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Kõre AC, Joonsalu T, Serg M, Pauklin P, Voitk J, Roose I, Eha J, Kampus P. Implications of pulse wave velocity and central pulse pressure in heart failure with reduced ejection fraction. Blood Press 2024; 33:2359932. [PMID: 38819846 DOI: 10.1080/08037051.2024.2359932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/18/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Carotid-femoral pulse wave velocity (cfPWV) and central pulse pressure (PP) are recognised as significant indicators of vascular health and predictors of cardiovascular outcomes. In this study, associations between central hemodynamics and left ventricular (LV) echocardiographic parameters were investigated in subjects with heart failure with reduced ejection fraction (HFrEF), comparing the results to healthy individuals. METHODS AND RESULTS This cross-sectional prospective controlled study included 50 subjects with HFrEF [mean LV ejection fraction (EF) 26 ± 6.5%] and 30 healthy controls (mean LVEF 65.9 ± 5.3%). Pulse wave analysis (PWA) and carotid-femoral pulse wave velocity (cfPWV) were used to measure central hemodynamics and arterial stiffness. The HFrEF group displayed higher cfPWV (8.2 vs. 7.2 m/s, p = 0.007) and lower central (111.3 vs. 121.7 mmHg, p = 0.001) and peripheral (120.1 vs. 131.5 mmHg, p = 0.002) systolic blood pressure. Central pulse pressure (PP) was comparable between the two groups (37.6 vs. 40.4 mmHg, p = 0.169). In the HFrEF group, cfPWV significantly correlated with left ventricular end-diastolic volume (LVEDV) index (mL/m2) and LVEF, with LVEDV index being a significant independent predictor of cfPWV (R2 = 0.42, p = 0.003). Central PP was significantly associated with heart rate, LVEF and LVEDV index, with the latter being a significant independent predictor of central PP (R2 = 0.41, p < 0.001). These correlations were not observed in healthy controls. CONCLUSIONS Significant associations between central hemodynamic measures and LV echocardiographic parameters were identified, suggesting the potential to use PWA and cfPWV as possible tools for managing HFrEF.
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Affiliation(s)
- Anette Caroline Kõre
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
| | - Tuuli Joonsalu
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - Martin Serg
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
- North Estonia Medical Centre, Centre of Cardiology, Tallinn, Estonia
| | - Priit Pauklin
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - Jüri Voitk
- North Estonia Medical Centre, Centre of Cardiology, Tallinn, Estonia
| | - Indrek Roose
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - Jaan Eha
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
- Tartu University Hospital, Heart Clinic, Tartu, Estonia
| | - Priit Kampus
- Institute of Clinical Medicine, Department of Cardiology, University of Tartu, Tartu, Estonia
- North Estonia Medical Centre, Centre of Cardiology, Tallinn, Estonia
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Masini G, Gargani L, Morizzo C, Guarini G, Bort IR, Baldini M, Tamborrino PP, Vitale C, Palombo C, De Caterina R. Prognostic impact of peripheral artery disease-related parameters in patients with acute coronary syndrome. J Cardiovasc Med (Hagerstown) 2024; 25:749-756. [PMID: 39101369 DOI: 10.2459/jcm.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. METHODS We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. RESULTS Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). CONCLUSIONS LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.
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Affiliation(s)
- Gabriele Masini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa University Hospital, and Chair of Cardiology, University of Pisa, Pisa, Italy
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Yang H, Ou W, Song X, Chen A. Causal association between blood metabolites and abdominal aortic calcification: A bidirectional Mendelian randomization study. Medicine (Baltimore) 2024; 103:e39451. [PMID: 39252291 PMCID: PMC11383265 DOI: 10.1097/md.0000000000039451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Previous studies have reported correlations between metabolic factors and abdominal aortic calcification (AAC). However, the causal relationship between blood metabolites and AAC remains to be fully explored. We employed bidirectional two-sample Mendelian randomization (MR) to investigate the potential causal relationships between 486 blood metabolites and AAC. The inverse variance weighted method was primarily utilized for MR analysis, and the MR-Egger, weighted median, and Robust Adjusted Profile Score methods were used for supplementary analysis. Sensitivity analyses were conducted using Radial MR, MR-PRESSO, Cochran Q test, MR-Egger intercept, and leave-one-out analysis to evaluate the heterogeneity and pleiotropy. Furthermore, the Steiger test and linkage disequilibrium score regression were used to assess genetic correlation and directionality. Multivariable MR analysis was performed to evaluate the direct effect of metabolites on AAC. Through rigorous screening, we identified 6 metabolites with presumed causal effects on AAC: 4-methyl-2-oxopentanoate (effect size [ES] 0.46, 95% confidence interval [CI]: 0.10-0.82), erythrose (ES -0.35, 95% CI: -0.59 to -0.11), 10-undecenoate (11:1n1) (ES 0.14, 95% CI: 0.03-0.25), 1-myristoylglycerophosphocholine (ES 0.31, 95% CI: 0.11-0.50), glycerol 2-phosphate (ES 0.20, 95% CI: 0.04-0.37), and the unidentified metabolite X-11469 (ES 0.19, 95% CI: 0.08-0.30). Multivariable MR analysis revealed that genetically predicted erythrose, 10-undecenoate, 1-myristoylglycerophosphocholine, and X-11469 could directly affect AAC independent of other metabolites. Reverse MR analysis revealed an alteration in 12 blood metabolites due to AAC, including caffeine, 1,7-dimethylurate, arachidonic acid, and 1-arachidonoylglycerophosphocholine. This study provides evidence supporting a causal relationship between metabolites and AAC. These findings help elucidate the underlying biological mechanisms of AAC and may offer insights into screening, prevention, and treatment approaches.
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Affiliation(s)
- Hongwei Yang
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Wen Ou
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xudong Song
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Aihua Chen
- Department of Cardiology, Laboratory of Heart Center, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Southern Medical University, Guangzhou, Guangdong, People's Republic of China
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4
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Schulz A, Schellinger IN, Backhaus SJ, Adler AS, Lange T, Evertz R, Kowallick JT, Hoffmann A, Matek C, Tsao PS, Hasenfuß G, Raaz U, Schuster A. Association of Cardiac MRI-derived Aortic Stiffness with Early Stages and Progression of Heart Failure with Preserved Ejection Fraction. Radiol Cardiothorac Imaging 2024; 6:e230344. [PMID: 39145733 PMCID: PMC11369653 DOI: 10.1148/ryct.230344] [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: 10/25/2023] [Revised: 05/28/2024] [Accepted: 07/09/2024] [Indexed: 08/16/2024]
Abstract
Purpose To investigate if aortic stiffening as detected with cardiac MRI is an early phenomenon in the development and progression of heart failure with preserved ejection fraction (HFpEF). Materials and Methods Both clinical and preclinical studies were performed. The clinical study was a secondary analysis of the prospective HFpEF stress trial (August 2017 through September 2019) and included 48 participants (median age, 69 years [range, 65-73 years]; 33 female, 15 male) with noncardiac dyspnea (NCD, n = 21), overt HFpEF at rest (pulmonary capillary wedge pressure [PCWP] ≥ 15 mm Hg, n = 14), and masked HFpEF at rest diagnosed during exercise stress (PCWP ≥ 25 mm Hg, n = 13) according to right heart catheterization. Additionally, all participants underwent echocardiography and cardiac MRI at rest and during exercise stress. Aortic pulse wave velocity (PWV) was calculated. The mechanistic preclinical study characterized cardiac function and structure in transgenic mice with induced arterial stiffness (Runx2-smTg mice). Statistical analyses comprised nonparametric and parametric comparisons, Spearman correlations, and logistic regression models. Results Participants with HFpEF showed increased PWV (NCD vs masked HFpEF: 7.0 m/sec [IQR: 5.0-9.5 m/sec] vs 10.0 m/sec [IQR: 8.0-13.4 m/sec], P = .005; NCD vs overt HFpEF: 7.0 m/sec [IQR: 5.0-9.5 m/sec] vs 11.0 m/sec [IQR: 7.5-12.0 m/sec], P = .01). Increased PWV correlated with higher PCWP (P = .006), left atrial and left ventricular long-axis strain (all P < .02), and N-terminal pro-brain natriuretic peptide levels (P < .001). Participants with overt HFpEF had higher levels of myocardial fibrosis, as demonstrated by increased native T1 times (1199 msec [IQR: 1169-1228 msec] vs 1234 msec [IQR: 1208-1255 msec], P = .009). Aortic stiffness was independently associated with HFpEF on multivariable analyses (odds ratio, 1.31; P = .049). Runx2-smTG mice exhibited an "HFpEF" phenotype compared with wild-type controls, with preserved left ventricular fractional shortening but an early and late diastolic mitral annulus velocity less than 1 (mean, 0.67 ± 0.39 [standard error of the mean] vs 1.45 ± 0.47; P = .004), increased myocardial collagen deposition (mean, 11% ± 1 vs 2% ± 1; P < .001), and increased brain natriuretic peptide levels (mean, 171 pg/mL ± 23 vs 101 pg/mL ± 10; P < .001). Conclusion This study provides translational evidence that increased arterial stiffness might be associated with development and progression of HFpEF and may facilitate its early detection. Keywords: MR Functional Imaging, MR Imaging, Animal Studies, Cardiac, Aorta, Heart ClinicalTrials.gov identifier NCT03260621 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Alexander Schulz
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Isabel N. Schellinger
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | | | - Ansgar S. Adler
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Torben Lange
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Ruben Evertz
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Johannes T. Kowallick
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Annett Hoffmann
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Christian Matek
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Philip S. Tsao
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
| | - Gerd Hasenfuß
- From the Department of Medicine, Cardiovascular Division, Beth Israel
Deaconess Medical Center and Harvard Medical School, Boston, Mass (A. Schulz);
Department of Cardiology and Pneumology, University Medical Center
Göttingen, Georg-August-University Göttingen, Robert-Koch-Str. 40,
37099 Göttingen, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H.,
U.R., A. Schuster); German Center for Cardiovascular Research (DZHK), Partner
Site Lower Saxony, Germany (A. Schulz, I.N.S., S.J.B., T.L., R.E., G.H., U.R.,
A. Schuster); School of Biomedical Engineering and Imaging Sciences,
King’s College London, London, United Kingdom (S.J.B., A. Schuster);
Institute of Biomedical Imaging, University of Graz, Graz, Austria (A.S.A.);
FORUM Radiology, Rosdorf, Germany (J.T.K.); German Center for Cardiovascular
Research (DZHK), Partner Site Lower Saxony, Germany (J.T.K.); Department of
General, Visceral, Transplant, Vascular and Pediatric Surgery, University
Hospital Würzburg, Würzburg, Germany (A.H.); Institute of
Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Germany (C.M.); Division of Cardiovascular
Medicine, Stanford University School of Medicine, Stanford, Calif (P.S.T.); VA
Palo Alto Health Care System, Palo Alto, Calif (P.S.T.); and FORUM Cardiology,
Rosdorf, Germany (A. Schuster)
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5
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Kim HL, Jo SH. Arterial Stiffness and Heart Failure With Preserved Ejection Fraction. J Korean Med Sci 2024; 39:e195. [PMID: 38887204 PMCID: PMC11182699 DOI: 10.3346/jkms.2024.39.e195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/20/2024] [Indexed: 06/20/2024] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is prevalent and associated with a poor prognosis, imposing a significant burden on society. Arterial stiffness is increasingly recognized as a crucial factor in the pathophysiology of HFpEF, affecting diagnosis, management, and prognosis. As a hallmark of vascular aging, arterial stiffness contributes to increased afterload on the left ventricle (LV), leading to diastolic dysfunction, a key feature of HFpEF. Elevated arterial stiffness is linked with common cardiovascular risk factors in HFpEF, such as hypertension, diabetes and obesity, exacerbating the progression of disease. Studies have demonstrated that patients with HFpEF exhibit significantly higher levels of arterial stiffness compared to those without HFpEF, highlighting the value of arterial stiffness measurements as both diagnostic and prognostic tools. Moreover, interventions aimed at reducing arterial stiffness, whether through pharmacological therapies or lifestyle modifications, have shown potential in improving LV diastolic function and patient outcomes. Despite these advancements, the precise mechanisms by which arterial stiffness contributes to HFpEF are still not fully understood, necessitating the need for further research.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea.
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Huang CC, Sung SH, Wang WT, Su YY, Huang CJ, Chu TY, Chuang SY, Chiang CE, Chen CH, Lin CC, Cheng HM. Examining arterial pulsation to identify and risk-stratify heart failure subjects with deep neural network. Phys Eng Sci Med 2024; 47:477-489. [PMID: 38361179 PMCID: PMC11166827 DOI: 10.1007/s13246-023-01378-6] [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: 01/13/2023] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Abstract
Hemodynamic parameters derived from pulse wave analysis have been shown to predict long-term outcomes in patients with heart failure (HF). Here we aimed to develop a deep-learning based algorithm that incorporates pressure waveforms for the identification and risk stratification of patients with HF. The first study, with a case-control study design to address data imbalance issue, included 431 subjects with HF exhibiting typical symptoms and 1545 control participants with no history of HF (non-HF). Carotid pressure waveforms were obtained from all the participants using applanation tonometry. The HF score, representing the probability of HF, was derived from a one-dimensional deep neural network (DNN) model trained with characteristics of the normalized carotid pressure waveform. In the second study of HF patients, we constructed a Cox regression model with 83 candidate clinical variables along with the HF score to predict the risk of all-cause mortality along with rehospitalization. To identify subjects using the HF score, the sensitivity, specificity, accuracy, F1 score, and area under receiver operating characteristic curve were 0.867, 0.851, 0.874, 0.878, and 0.93, respectively, from the hold-out cross-validation of the DNN, which was better than other machine learning models, including logistic regression, support vector machine, and random forest. With a median follow-up of 5.8 years, the multivariable Cox model using the HF score and other clinical variables outperformed the other HF risk prediction models with concordance index of 0.71, in which only the HF score and five clinical variables were independent significant predictors (p < 0.05), including age, history of percutaneous coronary intervention, concentration of sodium in the emergency room, N-terminal pro-brain natriuretic peptide, and hemoglobin. Our study demonstrated the diagnostic and prognostic utility of arterial waveforms in subjects with HF using a DNN model. Pulse wave contains valuable information that can benefit the clinical care of patients with HF.
