circulatory support, where rapid haemodynamic recovery was observed after therapeutic plasma exchange, used as an adjunct to the inhibition of prolactin release. The patient recovered and after 2 months was discharged from the hospital without clinical symptoms of heart disease.
Collapse
Affiliation(s)
| | - Romuald Lango
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Maciej Kowalik
- Department of Cardiac Anesthesiology, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Jarmoszewicz
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| |
Collapse
|
30
|
Bloomfield GS, Khazanie P, Morris A, Rabadán-Diehl C, Benjamin LA, Murdoch D, Radcliff VS, Velazquez EJ, Hicks C. HIV and noncommunicable cardiovascular and pulmonary diseases in low- and middle-income countries in the ART era: what we know and best directions for future research. J Acquir Immune Defic Syndr 2014; 67 Suppl 1:S40-53. [PMID: 25117960 PMCID: PMC4133739 DOI: 10.1097/qai.0000000000000257] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the advent of effective antiretroviral therapy (ART), HIV is becoming a chronic disease. HIV-seropositive (+) patients on ART can expect to live longer and, as a result, they are at risk of developing chronic noncommunicable diseases related to factors, such as aging, lifestyle, long-term HIV infection, and the potential adverse effects of ART. Although data are incomplete, evidence suggests that even in low- and middle-income countries (LMICs), chronic cardiovascular and pulmonary diseases are increasing in HIV-positive patients. This review summarizes evidence-linking HIV infection to the most commonly cited chronic cardiovascular and pulmonary conditions in LMICs: heart failure, hypertension, coronary artery disease/myocardial infarction, stroke, obstructive lung diseases, and pulmonary arterial hypertension. We describe the observed epidemiology of these conditions, factors affecting expression in LMICs, and key populations that may be at higher risk (ie, illicit drug users and children), and finally, we suggest that strategic areas of research and training intended to counter these conditions effectively. As access to ART in LMICs increases, long-term outcomes among HIV-positive persons will increasingly be determined by a range of associated chronic cardiovascular and pulmonary complications. Actions taken now to identify those conditions that contribute to long-term morbidity and mortality optimize early recognition and diagnosis and implement effective prevention strategies and/or disease interventions are likely to have the greatest impact on limiting cardiovascular and pulmonary disease comorbidity and improving population health among HIV-positive patients in LMICs.
Collapse
Affiliation(s)
- Gerald S. Bloomfield
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Prateeti Khazanie
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Alison Morris
- Departments of Medicine and Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cristina Rabadán-Diehl
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laura A. Benjamin
- Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3BX, UK
- Malawi-Liverpool-Wellcome Major Overseas Clinical Research Programme, College of Medicine, University of Malawi, Blantyre, Malawi
| | - David Murdoch
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Virginia S. Radcliff
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Eric J. Velazquez
- Division of Cardiology and Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Charles Hicks
- Division of Infectious Diseases, Department of Medicine, Duke University, Durham, NC, USA
| |
Collapse
|
31
|
Fett JD. Earlier detection can help avoid many serious complications of peripartum cardiomyopathy. Future Cardiol 2014; 9:809-16. [PMID: 24180539 DOI: 10.2217/fca.13.63] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Peripartum cardiomyopathy (PPCM) has a remarkable potential for recovery. It may be within our capability to help almost all women with PPCM not only to survive, but also to completely recover heart function. Time-of-diagnosis left ventricular ejection fraction (LVEF) ≥0.35 is associated with better survival rates and higher full recovery rates. Increased mortality, chronic cardiomyopathy, thromboembolic complications and serious ventricular tachyarrhythmias are associated with diagnostic LVEF <0.30. Delays in diagnosis may result in lower LVEF at diagnosis and subsequent lower recovery rates. Greater awareness of the possibility of heart failure developing in previously healthy young women, with no history of heart disease, will contribute to earlier diagnosis, with potentially better preserved heart function. Women of African descent may be at higher risk for poorer outcomes. Recent investigations suggest newer biomarkers may help with earlier detection of PPCM.