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Affiliation(s)
- Chieh-Chun Huang
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Wei-Ting Wang
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan
| | - Yin-Yuan Su
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Chi-Jung Huang
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Yu Chu
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Shao-Yuan Chuang
- Institute of Population Health Science, National Health Research Institute, Miaoli, Taiwan
| | - Chern-En Chiang
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Ching Lin
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
| | - Hao-Min Cheng
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, 112, No. 201, Sec. 2, Shih-Pai Road, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
- Center for Evidence-Based Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Public Health, National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan.
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan.
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Hametner B, Maurer S, Sehnert A, Bachler M, Orter S, Zechner O, Müllner-Rieder M, Penkler M, Wassertheurer S, Sehnert W, Mengden T, Mayer CC. Non-invasive pulse arrival time as a surrogate for oscillometric systolic blood pressure changes during non-pharmacological intervention. Physiol Meas 2024; 45:055015. [PMID: 38688296 DOI: 10.1088/1361-6579/ad45ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/30/2024] [Indexed: 05/02/2024]
Abstract
Background.Non-invasive continuous blood pressure (BP) monitoring is of longstanding interest in various cardiovascular scenarios. In this context, pulse arrival time (PAT), i.e., a surrogate parameter for systolic BP (change), became very popular recently, especially in the context of cuffless BP measurement and dedicated lifestyle interventions. Nevertheless, there is also understandable doubt on its reliability in uncontrolled and mobile settings.Objective.The aim of this work is therefore the investigation whether PAT follows oscillometric systolic BP readings during moderate interventions by physical or mental activity using a medical grade handheld device for non-invasive PAT assessment.Approach.A study was conducted featuring an experimental group performing a physical and a mental task, and a control group. Oscillometric BP and PAT were assessed at baseline and after each intervention. Interventions were selected randomly but then performed sequentially in a counterbalanced order. Multivariate analyses of variance were used to test within-subject and between-subject effects for the dependent variables, followed by univariate analyses for post-hoc testing. Furthermore, correlation analysis was performed to assess the association of intervention effects between BP and PAT.Mainresults.The study included 51 subjects (31 females). Multivariate analysis of variances showed that effects in BP, heart rate, PAT and pulse wave parameters were consistent and significantly different between experimental and control groups. After physical activity, heart rate and systolic BP increased significantly whereas PAT decreased significantly. Mental activity leads to a decrease in systolic BP at stable heart rate. Pulse wave parameters follow accordingly by an increase of PAT and mainly unchanged pulse wave analysis features due to constant heart rate. Finally, also the control group behaviour was accurately registered by the PAT method compared to oscillometric cuff. Correlation analyses revealed significant negative associations between changes of systolic BP and changes of PAT from baseline to the physical task (-0.33 [-0.63, 0.01],p< 0.048), and from physical to mental task (-0.51 [-0.77, -0.14],p= 0.001), but not for baseline to mental task (-0.12 [-0,43,0,20],p= 0.50) in the experimental group.Significance.PAT and the used digital, handheld device proved to register changes in BP and heart rate reliably compared to oscillometric measurements during intervention. Therefore, it might add benefit to future mobile health solutions to support BP management by tracking relative, not absolute, BP changes during non-pharmacological interventions.
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Affiliation(s)
- Bernhard Hametner
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Severin Maurer
- Institute of Market Research and Methodology, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Alina Sehnert
- Institute for Clinical Research Sehnert, Dortmund, Germany
| | - Martin Bachler
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Stefan Orter
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Olivia Zechner
- AIT Austrian Institute of Technology, Center for Technology Experience, Experience Business Transformation, Vienna, Austria
| | - Markus Müllner-Rieder
- AIT Austrian Institute of Technology, Center for Health & Bioresources, Digital Health Information Systems, Vienna, Austria
| | - Michael Penkler
- Institute of Market Research and Methodology, University of Applied Sciences Wiener Neustadt, Wiener Neustadt, Austria
| | - Siegfried Wassertheurer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
| | - Walter Sehnert
- Institute for Clinical Research Sehnert, Dortmund, Germany
| | - Thomas Mengden
- Kerckhoff Clinic, Rehabilitation, ESH Excellence Centre, Bad Nauheim, Germany
| | - Christopher C Mayer
- AIT Austrian Institute of Technology GmbH, Center for Health & Bioresources, Medical Signal Analysis, Vienna, Austria
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Xu M, Wei X, Wang J, Li Y, Huang Y, Cheng A, He F, Zhang L, Zhang C, Liu Y. The NRF2/ID2 Axis in Vascular Smooth Muscle Cells: Novel Insights into the Interplay between Vascular Calcification and Aging. Aging Dis 2024:AD.2024.0075. [PMID: 38916733 DOI: 10.14336/ad.2024.0075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 05/20/2024] [Indexed: 06/26/2024] Open
Abstract
Vascular calcification (VC) increases with age and markedly exacerbates the risk of cardiovascular morbidity and mortality. However, effective pharmaceutical interventions are lacking and the molecular mechanisms linking aging to VC remain elusive. This study explored the role of nuclear factor erythroid 2-related factor 2 (NRF2) in age-associated VC, specifically focusing on vascular smooth muscle cell (VSMC) senescence. Using a chronologically aging mouse model, we noted a significant decline in the expression of NRF2 in the aged mice aortas, coinciding with increased VC. Administering NRF2 activators effectively reduced calcification. By establishing adenine-and vitamin D-induced VC models in VSMC-specific Nrf2 knockout (Nrf2SMCKO) mice, there was an increase in VC with increased VSMC senescence. Aortic rings and primary VSMCs from Nrf2SMCKO mice also showed increased VC under high-phosphate conditions. Furthermore, Nrf2 overexpression inhibited VSMC calcification with decreased VSMC senescence and an osteogenic phenotype, whereas Nrf2 silencing aggravated calcification. Transcriptome RNA-seq analysis of the aortas from Nrf2SMCKO and control mice revealed that inhibitor of DNA binding 2 (Id2) is a core downstream gene of NRF2. Id2 overexpression alleviated NRF2 knockdown-induced VC and VSMC senescence, while silencing Id2 negated the protective effects of NRF2. Moreover, results of a dual luciferase reporter assay indicated that NRF2 promotes the transcriptional activity of the Id2 gene promoter region. This study emphasizes the critical role of age-related NRF2 dysfunction in the nexus between VSMC senescence and VC. The NRF2-ID2 axis in VSMCs has been proposed as a promising therapeutic target for reducing VC and mitigating age-related cardiovascular diseases.
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Affiliation(s)
- Mulin Xu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of General Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiuxian Wei
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinli Wang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Li
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Huang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Anying Cheng
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fan He
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Nephrology, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, China
| | - Le Zhang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cuntai Zhang
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yu Liu
- Department of Geriatrics, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Key Laboratory of Vascular Aging, Ministry of Education, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Tolu‐Akinnawo OZ, Awoyemi T, Guzman RB, Naveed A. Olanzapine-induced cardiomyopathy: A mimicker of obesity cardiomyopathy? Clin Cardiol 2024; 47:e24278. [PMID: 38767024 PMCID: PMC11103636 DOI: 10.1002/clc.24278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/24/2024] [Indexed: 05/22/2024] Open
Abstract
Olanzapine, an atypical antipsychotic medication, has gained prominence in the treatment of schizophrenia and related psychotic disorders due to its effectiveness and perceived safety profile. However, emerging evidence suggests a potential link between olanzapine use and adverse cardiovascular effects, including cardiomyopathy. This narrative review explores the mechanisms, clinical implications, and management strategies associated with olanzapine-induced cardiomyopathy. A comprehensive review of the literature was conducted to investigate the relationship between olanzapine and cardiomyopathy. The search included epidemiological studies, clinical case reports, and mechanistic research focusing on the pathophysiology of olanzapine-induced cardiomyopathy. The review also examined treatment strategies for managing this potential complication. Olanzapine-induced cardiomyopathy is hypothesized to be associated with metabolic disturbances and receptor antagonism. The metabolic effects of olanzapine, such as weight gain, insulin resistance, and dyslipidemia, share similarities with obesity-related cardiomyopathy. Additionally, olanzapine's antagonism of certain receptors may contribute to cardiovascular stress. The review highlighted that patients with new-onset heart failure and significant weight gain while on olanzapine should be closely monitored for signs of cardiomyopathy. Early detection and prompt withdrawal of olanzapine, along with initiation of goal-directed medical therapy, are crucial for mitigating this potentially life-threatening condition. The relationship between olanzapine and cardiomyopathy is complex and not yet fully understood. However, the potential for significant cardiovascular risk necessitates vigilance among healthcare providers. Early identification and management of olanzapine-induced cardiomyopathy can improve patient outcomes. Further research is needed to elucidate the precise mechanisms behind this adverse effect and to develop optimized treatment strategies for patients requiring antipsychotic therapy.
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Yoon HM, Joo SJ, Boo KY, Lee JG, Choi JH, Kim SY, Lee SY. Impact of cardiac rehabilitation on ventricular-arterial coupling and left ventricular function in patients with acute myocardial infarction. PLoS One 2024; 19:e0300578. [PMID: 38574078 PMCID: PMC10994279 DOI: 10.1371/journal.pone.0300578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024] Open
Abstract
To maintain efficient myocardial function, optimal coordination between ventricular contraction and the arterial system is required. Exercise-based cardiac rehabilitation (CR) has been demonstrated to improve left ventricular (LV) function. This study aimed to investigate the impact of CR on ventricular-arterial coupling (VAC) and its components, as well as their associations with changes in LV function in patients with acute myocardial infarction (AMI) and preserved or mildly reduced ejection fraction (EF). Effective arterial elastance (EA) and index (EAI) were calculated from the stroke volume and brachial systolic blood pressure. Effective LV end-systolic elastance (ELV) and index (ELVI) were obtained using the single-beat method. The characteristic impedance (Zc) of the aortic root was calculated after Fourier transformation of both aortic pressure and flow waveforms. Pulse wave separation analysis was performed to obtain the reflection magnitude (RM). An exercise-based, outpatient cardiac rehabilitation (CR) program was administered for up to 6 months. Twenty-nine patients were studied. However, eight patients declined to participate in the CR program and were subsequently classified as the non-CR group. At baseline, E' velocity showed significant associations with EAI (beta -0.393; P = 0.027) and VAC (beta -0.375; P = 0.037). There were also significant associations of LV global longitudinal strain (LV GLS) with EAI (beta 0.467; P = 0.011). Follow-up studies after a minimum of 6 months demonstrated a significant increase in E' velocity (P = 0.035), improved EF (P = 0.010), and LV GLS (P = 0.001), and a decreased EAI (P = 0.025) only in the CR group. Changes in E' velocity were significantly associated with changes in EAI (beta -0.424; P = 0.033). Increased aortic afterload and VA mismatch were associated with a negative impact on both LV diastolic and systolic function. The outpatient CR program effectively decreased aortic afterload and improved LV diastolic and systolic dysfunction in patients with AMI and preserved or mildly reduced EF.
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Affiliation(s)
- Ho-Min Yoon
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Ki Young Boo
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Jae-Geun Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Joon-Hyouk Choi
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - Song-Yi Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Internal Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
| | - So Young Lee
- Department of Rehabilitation Medicine, Jeju National University Hospital, Jeju, Republic of Korea
- Department of Rehabilitation Medicine, Jeju National University College of Medicine, Jeju, Republic of Korea
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Zhang H, Lin L, Yang A, Liang Y, Huang B. Scutellarin alleviates tensile stress-induced proliferation and migration of venous smooth muscle cells via mediating the p38 MAPK pathway. Tissue Cell 2024; 87:102300. [PMID: 38211409 DOI: 10.1016/j.tice.2024.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/08/2023] [Accepted: 01/01/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVE Abnormal proliferation and migration of biomechanical force-induced venous smooth muscle cells (VSMCs) is a major cause to limit the efficacy of coronary artery bypass grafting (CABG) for coronary heart disease (CHD). Scutellarin is the main active ingredient of Erigeron Breviscapus, and has broad-spectrum pharmacological effects. Therefore, the present study was proposed to investigate the effect of Scutellarin on VSMCs under tensile stress. METHODS After interfering with VSMCs at different tensile stresses, the optimal tensile stress was screened. In a tensile stress environment, 100 μM Scutellarin and Hesperetin (p38 MAPK pathway activator) was used to treatment with VSMCs. CCK-8, EDU, Wound healing, flow cytometry and western blotting assays were used to detect cell proliferation, migration, apoptosis, and the expression of apoptosis-related proteins (Caspase3, Bcl2 and Bax). RESULTS Tensile stress with 10% significantly enhanced the activity, wound-healing ratio, and EDU+ cells of VSMCs, and decreased their apoptosis ratio. Moreover, it upregulated Bcl2 expression, and downregulated cleaved-Caspase3 and Bax expression of VSMCs. Hence, 10% tensile stress was selected to creates a tensile stress environment for VSMCs. Interestingly, 100 μM Scutellarin alleviated the effect of 10% tensile stress on the phenotype of VSMCs. Notably, 10% tensile stress increased the phosphorylation level of p38 MAPK (Thr180 +Tyr182) in VSMCs, which was restricted by Scutellarin. Further, Hesperetin restored the effect of Scutellarin on the phenotype of VSMCs. CONCLUSION Scutellarin alleviates tension stress-induced proliferation and migration of VSMCs via suppressing p38 MAPK pathway. Scutellarin may be used as an adjunctive strategy for future GABG treatment in CHD patients.
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Affiliation(s)
- Hu Zhang
- Departments of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Ling Lin
- Departments of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Ailing Yang
- Departments of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Yasha Liang
- Departments of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China
| | - Bo Huang
- Operating Room, The First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan 650032, China.
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Mulligan LJ, Thrash J, Mitrev L, Folk D, Exarchakis A, Ewert D, Hill JC. Evaluation of vascular aging on measures of cardiac function and mechanical efficiency: insights from in-silico modeling. Front Cardiovasc Med 2024; 11:1351484. [PMID: 38601041 PMCID: PMC11004371 DOI: 10.3389/fcvm.2024.1351484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 04/12/2024] Open
Abstract
Introduction This study evaluated the hypothesis that vascular aging (VA) reduces ventricular contractile function and mechanical efficiency (ME) using the left ventricular pressure-volume (PV) construct. Methods A previously published in-silico computational model (CM) was modified to evaluate the hypothesis in two phases. In phase I, the CM included five settings of aortic compliance (CA) from normal to stiff, studied at a heart rate of 80 bpm, and phase II included the normal to stiff CA settings evaluated at 60, 100, and 140 bpm. The PV construct provided steady-state and transient data through a simulated vena caval occlusion (VCO). The steady-state data included left ventricular volumes (EDV and ESV), stroke work (SW), and VCO provided the PV area (PVA) data in addition to the three measures of contractile state (CS): end-systolic pressure-volume relationship (ESPVR), dP/dtmax-EDV and preload recruitable stroke work (PRSW). Finally, ME was calculated with the SW/PVA parameter. Results In phase I, EDV and ESV increased, as did SW and PVA. The impact on the CS parameters demonstrated a small decrease in ESPVR, no change in dP/dtmax-EDV, and a large increase in PRSW. ME decreased from 71.5 to 60.8%, respectively. In phase II, at the normal and stiff CA settings, across the heart rates studied, EDV and ESV decreased, ESPVR and dP/dtmax-EDV increased and PRSW decreased. ME decreased from 76.4 to 62.6% at the normal CA and 65.8 to 53.2% at the stiff CA. Discussion The CM generated new insights regarding how the VA process impacts the contractile state of the myocardium and ME.
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Affiliation(s)
- Lawrence J. Mulligan
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ, United States
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Julian Thrash
- Department of Electrical and Computer Engineering, North Dakota State University, Fargo, ND, United States
| | - Ludmil Mitrev
- Department of Anesthesiology, Cooper University Hospital, Camden, NJ, United States
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Douglas Folk
- Department of Integrated Engineering, Minnesota State UniversityMankato, MN, United States
| | - Alyssa Exarchakis
- Cooper Medical School of Rowan University, Camden, NJ, United States
| | - Daniel Ewert
- Department of Biomedical Engineering, University of North Dakota, Grand Forks, ND, United States
| | - Jeffrey C. Hill
- Department of Diagnostic Medical Sonography, School of Medical Imaging and Therapeutics, Massachusetts College of Pharmacy and Health Sciences University, Worcester, MA, United States
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Beussink-Nelson L, Freed BH, Chirinos JA, Brubaker PH, Kitzman DW, Yeboah J, Rosas SE, Hu M, Lima JAC, Pandit J, Bertoni AG, Shah SJ. Multi-Ethnic Study of Atherosclerosis Early Heart Failure Study: Rationale, Design, and Baseline Characteristics. Circ Heart Fail 2024; 17:e010289. [PMID: 38456289 PMCID: PMC11073782 DOI: 10.1161/circheartfailure.122.010289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 12/20/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Current prevalence estimates of heart failure (HF) are primarily based on self-report or HF hospitalizations. There is an unmet need to define the prevalence and pathogenesis of early symptomatic HF, which may be undiagnosed and precedes HF hospitalization. METHODS The MESA (Multi-Ethnic Study of Atherosclerosis) Early HF study was conducted during MESA exam 6 to determine the prevalence of early HF and investigate the transition from risk factors to early HF in a diverse population-based cohort of older adults. Between 2016 and 2018, 3285 MESA participants from 6 field centers underwent comprehensive speckle-tracking echocardiography with passive leg raise maneuver, Kansas City Cardiomyopathy Questionnaire, 6-minute walk test, arterial stiffness assessment, and proteomics (including NT-proBNP [N-terminal pro-B-type natriuretic peptide]). RESULTS Median age was 73 (25th-75th percentile 67-81) years, 53.2% were female, 25.6% were Black, 12.8% were Chinese, and 40.0% were White. The prevalence of HF risk factors was high: hypertension, 61.9%; former or current smoking, 53.7%; obesity 34.8%; diabetes; 24.7%; and chronic kidney disease; 22%. Overt cardiovascular disease, which ranged from 2.1% (HF) to 13.6% (atrial fibrillation), was less common. Of the 3285 participants, 96% underwent proteomics, 94% Kansas City Cardiomyopathy Questionnaire, 93% speckle-tracking echocardiography with passive leg raise, 82% arterial stiffness exam, and 77% 6-minute walk test. Feasibility of resting speckle-tracking echocardiography (87%-99% across cardiac chambers) and passive leg raise Doppler/speckle-tracking echocardiography (>84%) measurements was high. A total of 120 unique echocardiographic indices were measured. CONCLUSIONS The MESA Early HF study is a key resource for cardiovascular researchers who are interested in improving the epidemiological and phenotypic characterization of early HF. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005487.
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Affiliation(s)
- Lauren Beussink-Nelson
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Benjamin H Freed
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Julio A Chirinos
- Division of Cardiology, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia (J.A.C.)
| | - Peter H Brubaker
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Dalane W Kitzman
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Joseph Yeboah
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sylvia E Rosas
- Kidney and Hypertension Unit, Joslin Diabetes Center (S.E.R.), Harvard Medical School, Boston, MA
| | - Mo Hu
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - João A C Lima
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD (J.A.C.L.)
| | - Jay Pandit
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
| | - Alain G Bertoni
- Wake Forest School of Medicine (P.H.B., D.W.K., J.Y., A.G.B.), Harvard Medical School, Boston, MA
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (L.B.-N., B.H.F., M.H., J.P., S.J.S.)
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14
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Dillon KN, Kang Y, Maharaj A, Martinez MA, Fischer SM, Figueroa A. L-Citrulline supplementation attenuates aortic pressure and pressure waves during metaboreflex activation in postmenopausal women. Br J Nutr 2024; 131:474-481. [PMID: 37664994 DOI: 10.1017/s000711452300199x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Postmenopausal women have augmented pressure wave responses to low-intensity isometric handgrip exercise (IHG) due to an overactive metaboreflex (postexercise muscle ischaemia, PEMI), contributing to increased aortic systolic blood pressure (SBP). Menopause-associated endothelial dysfunction via arginine (ARG) and nitric oxide deficiency may contribute to exaggerated exercise SBP responses. L-Citrulline supplementation (CIT) is an ARG precursor that decreases SBP, pulse pressure (PP) and pressure wave responses to cold exposure in older adults. We investigated the effects of CIT on aortic SBP, PP, and pressure of forward (Pf) and backward (Pb) waves during IHG and PEMI in twenty-two postmenopausal women. Participants were randomised to CIT (10 g/d) or placebo (PL) for 4 weeks. Aortic haemodynamics were assessed via applanation tonometry at rest, 2 min of IHG at 30 % of maximal strength, and 3 min of PEMI. Responses were analysed as change (Δ) from rest to IHG and PEMI at 0 and 4 weeks. CIT attenuated ΔSBP (−9 ± 2 v. −1 ± 1 mmHg, P = 0·006), ΔPP (−5 ± 2 v. 0 ± 1 mmHg, P = 0·03), ΔPf (−6 ± 2 v. −1 ± 1 mmHg, P = 0·01) and ΔPb (−3 ± 1 v. 0 ± 1 mmHg, P = 0·02) responses to PEMI v. PL. The ΔPP during PEMI was correlated with ΔPf (r = 0·743, P < 0·001) and ΔPb (r = 0·724, P < 0·001). Citrulline supplementation attenuates the increase in aortic pulsatile load induced by muscle metaboreflex activation via reductions in forward and backward pressure wave amplitudes in postmenopausal women.
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Affiliation(s)
- Katherine N Dillon
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Yejin Kang
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Arun Maharaj
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Mauricio A Martinez
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Stephen M Fischer
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
| | - Arturo Figueroa
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX79409, USA
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15
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Coggan AR, Park LK, Racette SB, Davila-Roman VG, Lenzen P, Vehe K, Dore PM, Schechtman KB, Peterson LR. The inorganic NItrate and eXercise performance in Heart Failure (iNIX-HF) phase II clinical trial: Rationale and study design. Contemp Clin Trials Commun 2023; 36:101208. [PMID: 37842318 PMCID: PMC10568282 DOI: 10.1016/j.conctc.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/16/2023] [Accepted: 09/15/2023] [Indexed: 10/17/2023] Open
Abstract
Background Heart failure (HF) is a debilitating and often fatal disease that affects millions of people worldwide. Diminished nitric oxide synthesis, signaling, and bioavailability are believed to contribute to poor skeletal muscle function and aerobic capacity. The aim of this clinical trial (iNIX-HF) is to determine the acute and longer-term effectiveness of inorganic nitrate supplementation on exercise performance in patients with HF with reduced ejection fraction (HFrEF). Methods This clinical trial is a double-blind, placebo-controlled, randomized, parallel-arm design study in which patients with HFrEF (n = 75) are randomized to receive 10 mmol potassium nitrate (KNO3) or a placebo capsule daily for 6 wk. Primary outcome measures are muscle power determined by isokinetic dynamometry and peak aerobic capacity (VO2peak) determined during an incremental treadmill exercise test. Endpoints include the acute effects of a single dose of KNO3 and longer-term effects of 6 wk of KNO3. The study is adequately powered to detect expected increases in these outcomes at P < 0.05 with 1-β>0.80. Discussion The iNIX-HF phase II clinical trial will evaluate the effectiveness of inorganic nitrate supplements as a new treatment to ameliorate poor exercise capacity in HFrEF. This study also will provide critical preliminary data for a future 'pivotal', phase III, multi-center trial of the effectiveness of nitrate supplements not only for improving exercise performance, but also for improving symptoms and decreasing other major cardiovascular endpoints. The potential public health impact of identifying a new, relatively inexpensive, safe, and effective treatment that improves overall exercise performance in patients with HFrEF is significant.
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Affiliation(s)
- Andrew R. Coggan
- Department of Kinesiology, School of Health & Human Sciences, And Indiana Center for Musculoskeletal Health, School of Medicine, Indiana University Purdue University Indianapolis, Indianapolis, IN, USA
| | - Lauren K. Park
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | - Susan B. Racette
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | | | - Pattie Lenzen
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
| | | | - Peter M. Dore
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Kenneth B. Schechtman
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, MO, USA
| | - Linda R. Peterson
- Department of Medicine, Washington University School of Medicine, Saint Louis, MO, USA
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16
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Hotek JC, Detwiler TJ, Chirinos JA, Regan CP. A generalized canine transfer function accurately reconstructs central aortic pressure waveforms to enable enhanced pulse wave analysis. J Pharmacol Toxicol Methods 2023; 124:107476. [PMID: 37931824 DOI: 10.1016/j.vascn.2023.107476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/20/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
Routine preclinical blood pressure evaluation is an important risk assessment tool. Although proximal aortic pressure is most relevant for key target organs, abdominal aortic pressures are more commonly recorded. Pulse pressure amplification and waveform distortion in abdominal waveforms make it inappropriate for central hemodynamic analytical methods without the use of a mathematical transfer function. Clinical transfer functions have been developed to estimate ascending aortic waveforms from brachial or radial artery waveforms in humans, but no preclinical analogues exist. The aim of this study was to develop a canine-specific transfer function to reconstruct thoracic aortic pressure waveforms from abdominal aortic data to enable the application of central hemodynamic analytical methods. Simultaneous abdominal and thoracic blood pressures were recorded from seven conscious, male beagle dogs administered 3 well-characterized pharmacologic standards and animals were appointed to a training (n = 3) or validation (n = 4) group at baseline and during dosing. A generalized transfer function was developed from the training group data and evaluated for its ability to synthesize thoracic pressure waves in the training and validation groups. Select hemodynamic parameters were evaluated in measured and synthesized thoracic data. There was a high degree of correlation between measured and synthesized thoracic parameters (r2 = 0.74-0.99). There was no difference between indices computed from synthesized or actual thoracic waveforms at baseline or after administration of pharmacologic standards. This work demonstrates that a generalized preclinical transfer function can reproduce thoracic pressure waves across a range of hemodynamic responses thus enabling the application of central hemodynamic analytical methods.
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Affiliation(s)
- Julia C Hotek
- Safety & Exploratory Pharmacology (SEP), Merck & Co., Inc., Rahway, NJ, USA.
| | | | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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17
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Stock JM, Shenouda N, Chouramanis NV, Patik JC, Martens CR, Farquhar WB, Chirinos JA, Edwards DG. Effect of acute handgrip and aerobic exercise on wasted pressure effort and arterial wave reflections in healthy aging. Am J Physiol Heart Circ Physiol 2023; 325:H617-H628. [PMID: 37477688 PMCID: PMC10642996 DOI: 10.1152/ajpheart.00133.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/22/2023]
Abstract
Aging increases arterial stiffness and wave reflections that augment left ventricular wasted pressure effort (WPE). A single bout of exercise may be effective at acutely reducing WPE via reductions in arterial wave reflections. In young adults (YA) acute aerobic exercise decreases, whereas handgrip increases, wave reflections. Whether acute exercise mitigates or exacerbates WPE and arterial wave reflection in healthy aging warrants further examination. The purpose of this study was to determine if there are age-related differences in WPE and wave reflection during acute handgrip and aerobic exercise. When compared with baseline, WPE increased substantially in older adults (OA) during handgrip (5,219 ± 2,396 vs. 7,019 ± 2,888 mmHg·ms, P < 0.001). When compared with baseline, there was a robust reduction in WPE in OA during moderate-intensity aerobic exercise (5,428 ± 2,084 vs. 3,290 ± 1,537 mmHg·ms, P < 0.001), despite absolute WPE remaining higher in OA compared with YA during moderate-intensity aerobic exercise (OA 3,290 ± 1,537 vs. YA 1,188 ± 962 mmHg·ms, P < 0.001). There was no change in wave reflection timing indexed to ejection duration in OA during handgrip (40 ± 6 vs. 38 ± 4%, P = 0.41) or moderate-intensity aerobic exercise (40 ± 5 vs. 42 ± 8%, P = 0.99). Conversely, there was an earlier return of wave reflection in YA during handgrip (60 ± 11 vs. 52 ± 6%, P < 0.001) and moderate-intensity aerobic exercise (59 ± 7 vs. 51 ± 9%, P < 0.001). Changes in stroke volume were not different between groups during handgrip (P = 0.08) or aerobic exercise (P = 0.47). The greater increase in WPE during handgrip and decrease in WPE during aerobic exercise suggest that aortic hemodynamic responses to acute exercise are exaggerated with healthy aging without affecting stroke volume.NEW & NOTEWORTHY We demonstrated that acute aerobic exercise attenuated, whereas handgrip augmented, left ventricular hemodynamic load from wave reflections more in healthy older (OA) compared with young adults (YA) without altering stroke volume. These findings suggest an exaggerated aortic hemodynamic response to acute exercise perturbations with aging. They also highlight the importance of considering exercise modality when examining aortic hemodynamic responses to acute exercise in older adults.