Collapse
Affiliation(s)
- James D Fett
- Hospital Albert Schweitzer, Deschapelles, Haiti, c/o 2331 Mt Hood Ct SE, Lacey, WA 98503, USA and Peripartum Cardiomyopathy Network, USA, Investigations in Pregnancy Associated Cardiomyopathy, Central Office, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
| |
Collapse
|
32
|
Abstract
PURPOSE OF REVIEW Peripartum cardiomyopathy (PPCM) is a disorder in which initial left ventricular systolic dysfunction and symptoms of heart failure occur between the late stages of pregnancy and the early postpartum period. Incidences vary geographically; it is common in some countries and rare in others. The acute form of PPCM is a clinical syndrome with reduced cardiac output, tissue hypoperfusion, and increase in the pulmonary capillary wedge pressure. Monitoring of the patient with the acute form of PPCM should be initiated as soon as possible. The syndrome carries a high morbidity and mortality and diagnosis is often delayed. This review focuses on new data and aspects in terms of diagnosis, causes of disease, pharmacological therapy, and management of delivery in patients with PPCM. RECENT FINDINGS New investigations reveal that PPCM is likely due to multiple factors. It develops based on oxidative stress leading to cleavage of deleterious 16-kDa prolactin, which can be blocked with bromocriptine. New data show furthermore that it is partly a two-hit vascular disease due to imbalances in angiogenic signaling worsening the severity of the disease. SUMMARY Different mechanisms have been investigated and give rise to promising therapeutic approach, which will be developed based on the new findings.
Collapse
|
33
|
Liman TG, Bachelier-Walenta K, Neeb L, Rosinski J, Reuter U, Böhm M, Endres M. Circulating endothelial microparticles in female migraineurs with aura. Cephalalgia 2014; 35:88-94. [PMID: 24715500 DOI: 10.1177/0333102414529671] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Endothelial microparticles (EMPs) are vesicles that are released from activated endothelial cells and serve as a surrogate for endothelial dysfunction (ED). ED may be involved in migraine pathophysiology and contribute to the increased risk of ischemic stroke, particularly in female migraineurs with aura (MA). We sought to determine whether EMPs are elevated in women with MA. METHODS In this case-control study, EMPs were detected by analysing surface markers using fluorescence-activated cell sorting (FACS). Surface markers were measured covering the main cell lines relevant in cardiovascular disease like endothelial cells, platelets, monocytes and leucocytes. Microparticles (MPs) were identified in correlation to calibration by 1 -µm calibrator beads (Beckman Coulter). Arterial stiffness was assessed using fingertip tonometry and the heart rate-adjusted augmentation index (AI). RESULTS We included 29 patients with MA and 29 matched controls. MA patients had significantly higher EMPs (CD62E(+)AnnexinV(+): 5142/µl vs 1535/µl; p < 0.001; CD144(+)AnnexinV(+): 6683/µl vs 3107/µl; p < 0.001), monocytic (CD14(+)AnnexinV(+) 6378 vs 3161; p < 0.001), and platelet MPs (CD62P(+)CD42b(+)AnnexinV(+) 5450 vs 3204; p < 0.001). Activated EMPs (CD62E(+)AnnexinV(+)) correlated with heart-rate adjusted AI (r = 0.46; p < 001). CONCLUSION EMP levels are significantly elevated in women with MA and correlated with increased AI. Our findings suggest that endothelial activation is present in women with MA. This might contribute to higher stroke risk in MA.
Collapse
Affiliation(s)
- Thomas G Liman
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Katrin Bachelier-Walenta
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Lars Neeb
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Jana Rosinski
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Uwe Reuter
- Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany Excellence Cluster NeuroCure, Charité - Universitätsmedizin, Germany German Center for Cardiovascular Research (DZHK), Charité - Universitätsmedizin, Germany
| |
Collapse
|
34
|
|
35
|
Sliwa K, Hilfiker-Kleiner D, Mebazaa A, Petrie MC, Maggioni AP, Regitz-Zagrosek V, Schaufelberger M, Tavazzi L, van Veldhuisen DJ, Roos-Hesslink JW, Shah AJ, Seferovic PM, Elkayam U, van Spaendonck-Zwarts K, Bachelier-Walenta K, Mouquet F, Kraigher-Krainer E, Hall R, Ponikowski P, McMurray JJV, Pieske B. EURObservational Research Programme: a worldwide registry on peripartum cardiomyopathy (PPCM) in conjunction with the Heart Failure Association of the European Society of Cardiology Working Group on PPCM. Eur J Heart Fail 2014; 16:583-91. [DOI: 10.1002/ejhf.68] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 12/05/2013] [Accepted: 12/13/2013] [Indexed: 11/07/2022] Open
Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa; University of Cape Town; South Africa
| | | | - Alexandre Mebazaa
- Hôpital Lariboisière; Université Paris Diderot, Inserm 942; Paris France
| | | | - Aldo P. Maggioni
- EURObservational Research Programme (EORP); European Society of Cardiology; Sophie Antipolis France
| | - Vera Regitz-Zagrosek
- Institute of Gender in Medicine (GiM); Charité - Universitätsmedizin; Berlin Germany
| | - Maria Schaufelberger
- Department of Medicine; Sahlgrenska University Hospital Ostra; Gothenburg Sweden
| | - Luigi Tavazzi
- Maria Cecilia Hospital; GVM Care & Research, E.S. Health Science Foundation; Cotignola Italy
| | | | | | - Ajay J. Shah
- King's College London BHF Centre of Excellence; London UK
| | | | - Uri Elkayam
- University of Southern California; Los Angeles CA USA
| | | | - Katrin Bachelier-Walenta
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin; Universitätsklinikum des Saarlandes; Homburg Saar Germany
| | - Frederic Mouquet
- Service de Cardiologie, Pôle Cardio-vasculaire et Pulmonaire; Hôpital Cardiologique; CHRU Lille France
| | - Elisabeth Kraigher-Krainer
- Department of Cardiology; Medical University Graz & Ludwig-Boltzmann Institute for Translational Heart Failure Research; Graz Austria
| | - Roger Hall
- Norfolk and Norwich University Hospitals; UK
| | - Piotr Ponikowski
- Department of Cardiology; Military Hospital, Center for Heart Diseases; Wroclaw Poland
| | | | - Burkert Pieske
- Department of Cardiology; Medical University Graz; Austria
| |
Collapse
|
36
|
Regitz-Zagrosek V, Gohlke-Bärwolf C, Iung B, Pieper PG. Management of cardiovascular diseases during pregnancy. Curr Probl Cardiol 2014; 39:85-151. [PMID: 24794710 DOI: 10.1016/j.cpcardiol.2014.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of cardiovascular diseases (CVDs) in women of childbearing age is rising. The successes in medical and surgical treatment of congenital heart disease have led to an increasing number of women at childbearing age presenting with problems of treated congenital heart disease. Furthermore, in developing countries and in immigrants from these countries, rheumatic valvular heart disease still plays a significant role in young women. Increasing age of pregnant women and increasing prevalence of atherosclerotic risk factors have led to an increase in women with coronary artery disease at pregnancy. Successful management of pregnancy in women with CVDs requires early diagnosis, a thorough risk stratification, and appropriate management by a multidisciplinary team of obstetricians, cardiologists, anesthesiologists, and primary care physicians. The following review is based on the recent European guidelines on the management of CVDs during pregnancy, which aim at providing concise and simple recommendations for these challenging problems.