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Affiliation(s)
- Joseph M Stock
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Ninette Shenouda
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Nicholas V Chouramanis
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Jordan C Patik
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Christopher R Martens
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - William B Farquhar
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
| | - Julio A Chirinos
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - David G Edwards
- Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware, United States
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18
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Agbaje AO, Zachariah JP, Tuomainen TP. Arterial stiffness but not carotid intima-media thickness progression precedes premature structural and functional cardiac damage in youth: A 7-year temporal and mediation longitudinal study. Atherosclerosis 2023; 380:117197. [PMID: 37582328 DOI: 10.1016/j.atherosclerosis.2023.117197] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/26/2023] [Accepted: 07/26/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND AIMS The longitudinal relations of cardiac indices with the aorta and carotid vessel and the time sequence for early cardiac disease development are uncharacterized in youth. We examined the temporal longitudinal associations of carotid-femoral pulse wave velocity (cfPWV) and carotid intima-media thickness (cIMT) with left ventricular hypertrophy (LVH) and diastolic dysfunction (LVDD). METHODS From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 adolescents (1011 females) at a mean (SD) age 17.7 (0.3) years were followed up for 7 years. Vicorder-measured cfPWV and ultrasound-measured cIMT were grouped in tertiles as low (reference), moderate, and high. Echocardiography measured cardiac abnormalities are left ventricular mass indexed for height2.7 (LVMI2.7) ≥51 g/m2.7 as LVH; relative wall thickness ≥44 as hiRWT; LVD function E/A <1.5 as LVD dysfunction (LVDD); and LV filling pressure E/e' ≥8 as hiLVFP. Data were analysed with generalized logit mixed-effect models, cross-lagged path, and mediation structural equation models adjusting for cardiometabolic and lifestyle factors. RESULTS Over follow-up, LVH prevalence increased from 3.6% to 7.2% and LVDD from 11.1 to 16.3%. High cfPWV progression was associated with worsening LVH [Odds ratio 1.23 (1.13-1.35); p < 0.001] in the total cohort, males, overweight/obese, and normotensive. High cfPWV progression was associated with worsening hiLVFP in the total cohort, females, and normal weight. Likewise, high cIMT progression was associated with worsening LVH [1.27 (1.26-1.27); p < 0.0001] in the total cohort, overweight/obese and elevated BP/hypertensive. Neither cfPWV nor cIMT progression was associated with worsening hiRWT in the total cohort. In cross-lagged models, higher baseline cfPWV was associated with future LVMI2.7 (β = 0.06, SE, 5.14, p = 0.035), RWT, LVDF, and LVFP. However, baseline LVMI2.7, RWT, LVDF, and LVFP were not associated with follow-up cfPWV. Baseline cIMT was not associated with follow-up cardiac indices and vice versa. Cumulative increased systolic blood pressure (34.3% mediation) and insulin resistance (15.1% mediation) mediated the direct associations of cumulative cfPWV with cumulative LVMI2.7. CONCLUSIONS Arterial stiffness progression temporally preceded worsening structural and functional cardiac damage in youth with increased systolic blood pressure and insulin resistance partly mediating the relationships. Future interventions aimed at attenuating premature cardiac damage in adolescents and young adults may consider a simultaneous treatment of both arterial stiffness, elevated blood pressure and insulin resistance.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland; Children's Health and Exercise Research Centre, Department of Public Health and Sports Sciences, Faculty of Health and Life Sciences, University of Exeter, Exeter, UK.
| | - Justin P Zachariah
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Tomi-Pekka Tuomainen
- Institute of Public Health and Clinical Nutrition, School of Medicine, University of Eastern Finland, Kuopio, Finland
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19
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Climie RE, Alastruey J, Mayer CC, Schwarz A, Laucyte-Cibulskiene A, Voicehovska J, Bianchini E, Bruno RM, Charlton PH, Grillo A, Guala A, Hallab M, Hametner B, Jankowski P, Königstein K, Lebedeva A, Mozos I, Pucci G, Puzantian H, Terentes-Printzios D, Yetik-Anacak G, Park C, Nilsson PM, Weber T. Vascular ageing: moving from bench towards bedside. Eur J Prev Cardiol 2023; 30:1101-1117. [PMID: 36738307 PMCID: PMC7614971 DOI: 10.1093/eurjpc/zwad028] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 02/05/2023]
Abstract
Prevention of cardiovascular disease (CVD) remains one of the largest public health challenges of our time. Identifying individuals at increased cardiovascular risk at an asymptomatic, sub-clinical stage is of paramount importance for minimizing disease progression as well as the substantial health and economic burden associated with overt CVD. Vascular ageing (VA) involves the deterioration in vascular structure and function over time and ultimately leads to damage in the heart, brain, kidney, and other organs. Vascular ageing encompasses the cumulative effect of all cardiovascular risk factors on the arterial wall over the life course and thus may help identify those at elevated cardiovascular risk, early in disease development. Although the concept of VA is gaining interest clinically, it is seldom measured in routine clinical practice due to lack of consensus on how to characterize VA as physiological vs. pathological and various practical issues. In this state-of-the-art review and as a network of scientists, clinicians, engineers, and industry partners with expertise in VA, we address six questions related to VA in an attempt to increase knowledge among the broader medical community and move the routine measurement of VA a little closer from bench towards bedside.
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Affiliation(s)
- Rachel E. Climie
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool St, 7000 Hobart, Australia
- Sports Cardiology, Baker Heart and Diabetes Institute, 99 Commercial Rd, Melbourne 3000, Australia
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Jordi Alastruey
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, 249 Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher C. Mayer
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Achim Schwarz
- ALF Distribution GmbH, Stephanstrasse 19, 52064 Aachen, Germany
| | - Agne Laucyte-Cibulskiene
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
- Faculty of Medicine, Vilnius University, M. K. C iurlionio g. 21, 03101 Vilnius, Lithuania
| | - Julija Voicehovska
- Department of Internal Diseases, Riga Stradins University, Dzirciema str. 16, Riga, L-1007, Latvia
- Nephrology and Renal Replacement Therapy Clinics, Riga East University Hospital, Hipokrata str. 2, Riga, LV-1079, Latvia
| | - Elisabetta Bianchini
- Institute of Clinical Physiology, Italian National Research Council (CNR), Via Moruzzi, 1, 56124 Pisa (PI), Italy
| | - Rosa-Maria Bruno
- Integrative Epidemiology of Cardiovascular Disease, Université de Paris, INSERM, U970, Paris Cardiovascular Research Center (PARCC), 56 rue Leblanc, 75015 Paris, France
| | - Peter H. Charlton
- Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, 2 Worts Causeway, Cambridge CB1 8RN, UK
| | - Andrea Grillo
- Medicina Clinica, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy
| | - Andrea Guala
- Vall d’Hebron Institut de Recerca (VHIR), Paseo de la Vall d’Hebron, 129, 08035 Barcelona, Spain
| | - Magid Hallab
- Clinique Bizet, 23 Georges Bizet, 75116 Paris, France
| | - Bernhard Hametner
- Medical Signal Analysis, Center for Health & Bioresources, AIT Austrian Institute of Technology, Giefinggasse 4, 1210 Vienna, Austria
| | - Piotr Jankowski
- Department of Internal Medicine and Geriatric Cardiology, Centre of Postgraduate Medical Education, 231 Czerniakowska St., 00-416 Warsaw, Poland
| | - Karsten Königstein
- Department of Sport, Exercise and Health (DSBG) University of Basel, Grosse Allee 6, 4052 Basel, Switzerland
| | - Anna Lebedeva
- Department of Internal Medicine and Cardiology, Dresden Heart Centre, Dresden University of Technology, Fetscher str. 76, 01307 Dresden, Germany
| | - Ioana Mozos
- Department of Functional Sciences-Pathophysiology, Center for Translational Research and Systems Medicine, ‘Victor Babes’ University of Medicine and Pharmacy, T. Vladimirescu Street 14, 300173 Timisoara, Romania
| | - Giacomo Pucci
- Unit of Internal Medicine, Terni University Hospital - Department of Medicine and Surgery, University of Perugia, Terni, Italy
| | - Houry Puzantian
- Hariri School of Nursing, American University of Beirut, P.O. Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology, Hippokration Hospital, Medical School, National and Kapodistrian University of Athens, 114 Vasilissis Sofias Avenue, 11527 Athens, Greece
| | - Gunay Yetik-Anacak
- Department of Pharmacology, Faculty of Pharmacy, Acibadem Mehmet Ali Aydinlar University, Kayisdagi Cad. No:32 Atasehir, 34752 Istanbul, Turkey
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing at UCL, 1-19 Torrington Place, London WC1E 7HB, UK; and
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Sölvegatan 19 - BMC F12, 221 84 Lund, Malmö, Sweden
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Grieskirchnerstrasse 42, 4600 Wels, Austria
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20
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Li FXZ, Liu JJ, Xu F, Shan SK, Zheng MH, Lei LM, Lin X, Guo B, Li CC, Wu F, Tang KX, Cao YC, Wu YY, Duan JY, Wu YL, He SY, Chen X, Yuan LQ. Cold exposure protects against medial arterial calcification development via autophagy. J Nanobiotechnology 2023; 21:226. [PMID: 37461031 PMCID: PMC10351118 DOI: 10.1186/s12951-023-01985-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/06/2023] [Indexed: 07/20/2023] Open
Abstract
Medial arterial calcification (MAC), a systemic vascular disease different from atherosclerosis, is associated with an increased incidence of cardiovascular events. Several studies have demonstrated that ambient temperature is one of the most important factors affecting cardiovascular events. However, there has been limited research on the effect of different ambient temperatures on MAC. In the present study, we showed that cold temperature exposure (CT) in mice slowed down the formation of vitamin D (VD)-induced vascular calcification compared with room temperature exposure (RT). To investigate the mechanism involved, we isolated plasma-derived exosomes from mice subjected to CT or RT for 30 days (CT-Exo or RT-Exo, respectively). Compared with RT-Exo, CT-Exo remarkably alleviated the calcification/senescence formation of vascular smooth muscle cells (VSMCs) and promoted autophagy by activating the phosphorylation of AMP-activated protein kinase (p-AMPK) and inhibiting phosphorylation of mammalian target of rapamycin (p-mTOR). At the same time, CT-Exo promoted autophagy in β-glycerophosphate (β-GP)-induced VSMCs. The number of autophagosomes and the expression of autophagy-related proteins ATG5 and LC3B increased, while the expression of p62 decreased. Based on a microRNA chip microarray assay and real-time polymerase chain reaction, miR-320a-3p was highly enriched in CT-Exo as well as thoracic aortic vessels in CT mice. miR-320a-3p downregulation in CT-Exo using AntagomiR-320a-3p inhibited autophagy and blunted its anti-calcification protective effect on VSMCs. Moreover, we identified that programmed cell death 4 (PDCD4) is a target of miR-320a-3p, and silencing PDCD4 increased autophagy and decreased calcification in VSMCs. Treatment with CT-Exo alleviated the formation of MAC in VD-treated mice, while these effects were partially reversed by GW4869. Furthermore, the anti-arterial calcification protective effects of CT-Exo were largely abolished by AntagomiR-320a-3p in VD-induced mice. In summary, we have highlighted that prolonged cold may be a good way to reduce the incidence of MAC. Specifically, miR-320a-3p from CT-Exo could protect against the initiation and progression of MAC via the AMPK/mTOR autophagy pathway.
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Affiliation(s)
- Fu-Xing-Zi Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jun-Jie Liu
- Department of Periodontal Division, Hunan Xiangya Stomatological Hospital, Central South University, Changsha, China
| | - Feng Xu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Su-Kang Shan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ming-Hui Zheng
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Li-Min Lei
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xiao Lin
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bei Guo
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Chang-Chun Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Feng Wu
- Department of Pathology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ke-Xin Tang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ye-Chi Cao
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yun-Yun Wu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Jia-Yue Duan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Yan-Lin Wu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Si-Yang He
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Xi Chen
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China
| | - Ling-Qing Yuan
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Disease, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
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21
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Agbaje AO. Elevated Blood Pressure and Worsening Cardiac Damage During Adolescence. J Pediatr 2023; 257:113374. [PMID: 36870560 DOI: 10.1016/j.jpeds.2023.02.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES To examine the longitudinal course for the development of elevated blood pressure (BP)/hypertension and cardiac damage in adolescents. STUDY DESIGN From the Avon Longitudinal Study of Parents and Children, UK birth cohort, 1856 (1011 female) 17-year-old adolescents were followed up for 7 years. BP and echocardiography were assessed at ages 17 and 24 years. Elevated/hypertensive BP was defined as ≥130 mm Hg systolic and ≥85 mm Hg diastolic. Left ventricular (LV) mass indexed for height2.7 (LVMI2.7) ≥51 g/m2.7 was defined as LV hypertrophy (LVH) and LV diastolic function (LVDF) E/A <1.5 as LVD dysfunction (LVDD). Data were analyzed with generalized logit mixed-effect models and cross-lagged structural equation temporal path models adjusting for cardiometabolic and lifestyle factors. RESULTS Over follow-up, the prevalence of elevated systolic BP/hypertension increased from 6.4% to 12.2%, LVH from 3.6% to 7.2%, and LVDD from 11.1% to 16.3%. Cumulative elevated systolic BP/hypertension was associated with worsening LVH in female participants (OR 1.61, CI 1.43-1.80 P < .001) but not in male participants. Elevated systolic BP/hypertension was associated with worsening LVDD in male and female participants. Elevated diastolic BP/hypertension was associated with worsening LVH in male and female participants. In cross-lagged temporal path models, higher baseline systolic BP was associated with LVDF (β = 0.09, SE = 0.002, P = .029) but not LVMI2.7 at follow-up. Higher baseline cardiac indices were not associated with follow-up systolic BP. Higher baseline diastolic BP was associated with follow-up higher cardiac indices except LVDF. Baseline LVMI2.7 was not associated with follow-up diastolic BP. CONCLUSIONS Elevated BP/hypertension may temporally precede premature cardiac damage in youth.