Collapse
|
37
|
Ricke-Hoch M, Bultmann I, Stapel B, Condorelli G, Rinas U, Sliwa K, Scherr M, Hilfiker-Kleiner D. Opposing roles of Akt and STAT3 in the protection of the maternal heart from peripartum stress. Cardiovasc Res 2014; 101:587-96. [PMID: 24448315 DOI: 10.1093/cvr/cvu010] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Peripartum cardiomyopathy (PPCM) is a pregnancy-associated cardiomyopathy in previously healthy women. Mice with a cardiomyocyte-restricted deletion of signal transducer and activator of transcription-3 (STAT3, CKO) develop PPCM. PI3K-Akt signalling is thought to promote cardiac hypertrophy and protection during pregnancy. We evaluated the role of activated Akt signalling in the maternal heart postpartum. METHODS AND RESULTS CKO mice were bred to mice harbouring an Akt transgene, specifically expressed in cardiomyocytes (CAkt(tg)) generating CKO; CAkt(tg), CAkt(tg), CKO, and wild-type sibling mice. CAkt(tg) and CKO;CAkt(tg) female mice developed PPCM with systolic dysfunction. Both genotypes displayed cardiac hypertrophy and lower capillary density, showed increased phosphorylation of p66 Src homology 2 domain containing protein and FoxO3A, and reduced expression of manganese superoxide dismutase as well as increased cathepsin D activity and increased miR-146a levels [indicative for generation of the anti-angiogenic 16 kDa prolactin (PRL)]. Cardiac inflammation and fibrosis was accelerated in CKO;CAkt(tg) and associated with high postpartum mortality. The PRL blocker, bromocriptine (BR), prevented heart failure and the decrease in capillary density in CKO;CAkt(tg) and CAkt(tg) mice. BR attenuated high mortality, up-regulation of CCL2, and cardiac inflammation as well as fibrosis in CKO;CAkt(tg). PRL infusion induced cardiac inflammation in CKO;CAkt(tg) independent of pregnancy. In neonatal rat cardiomyocytes, PRL and interferon γ (IFNγ) induced the expression of CCL2 via activation of Akt. CONCLUSION Postpartum Akt activation is detrimental for the peripartum heart as it lowers anti-oxidative defence and in combination with low STAT3 conditions, accelerate cardiac inflammation and fibrosis. PRL and its cleaved 16 kDa form are central for Akt-induced PPCM as indicated by the protection from the disease by PRL blockade.
Collapse
Affiliation(s)
- Melanie Ricke-Hoch
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg Str. 1, 30625 Hannover, Germany
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Westhoff-Bleck M, Podewski E, Hilfiker A, Hilfiker-Kleiner D. Cardiovascular disorders in pregnancy: diagnosis and management. Best Pract Res Clin Obstet Gynaecol 2013; 27:821-34. [PMID: 23932772 DOI: 10.1016/j.bpobgyn.2013.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 06/03/2013] [Accepted: 07/12/2013] [Indexed: 11/28/2022]
Abstract
Cardiovascular diseases (CVDs) are a major cause of complications in pregnancy worldwide and the number of patients who develop cardiac problems during pregnancy is increasing. This review summarises recent literature on the aetiology and the underlying pathophysiology, diagnostic tools, risk stratification and prognosis in women who develop heart failure during pregnancy and in the peri-partum phase as well as in patients with pre-existing cardiomyopathies undergoing pregnancy. We specifically highlight peri-partum cardiomyopathy, valvular disease and Marfan's syndrome. Furthermore, we provide overviews on established treatment concepts and novel therapeutic strategies for these different disease types, stressing the point that pregnancy-associated cardiac disease requires interdisciplinary concepts for diagnosis, management and treatment.
Collapse
|
39
|
Haghikia A, Podewski E, Libhaber E, Labidi S, Fischer D, Roentgen P, Tsikas D, Jordan J, Lichtinghagen R, von Kaisenberg CS, Struman I, Bovy N, Sliwa K, Bauersachs J, Hilfiker-Kleiner D. Phenotyping and outcome on contemporary management in a German cohort of patients with peripartum cardiomyopathy. Basic Res Cardiol 2013; 108:366. [PMID: 23812247 PMCID: PMC3709080 DOI: 10.1007/s00395-013-0366-9] [Citation(s) in RCA: 224] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 06/07/2013] [Accepted: 06/12/2013] [Indexed: 12/14/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a life-threatening heart disease developing towards the end of pregnancy or in the months following delivery in previously healthy women in terms of cardiac disease. Enhanced oxidative stress and the subsequent cleavage of the nursing hormone Prolactin into an anti-angiogenic 16 kDa subfragment emerged as a potential causal factor of the disease. We established a prospective registry with confirmed PPCM present in 115 patients (mean baseline left ventricular ejection fraction, LVEF: 27 ± 9 %). Follow-up data (6 ± 3 months) showed LVEF improvement in 85 % and full recovery in 47 % while 15 % failed to recover with death in 2 % of patients. A positive family history of cardiomyopathy was present in 16.5 %. Pregnancy-associated hypertension was associated with a better outcome while a baseline LVEF ≤ 25 % was associated with a worse outcome. A high recovery rate (96 %) was observed in patients obtaining combination therapy with beta-blocker, angiotensin-converting enzyme (ACE) inhibitors/angiotensin-receptor-blockers (ARBs) and bromocriptine. Increased serum levels of Cathepsin D, the enzyme that generates 16 kDa Prolactin, miR-146a, a direct target of 16 kDa Prolactin, N-terminal-pro-brain-natriuretic peptide (NT-proBNP) and asymmetric dimethylarginine (ADMA) emerged as biomarkers for PPCM. In conclusion, low baseline LVEF is a predictor for poor outcome while pregnancy-induced hypertensive disorders are associated with a better outcome in this European PPCM cohort. The high recovery rate in this collective is associated with a treatment concept using beta-blockers, ACE inhibitors/ARBs and bromocriptine. Increased levels of Cathepsin D activity, miR-146a and ADMA in serum of PPCM patients support the pathophysiological role of 16 kDa Prolactin for PPCM and may be used as a specific diagnostic marker profile.
Collapse
Affiliation(s)
- A. Haghikia
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - E. Podewski
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - E. Libhaber
- Department of Medicine, Faculty of Health Sciences, Hatter Cardiovascular Research Institute, University of Cape Town, Cape Town, South Africa
- School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - S. Labidi
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - D. Fischer
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - P. Roentgen
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - D. Tsikas
- Department of Clinical Pharmacology, Medical School Hannover, Hannover, Germany
| | - J. Jordan
- Department of Clinical Pharmacology, Medical School Hannover, Hannover, Germany
| | - R. Lichtinghagen
- Department of Clinical Chemistry, Medical School Hannover, Hannover, Germany
| | - C. S. von Kaisenberg
- Department of Gynecology and Prenatal Medicine, Medical School Hannover, Hannover, Germany
| | - I. Struman
- Unit of Molecular Biology and Genetic Engineering, GIGA, University of Liège, Liège, Belgium
| | - N. Bovy
- Unit of Molecular Biology and Genetic Engineering, GIGA, University of Liège, Liège, Belgium
| | - K. Sliwa
- Department of Medicine, Faculty of Health Sciences, Hatter Cardiovascular Research Institute, University of Cape Town, Cape Town, South Africa
| | - J. Bauersachs
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| |
Collapse
|
40
|