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Affiliation(s)
- Andrew O Agbaje
- Institute of Public Health and Clinical Nutrition, School of Medicine, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland.
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22
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Moulton MJ, Secomb TW. A fast computational model for circulatory dynamics: effects of left ventricle-aorta coupling. Biomech Model Mechanobiol 2023; 22:947-959. [PMID: 36639560 PMCID: PMC10167185 DOI: 10.1007/s10237-023-01690-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 01/15/2023]
Abstract
The course of diseases such as hypertension, systolic heart failure and heart failure with a preserved ejection fraction is affected by interactions between the left ventricle (LV) and the vasculature. To study these interactions, a computationally efficient, biophysically based mathematical model for the circulatory system is presented. In a four-chamber model of the heart, the LV is represented by a previously described low-order, wall volume-preserving model that includes torsion and base-to-apex and circumferential wall shortening and lengthening, and the other chambers are represented using spherical geometries. Active and passive myocardial mechanics of all four chambers are included. The cardiac model is coupled with a wave propagation model for the aorta and a closed lumped-parameter circulation model. Parameters for the normal heart and aorta are determined by fitting to experimental data. Changes in the timing and magnitude of pulse wave reflections by the aorta are demonstrated with changes in compliance and taper of the aorta as seen in aging (decreased compliance, increased diameter and length), and resulting effects on LV pressure-volume loops and LV fiber stress and sarcomere shortening are predicted. Effects of aging of the aorta combined with reduced LV contractile force (failing heart) are examined. In the failing heart, changes in aortic properties with aging affect stroke volume and sarcomere shortening without appreciable augmentation of aortic pressure, and the reflected pressure wave contributes an increased proportion of aortic pressure.
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Affiliation(s)
- Michael J Moulton
- Department of Surgery, Cardiothoracic Surgery, University of Nebraska Medical Center, 982315 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Timothy W Secomb
- Program in Applied Mathematics, University of Arizona, Tucson, AZ, 85724, USA
- Department of Physiology, University of Arizona, Tucson, AZ, 85724, USA
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23
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Joshi M, Tran P, Barber TM, Ayub W, Kuehl M, Banerjee P. The Role of the Vasculature in Heart Failure. Curr Heart Fail Rep 2023; 20:179-190. [PMID: 37160641 DOI: 10.1007/s11897-023-00602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
The contribution of the vasculature in the development and progression of heart failure (HF) syndromes is poorly understood and often neglected. Incorporating both arterial and venous systems, the vasculature plays a significant role in the regulation of blood flow throughout the body in meeting its metabolic requirements. A deterioration or imbalance between the cardiac and vascular interaction can precipitate acute decompensated HF in both preserved and reduced ejection fraction phenotypes. This is characterised by the increasingly recognised concept of ventricular-arterial coupling: a well-balanced relationship between ventricular and vascular stiffness, which has major implications in HF. Often, the cause of decompensation is unknown, with international guidelines mainly centred on arrhythmia, infection, acute coronary syndrome and its mechanical complications as common causes of decompensation; the vascular component is often underrecognised. A better understanding of the vascular contribution in cardiovascular failure can improve risk stratification, earlier diagnosis and facilitate earlier optimal treatment. This review focuses on the role of the vasculature by integrating the concepts of ventricular-arterial coupling, arterial stiffness and venous return in a failing heart.
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Affiliation(s)
- Mithilesh Joshi
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
| | - Patrick Tran
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
| | - Thomas M Barber
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Waqar Ayub
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Michael Kuehl
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Prithwish Banerjee
- University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
- Centre for Sport, Exercise, Life Sciences, Faculty of Health and Life Sciences, Alison Gingell Building, Coventry University, Coventry, CV1 2DS, UK
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24
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Cavero-Redondo I, Saz-Lara A, Martínez-García I, Bizzozero-Peroni B, Díaz-Goñi V, Díez-Fernández A, Moreno-Herráiz N, Pascual-Morena C. Comparative Effect of Two Types of Physical Exercise for the Improvement of Exercise Capacity, Diastolic Function, Endothelial Function and Arterial Stiffness in Participants with Heart Failure with Preserved Ejection Fraction (ExIC-FEp Study): Protocol for a Randomized Controlled Trial. J Clin Med 2023; 12:3535. [PMID: 37240641 PMCID: PMC10218785 DOI: 10.3390/jcm12103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/18/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
(1) Background: Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for approximately 50% of all patients with HF. In the absence of pharmacological treatments that have been successful in reducing mortality or morbidity in this pathology, physical exercise is recognized as an important adjunct in the treatment of HF. Therefore, the objective of this study is to compare the efficacy of combined training and high intensity interval training (HIIT) on exercise capacity, diastolic function, endothelial function, and arterial stiffness in participants with HFpEF. (2) Methods: The ExIC-FEp study will be a single-blind, 3-arm, randomized clinical trial (RCT) conducted at the Health and Social Research Center of the University of Castilla-La Mancha. Participants with HFpEF will be randomly assigned (1:1:1) to the combined exercise, HIIT or control group to evaluate the efficacy of physical exercise programs on exercise capacity, diastolic function, endothelial function, and arterial stiffness. All participants will be examined at baseline, at three months and at six months. (3) Results: The findings of this study will be published in a peer-reviewed journal. (4) Conclusions: This RCT will represent a significant advance in the available scientific evidence on the efficacy of physical exercise in the treatment of HFpEF.
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Affiliation(s)
- Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
| | - Alicia Saz-Lara
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
| | - Irene Martínez-García
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
| | - Bruno Bizzozero-Peroni
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
- Instituto Superior de Educación Física, Universidad de la República, Rivera 40000, Uruguay
| | - Valentina Díaz-Goñi
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
| | - Ana Díez-Fernández
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
- Facultad de Enfermería, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
| | - Nerea Moreno-Herráiz
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
| | - Carlos Pascual-Morena
- Health and Social Research Centre, Universidad de Castilla-La Mancha, 16001 Cuenca, Spain
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25
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Fan L, Shi X, Wang Z, Zhang R, Zhang J. Disease identification method based on graph features between pulse cycles. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2023.104670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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26
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Hobson S, Arefin S, Witasp A, Hernandez L, Kublickiene K, Shiels PG, Stenvinkel P. Accelerated Vascular Aging in Chronic Kidney Disease: The Potential for Novel Therapies. Circ Res 2023; 132:950-969. [PMID: 37053277 DOI: 10.1161/circresaha.122.321751] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
The pathophysiology of vascular disease is linked to accelerated biological aging and a combination of genetic, lifestyle, biological, and environmental risk factors. Within the scenario of uncontrolled artery wall aging processes, CKD (chronic kidney disease) stands out as a valid model for detailed structural, functional, and molecular studies of this process. The cardiorenal syndrome relates to the detrimental bidirectional interplay between the kidney and the cardiovascular system. In addition to established risk factors, this group of patients is subjected to a plethora of other emerging vascular risk factors, such as inflammation, oxidative stress, mitochondrial dysfunction, vitamin K deficiency, cellular senescence, somatic mutations, epigenetic modifications, and increased apoptosis. A better understanding of the molecular mechanisms through which the uremic milieu triggers and maintains early vascular aging processes, has provided important new clues on inflammatory pathways and emerging risk factors alike, and to the altered behavior of cells in the arterial wall. Advances in the understanding of the biology of uremic early vascular aging opens avenues to novel pharmacological and nutritional therapeutic interventions. Such strategies hold promise to improve future prevention and treatment of early vascular aging not only in CKD but also in the elderly general population.
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Affiliation(s)
- S Hobson
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - S Arefin
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - A Witasp
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - L Hernandez
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - K Kublickiene
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
| | - P G Shiels
- School of Molecular Biosciences, MVLS, University of Glasgow, United Kingdom (P.G.S.)
| | - P Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden (S.H., S.A., A.W., L.H., K.K., P.S.)
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27
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Aortic Stiffness: A Major Risk Factor for Multimorbidity in the Elderly. J Clin Med 2023; 12:jcm12062321. [PMID: 36983321 PMCID: PMC10058400 DOI: 10.3390/jcm12062321] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023] Open
Abstract
Multimorbidity, the coexistence of multiple health conditions in an individual, has emerged as one of the greatest challenges facing health services, and this crisis is partly driven by the aging population. Aging is associated with increased aortic stiffness (AoStiff), which in turn is linked with several morbidities frequently affecting and having disastrous consequences for the elderly. These include hypertension, ischemic heart disease, heart failure, atrial fibrillation, chronic kidney disease, anemia, ischemic stroke, and dementia. Two or more of these disorders (multimorbidity) often coexist in the same elderly patient and the specific multimorbidity pattern depends on several factors including sex, ethnicity, common morbidity routes, morbidity interactions, and genomics. Regular exercise, salt restriction, statins in patients at high atherosclerotic risk, and stringent blood pressure control are interventions that delay progression of AoStiff and most likely decrease multimorbidity in the elderly.
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28
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Quarti-Trevano F, Dell’Oro R, Cuspidi C, Ambrosino P, Grassi G. Endothelial, Vascular and Sympathetic Alterations as Therapeutic Targets in Chronic Heart Failure. Biomedicines 2023; 11:803. [PMID: 36979781 PMCID: PMC10044749 DOI: 10.3390/biomedicines11030803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/21/2023] [Accepted: 03/03/2023] [Indexed: 03/09/2023] Open
Abstract
Vascular and sympathetic abnormalities characterize chronic heart failure (CHF). Alterations include (1) a reduction in arterial distensibility, (2) endothelial dysfunction, (3) a decrease in arterial compliance and a parallel increase in arterial stiffness, and (4) sympathetic cardiovascular activation. Altogether, these alterations represent important targets in therapeutic interventions, because they display an independent negative impact on the disease prognosis, favouring disease progression and the development of cardiovascular complications with direct and indirect mechanisms. The present review will examine the effects of the different therapeutic interventions targeting the vascular/sympathetic alterations detected in CHF. Non-pharmacological, pharmacological and device-based treatments will be discussed in detail, highlighting the possible mechanisms responsible for the vascular/sympathetic effects of each intervention. Finally, the unmet goals in treatment in relation to endothelial and adrenergic targets will be also discussed.
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Affiliation(s)
- Fosca Quarti-Trevano
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Raffaella Dell’Oro
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Cesare Cuspidi
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Directorate of Telese Terme Institute, 82037 Telese Terme, Italy
| | - Guido Grassi
- Clinica Medica, School of Medicine and Surgery, University Milano-Bicocca, 20052 Monza, Italy
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29
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Yofoglu LK, Karachalias F, Georgakis MK, Tountas C, Argyris AA, Zhang Y, Papaioannou TG, Blacher J, Weber T, Vlachopoulos C, Safar M, Protogerou AD. Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis. Hypertension 2023; 80:e29-e42. [PMID: 36583390 DOI: 10.1161/hypertensionaha.122.19980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Pressure wave reflections (PWRs) within the circulation are assessed at various arterial sites by various noninvasive methods. We aimed at reviewing the conflicting data regarding the hypothesis that higher PWRs are associated with higher left ventricular mass and tested whether this association stands for all available indices of PWRs, all (proximal or distal to the heart) sites of assessment, and is modified by sex, age and heart rate. METHODS Based on a predefined protocol applying the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines, we identified eligible for meta-analysis data regarding: augmentation index, augmentation pressure, backward pressure (Pb), reflection index, and their association with left ventricular mass index (19 studies, total population n=8686). RESULTS We found statistically significant associations, independent from blood pressure level, for all indices of PWRs at all arterial sites (carotid augmentation index; odds ratio; standardized beta coefficient [β]: 0.14 [95% CI, 0.07% to 0.21%], per SD increase), radial augmentation index (β: 0.21; 0.11 to 0.31), central augmentation pressure (β: 0.15; 0.03 to 0.27), central Pb (β: 0.23; 0.05 to 0.42), and central reflection index (β: 0.14; 0.06 to 0.22), except for aortic augmentation index as estimated by generalized transfer functions. Meta-regression analysis showed that the association between carotid augmentation index and left ventricular mass was higher among populations with higher heart rate (P=0.036, beta: 0.017 [95% CI, 0.001 to 0.033]) and tended to be higher in middle-aged (P=0.07, beta: -0.001; -0.021 to 0.001). CONCLUSIONS A clinically meaningful association between PWRs and left ventricular mass, assessed at either central or peripheral arterial sites by most available methods was shown, suggesting that PWR reduction strategies might be useful. Based on the present evidence, such trials should target middle-aged populations with high normal heart rate.
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Affiliation(s)
- Lazaros K Yofoglu
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Fotios Karachalias
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany (M.K.G.)
| | - Christos Tountas
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Antonios A Argyris
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, China (Y.Z.)
| | - Theodoros G Papaioannou
- Biomedical Engineering Unit, 1st Department of Cardiology, "Hippokration" Hospital, Medical School of the National and Kapodistrian University of Athens, Greece (T.G.P.)
| | - Jacques Blacher
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W.)
| | | | - Michel Safar
- Paris Descartes University, AP-HP, Diagnosis and Therapeutic Center, Hôtel-Dieu, Paris, France (J.B., M.S.)
| | - Athanase D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic/Laboratory of Pathophysiology, Medical School, National and Kapodistrian University of Athens, Greece (L.K.Y., F.K., C.T., A.A.A., A.D.P.)