Hulsmans M, Holvoet P. MicroRNA-containing microvesicles regulating inflammation in association with atherosclerotic disease. Cardiovasc Res 2013; 100:7-18. [PMID: 23774505 DOI: 10.1093/cvr/cvt161] [Citation(s) in RCA: 257] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In addition to intracellular organelles, eukaryotic cells contain extracellular organelles which are released, or shed, into the microenvironment. In practice, most human studies have examined mixed populations containing both exosomes and shedding microvesicles (also called ectosomes or microparticles); only a few studies have rigorously distinguished between the two. Accordingly, in this review, exosomes and shedding microvesicles are collectively called microvesicles. The first aim of this review was to discuss the role of microvesicles in cell-to-cell communication in general and in specific interactions between cells in chronic inflammation associated with atherosclerotic disease. Hereby, we focused on cell-specific microvesicles derived from platelets, endothelial cells and monocyte and monocyte-derived cells. The latter were also found to be associated with inflammation in obesity and type 2 diabetes prior to atherosclerotic disease, and cancer. Our second aim was to discuss specific changes in microvesicle content in relation with inflammation associated with metabolic and atherosclerotic disease, and cancer. Because many studies supported the putative diagnostic value of microRNAs, we emphasized therein changes in microRNA content rather than protein or lipid content. The most interesting microRNAs in inflammatory microvesicles in association with metabolic and cardiovascular diseases were found to be the let-7 family, miR-17/92 family, miR-21, miR-29, miR-126, miR-133, miR-146, and miR-155. These data warrant further investigation of the potential of microvesicles as putative biomarkers and as novel carriers for the cell-specific transfer of microRNAs and other therapeutic agents.
Collapse
Affiliation(s)
- Maarten Hulsmans
- Atherosclerosis and Metabolism Unit, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, PB 705, Leuven B-3000, Belgium
| | | |
Collapse
|
41
|
Sliwa K, Mayosi BM. Recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy in Africa. Heart 2013; 99:1317-22. [PMID: 23680887 DOI: 10.1136/heartjnl-2013-303592] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
This review addresses recent advances in the epidemiology, pathogenesis and prognosis of acute heart failure and cardiomyopathy based on research conducted in Africa. We searched Medline/PubMed for publications on acute decompensated heart failure and cardiomyopathy in Africa for the past 5 years (ie, 1 January 2008 to 31 December 2012). This was supplemented with personal communications with colleagues from Africa working in the field. A large prospective registry has shown that acute decompensated heart failure is caused by hypertension, cardiomyopathy and rheumatic heart disease in 90% of cases, a pattern that is in contrast with the dominance of coronary artery disease in North America and Europe. Furthermore, acute heart failure is a disease of the young with a mean age of 52 years, occurs equally in men and women, and is associated with high mortality at 6 months (∼18%), which is, however, similar to that observed in non-African heart failure registries, suggesting that heart failure has a dire prognosis globally, regardless of aetiology. The molecular genetics of dilated cardiomyopathy, hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy in Africans is consistent with observations elsewhere in the world; the unique founder effects in the Afrikaner provide an opportunity for the study of genotype-phenotype correlations in large numbers of individuals with cardiomyopathy due to the same mutation. Advances in the understanding of the molecular mechanisms of peripartum cardiomyopathy have led to promising clinical trials of bromocriptine in the treatment of peripartum heart failure. The key challenges of management of heart failure are the urgent need to increase the use of proven treatments by physicians, and the control of hypertension in primary care and at the population level.
Collapse
Affiliation(s)
- Karen Sliwa
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | | |
Collapse
|
42
|
Bloomfield GS, Barasa FA, Doll JA, Velazquez EJ. Heart failure in sub-Saharan Africa. Curr Cardiol Rev 2013; 9:157-73. [PMID: 23597299 PMCID: PMC3682399 DOI: 10.2174/1573403x11309020008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 11/15/2012] [Accepted: 11/18/2012] [Indexed: 02/06/2023] Open
Abstract
The heart failure syndrome has been recognized as a significant contributor to cardiovascular disease burden in sub-Saharan African for many decades. Seminal knowledge regarding heart failure in the region came from case reports and case series of the early 20th century which identified infectious, nutritional and idiopathic causes as the most common. With increasing urbanization, changes in lifestyle habits, and ageing of the population, the spectrum of causes of HF has also expanded resulting in a significant burden of both communicable and non-communicable etiologies. Heart failure in sub-Saharan Africa is notable for the range of etiologies that concurrently exist as well as the healthcare environment marked by limited resources, weak national healthcare systems and a paucity of national level data on disease trends. With the recent publication of the first and largest multinational prospective registry of acute heart failure in sub-Saharan Africa, it is timely to review the state of knowledge to date and describe the myriad forms of heart failure in the region. This review discusses several forms of heart failure that are common in sub-Saharan Africa (e.g., rheumatic heart disease, hypertensive heart disease, pericardial disease, various dilated cardiomyopathies, HIV cardiomyopathy, hypertrophic cardiomyopathy, endomyocardial fibrosis, ischemic heart disease, cor pulmonale) and presents each form with regard to epidemiology, natural history, clinical characteristics, diagnostic considerations and therapies. Areas and approaches to fill the remaining gaps in knowledge are also offered herein highlighting the need for research that is driven by regional disease burden and needs.
Collapse
|
43
|
Bachelier-Walenta K, Hilfiker-Kleiner D, Sliwa K. Article Commentary: Acute Heart Failure: Is it Peripartum Cardiomyopathy or Not? Obstet Med 2013; 6:42-44. [PMID: 27757154 PMCID: PMC5052784 DOI: 10.1258/om.2012.120042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2012] [Indexed: 03/27/2024] Open
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening disease that occurs in women of childbearing age.
Collapse
Affiliation(s)
- Katrin Bachelier-Walenta
- Department of Medicine, Cardiology, Angiology and Internal Intensive Care, Homburg/Saar, Germany
| | | | - Karen Sliwa
- Department of Medicine, Medical School, Hatter Institute for Cardiovascular Research in Africa, Groote Schuur Hospital and University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa
| |
Collapse
|
44
|
Hilfiker-Kleiner D, Struman I, Hoch M, Podewski E, Sliwa K. 16-kDa prolactin and bromocriptine in postpartum cardiomyopathy. Curr Heart Fail Rep 2012; 9:174-82. [PMID: 22729360 DOI: 10.1007/s11897-012-0095-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Peripartum cardiomyopathy (PPCM) is a potentially life-threatening heart disease emerging toward the end of pregnancy or in the first postpartal months in previously healthy women. Recent data suggest a central role of unbalanced peri-/postpartum oxidative stress that triggers the proteolytic cleavage of the nursing hormone prolactin (PRL) into a potent antiangiogenic, proapoptotic, and proinflammatory 16-kDa PRL fragment. This notion is supported by the observation that inhibition of PRL secretion by bromocriptine, a dopamine D2-receptor agonist, prevented the onset of disease in an animal model of PPCM and by first clinical experiences where bromocriptine seem to exert positive effects with respect to prevention or treatment of PPCM patients. Here, we highlight the current state of knowledge on diagnosis of PPCM, provide insights into the biology and pathophysiology of 16-kDa PRL and bromocriptine, and outline potential consequences for the clinical management and treatment options for PPCM patients.
Collapse
Affiliation(s)
- Denise Hilfiker-Kleiner
- Department of Cardiology and Angiology, Medizinische Hochschule Hannover, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | | | | | | | | |
Collapse
|
45
|
Stewart GC. Management of Peripartum Cardiomyopathy. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:622-36. [DOI: 10.1007/s11936-012-0210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
46
|
Güder G, Brenner S, Morr AK, Frantz S, Angermann CE, Störk S. Serial cardiac imaging in peripartum cardiomyopathy. Int J Cardiol 2012; 157:308-9. [PMID: 22498417 DOI: 10.1016/j.ijcard.2012.03.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 03/10/2012] [Accepted: 03/14/2012] [Indexed: 11/18/2022]
|