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30
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Egbe AC, Miranda WR, Jain CC, Connolly HM. On-treatment blood pressure and cardiovascular mortality in adults with repaired coarctation of aorta. Am Heart J 2023; 255:22-30. [PMID: 36220358 DOI: 10.1016/j.ahj.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 10/04/2022] [Accepted: 10/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although, hypertension is common in adults with repaired coarctation of aorta (COA), there are no data about on-treatment blood pressure (BP), and its relationship to outcomes in this population. The purpose of this study was to determine the relationship between on-treatment BP and cardiovascular mortality in adults with repaired COA. METHODS Retrospective study of adults with repaired COA on antihypertensive therapy (n = 461, age 39 ± 11). All BP measurements obtained within the first 3 years were averaged to determine the on-treatment BP, and the patients were stratified into BP quartiles using the cut-off points from the guidelines. RESULTS Being in the upper systolic BP (SBP) quartiles (SBP 120-129, 130-139 and ≥140) was associated with higher risk of cardiovascular mortality (HR 1.05, 95%CI 1.01-1.07, HR 1.12, 95%CI 1.04 to 1.15 and HR 1.39, 95%CI 1.13 to 1.59), as compared to being the lowest SBP quartile. We observed a 7% increase in the risk of cardiovascular mortality for every 5 mmHg increase in SBP, and a 4% increase in risk of cardiovascular mortality for every 5 mmHg increase in DBP. CONCLUSIONS Collectively, these data suggest that even s less severe form of hypertension SBP (120-129 mmHg) was not benign, and perhaps should be considered for antihypertensive therapy. A randomized controlled clinical trial is required to determine whether this group of patients (SBP 120 to 129 mmHg) would benefit from antihypertensive therapy, and to determine the optimal type and intensity of antihypertensive therapy in this population.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
| | | | | | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
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31
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Spetko N, Rong J, Larson MG, Haidar M, Raber I, Peters K, Benjamin EJ, O'Donnell CJ, Manning WJ, Vasan RS, Mitchell GF, Tsao CW. Cross-Sectional Relationships of Proximal Aortic Stiffness and Left Ventricular Diastolic Function in Adults in the Community. J Am Heart Assoc 2022; 11:e027230. [PMID: 36533620 PMCID: PMC9798804 DOI: 10.1161/jaha.122.027230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Stiffness of the proximal aorta may play a critical role in adverse left ventricular (LV)-vascular interactions and associated LV diastolic dysfunction. In a community-based sample, we sought to determine the association between proximal aortic stiffness measured by cardiovascular magnetic resonance (CMR) and several clinical measures of LV diastolic mechanics. Methods and Results Framingham Heart Study Offspring adults (n=1502 participants, mean 67±9 years, 54% women) with available 1.5T CMR and transthoracic echocardiographic measures were included. Measures included proximal descending aortic strain and aortic arch pulse wave velocity by CMR (2002-2006) and diastolic function (mitral Doppler E and A wave velocity, E wave area, and LV tissue Doppler e' velocity) by echocardiography (2005-2008). Multivariable linear regression analysis was used to relate CMR aortic stiffness measures to measures of echocardiographic LV diastolic function. All continuous variables were standardized. In multivariable-adjusted regression analyses, aortic strain was inversely associated with E wave deceleration time (estimated β=-0.10±0.032, P=0.001), whereas aortic arch pulse wave velocity was inversely associated with E/A ratio (estimated β=-0.094±0.027, P=0.0006), E wave area (estimated β=-0.070±0.027, P=0.010), and e' (estimated β=-0.061±0.027, P=0.022), all indicating associations of higher aortic stiffness by CMR with less favorable LV diastolic function. Compared with men, women had a larger inverse relationship between pulse wave velocity and E/A ratio (interaction β=-0.085±0.031, P=0.0064). There was no significant effect modification by age or a U-shaped (quadratic) relation between aortic stiffness and LV diastolic function measures. Conclusions Higher proximal aortic stiffness is associated with less favorable LV diastolic function. Future studies may clarify temporal relations of aortic stiffness with varying patterns and progression of LV diastolic dysfunction.
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Affiliation(s)
- Nicholas Spetko
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Jian Rong
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA
| | - Martin G. Larson
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Department of Mathematics and StatisticsBoston UniversityBostonMA
| | | | - Inbar Raber
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Kevin Peters
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Emelia J. Benjamin
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | - Christopher J. O'Donnell
- Department of Medicine, Cardiology Section, VA Boston Healthcare System, and Division of Cardiovascular Medicine, Brigham and Women’s HospitalHarvard Medical SchoolWest RoxburyMA
| | - Warren J. Manning
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA,Department of Radiology, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
| | - Ramachandran S. Vasan
- Boston University and National Heart, Blood and Lung Institute’s Framingham Heart StudyFraminghamMA,Sections of Preventive Medicine and Epidemiology and Cardiology, Department of MedicineBoston University School of Medicine, Department of Epidemiology, Boston University School of Public HealthBostonMA
| | | | - Connie W. Tsao
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical CenterHarvard Medical SchoolBostonMA
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Lauder L, Mahfoud F, Azizi M, Bhatt DL, Ewen S, Kario K, Parati G, Rossignol P, Schlaich MP, Teo KK, Townsend RR, Tsioufis C, Weber MA, Weber T, Böhm M. Hypertension management in patients with cardiovascular comorbidities. Eur Heart J 2022:6808663. [DOI: 10.1093/eurheartj/ehac395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 06/23/2022] [Accepted: 07/08/2022] [Indexed: 11/09/2022] Open
Abstract
Abstract
Arterial hypertension is a leading cause of death globally. Due to ageing, the rising incidence of obesity, and socioeconomic and environmental changes, its incidence increases worldwide. Hypertension commonly coexists with Type 2 diabetes, obesity, dyslipidaemia, sedentary lifestyle, and smoking leading to risk amplification. Blood pressure lowering by lifestyle modifications and antihypertensive drugs reduce cardiovascular (CV) morbidity and mortality. Guidelines recommend dual- and triple-combination therapies using renin–angiotensin system blockers, calcium channel blockers, and/or a diuretic. Comorbidities often complicate management. New drugs such as angiotensin receptor-neprilysin inhibitors, sodium–glucose cotransporter 2 inhibitors, glucagon-like peptide-1 receptor agonists, and non-steroidal mineralocorticoid receptor antagonists improve CV and renal outcomes. Catheter-based renal denervation could offer an alternative treatment option in comorbid hypertension associated with increased sympathetic nerve activity. This review summarises the latest clinical evidence for managing hypertension with CV comorbidities.
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Affiliation(s)
- Lucas Lauder
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Michel Azizi
- Université Paris Cité, INSERM CIC1418 , F-75015 Paris , France
- AP-HP, Hôpital Européen Georges-Pompidou, Hypertension Department, DMU CARTE , F-75015 Paris , France
- FCRIN INI-CRCT , Nancy , France
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center, Harvard Medical School , Boston, MA , USA
| | - Sebastian Ewen
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine , Tochigi , Japan
| | - Gianfranco Parati
- Department of Medicine and Surgery, Cardiology Unit, University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS , Milan , Italy
| | - Patrick Rossignol
- FCRIN INI-CRCT , Nancy , France
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques - Plurithématique 14-33 and INSERM U1116 , Nancy , France
- CHRU de Nancy , Nancy , France
| | - Markus P Schlaich
- Dobney Hypertension Centre, Medical School—Royal Perth Hospital Unit, Medical Research Foundation, The University of Western Australia , Perth, WA , Australia
- Departments of Cardiology and Nephrology, Royal Perth Hospital , Perth, WA , Australia
| | - Koon K Teo
- Population Health Research Institute, McMaster University , Hamilton, ON , Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania , Philadelphia, PA , USA
| | - Costas Tsioufis
- National and Kapodistrian University of Athens, 1st Cardiology Clinic, Hippocratio Hospital , Athens , Greece
| | | | - Thomas Weber
- Department of Cardiology, Klinikum Wels-Grieskirchen , Wels , Austria
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University , Kirrberger Str. 1, 66421 Homburg , Germany
- Cape Heart Institute (CHI), Faculty of Health Sciences, University of Cape Town , Cape Town , South Africa
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Gusmão WDP, Pureza IROM, Moreno CRC. Shift Work and Early Arterial Stiffness: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14569. [PMID: 36361448 PMCID: PMC9654495 DOI: 10.3390/ijerph192114569] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
Shift work is a way of organizing rotating schedules throughout the day. This can include 1-3 shifts for the same person on a rotational basis with other workers. Schedules that include night work have been associated with cardiovascular risk, mainly due to circadian misalignment. This systematic review sought to determine whether shift work is a risk factor for increased arterial stiffness. A systematic review of different databases was performed, using the following keywords: work shift, night work, arteriosclerosis, vascular stiffness, arterial stiffness, pulse wave velocity, and their Medical Subject Headings. We selected and analyzed 11 articles regarding pulse wave velocity as an indicator of arterial stiffness. Two studies identified higher levels of arterial stiffness in shift workers compared to day workers, while two studies found the opposite. In addition, four studies found no differences in arterial stiffness between shifts, two studies associated shorter sleep duration with arterial stiffness, and one study observed that physical activity could prevent adverse cardiovascular outcomes in shift workers. The findings are heterogeneous and preclude any robust conclusions. However, the present review points to the need for further studies to investigate arterial stiffness in shift workers, with greater control for confounding factors and longitudinal design.
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Affiliation(s)
- Waléria D. P. Gusmão
- Department of Health, Life Cycles and Society, School of Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil
| | - Isabele R. O. M. Pureza
- Department of Nutrition, Campus I—Prof. Eduardo Almeida, Centro Universitário Cesmac, Maceió 57051-160, Brazil
| | - Claudia R. C. Moreno
- Department of Health, Life Cycles and Society, School of Public Health, University of Sao Paulo, Sao Paulo 01246-904, Brazil
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Bouwmeester TA, van de Velde L, Galenkamp H, Postema PG, Westerhof BE, van den Born BJH, Collard D. Association between the reflection magnitude and blood pressure in a multiethnic cohort: the Healthy Life in an Urban Setting study. J Hypertens 2022; 40:2263-2270. [PMID: 35950966 PMCID: PMC9553245 DOI: 10.1097/hjh.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/07/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022]
Abstract
AIMS Reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to predict cardiovascular events. However, the association with blood pressure (BP) and hypertension is unclear. METHODS We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18 and 70 years (54.2% female) participating in the Healthy Life in an Urban Setting study. To determine RM, central arterial pressure and flow were reconstructed from finger BP. Hypertension was defined based on office-BP and medication. Associations with BP, hypertension, and hypertensive organ damage were assessed using linear regression models with correction for relevant covariates. RESULTS Mean RM was 62.5% (standard deviation [SD] 8.0) in men and 63.8% (SD 8.1) in women. RM was lowest in Dutch and highest in South-Asian and African participants. RM increased linearly with 1.35 (95% confidence interval [CI] 1.23-1.46) for every 10 mmHg increase in systolic BP from 120 mmHg onwards, while the relation with diastolic BP was nonlinear. RM was 2.40 (95% CI 2.04-2.76) higher in hypertensive men and 3.82 (95% CI 3.46-4.19) higher in hypertensive women compared to normotensive men and women. In hypertensive men and women with ECG-based left ventricular hypertrophy or albuminuria RM was 1.64 (95% CI 1.09-2.20) and 0.94 (95% CI 0.37-1.52) higher compared to hypertensive participants without hypertensive organ damage. CONCLUSION RM is associated with BP, hypertension and hypertensive organ damage, and may in part explain disparities in hypertension associated cardiovascular risk.
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Affiliation(s)
- Thomas A. Bouwmeester
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
| | - Lennart van de Velde
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Faculty of Science and Technology, Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
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35
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Bouwmeester TA, van de Velde L, Galenkamp H, Postema PG, Westerhof BE, van den Born BJH, Collard D. Association between the reflection magnitude and blood pressure in a multiethnic cohort: the Healthy Life in an Urban Setting study. J Hypertens 2022; 40:2263-2270. [DOI: https:/doi.org/10.1097%2fhjh.0000000000003256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
Aims:
Reflection magnitude (RM), the ratio of the amplitudes of the backward and forward central arterial pressure waves, has been shown to predict cardiovascular events. However, the association with blood pressure (BP) and hypertension is unclear.
Methods:
We assessed RM in 10 195 individuals of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin aged between 18 and 70 years (54.2% female) participating in the Healthy Life in an Urban Setting study. To determine RM, central arterial pressure and flow were reconstructed from finger BP. Hypertension was defined based on office-BP and medication. Associations with BP, hypertension, and hypertensive organ damage were assessed using linear regression models with correction for relevant covariates.
Results:
Mean RM was 62.5% (standard deviation [SD] 8.0) in men and 63.8% (SD 8.1) in women. RM was lowest in Dutch and highest in South-Asian and African participants. RM increased linearly with 1.35 (95% confidence interval [CI] 1.23–1.46) for every 10 mmHg increase in systolic BP from 120 mmHg onwards, while the relation with diastolic BP was nonlinear. RM was 2.40 (95% CI 2.04–2.76) higher in hypertensive men and 3.82 (95% CI 3.46–4.19) higher in hypertensive women compared to normotensive men and women. In hypertensive men and women with ECG-based left ventricular hypertrophy or albuminuria RM was 1.64 (95% CI 1.09–2.20) and 0.94 (95% CI 0.37–1.52) higher compared to hypertensive participants without hypertensive organ damage.
Conclusion:
RM is associated with BP, hypertension and hypertensive organ damage, and may in part explain disparities in hypertension associated cardiovascular risk.
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Affiliation(s)
- Thomas A. Bouwmeester
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
| | - Lennart van de Velde
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Faculty of Science and Technology, Multi-Modality Medical Imaging Group, Technical Medical Centre, University of Twente, Enschede
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Pieter G. Postema
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences
| | - Berend E. Westerhof
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bert-Jan H. van den Born
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam
| | - Didier Collard
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam
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Kim M, Kim HL, Lim WH, Seo JB, Kim SH, Kim MA, Zo JH. Association between arterial stiffness and left ventricular diastolic function: A large population-based cross-sectional study. Front Cardiovasc Med 2022; 9:1001248. [PMID: 36312236 PMCID: PMC9606341 DOI: 10.3389/fcvm.2022.1001248] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 09/27/2022] [Indexed: 12/05/2022] Open
Abstract
Background The association between arterial stiffness and left ventricular (LV) diastolic function has been demonstrated in several studies, but the samples size in those studies was small. This study aims to verify this issue in a large number of study subjects. Methods A total of 7,013 consecutive participants (mean age 60.6 years and 43.3% female) who underwent both baPWV and transthoracic echocardiography were retrospectively analyzed. Subjects with significant cardiac structural abnormalities were excluded. Results There were significant correlations of baPWV with septal e′ velocity (r = – 0.408; P < 0.001), septal E/e′ (r = 0.349; P < 0.001), left atrial volume index (LAVI) (r = 0.122; P < 0.001) and maximal velocity of tricuspid valve regurgitation (TR Vmax) (r = 0.322; P < 0.001). The baPWV values increased proportionally with an increase in the number of LV diastolic indices meeting LV diastolic dysfunction criteria (P-for-trend < 0.001). In multivariable analyses with adjustment for confounding effects of various clinical covariates, higher baPWV was independently associated with septal e′ < 7 (odds ratio [OR], 1.30; 95% confidence interval [CI] 1.20–1.60; P < 0.001), septal E/e′ ≥ 15 (OR, 1.46; 95% CI, 1.21–1.78; P < 0.001), and TR Vmax > 2.8 m/s (OR, 1.60; 95% CI, 1.23–2.09; P < 0.001) but not with LAVI ≥ 34 mL/m2 (OR, 0.89; 95% CI, 0.76–1.03; P = 0.123). Conclusions Increased arterial stiffness, as measured by baPWV, was associated with abnormal diastolic function parameters in a large number of study participants, providing strong evidence to the existing data about ventricular-vascular coupling.
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Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, South Korea
| | - Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Hack-Lyoung Kim
| | - Woo-Hyun Lim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae-Bin Seo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung-A Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Joo-Hee Zo
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea,Joo-Hee Zo
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Vidula MK, Bravo PE, Chirinos JA. The Role of Multimodality Imaging in the Evaluation of Heart Failure with Preserved Ejection Fraction. Cardiol Clin 2022; 40:443-457. [DOI: 10.1016/j.ccl.2022.06.002] [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: 11/02/2022]
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Pan Y, Lin J, Wang Y, Li J, Xu P, Zeng M, Shan Y. Association of aortic distensibility and left ventricular function in patients with stenotic bicuspid aortic valve and preserved ejection fraction: a CMR study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2025-2033. [PMID: 35279784 DOI: 10.1007/s10554-022-02581-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
To determine the relationship between aortic distensibility and left ventricular (LV) remodeling, myocardial strain and blood biomarkers in patients with stenotic bicuspid aortic valve (BAV) and preserved ejection fraction (EF) by cardiovascular magnetic resonance (CMR). 43 stenotic BAV patients were prospectively selected for 3.0 T CMR. Patients were divided into LV remodeling group (LV mass/volume ≥ 1.15, n = 21) and non-remodeling group (LV mass/volume < 1.15, n = 22). Clinical characteristics, biochemical data including cardiac troponin T(cTNT), N-terminal pro-B type natriuretic peptide (NT-proBNP) and creatine kinase isoenzyme (CK-MB) were noted. Distensibility of middle ascending aorta (mid-AA) and proximal descending aorta, LV structural and functional parameters, global and regional myocardial strain were measured. Compared to non-remodeling group, LV remodeling group had significantly decreased LV global strain (radial: 26.04 ± 8.70% vs. 32.92 ± 7.81%, P = 0.009; circumferential: - 17.20 ± 3.38% vs. - 19.65 ± 2.34%, P = 0.008; longitudinal: - 9.13 ± 2.34% vs. - 11.63 ± 1.99%, P < 0.001) and decreased mid-AA distensibility (1.22 ± 0.24 10-3 mm/Hg vs 1.60 ± 0.41 10-3 mm/Hg, P = 0.001). In addition, mid-AA distensibility was independently associated with LV remodeling (β = - 0.282, P = 0.003), and it was also significantly correlated with LV global strain (radial: r = 0.392, P = 0.009; circumferential: r = - 0.348, P = 0.022; longitudinal: r = - 0.333, P = 0.029), cTNT (r = - 0.333, P = 0.029) and NT-proBNP (r = - 0.440, P = 0.003). In this cohort with stenotic BAV and preserved EF, mid-AA distensibility is found significantly associated with LV remolding, which encouraging to better understand mechanism of ventricular vascular coupling.
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Affiliation(s)
- Yijun Pan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jiang Lin
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongshi Wang
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Jun Li
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Pengju Xu
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Mengsu Zeng
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yan Shan
- Shanghai Institute of Medical Imaging, Shanghai, 200032, China.
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
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Chirinos JA. Ventricular-Arterial Coupling in Heart Failure. JACC Cardiovasc Imaging 2022; 15:1560-1562. [DOI: 10.1016/j.jcmg.2022.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/04/2022] [Indexed: 11/29/2022]
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40
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Weber T, Wassertheurer S, Mayer CC, Hametner B, Danninger K, Townsend RR, Mahfoud F, Kario K, Fahy M, DeBruin V, Peterson N, Negoita M, Weber MA, Kandzari DE, Schmieder RE, Tsioufis KP, Binder RK, Böhm M. Twenty-Four-Hour Pulsatile Hemodynamics Predict Brachial Blood Pressure Response to Renal Denervation in the SPYRAL HTN-OFF MED Trial. Hypertension 2022; 79:1506-1514. [PMID: 35582957 PMCID: PMC9172874 DOI: 10.1161/hypertensionaha.121.18641] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Renal denervation (RDN) lowers blood pressure (BP), but BP response is variable in individual patients. We investigated whether measures of pulsatile hemodynamics, obtained during 24-hour ambulatory BP monitoring, predict BP drop following RDN.
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Affiliation(s)
- Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | | | - Christopher C Mayer
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Bernhard Hametner
- AIT - Austrian Institute of Technology, Vienna, Austria (S.W., C.C.M., B.H.)
| | - Kathrin Danninger
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.)
| | - Felix Mahfoud
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
| | - Kazuomi Kario
- Jichi Medical University School of Medicine, Tochigi, Japan (K.K.)
| | - Martin Fahy
- Medtronic PLC, Santa Rosa, CA (M.F., V.D., N.P., M.N.)
| | | | | | | | | | | | - Roland E Schmieder
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich Alexander University Erlangen Nürnberg, Germany (R.E.S.)
| | - Konstantinos P Tsioufis
- 1st Cardiology Clinic, National and Kapodistrian University of Athens, Hippokration Hospital, Greece (K.P.T.)
| | - Ronald K Binder
- Cardiology Department, Klinikum Wels-Grieskirchen, Austria (T.W., K.D., R.K.B.)
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg/Saar, Germany (F.M., M.B.)
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PERCUTANEOUS CIRCULATORY SUPPORT IN HIGH-RISK PCI: PULSATILE OR CONTINUOUS FLOW DEVICES? Int J Cardiol 2022; 366:80-81. [PMID: 35787432 DOI: 10.1016/j.ijcard.2022.06.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 11/23/2022]
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Anastasio F, Testa M, Ferreri C, Rossi A, Ruocco G, Feola M. The Analysis of Arterial Stiffness in Heart Failure Patients: The Prognostic Role of Pulse Wave Velocity, Augmentation Index and Stiffness Index. J Clin Med 2022; 11:jcm11123507. [PMID: 35743576 PMCID: PMC9224844 DOI: 10.3390/jcm11123507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/06/2022] [Accepted: 06/15/2022] [Indexed: 12/28/2022] Open
Abstract
Background: The role of arterial stiffness in the pathogenesis and clinical outcome of heart failure (HF) patients has to be clarified. The aim of this study was to evaluate the prognostic role of arterial stiffness in HF patients discharged after acute episode of decompensation by evaluating cut-off values for clinical assessment. Methods: Patients admitted for decompensated heart failure (ADHF) underwent pre-discharge evaluation. Arterial stiffness was measured by aortic pulse wave velocity (aPWV), augmentation index (AIx75) and stiffness index (β0). Patients were also evaluated after discharge for a variable follow-up time. Results: We observed 199 patients (male 61.3%, age 76.2 ± 10.7 years) after discharge for a median of 437 days (IQR 247-903), 69 (34.7%) patients suffered HF with preserved ejection fraction (HFpEF), 45 (22.6%) patients experienced HF with mid-range ejection fraction (HFmEF) and 85 (42.7%) reported an HF with reduced ejection fraction (HFrEF). After the adjustment for principal confounders, aPWV, AIx75 and β0 were inversely correlated with free-event survival (p = 0.006, p < 0.001, p = 0.001): only β0 was inversely correlated with overall survival (p = 0.03). Analysing the threshold, overall survival was inversely correlated with β0 ≥3 (HR 2.1, p = 0.04) and free-event survival was inversely correlated with aPWV ≥10 m/s (HR 1.7, p = 0.03), AIx75 ≥ 25 (HR 2.4, p < 0.001), and β0 ≥ 3 (HR 2.0, p = 0.009). Dividing HF patients for LV ejection fraction, β0 and AIx75 appeared to be accurate prognostic predictors among the three different classes according to free-event survival. Conclusions: The non-invasive measurements of arterial stiffness proved to be strong prognostic parameters in HF patients discharged after an acute HF decompensation.
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Affiliation(s)
- Fabio Anastasio
- Cardiology Division, Regina Montis Regalis Hospital, 12084 Cuneo, Italy; (F.A.); (M.T.)
| | - Marzia Testa
- Cardiology Division, Regina Montis Regalis Hospital, 12084 Cuneo, Italy; (F.A.); (M.T.)
| | - Cinzia Ferreri
- Department of Geriatry, University of Turin, 10123 Turin, Italy; (C.F.); (A.R.)
| | - Arianna Rossi
- Department of Geriatry, University of Turin, 10123 Turin, Italy; (C.F.); (A.R.)
| | - Gaetano Ruocco
- Cardiology Division, Ospedali Riuniti di Valdichiana Montepulciano, 53100 Siena, Italy;
| | - Mauro Feola
- Cardiology Division, Regina Montis Regalis Hospital, 12084 Cuneo, Italy; (F.A.); (M.T.)
- Correspondence: ; Tel.: +39-33-5543-9206
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Stamatelopoulos K, Delialis D, Georgiopoulos G, Tselegkidi MI, Theodorakakou F, Dialoupi I, Bambatsias D, Petropoulos I, Vergaro G, Ikonomidis I, Tzortzis S, Briasoulis A, Kanakakis J, Trougakos I, Dimopoulos MA, Kastritis E. Determining patterns of vascular function and structure in wild-type transthyretin cardiac amyloidosis. A comparative study. Int J Cardiol 2022; 363:102-110. [PMID: 35716935 DOI: 10.1016/j.ijcard.2022.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/10/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The impact of wild-type transthyretin-related cardiac amyloidosis (ATTRwt) on functional and structural peripheral vascular measures is unknown. In the present study, we explored patterns of vascular dysfunction in patients with ATTRwt in comparison to diseases with similar cardiac phenotype. METHODS Treatment-naïve patients with ATTRwt (n = 32) were compared to: 1. Age-and sex-matched reference population without amyloidosis (n = 32), 2. Age-and sex-matched patients with systemic AL amyloidosis (n = 32), and 3. patients with cardiac AL amyloidosis (AL-HF, n = 23) or elderly patients with heart failure with preserved ejection fraction (HFpEF) (n = 16). All subjects underwent peripheral vascular assessment using carotid artery ultrasonography, brachial artery flow-mediated dilation (FMD), measurement of arterial stiffness and aortic hemodynamics including heart rate-adjusted time of return of reflected waves (Tr/HR). RESULTS After adjustment for traditional cardiovascular risk factors and coronary artery disease (core model), peripheral and aortic blood pressures (BP) were lower in patients with ATTRwt (p < 0.05) whereas other vascular markers were preserved compared to the reference non-amyloidosis group. ATTRwt was independently associated with lower BP and longer Tr/HR compared to AL. Compared to AL-HF, FMD was lower in ATTRwt (p = 0.033). ATTRwt patients had lower BP and higher Tr/HR than HFpEF (p < 0.05). By ROC analysis, Tr/HR discriminated ATTRwt vs. AL-HF (sensitivity 93%, specificity 75%) and HFpEF (sensitivity 100%, specificity 94%) and lower FMD increased the likelihood for ATTRwt at low Tr/HR values. CONCLUSION ATTRwt patients present a distinct peripheral vascular fingerprint which is different from AL-HF or HFpEF, consisting of lower peripheral and aortic BP, prolonged Tr/HR and FMD at reference-population range.
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Affiliation(s)
- Kimon Stamatelopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece..
| | - Dimitrios Delialis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Maria-Irini Tselegkidi
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Foteini Theodorakakou
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioanna Dialoupi
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Dimitrios Bambatsias
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioannis Petropoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giuseppe Vergaro
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ignatios Ikonomidis
- 2(nd) Department of Cardiology, School of Medicine of the National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Stavros Tzortzis
- 2(nd) Department of Cardiology, School of Medicine of the National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alexandros Briasoulis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - John Kanakakis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Ioannis Trougakos
- Department of Cell Biology and Biophysics, Faculty of Biology, National and Kapodistrian University of Athens; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, University of Athens Medical School, Athens, Greece.; Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy; Cardiology Division, Fondazione Toscana Gabriele Monasterio, Pisa, Italy..
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Mazimba S, Mwansa H, Breathett K, Strickling JE, Shah K, McNamara C, Mehta N, Kwon Y, Lamp J, Feng L, Tallaj J, Pamboukian S, Mubanga M, Matharoo J, Lim S, Salerno M, Mwansa V, Bilchick KC. Systemic arterial pulsatility index (SAPi) predicts adverse outcomes in advanced heart failure patients. Heart Vessels 2022; 37:1719-1727. [PMID: 35534640 DOI: 10.1007/s00380-022-02070-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022]
Abstract
Ventriculo-arterial (VA) coupling has been shown to have physiologic importance in heart failure (HF). We hypothesized that the systemic arterial pulsatility index (SAPi), a measure that integrates pulse pressure and a proxy for left ventricular end-diastolic pressure, would be associated with adverse outcomes in advanced HF. We evaluated the SAPi ([systemic systolic blood pressure-systemic diastolic blood pressure]/pulmonary artery wedge pressure) obtained from the final hemodynamic measurement in patients randomized to therapy guided by a pulmonary arterial catheter (PAC) and with complete data in the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial. Cox proportional hazards regression was performed for the outcomes of (a) death, transplant, left ventricular assist device (DTxLVAD) or hospitalization, (DTxLVADHF) and (b) DTxLVAD. Among 142 patients (mean age 56.8 ± 13.3 years, 30.3% female), the median SAPi was 2.57 (IQR 1.63-3.45). Increasing SAPi was associated with significant reductions in DTxLVAD (HR 0.60 per unit increase in SAPi, 95% CI 0.44-0.84) and DTxLVADHF (HR 0.81 per unit increase, 95% CI 0.70-0.95). Patients with a SAPi ≤ 2.57 had a marked increase in both outcomes, including more than twice the risk of DTxLVAD (HR 2.19, 95% CI 1.11-4.30) over 6 months. Among advanced heart failure patients with invasive hemodynamic monitoring in the ESCAPE trial, SAPi was strongly associated with adverse clinical outcomes. These findings support further investigation of the SAPi to guide treatment and prognosis in HF undergoing invasive hemodynamic monitoring.
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Affiliation(s)
- Sula Mazimba
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA.
| | - Hunter Mwansa
- Division of Internal Medicine, University of Illinois College of Medicine, Peoria, IL, USA
| | - Khadijah Breathett
- Division of Cardiovascular Medicine, Indiana University, Indianapolis, IN, USA
| | - Jarred E Strickling
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Kajal Shah
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Coleen McNamara
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Nishaki Mehta
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Younghoon Kwon
- Division of Cardiovascular Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Josephine Lamp
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Lu Feng
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Jose Tallaj
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Salpy Pamboukian
- Division of Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Mwenya Mubanga
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Stockholm, Sweden
| | - Jashanjeet Matharoo
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Scott Lim
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Michael Salerno
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
| | - Victor Mwansa
- Division of Cardiology, Heartland Regional Medical Group, Marion, IL, USA
| | - Kenneth C Bilchick
- Division of Cardiovascular Medicine, University of Virginia Health System, 1215 Lee St., PO Box 800158, Charlottesville, VA, 22908-0158, USA
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45
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Mandigers TJ, Bissacco D, Domanin M, D’Alessio I, Tolva VS, Piffaretti G, van Herwaarden JA, Trimarchi S. Cardiac and aortic modifications after endovascular repair for blunt thoracic aortic injury: a systematic review. Eur J Vasc Endovasc Surg 2022; 64:176-187. [DOI: 10.1016/j.ejvs.2022.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/09/2022] [Accepted: 05/01/2022] [Indexed: 11/24/2022]
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46
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Nathaniel S, McGinty S, Witman MAH, Edwards DG, Farquhar WB, Hosmane V, Wenner MM. Impact of angiotensin receptor-neprilysin inhibition on vascular function in heart failure with reduced ejection fraction: A pilot study. Physiol Rep 2022; 10:e15209. [PMID: 35246960 PMCID: PMC8897740 DOI: 10.14814/phy2.15209] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023] Open
Abstract
The mechanisms for the benefits of Angiotensin Receptor Neprilysin Inhibition (ARNi) in heart failure patients with reduced ejection fraction (HFrEF) are likely beyond blood pressure reduction. Measures of vascular function such as arterial stiffness and endothelial function are strong prognostic markers of cardiovascular outcomes in HFrEF, yet the impact of ARNi on vascular health remains to be explored. We hypothesized that arterial stiffness and endothelial function would improve after 12 weeks of ARNi in HFrEF. We tested 10 stable HFrEF patients at baseline and following 12 weeks of ARNi [64 ± 9 years, Men/Women: 9/1, left ventricular ejection fraction (EF): 28 ± 6%] as well as 10 stable HFrEF patients that remained on conventional treatment (CON: 60 ± 7 years, Men/Women: 6/4, EF: 31 ± 5%; all p = NS). Arterial stiffness was assessed via carotid-femoral pulse wave velocity (PWV) and endothelial function was assessed via brachial artery flow-mediated dilation (FMD). PWV decreased after 12 weeks of ARNi (9.0 ± 2.1 vs. 7.1 ± 1.2 m/s; p < 0.01) but not in CON (7.0 ± 2.4 vs. 7.5 ± 2.3 m/s; p = 0.35), an effect that remained when controlling for reductions in mean arterial pressure (p < 0.01). FMD increased after 12 weeks of ARNi (2.2 ± 1.9 vs. 5.5 ± 2.1%; p < 0.001) but not in CON (4.8 ± 3.8 vs. 5.4 ± 3.4%; p = 0.34). Baseline PWV (p = 0.06) and FMD (p = 0.07) were not different between groups. These preliminary data suggest that 12 weeks of ARNi therapy may reduce arterial stiffness and improve endothelial function in HFrEF. Thus, the findings from this pilot study suggest that the benefits of ARNi are beyond blood pressure reduction and include improvements in vascular function.
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Affiliation(s)
- Sangeetha Nathaniel
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Shane McGinty
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Melissa A. H. Witman
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - David G. Edwards
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - William B. Farquhar
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Vinay Hosmane
- Hosmane Cardiology and Section of CardiologyChristiana Care Healthcare SystemNewarkDelawareUSA
| | - Megan M. Wenner
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
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Malhotra R, Nicholson CJ, Wang D, Bhambhani V, Paniagua S, Slocum C, Sigurslid HH, Cardenas CLL, Li R, Boerboom SL, Chen YC, Hwang SJ, Yao C, Ichinose F, Bloch DB, Lindsay ME, Lewis GD, Aragam JR, Hoffmann U, Mitchell GF, Hamburg NM, Vasan RS, Benjamin EJ, Larson MG, Zapol WM, Cheng S, Roh JD, O’Donnell CJ, Nguyen C, Levy D, Ho JE. Matrix Gla Protein Levels Are Associated With Arterial Stiffness and Incident Heart Failure With Preserved Ejection Fraction. Arterioscler Thromb Vasc Biol 2022; 42:e61-e73. [PMID: 34809448 PMCID: PMC8792238 DOI: 10.1161/atvbaha.121.316664] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Arterial stiffness is a risk factor for cardiovascular disease, including heart failure with preserved ejection fraction (HFpEF). MGP (matrix Gla protein) is implicated in vascular calcification in animal models, and circulating levels of the uncarboxylated, inactive form of MGP (ucMGP) are associated with cardiovascular disease-related and all-cause mortality in human studies. However, the role of MGP in arterial stiffness is uncertain. Approach and Results: We examined the association of ucMGP levels with vascular calcification, arterial stiffness including carotid-femoral pulse wave velocity (PWV), and incident heart failure in community-dwelling adults from the Framingham Heart Study. To further investigate the link between MGP and arterial stiffness, we compared aortic PWV in age- and sex-matched young (4-month-old) and aged (10-month-old) wild-type and Mgp+/- mice. Among 7066 adults, we observed significant associations between higher levels of ucMGP and measures of arterial stiffness, including higher PWV and pulse pressure. Longitudinal analyses demonstrated an association between higher ucMGP levels and future increases in systolic blood pressure and incident HFpEF. Aortic PWV was increased in older, but not young, female Mgp+/- mice compared with wild-type mice, and this augmentation in PWV was associated with increased aortic elastin fiber fragmentation and collagen accumulation. CONCLUSIONS This translational study demonstrates an association between ucMGP levels and arterial stiffness and future HFpEF in a large observational study, findings that are substantiated by experimental studies showing that mice with Mgp heterozygosity develop arterial stiffness. Taken together, these complementary study designs suggest a potential role of therapeutically targeting MGP in HFpEF.
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Affiliation(s)
- Rajeev Malhotra
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Christopher J. Nicholson
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Dongyu Wang
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Vijeta Bhambhani
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Samantha Paniagua
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Charles Slocum
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Haakon H. Sigurslid
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Christian L. Lino Cardenas
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Rebecca Li
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Sophie L. Boerboom
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Yin-Ching Chen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA, and Schepens Eye Research Institute/Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Shih-Jen Hwang
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Chen Yao
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Fumito Ichinose
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Donald B. Bloch
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
- Division of Rheumatology, Allergy, and Immunology; Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Mark E. Lindsay
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Gregory D. Lewis
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Udo Hoffmann
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Naomi M. Hamburg
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA
| | - Ramchandran S. Vasan
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health & Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Emelia J. Benjamin
- Framingham Heart Study, Framingham, MA
- Department of Epidemiology, Boston University School of Public Health & Sections of Preventive Medicine and Epidemiology and Cardiology, Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Martin G. Larson
- Framingham Heart Study, Framingham, MA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Warren M. Zapol
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Susan Cheng
- Framingham Heart Study, Framingham, MA
- Barbara Streisand Women’s Heart Center, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Jason D. Roh
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - Christopher Nguyen
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA, and Schepens Eye Research Institute/Massachusetts Eye and Ear Infirmary, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Daniel Levy
- Framingham Heart Study, Framingham, MA
- Population Sciences Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jennifer E. Ho
- Cardiovascular Research Center and Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA
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48
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Lau ES, Panah LG, Zern EK, Liu EE, Farrell R, Schoenike MW, Namasivayam M, Churchill TW, Curreri L, Malhotra R, Nayor M, Lewis GD, Ho JE. Arterial Stiffness and Vascular Load in HFpEF: Differences Among Women and Men. J Card Fail 2022; 28:202-211. [PMID: 34955334 PMCID: PMC8840989 DOI: 10.1016/j.cardfail.2021.10.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Mechanisms underlying sex differences in heart failure with preserved ejection fraction (HFpEF) are poorly understood. We sought to examine sex differences in measures of arterial stiffness and the association of arterial stiffness measures with left ventricular hemodynamic responses to exercise in men and women. METHODS We studied 83 men (mean age 62 years) and 107 women (mean age 59 years) with HFpEF who underwent cardiopulmonary exercise testing with invasive hemodynamic monitoring and arterial stiffness measurement (augmentation pressure [AP], augmentation index [AIx], and aortic pulse pressure [AoPP]). Sex differences were compared using multivariable linear regression. We examined the association of arterial stiffness with abnormal left ventricular diastolic response to exercise, defined as a rise in pulmonary capillary wedge pressure relative to cardiac output (∆PCWP/∆CO) ≥ 2 mmHg/L/min by using logistic regression models. RESULTS Women with HFpEF had increased arterial stiffness compared with men. AP was nearly 10 mmHg higher, and AIx was more than 10% higher in women compared with men (P < 0.0001 for both). Arterial stiffness measures were associated with a greater pulmonary capillary wedge pressure response to exercise, particularly among women. A 1-standard deviation higher AP was associated with > 3-fold increased odds of abnormal diastolic exercise response (AP: OR 3.16, 95% CI 1.34-7.42; P = 0.008 [women] vs OR 2.07, 95% CI 0.95-5.49; P = 0.15 [men]) with similar findings for AIx and AoPP. CONCLUSIONS Arterial stiffness measures are significantly higher in women with HFpEF than in men and are associated with abnormally steep increases in pulmonary capillary wedge pressure with exercise, particularly in women. Arterial stiffness may preferentially contribute to abnormal diastolic function during exercise in women with HFpEF compared with men.
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Affiliation(s)
- Emily S Lau
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Lindsay G Panah
- Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennesee
| | - Emily K Zern
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth E Liu
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Robyn Farrell
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Mark W Schoenike
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Mayooran Namasivayam
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts; Department of Cardiology, St. Vincent's Hospital, Faculty of Medicine, University of New South Wales and Victor Chang Cardiac Research Institute, Sydney, Australia
| | | | - Lisa Curreri
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Rajeev Malhotra
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, Massachusetts; Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Matthew Nayor
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Gregory D Lewis
- Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer E Ho
- CardioVascular Institute and Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
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49
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Chirinos JA. Matrix GIa Protein, Large Artery Stiffness, and the Risk of Heart Failure With Preserved Ejection Fraction. Arterioscler Thromb Vasc Biol 2022; 42:223-226. [PMID: 34965735 PMCID: PMC8792235 DOI: 10.1161/atvbaha.121.317206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Julio A. Chirinos
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Hospital of the University of Pennsylvania and Perelman Center for Advanced Medicine, Philadelphia, PA, USA
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50
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Omote K, Verbrugge FH, Borlaug BA. Heart Failure with Preserved Ejection Fraction: Mechanisms and Treatment Strategies. Annu Rev Med 2022; 73:321-337. [PMID: 34379445 PMCID: PMC9002335 DOI: 10.1146/annurev-med-042220-022745] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Approximately half of all patients with heart failure (HF) have a preserved ejection fraction, and the prevalence is growing rapidly given the aging population in many countries and the rising prevalence of obesity, diabetes, and hypertension. Functional capacity and quality of life are severely impaired in heart failure with preserved ejection fraction (HFpEF), and morbidity and mortality are high. In striking contrast to HF with reduced ejection fraction, there are few effective treatments currently identified for HFpEF, and these are limited to decongestion by diuretics, promotion of a healthy active lifestyle, and management of comorbidities. Improved phenotyping of subgroups within the overall HFpEF population might enhance individualization of treatment. This review focuses on the current understanding of the pathophysiologic mechanisms underlying HFpEF and treatment strategies for this complex syndrome.
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Affiliation(s)
- Kazunori Omote
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
| | - Frederik H. Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States;,Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium;,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Barry A. Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States
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